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By Katelyn Sheehan, PT

​Around the holidays and the new year there is a lot of focus on celebration and on trying to live a healthier lifestyle. Usually this includes changes in our usual diet or eating habits. Patients will often bring up how the holidays and their changes in diet are affecting their symptoms. So, I wanted to discuss how your diet and pelvic health can impact each other.

​A lot of patients that we see are aware that how much they drink, and what they eat can affect their bowel and bladder habits, but they don’t always know all the effects it can have on their pelvic floor function. In fact, some pelvic floor dysfunction can even cause us to alter our eating habits. In this article disordered eating could be defined as altered eating habits such as increased or decreased volume of food intake or altered food intake quality. This is including, but not limited to other eating disorders such as bulimia nervosa, binge eating, and anorexia nervosa.

Here are a few things our diet AND pelvic floor impact:

Since there is a large overlap between how our diet can impact us and the how the pelvic floor can impact us we often see a correlation between abnormal eating habits and pelvic floor dysfunction.

• One example of how eating can affect the pelvic floor is binge eating. Binge eating has been associated with menstrual changes, PCOS (Poly Cystic Ovarian Syndrome), abdominal discomfort including abdominal pressure and bloating which can impact pelvic organ prolapse.
• An example on how the pelvic floor can impact our diet is in patients with chronic constipation due to poor coordination of the pelvic floor may have a decreased appetite, or fear of eating, because it causes discomfort and fullness.

Our diet can also directly impact the function of the pelvic floor:

• Hormones: can affect our pelvic floor muscle elasticity, muscle growth and thus pelvic muscle function
• Nutrient and Protein absorption/utilization: This goes in line with hormones. Our food is a main source of vitamins needed for muscle growth and mobility.

​If you have noticed your diet impacting your pelvic floor function, or you have noticed your pelvic floor symptoms impacting your diet please talk to a pelvic health physical therapist to help you devise a plan and see if your pelvic floor could be driving your symptoms. One thing you can do to help is keep a bowel/bladder log. You can use many apps, make your own, ask your therapist for one, or use this link.

Shock is a condition that occurs when the body is not getting enough blood flow, oxygen, or nutrients to function properly. (1) Shock can be triggered by an intense physical and/or emotional response to trauma, an accident, violence, grief or upsetting news. (2) For proper function, the cells of the body need energy, oxygen, and glucose, so when a disruption occurs, many organs and systems in the body can be affected in a detrimental way. Many of the people who come to physical therapy have experienced shock and trauma at some time in their life. They may have managed to “move on” from the initial experience, their physical wounds may be healed, but their system may still be struggling with effects of the trauma, often unconsciously. Working with certain points in the body to restore balance can be a step in turning around this process.

Here are a few steps you can take to on your own to work with your shock points.

1. Press your thumbs into the ball of your foot for about 1 minute (K1 in acupoint).
2. Hold your fingers over your toes and comfortably squeeze the sides of your feet.
3. Press your thumbs into the “Shock point” in the middle of the heel. Hold this for 30-60 seconds.
4. Do these steps on each foot.
5. Place your hands on your heart and take 3-5 slow, conscious breaths, inhaling for a count of 4; exhaling for a count of 8.
6. Trace figure 8's around your eyes.

Ever hear about "The 5 Love Languages" book? Dr. Gary Chapman discusses in his book the different ways to express and receive love, specifically through: acts of service, receiving gifts, physical touch, words of affirmation, and quality time. I’m always asking my husband for more quality time! That’s how I connect best to him.

Our bodies have their own language, and they’re speaking to us all the time. One of my body's love languages is physical touch with loved ones--hugs with friends and family, giving or receiving a hand on the shoulder for assurance, tucking my kids in at night.

When we feel good, our bodies tell us what we’re doing right – that we’re going to bed on time, eating the right food, surrounding ourselves with the right people. When we don’t feel well, our bodies are telling us – and sometimes screaming at us – to tell us that something isn’t right. These signs can come in the form of pain or muscle aches, and even fatigue, or anxiety.

• Sometimes they're tight and asking to be lengthened.
• Sometimes they feel weighed down or unstable and need physical support.
• Sometimes they feel wired and need quiet and calm.

​Take a moment to listen to your body and learn your body's love language. Below are some examples of the love languages our therapists have with their bodies!

Even wide shoes tend to be too narrow in the toe box. Shoes need to be wide across the balls of the feet for a proper fit, but they also need to be wide across the toes. Shoes that have a narrow toe box will squish the toes together.​​ Take your shoes off and notice that your toes are the same width as your metatarsal bones. (Or should be!) Therefore, doesn’t it make sense the toe box should also be as wide as the ball of your foot?

Another great tool that is becoming popular is something called toe spacers. These are made of soft silicone and help to spread the toes apart, allowing them to go back into their proper alignment. Toe spacers are available on the internet. I have a pair from a company called Correct Toes and I often wear them around my house while bare foot. I’ll even wear them in my athletic shoes during my power walks. I can definitely feel the difference in my body when my toes and feet are in the correct alignment. 

​So, if you are guilty of wearing shoes that have reduced your proper toe splay, switch your shoes to a pair with a wider toe box and try the above suggestions. Or come see us at Connect PT. We’ll have you back on your toes in no time!​​

Sometimes we're looking for something easy and quick to help us regain balance during our busy day. Here is a quick vagus nerve-regulating exercise that can be done daily. It will help to:

• Lower stress, heart rate and blood pressure
• Decrease anxiety
• Calm your nervous system
• Support sleep issues
• Reduce body pain.
• It can be useful for fainting, POTS, seizures, and epilepsy. 

This exercise provides general access to the vagus nerve where it comes around the ear. Please refer to the pictures.

By Shraddha Wagh, PT

Everyone’s heard the saying “sit up straight” or “stand up with good posture” at some point in his/her lives - but what is good posture, and why is it important?

There is no such thing as one “perfect posture,” and it is unrealistic to try to maintain one specific posture when performing various activities throughout the day. Each individual has varying body types, muscle flexibility, and muscle tone that can contribute to poor posture. Although there is no ONE perfect posture,  good posture is important for multiple reasons.

1. Prevents injuries during physical activities and exercise
2. Allows you to center weight over your feet and equally throughout your body
3. Improves balance and can reduce risk of falls
4. Improves blood flow and circulation
5. Increases muscle flexibility and mobility

As more and more jobs are transitioning to remote or involve sitting for extended periods of the day, sitting posture is one of the biggest things to address to prevent future injury and or pain.

See a physical therapist to receive individualized recommendations and exercises for postural corrections and improvements!

In February of this year, I moved from New Jersey to Florida. I was excited about this new chapter in my life, and received a farewell gift from the daughter of Michelle Dela Rosa. Elise is 9 years old (such a fabulous age of wonder and creativity) and she created a hobo bag with a long stick, a piece of yarn and ball of tissue paper dangling from it. I was tickled at how Elise imagined me striding towards my next adventure with a hobo bag over my shoulder. But deep down, I was quite scared about leaving everything and everyone that I loved in NJ. I was also well aware that such a big relocation would put my nervous system into overdrive and that my sympathetic nervous system would react and play a dominant role in the next few months.

So, I decided to take action. I put a plan into place to help support my parasympathetic (calming) system during a time when I knew that it needed bolstering. There is significant research supporting ways to allow the parasympathetic system to have its voice during times of duress.  I discovered some on my own, and needed to ask for help for the others. Here is what worked and what you can do to prepare when you know that hardship or major life changes are coming:

• Exercise Regular exercise slows down the sympathetic “fight or flight” response to life stress. Exercise activates the parasympathetic system, which leads to more restful sleep, improved mood, decreased anxiety and depression and decreased perception of pain. I walked five miles daily under the swaying palm trees. It was during some of those long walks when I discovered the next habit to improve nervous system balance.
• Breathing I called Donna Zamost on many of my walks. I’ve worked with Donna for awhile at the Howell office of Connect PT. She danced and sang on Broadway in her twenties. Donna insisted that I begin a breathing program to help with my anxiety. She spoke of how prolonged exhalation can activate the vagus nerve, and that this is proven to help boost the parasympathetic system. I told Donna I don’t do well with sitting still and breathing, so she suggested that I sing! In singing, I could prolong exhalation and resist shallow breathing, which creates stress. I now sing show tunes every day and think of Donna.
• Time in Nature  It was another friend from Connect, Bryn Zolty, who encouraged me to spend time in nature to soothe my nervous system. Every weekend, Bryn and her family go on extensive bike rides in remote areas of NJ. I took her advice and visited a local nature sanctuary with wildlife. There is a bobcat who lives there who stays far away from people and doesn’t bother anyone. But with her long limbs and dark coat of hair, she reminds me of Bryn. Watching that bobcat from afar is a magnificent thing. Bryn was right – observing the creatures of Mother Earth is deeply calming.
• Believe  Marzena Bard, yogi extraordinaire, sent me on my journey to Florida with three books by the Vietnamese monk, Thich Nhat Hanh. These books are about mindfulness and finding meaning in otherwise mundane activities. What made her present so remarkable is that I gifted her with a statue of Kuan Yin,the Buddhist Goddess of Mercy. Reading the words of this monk and imagining Kuan Yin in Marzena’s home reminds me that belief in something can transform the soul. I realized it doesn’t matter what the belief system is. It could be your favorite sports team! But belief in something creates waves of happiness in the nervous system.
• Returning to Childhood  It took three months for these aforementioned tactics to help me to calm down. The final lesson I learned about how to activate my parasympathetic system was from Elise, the nine year old who made me the hobo bag. Because of her gift to me, I can finally visualize myself as a young child, going into the forest for adventure, with delicious cakes in my bag that I can eat with relish and then climb a tree and watch the leaves rustle above me. Seeing life with curiosity and wonder is linked to feeling content and at peace, and something that cannot be accomplished with the sympathetic nervous system in overdrive.

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That is how, four months after moving, I came to coax my body back into a state of calm. I didn’t have to be a slave to a racing heartbeat, shallow breathing, and worrisome thoughts. It is important to remember that when the next big change is coming your way, you can try exercise, breathing, time in nature, believing in something bigger than yourself and viewing life as a child does. And don’t forget to ask for help! Tell others that you need them, until you are ready to pick up your hobo bag and walk bravely towards your new adventure.

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Insert the tip of your finger into the vagina and gently apply some pressure backward, toward your spine. ​

Step 1 - Place both hands behind your head, right at the bump behind your head.

By Jennifer Watt, PT

​This time of year for Crossfitters is the CrossFit Games season, where it starts with a worldwide event called the CrossFit Open. Hundreds of thousands of people all over the world and of all ages and physical abilities compete in three workouts given across the timespan of three weeks. As someone who has been doing CrossFit since 2018, this will be my fourth CrossFit Open season that I have competed in. CrossFit has become my passion. ​

[#3] Pair activities together. Similar to getting a workout buddy, pair exercise with another activity. My kids don't use this particular strategy, but I know I do! It could be as simple as, I tied my exercise band to the bottom of the stairs (maybe not if you have little ones at home!), so every time I go up the stairs I do a set of exercises. When my kids still napped, I always did exercises while they fell asleep, then creeped back in to put a little blanket on them. 
​
For example, drive the route that ensures you pass the gym. Finish the online yoga class as a reward before you normally read your book or watch your favorite TV show. 

Cement in new habits by choosing one of these strategies, or develop something else that works for you. Make exercise a part of your daily routine, instead of something extra. ​

Your urologist has likely performed a digital exam (meaning they inserted a finger) to assess the size of your prostate. It is the test that NOBODY wants from their doctors. But the test is valuable because it can determine if your prostate is enlarged. And you are in good company, Sam, because the chances of having an enlarged prostate are as high as 50% in guys over the age of fifty. This condition is referred to as BPH, or benign prostatic hypertrophy, in the medical world. [1]

As a pelvic floor physical therapist, I have treated many men with enlarged prostates, or BPH. Their complaints range from difficulty peeing (hesitation, weak stream or dribbling) to the sensation of sitting on a golf ball (or a ping pong ball, if you prefer this sport over golf)! Furthermore, erectile dysfunction can also result from having an enlarged prostate.

While pelvic floor physical therapists cannot shrink enlarged prostates (we are not magicians), we can help with techniques to improve urinary flow, educate on the mechanics of urination to maximize that stream, and even teach men how to perform Kegel exercises to strengthen their pelvic floor muscles. Stronger muscles in the saddle region can lead to better erections.

​In response to your question, Sam, having an enlarged prostate is not a huge cause for concern. Remind yourself that roughly half of the guys from your graduating high school class now have the same condition. And if you want to refine what your pelvic floor muscles are doing for you, pelvic floor physical therapy is a nice option to take control of your symptoms and improve the quality of your life.

Question from Lars: I had my appendix removed over 6 months ago. I have noticed that my erections are not the same since my surgery. I spoke about it with my surgeon, who prescribed Cialis. Why is this happening? Is this normal?
​
Answer from Becca: This is such an interesting question, Lars. Erections are obviously governed by blood flow, which is likely why your doctor prescribed the Cialis. But there is also more involved with arousal than meets the naked eye (please excuse the pun. I just get so enthused when talking about this, I cannot help myself!)

The beginnings of an erection start with blood flow that is shunted to the groin. What makes erections so complex is that once the blood gets into the penis and testicles, it needs to remain there during the arousal process. In order for the blood to remain there, the pelvic floor muscles are required to lengthen to accommodate this new influx of pressure.

If the muscles responsible for containing this blood are too tight, they won’t be able to do their job, which is to act as a water balloon that expands to take in more water. With tight pelvic floor muscles, guys are left with a water balloon with a much smaller reservoir and volume capacity.

Now, let’s add another factor into your specific situation, Lars. The muscles of the core, specifically a deep abdominal muscle known as the transversus abdominus, have a very close relationship with the pelvic floor muscles. When the pelvic floor muscles contract in ejaculation, so does the transversus abdominus; conversely, when the pelvic floor muscles lengthen to accommodate blood in the penis and testicles, the transversus abdominus follows in suit.

Given the location of your appendix and the scar tissue incurred from its removal, there may have been a disruption in the coordination of your pelvic floor and core muscles. Decreased erectile function can certainly happen if these two muscle groups are not communicating in the exquisite and refined manner which they once did.

Pelvic floor physical therapists often hear of decreased quality of sex after abdominal surgeries in their patients. It is often one of the first questions I ask people who report a change in sexual habits. Lucky for you, Lars, and so many others, is that seeing a professional to manually release the scars of your surgical incisions and learning how to breathe properly during very basic life activities can reunite these muscle groups who have parted ways.

As a review, the appendix removal might have caused the abdominal muscles to become bound down and unable to expand. As a result, the pelvic floor muscles might have shortened and less blood was then allowed into the penis and testicles for Lars. There are so many people for whom this is the case. And there is help in pelvic floor physical therapy!

[1] http://utswmed.org/medblog/what-we-know-about-your-prostate/
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​Create an intention for yourself. You might see yourself in vibrant health, strong and prosperous. You may imagine yourself in healthy personal and work relationships, with plenty of leisure time. There are no limits to imagining your heart's desires. Use positive imagery as you create. Allow yourself to envision your life any way you’d like it. See, sense and feel this intention and your life however you would like to experience it.  Infuse this with feeling really good, really excited, really optimistic, really grateful, and really glad. Have joyful expectations and exuberance. Feel the energy in your body and see, sense and feel your life any way you would like it to be. You are joyful and exuberant, filled with glad expectation, optimism and inspiration. These are infusing in, through and around you and your entire experience. Take a few moments to amplify this and let it expand.  Amplify and accelerate it into your experience. Love every aspect of your creation, blessing every aspect, consciously aware and consciously participating. Feel yourself become that which you imagine. ​