Pelvic Health Blog

Vagus nerve support for digestion

5/10/2023

By Karen Bruno, PT

Support for your digestion, known as the microbiome, is assisted by the vagus nerve. The enteric nervous system, often referred to as the second brain, controls activity of the gastrointestinal tract which includes the stomach and intestines. (1) It has extensive nerve connections and communication between the central nervous system ( your brain and spinal cord) and the digestive system. The vagus nerve runs from the brain down to your organs, such as, the small and large intestines, regulating movement in the digestive tract. Signals are sent brain to gut and gut to brain.

This gentle exercise uses gateways, or touch points, to talk to the vagus nerve and to your gut health. Take one hand, cross it over your throat, and tuck it in the hollow space behind your ear (acupressure point Triple Warmer 17). Take the middle finger of the other hand and place it in your navel. Your touch pressure in both areas is very light. This hooks up the gut to the vagus nerve. Breathe in through the nose and out through the back of your throat to support the vagus nerve and digestive health. Take about 3-5 breathes; feel free to do it more if you have the time. Then switch your hands so that you connect the back of the ear on the opposite side and the belly button.

You can do this anytime during the day, for example, before or after a meal, before bed, first thing in the morning or whenever it is convenient. You can do this sitting, standing or laying down. This supports good vagus nerve connection from the brain to the gut and the gut back to the brain. (2)

(1) John B. Furness (2007) Enteric nervous system. Scholarpedia, 2(10):4064., revision #91225
(2) https://wellwithin.net/energy-medicine-for-gut-health/

Transcutaneous Electric Nerve Stimulation (TENS) for Vulvodynia

4/18/2023

By Bryn Zolty, PT

As many as 17% of women may experience pain in the area around the outside of the vagina known as the vulva (1).  Pain in this area can be multifactorial and potentially caused by hormonal changes, inflammatory conditions, musculoskeletal conditions, medications, trauma, nerve pain, cancer, and more. Severity can range from pain with certain activities to constant burning pain. Most women will experience pain with intimacy and intercourse.

Finding the right care team is important. With such a wide array of potential causes, many women will see several physicians before identifying the cause and starting treatment. One modality that may complement treatment is transcutaneous electric nerve stimulation, or TENS. This can be placed on areas outside the body, but several studies demonstrate improvement of symptoms when delivered transvaginally.

F. Murina, V. Bianco, et al, had women trial internal vaginal probes or external electrodes close to the sit bones or over the sacrum. They used the TENS for 20 minutes a session, 2 times a week for 10 weeks. These women demonstrated significant improvement of vulvar pain.

Murina F, Felice R, Di Francesco S, Oneda S. trialed TENS with vaginal Valium (Diazepam) versus TENS only. This study used TENS for 30 minutes, 3 times weekly for 60 days and found both groups had improvement, but the vaginal valium with the TENS was superior.  

If you think TENS may be a helpful addition to your pelvic pain plan of care, speak with your pelvic PT or practitioner. A pelvic physical therapist can help you figure out the best type of TENS for you and set up one of the protocols used in these studies.  

1 Murina F, Bianco V, Radici G, Felice R, Di Martino M, Nicolini U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG. 2008 Aug;115(9):1165-70. doi: 10.1111/j.1471-0528.2008.01803.x. PMID: 18715435.

2 Murina F, Felice R, Di Francesco S, Oneda S. Vaginal diazepam plus transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:148-153. doi: 10.1016/j.ejogrb.2018.06.026. Epub 2018 Jun 27. PMID: 29960200.

Yin yoga stretches for pelvic floor tension release

2/9/2023

By Marzena Bard, PTA

Are you one of those people who stretches religiously but still feels stiff as a board? The stretches work for a short while, and then you’re back to square one? Most likely it is because the stretches are working only at the muscle level, and you want to go deeper to the connective tissue level - fascia, tendons, ligaments. 

In yin yoga, the poses are held for 3-5 minutes and focus on deep, mindful breathing. We use props such as bolsters, yoga blocks, and pillows because one should never feel pain or discomfort while in yoga poses. The length of time spent in a particular posture helps deepen the stretch and keeps the benefits longer. All you need to do is to stay there and pay attention to your breath. You might find that this is an easy way to get into a little bit of meditation as well.

Addressing tight pelvic floor muscles means you need to provide more length and relaxation to muscles surrounding the pelvis, eg hamstrings, quadriceps, hip adductors, and hip abductors. Holding the stretches for a longer time may increase awareness of your whole pelvis and the muscles in and around it.

A randomized controlled trial, conducted in 2015 at Lund University in Sweden, performed a five week yin yoga-based intervention with stressed adults. It showed decreased plasma adrenomedullin and increased psychological health, highlighting the physiological and psychological benefits that yin yoga has to offer.

Yin yoga may also help to: 

stretch connective tissue
improve flexibility
boost circulation 
improve sleep 
enhance mental focus 
promote relaxation 
develop breath awareness 
heal injuries

Yin yoga is not suitable for: pregnant women, people with osteoporosis or osteopenia, and people with hypermobility. Ask us if including yin yoga in your physical therapy program is suitable for you!

Three of the key poses of yin yoga are demonstrated below.

1. Deer pose – hold 3-5 minutes each side (option with block)

2. Butterfly Pose – hold 3-5 minutes each side (option with block)

3. Melting Heart Post – hold 3-5 minutes each side

How to train your bladder | " I Pee Too Often!"

1/24/2023

By Bryn Zolty, PT

Do you know where every bathroom is when you leave the house?  
Do you pee more often than your friends and family?
Do you ever leak urine on the way to the bathroom?

These are symptoms that can occur when someone has urinary urgency/frequency and/or urge incontinence.   

Urinating more often than 5-8x/day is urinary frequency
Urinary urgency is a strong, sudden urge to urinate despite the strong urge, it can be a small amount of urine
Leaking urine with a strong urge, usually on the way to the bathroom is urge incontinence

People dealing with these symptoms will limit water intake, avoid social situations, and go to the bathroom ‘just in case’ throughout the day. However, despite how overwhelming the symptoms may seem, bladder retraining is an effective way to pee less frequently and stop leaking.  

You start with a bladder diary. Some things to include are bladder fluid intake, when you urinate, strength of the urge, how much you urinate, and if there were any leaks.  

By looking at the time between trips to the bathroom, we figure out how often you are urinating and determine the usual shortest interval that you could go without leaking urine. Looking at this diary, there were 1 hour and 2 hour intervals. Leaking occurred when the interval was 2 hours.  The shortest usual interval was 1 hour that no leaking occurred. Therefore, this is where this person would start, going to pee about every hour.  

If you are successful, then you add 15 to 30 minutes to your interval. For this diary, that would be a goal of 1 hour and 15 minutes to 1 hour 30 minutes. Once again, if you can make the new interval and not leak with an urge for several days, increase again by 15 to 30 minutes. This continues until you reach 3 hours or a comfortable amount of time for you. An expectation of 6 to 12 weeks to reach your goals is average.  

Other tips and tricks for stopping leaks and urinating less often:

Avoid peeing ‘just in case’; this trains the bladder to empty when it is not full.
Do not limit water.
Avoid caffeine and alcohol.
Sit and breathe calmly when you get an urge.
Perform 10 quick kegels when you have the urge to pee.
When you do walk to the bathroom, walk slowly.
Sit for at least a minute to empty.
Manage constipation.

A pelvic therapist can help you with a bladder diary and guide you through bladder retraining. In addition, being able to perform a kegel can be an important part of your program, and a therapist can make sure your kegel is effective. Together, we can quickly get your life revolving away from your bladder!
Women's Health in Physical Therapy. Jean and Glenn Irion.Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, ©2010
Evidence-Based Physical Therapy for the Pelvic Floor. Kari Bo.  Elsevier. 2015

New year's stretch goal

1/5/2023

By Michelle Dela Rosa, PT

Have you ever made too many New Year’s resolutions? Sometimes things spin so out of control during the holidays that there’s too many things to fix! Or the laundry list is full of things we didn’t get to complete (or start) in 2022. Maybe it’s time to just pick one thing and focus our efforts. Me, I’m going to stretch more. Well, technically I’m stretching all day when I’m with patients, but that’s not the same as stretching for myself. One of my favorites is starfish pose, shown beautifully by our own Marzena Bard, PTA.

I know that I won’t be successful though without a plan, so I’m setting aside certain times to do just two stretches (yes, I need to make the goal achievable!).

I hope this article can help some of you take steps toward meeting your New Year’s resolutions, like eliminating bladder leakage related to urgency, overcoming trauma, and understanding connections between altered eating habits and pelvic health.

Disordered eating and pelvic health

12/5/2022

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 and trauma relief

11/16/2022

By Karen Bruno, PT

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.

Press your thumbs into the ball of your foot for about 1 minute (K1 in acupoint).
Hold your fingers over your toes and comfortably squeeze the sides of your feet.
Press your thumbs into the “Shock point” in the middle of the heel. Hold this for 30-60 seconds.
Do these steps on each foot.
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.
Trace figure 8's around your eyes.

This is a basic self-help protocol to get you started. There is a more in-depth process that we can do as part of your physical therapy rehabilitation plan in our private Meditation Program.  Speak to primary physical therapist to schedule a session in the Meditation Program Series if you feel you would benefit this.

Your body has a love language, too

10/17/2022

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.

When is the last time you stopped to listen to your body? What did it ask for and did you give it the care it needed?

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!

Being active, especially biking and climbing. -Bryn Zolty, PT

Spending time being outside and exploring. -Katelyn Sheehan, PT

Walking my dogs. -Karen Bruno, PT

Taking a nap with my dogs. -Becca Ironside, PT

Yoga, being in the woods, and walking barefoot directly on the Earth. -Marzena Bard, PTA

Can you spread your toes?

10/3/2022

By Donna Zamost, PTA

As the weather turns cooler, it’s time to put away the flip flops and break out the fall boots. However, before you put on your favorite pair of fall shoes, ask yourself this important question; can you spread your toes in your shoes? If not, you may be wearing shoes that are too narrow.

Often, buying shoes labeled as “wide” will not solve the problem.

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?

The natural spread of your toes is known as toe splay.

It is an important part of how a foot functions. Toe splay is necessary for ankle stability and arch support, as well as activation of the intrinsic foot muscles (muscles within the feet). Allowing the toes to maintain their natural spread promotes a good base of support. This not only helps with balance, but it helps to reduce stress at the front of the foot when pushing off during walking and running. In shoes with a tapered or narrow toe box, the big toe angles in and all the toes are squished together, reducing the base of support. Over time, this can cause painful issues, such as bunions, hammer toes and ingrown toenails.

It is not surprising that narrow or pointy toe boxes are common in high heels and dress shoes; but, ironically, they are also found in sneakers and running shoes. During exercise and other physical activities, we need our feet to be functional and comfortable. Wearing shoes that force our toes into an uncomfortable position does not allow our feet to properly do their job. As a professional dancer, I was often required to dance in uncomfortable shoes. Broadway dancers frequently wear character shoes when performing. These shoes have a 3-inch heel and a round narrow toe box. While these shoes may help to elongate a dancer’s legs, they are tough on the feet!

After years of dancing in this type of shoe, when I would take my shoes off, my toes would stay squished together. Over time, this unnatural position of my toes led to bunions and arthritis. I even required surgery in one of my big toes to restore a normal range of motion and allow me to walk without pain. Understandably, I am now very careful with my choice of shoes.

If your toes feel a bit squished together, there are things you can do to help restore your natural toe splay: While sitting, cross your ankle onto your opposite thigh and interlace your fingers between your toes to help spread them out. You can use your fingers to help stretch the toes and then when comfortable, use your fingers to move your toes up and down and in circles.

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!

Making peace with your nervous system

9/26/2022

by Karen Bruno, PT

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.

Instructions

Tuck your middle fingers into the little hollow behind your earlobes.
No pressure is used; just make gentle, light contact.
Bring your palms together so they come together in front of your throat.
This connects into the vagus nerve in a variety of different ways.

Hand position

Peacemaker

Crossover peacemaker

Half peacemaker

Crossover half peacemaker

You can add some other techniques, such as humming, singing, toning, rocking or ujjayi breathing/dragon breath while you hold this position (see video).

For more information on the vagus nerve, please refer to these Connect PT blog articles:

Rib pain during pregnancy and postpartum

8/31/2022

by Bryn Zolty, PT

Rib pain during pregnancy and postpartum can make everything difficult. Taking care of kids, lifting, carrying, rolling over in bed, getting out of a chair, and even breathing can hurt.

In many cases, this is due to musculoskeletal changes that occur during pregnancy. Your ribs start changing position even before your uterus is large enough to push pressure up into the diaphragm and rib cage. Therefore, it is thought to be hormonal changes that may play a large role in the alteration of the rib cage.

Infrasternal Rib Angle
One of the ways we check rib cage changes is the infrasternal rib angle. Place your thumbs in towards the bottom of the sternum to get an estimate of your rib angle. A normal angle is close to 90 degrees.

Changes During Pregnancy
This angle can increase by 35 degrees during pregnancy (1). In addition, the ribs flare up and out by 10 to 15 cm and chest circumference increases by 5-7cm (1). This means your rib cage is wider.

Muscle Pain
These changes to your ribs cause stretching through the muscles that attach into the ribs, including the intercostal muscles and the abdominal muscles. The stretching can be very uncomfortable and can lead to muscle stretch injury or cartilage stretch injury.

Joint Pain
When inflammation is present between the ribs and the breastbone at the front chest wall, it is known as costochondritis and is tender to touch. At the back of the ribs, women may complain of stiffness, pain, and pressure where the ribs meet the spine.

Rare Musculoskeletal Pain Cause
In rare cases, women will experience transient osteoporosis during their pregnancy. Throughout your pregnancy the amount of calcium transferred from you to the baby increases drastically. It starts at about 2 mg/day and by the 3rd trimester it could be as much as 250mg/day (1)! As with anyone with osteoporosis or osteopenia, there is an increased risk for fracture in your bones including the ribs. A weakened bone can fracture under normal forces, and if you suspect this you should contact your doctor.

Muscle dysfunction, painful joints, stiffness, and trouble with normal daily activities can be treated by a physical therapist. If you are pregnant or postpartum and have a pelvic therapist nearby, contact them and make an appointment. They have additional training to help a woman during and after her pregnancy.

When Rib Pain Is Not Musculoskeletal
There are many causes of chest pain that can occur during pregnancy. These include cardiac causes, clots, pneumonia, heartburn, peptic ulcers, shingles, and more. Your physician will help order any tests needed.

Get Started Before You Make An Appointment
For some women, the musculoskeletal changes that occur during pregnancy do not go away on their own. Here are some ideas to get started in case you are not ready to start physical therapy.

For getting your abdominal muscles fully back on-line immediately postpartum
How to help your abdominal muscles immediately after delivery (connectpt.org)

Improve Mobility During Normal Tasks
If you feel it is difficult to find time to exercise and stretch, start with incorporating lots of movement into your day. Add trunk rotation and side bending into your normal tasks. This will help mobilize the ribs and the spine. It can also help encourage the obliques to mobilize the ribs as well.

when reaching for light objects, reach and twist
carry your baby on a different side to vary movement patterns
if breastfeeding, alternate positions
monitor for movements that you only do on one side consistently and change it up

Breathing Moves Your Ribs For You
To get your rib cage moving better, you need to use it for breathing! Pregnant and immediately postpartum, avoid pushing pressure down and out into the lower abdomen and pelvis when practicing this breathing. Instead of pushing your abdomen forward, as you inhale, feel your ribs move 360 degrees out and up, and as you slowly exhale feel them fall in and down.

See the pictures for hand placement to monitor your breathing. A hand on your chest and ribs can help you monitor what you do during the breathing exercise. Most of the time, we recommend the 360 movement. With both hands placed on the lateral ribs in the lower picture, your hands will appear to be moving your ribs like an accordion.

If your ribs feel wide and “stuck out’, focus on a long, full exhale. And absolutely work this breathing pattern into all kinds of stretches and yoga poses.

If you are pregnant and past your first trimester, it is important to monitor how you feel when laying on your back and limit this position. This breathing exercise can be done in sidelying, sitting, standing, reclined, or any other comfortable position.

If you feel like getting up and moving, some of these yoga poses may help. Combine them with your 360 breathing. Note she is twisting away from her bent knee in many poses to avoid compression in the groin and maintain open space for your baby.

Twisted crane pose

Fan pose

Goddess twist

Seated crossed leg twist

Seated straight leg twist

Make an Appointment

Rib flare left untreated can cause altered function of your core muscles. When you feel ready to attend therapy, your therapist will help customize a stretching, breathing, and strengthening program specific to your body.

What is good posture?

7/11/2022

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?

Which of the following is the perfect posture?

Answer: NONE of them!

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.

Prevents injuries during physical activities and exercise
Allows you to center weight over your feet and equally throughout your body
Improves balance and can reduce risk of falls
Improves blood flow and circulation
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.

Tip when working from home or in the office:

Place a post-it note with “posture” written on it somewhere on your desk around eye level. Every time you see that note, it will remind you to be more mindful of your posture and adjust it if needed- this improved awareness over time will allow you to remain in a better posture for longer periods of time and with less thinking as it will become more subconscious.

Sitting posture

Feet flat on floor
Hips and Knees at 90-degree angle
Elbows and forearms supported
Back support
Shoulders relaxed: no hunching forward or leaning back!
Forehead & eyes level with top of computer screen

Standing posture

Feet flat on floor
Chin tucked, shoulders back and relaxed
Avoid hunching shoulders or rounding upper back!
Balance weight over feet with low back and hips in neutral position. Avoid shifting weight on hips from side to side
Core engaged
Knees straight- no locking out!

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

Balancing the nervous system during times of big change

6/6/2022

By Becca Ironside, PT

I’ve been working with the folks at Connect PT for seven years now. When we talk amongst each other, we have a different insight into each other’s lives and this isn’t just because we are colleagues who share the same craft. Rather, we see the powerful role of the nervous systems in our bodies and how they play out in our lives.

I took a class last summer which focused on nervous system input and how it affects pain and depression or relaxation and joy. Your sympathetic nervous system is the “fight or flight” mechanism – your heart begins to race, blood is shunted away from your abdomen and pelvis towards your muscles. This helps you run away from perceived stress and has protected us from an evolutionary perspective for eons. Your parasympathetic system, on the other hand, allows you to feel content, sleep well, live without pain and form meaningful relationships – your breathing will slow, your muscles will relax, and you will digest and assimilate nutrients from your food.

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.

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.

Becca Ironside, PT continues to work at Connect PT from sunny Florida. She does Wellness Visits, where you can have an appointment online and ask questions about how your pelvic health is related to your other bodily systems. You can discuss how various pieces of your medical history gleaned from other medical practitioners can be peeled back for a comprehensive look at what might be driving pelvic floor issues, including bladder, bowel and sexual concerns. Becca also writes articles for Health Union, an online organization which supports those with chronic health conditions like multiple sclerosis, prostate cancer and endometriosis. She has been nominated for an award for Revolutionary Research by this company for her ability to take scientific studies and make them easy to digest with humor, compassion and simplicity.

Splinting to help empty the bladder or bowel

5/25/2022

by Katelyn Sheehan, PT

Splinting

Have you ever experienced any of these symptoms?

Constipation
Fecal incontinence
Heaviness in the Vagina
Feeling like you haven’t emptied your bladder all the way
Having drops of urine come out as you stand up from the toilet

If you answered yes, then splinting may be a useful tool for you. Splinting is a technique often used by patients with pelvic organ prolapse to help them fully empty their bowels or bladder. Splinting is primarily suggested for helping with constipation, but certain splinting techniques can also help with urinary symptoms. Typically, splinting is performed by inserting a clean finger into the vagina to help hold, or splint, the pelvic organs and stabilize them in a more optimal position while using the bathroom. This can help hold the bowels or bladder in a more upright position to allow for full emptying when you go to the bathroom. You may also find that splinting externally can also help; this involves applying some gentle upward pressure to the perineum (see pictures and video below).

Internal splinting for the bladder/urethra

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 forward, away from your spine.

External view (from below)

Internal view (from above)

INTERNAL splinting for the bowels

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.

External view (from below)

Internal view (from above)

EXTERNAL splinting for bowels

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Next gently apply some pressure with your finger to the perineum upward, toward your head.

How to help your abdominal muscles immediately after delivery

5/12/2022

by Bryn Zolty, PT

As a pelvic physical therapist there are many things I would have liked to have done differently immediately after giving birth to my daughter. If I had to pick one exercise to have started immediately after delivery, it would be this one.

During pregnancy, your abdominal wall lengthens. The muscles have been working because even though they were stretched, the baby kept them on tension. Remember feeling like your abdominal wall was so tight? How could it stretch any more?! Picture a long string from the bottom of your sternum to your pelvis over your pregnant belly. Now the baby is delivered and suddenly the tension on the long rope is gone. The abdominal muscles are now hanging down, feeling loose, almost like they aren’t even yours. So many women are told to start working on their abdominal muscles lying flat. But, when you lie flat, picture the string again as your muscles. It is loose, and we cannot contract our muscles in their full length. We need to flip over, so the muscles can be all the way long. We also need to get the ribs moving. Rib motion will help the abdominal muscles, the diaphragm, and other core muscles working sooner!

You can try it in a few positions - pick the one most comfortable for you. Remember that you should be facing down, since we want the belly to be able to fall down:

Stand at the kitchen counter with your elbows resting on the counter. Position your back in a comfortable position.
Sit in a chair with wide legs and rest your elbows in front on a high table.
Flip onto hands and knees, a mini version of cat/cow.

Start with your belly relaxed, hanging down, no tension in the muscles. Inhale and feel your ribs expand wide, but gently. Then start your exhale with a gentle “shhhh” sound, like you are calming your baby to sleep. The “shhhhh” sound should start to create some tightening in your abdominal muscles. The loudness of the “shhh” may affect the amount of tightening you feel.

Once you feel the abdominal muscles tightening, gently help them draw in. Can you feel the tension start lower, above the pubic bone, and then the middle and upper abdomen tightens? As you start to reach the end of your exhale, can you feel the ribs tightening in as well?

Now inhale. Feel the ribs move wide and back, opening like an umbrella. Now, we use the muscles in reverse by slowly lowering the abdominal muscles back down. Slow down. We need to use our muscles to control this without dropping them. They are still strengthening even though they are getting longer.

Repeat these steps. This is a gentle exercise, so you can do it throughout the day. Be mindful of how you feel to judge how much you should do this. I would recommend at least 3 times a day for 10 reps minimum. This can be done if you had a vaginal delivery or a c-section. It is just breathing and gentle tension as you are just following your breath. Pick the position that best suits how you feel.

Get out of fight or flight with the vagus nerve

4/4/2022

By Karen Bruno, PT

Ever get queasy from a shot or the site of blood? Or experience something and feel like fainting? Sometimes, those feelings are due to the overstimulation of the vagus nerve. And on the other end, the vagus nerve can also initiate relaxation after stress. So it makes sense that when we’re in fight or flight mode, the vagus nerve comes into play.

Fun fact: the vagus nerve is responsible for our “gut feelings”.

So how can we use the vagus nerve to our benefit? Well, once we understand what it is, we can control it to breathe more easily, and control our heart rate when we’re in tense conversations or high-pressured situations at the office.

What is the Vagus Nerve?
The vagus nerve is part of our central nervous system, which is made up of our brain and spinal cord. The central nervous system communicates with the body and processes information. The vagus nerve, also known as the tenth cranial nerve, starts in the brainstem and travels into the neck, trunk and abdomen. Having extensive reach and influence, the vagus nerve is responsible for the functioning of our internal organs and processes such as:

digestion,
elimination,
heart rate,
respiration,
immune health,
inflammation,
physical tension,
our response and adaptability to stress,
and social and emotional engagement.

In short, our vagus nerve has a central role in every aspect of our lives. Our well-being is dependent upon our ability to adapt and on our nervous system’s capacity to function properly. Vagus nerve exercises help us get out of the stress related fight, flight and freeze response and move us into a calmer state of rest, restore, relax and digest. So, whether you have pain, a bowel, bladder or sexual condition, an issue with digestion, anxiety, trauma, or any combination these, your vagus nerve could use a boost.

Sample exercise
There are numerous ways to support optimal function of your vagus nerve. Here is a simple, 2-step exercise you can perform. This technique comes from Stanley Rosenberg’s "Accessing the Power of the Vagus Nerve, Self-Help for Anxiety, Depression, Trauma and Autism."

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

Step 2

Turn your eyes to the right and hold them there for 30 to 60 seconds OR until you take a deep breath, swallow, sigh, or yawn.
Then, turn your eyes to center.
And finally, turn your eyes to the left and do the same thing, holding them for 30 to 60 seconds OR until you take a deep breath, swallow, sigh, or yawn.

Modifications

If you can't get both hands behind your head, just use one hand behind your head.
You can also do the same exercise with your arms at your side.
A third modification is taking your middle fingers and placing them gently behind your ear.

Here are some practical application suggestions to use the simple vagus nerve exercise.

If you are feeling neck pain, back pain, or pain of any kind, use this exercise.
Use it before doing an exercise routine.
Use it whenever you want to calm and relax your body and mind.
Use it to calm your body when you are experiencing urinary issues such as incontinence, urgency or frequency, or to relax your muscles when you are feeling constipated.
Use it before or after eating a meal to boost your digestion.
Use it before you go to sleep to get to sleep easier.
If you are prone to lightheadedness when you change positions, use this prior to changing positions.
Use it frequently if you experience ringing in the ear (tinnitus).
Use it to calm your nerves before meeting a new person, or engaging in a new activity or if you are feeling anxious.
Use it when you feel frustrated, irritated, angry, stressed, upset or sad.
Use it if you feel a headache beginning.
Use it to shift out of an anxiety state.
Vagus nerve exercises can be used for a rapid heart rate and for high blood pressure
If you get short of breath easily, use it before any activity such as walking up a flight of stairs.

Practice it daily and as often as needed throughout the day.

References:

Rosenberg, Stanley, Accessing the Power of the Vagus Nerve, Self-Help for Anxiety, Depression, Trauma and Autism (Berkeley, California: North Atlantic Books, 2017).
Front. Psychiatry, 13 March 2018 | https://doi.org/10.3389/fpsyt.2018.00044
Tap Into Your Vagus Nerve’s Healing Power to Rewire Your Nervous System for Optimal Health, Energy Medicine to Restore Your Physical, Mental and Emotional Wellbeing, with Dr. Melanie Smith/Theshiftnetwork.com

Electrical stimulation for slow-moving poop

3/27/2022

By Bryn Zolty, PT

Slow-moving poop, or slow transit constipation, is a type of functional constipation. It is exactly how it sounds, stool moves slower than normal through your system. As physical therapists we evaluate your pelvic muscles and determine if the muscle tension or coordination may be playing a role in your constipation. But after addressing those causes or ruling them out, there are still ways to help your slow transit.

One treatment we consider for our patients is a stimulation known as interferential current. The use of electrical stimulation for reducing pain and muscle strengthening is well known. But this special current can help your GI tract move a little faster. For our patients, it's 2 electrodes on your abdomen and 2 placed on your back. It feels like a tingling sensation.

Studies on interferential current for slow transit show it increases colonic activity. Beyond that, there are some theories on the mechanism of action. A few of these theories include: it affects the pacemaker cells of the GI tract, stimulates the enteric nervous system to the GI tract, or it stimulates the cells that are responsible for peristalsis.
What we do know is that it is non-invasive, cost-effective, and can be done at home. Many patients that we talk to are on an endless search for supplements. Slow transit constipation typically does not respond to laxatives and fiber. Therefore, this may be a good option to reduce over the counter supplements and improve your transit time.

Our pelvic therapists would be happy to discuss this type of stimulation with you and determine if this should be a part of your treatment.

References
J Neurogastroenterol Motil. 2018 Jan; 24(1): 19–29. Published online 2018 Jan 1. doi: 10.5056/jnm17071

Pessaries change pelvic floor muscles

3/10/2022

By Bryn Zolty, PT

Pelvic organ prolapse is experienced by many women as heaviness in the vagina. For some women this experience is painful, dull, aching. For others it feels as if there is something in the vagina or sliding out. This can occur when a woman has pelvic floor muscle injury and in the presence of increased tissue mobility such as hypermobility disorders. It is commonly seen after a vaginal delivery.

Different images of two different pessary shapes used with permission from Pelvic Guru®, LLC | www.pelvicglobal.com

Although these conditions all sound like weakness and lengthened muscles, as clinicians we often see an increase in pelvic muscle tension and activity. What appears to happen is when a woman stands up, the feeling of heaviness and falling out increases, and either knowingly or unknowingly, she increases the pelvic floor muscle that tries to hold the organs in. This can be seen on biofeedback as pelvic muscle overactivity.

A pessary is a device fitted for a woman that helps reduce the symptoms of heaviness by insertion into the vagina and providing support that your body is not able to provide. New research suggests it may also improve muscle function. One hypothesis is that the muscle will stop contracting all day in attempts to decrease the symptoms of the pelvic organ prolapse. This hypothesis states that the muscles, specifically the puborectalis, will now assume a more normal resting position/tension and therefore allow for better muscle function.

If you are experiencing symptoms of pelvic organ prolapse and other pelvic muscle dysfunctions, talk to your providers about the use of pessaries to not only improve the symptoms of the heaviness, but improve the way the muscles work. These muscles have important functions for urination, defecation, continence, movement, core strength, and sexual function.

CrossFit and pelvic floor dysfunction

2/28/2022

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.

Now as a pelvic floor physical therapist, I have run into a common situation at my gym. We look up on the white board that has the WOD (workout of the day) and I would see the term “double unders.” Double unders is a form of jump roping where your jump rope must go under you twice. As soon as I see that, I see many of both my female and male buddies head to the bathroom, and in many cases multiple times before the workout starts.

There is a well known video clip from CrossFit titled “Do You Pee During Workouts?” And when I watched it I got some interesting topics from the CrossFit community. Some say they definitely leak urine during double unders and box jumps. Many basically said it was a part of life as a CrossFitter and simply manage with pads. But is it okay?

As a pelvic floor physical therapist, I would say it is not okay. Peeing when exercising is telling us that there is a problem with our pelvic floor. A normal pelvic floor is simply one that can do all its functions – maintain continence, support the pelvic contents and contribute towards optimal movement during functional tasks. Now there are several reasons why it may not be normal or that there is pelvic floor muscle dysfunction.

What is pelvic floor dysfunction exactly? Pelvic floor dysfunction is simply where your pelvic floor is not doing its job properly. The pelvic floor is designed to provide support for your pelvic organs, help control intra abdominal pressure, control your urine and bowel movements, and help provide pleasure during sexual intercourse. One form of dysfunction could be that you have a weak pelvic floor. Common reasons why it is weak are: pregnancy and childbirth, surgery or other medical procedures, posture and behavioral habits, and lack of exercise. Another could be an overactive pelvic floor which is a condition where there may be increased pelvic floor muscle tension at rest, increased voluntary or involuntary contractile activity, or a decreased ability to fully relax the pelvic floor muscles. You could also have a damaged pelvic floor. Your pelvic floor might have been through a lot. Childbirth, cancer and radiotherapy, and other conditions can contribute to tearing, scarring and damage to the pelvic floor muscles. The nerves to the area can be damaged, the muscles themselves can become detached from the pubic bone, scarring from surgery and childbirth can cause asymmetrical contractions.

So what are some things to help? First and foremost, like I said before peeing when working out is NOT normal and should be addressed. Seeing your primary care physician, urologist, gynecologist, and to get a referral for pelvic floor physical therapy. These are health care providers who have taken extensive coursework, some even board certified, on the pelvic floor muscle anatomy and will be able to properly assess your own situation and create a plan specifically for you. Other things to consider, particularly in the realm of CrossFit. Try not to rely on items like lifting belts, braces, wraps, and other means of support. This allows you to really be aware of your physical limitations and hopefully will keep you from moving or lifting something you shouldn’t. Rely on good technique with all movements. Sometimes during these WODs, we push ourselves so much that technique goes out the window. And lastly what ties both the supports and technique is straight ego. Focus and train on your weaknesses and build upon them. If we’re leaking when we hit a certain amount of double unders or box jumps, then make that your target and to slowly build upon that. As I said, leaking during workouts is not normal and one should address it and not let it go.

Pelvic floor symptoms can be the reason that women stop exercising and end up living a more sedentary lifestyle. Don’t let this be you!

Reference used
https://academic.oup.com/ptj/article-abstract/102/3/pzab284/6478875?redirectedFrom=fulltext

To all my well-intentioned but over-scheduled friends...

2/8/2022

People need tune-ups, just like cars do. Many of our patients understand that coming back in for physical therapy is a healthy decision to make before and after they deliver their baby, before going back to work/school, or when they start to feel a twinge or ache somewhere. The single most common theme I hear upon return to therapy is, “I stopped doing my exercises.” Maybe there’s no more time with the baby. Or major life changes got in the way. I get that.

So I took a small poll with our patients that seem to have found a rhythm in doing their exercises not only consistently, but with ease! Here are the top 3 things they said helped them plug that time in for exercise:

[#1] Pre-schedule the workouts for the week. Schedule the day around the exercise to ensure it gets done. This moves exercise up on the priority list.

In my own family, my middle daughter regularly completed full exercise sets because COVID led to online gym classes. She knew the schedule ahead of time and welcomed exercise time when she was able to prepare for it. This video shows her in action.

[#2] Partner up! Part of what makes going to the gym appealing is the social environment of like-minded people working out at the same time. The same can be said when you find a walking partner or someone to attend gym classes with. That’s accountability. Maybe you won’t be consistent if you work out for yourself, but you’ll do it if you have to answer to someone.

In my family, I was only able to get my middle daughter to practice her jiu-jitsu exercises by getting my littlest one to join in. As you can see in this video, they're definitely getting tired as they go through them but at least they're doing it. Please don't mind the house mess :)

[#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.

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