By Karen Bruno, PT
Mini-relaxation exercises are focused breathing techniques which help reduce anxiety and tension immediately. You can informally cultivate mindfulness by focusing your attention on the moment to moment sensation during ordinary activities. You can simply do this by single tasking - the art of doing one thing at a time and giving it your full attention. As you wash your hands, pet the dog or eat a meal, slow down the process and be fully present, using all of your senses.
Mini Version 1: count very slowly to yourself from ten to zero, one number for each breath. With the first breath you say “ten” to yourself, with the next breath, you say “nine, etc.
Mini version 2: as you inhale, count very slowly up to four; as you exhale, count slowly back down to one.
Mini version 3: after each inhalation, pause for a few seconds; after each exhalation, pause again for a few seconds. Do this for several breaths.
By Becca Ironside, PT
Matt was a regular guy. At 36 years old, he had a successful career in IT and was newly married. Matt had been playing ice hockey from the time he was in grade school and had no intention of stopping in adulthood. Every Tuesday and Thursday night, Matt went to a local ice rink and laced up his skates to play with a men’s league. This was the release from the grind of his job and he felt like a young kid as the blade of his stick hit the puck away from the opponent’s net.
Matt always wore a mouth guard and a jock strap. They were as necessary as the shoulder pads under the jersey. Anything could happen on the ice, and Matt was taking every precaution necessary, while having the best release of adrenaline he ever felt during the workweek. Until one day when all of this hockey armor failed to protect Matt. He will never forget it, he said. How could he? One evening, as Matt was playing defense, the puck flew into the air and hit him just to the left of his groin. The trajectory of the puck was like a sharp-shooter, it got that very tender spot between his jock strap and
testicle. The pain was excruciating.
The only choice was surgery. The urologist made an incision down the seam in the middle of the scrotum and removed the damaged tissue. There was pain after the surgery, Matt said, but nothing as severe as the pain which brought him to the hospital after the puck’s errant contact with his groin. This surgical pain settled down, healing took place, and all seemed to return to normal.
It was not until three months later when Matt noticed that he was having difficulty with sex. He had developed premature ejaculation. There was also a strange sensation of fullness and tenderness in his testicles after climax. How had this happened, Matt wondered? And what could be done? Was there treatment for this?
It was Matt’s wife who found our clinic. This was not surprising, as women typically have a more visceral connection with their pelvic floors; we have periods as teenagers, we get examined internally when most men do not until later years and we often have pregnancies which put this area of our bodies in the spotlight. Matt came to Pelvic Floor physical therapy with his wife, Maria.
Maria explained that she was concerned about her husband’s premature ejaculation and discomfort after sex. Not only did Maria and Matt want to return to their very robust sex life, they also wanted to conceive a child. It was helpful to have both partners attend this initial session.
Matt returned for several physical therapy appointments by himself after that first evaluation. He learned methods to relax the muscles of his perineum. It was the scar adhesions of his testicular surgery that caused his muscles to go into spasm; this was driving the premature ejaculation and pain after intercourse he was experiencing. He learned techniques to release the scarring and relax his muscles and taught his wife how to help him. Together, this couple worked to recover Matt’s sexual and
It was nothing short of wonderful to get a letter from Matt a few months after he stopped attending PT. The letter read as follows:
“It was not easy to come to a physical therapy office and talk about erections. But I am so glad that I did it. Since then, Maria and I are able to have the kind of sex that we did before the injury. I am also back to playing hockey, but only one night a week. This is because we are expecting a baby girl in a few months and I need to be at home more to get ready for the baby.”
What was so successful about the outcome of this story, you might ask? Firstly, Matt had a traumatic injury to his groin and developed symptoms immediately thereafter, so the causation of the problem was easy to determine. Secondly, Matt was open to this type of therapy and it was readily available to him in the area in which he lived. Finally, and what is most important about this story, is that Matt and his wife Maria tackled the problem together. They both had to adjust their expectations, lifestyles and learn to overcome something which might have driven them apart. Instead, it brought them closer together.
Pelvic Floor physical therapy helped to make this happen. With a baby girl to reinforce the story! There is great power in looking at life’s problems and seeking help. It requires staring down our opponent on the ice. We need the shoulder pads and the mouth guards, but the puck might still hit us in the worst possible spot. With a team approach, we can recover. We cannot allow the fear of the puck to keep us out of the ice rink. Just like Matt and Maria, we have to keep skating.
Many patients have visited their pelvic floor physical therapist and wondered, “Why are you looking at my feet when I’m here for pelvic pain?” The answer is the alignment in your feet, and how you walk affects the muscles, joints, ligaments, and bones in your pelvis.
The foot is complicated. It contains 26 bones, 33 joints, and over 100 muscles, tendons and ligaments. But let’s keep this explanation simple. Its main functions are to soften, absorb shock and accommodate to the surface on which your foot lands, then become rigid to help you push off and take a step.
Here are two examples of how your foot alignment can affect your pelvis:
There are many more considerations in evaluating the foot than the two examples provided, but they all have a profound effect on the rest of the body. They can cause instability at joints, pain, strained muscles, overworked muscles, and much more. In pelvic health physical therapy, your therapist is not only treating the symptoms in the pelvis, but always looking for possible causes of the symptoms such as your feet!
By Michelle Dela Rosa, PT
Hesselman S, Högberg U, Råssjö E‐B, Schytt E, Löfgren M, Jonsson M. Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population‐based register study. BJOG 2018; 125:597–603.
I have been to 4 different practitioners for different reasons, from pelvic floor therapy to orthopedic therapy for my back and I can't sing their praises enough. This is the only truly holistic physical therapy center I have ever attended. The work they do is based on scientific medical practice but feels more like a nurturing yoga based treatment. I have learned so much about the connections between different body systems and how stress affects everything. Using what I have been taught and implementing it in everyday life has helped me maintain my well-being. Thanks guys! -Eva
By Bryn Zolty, PT
Its proposed treatments include a wide range of ailments, such as improving lymph drainage, improving blood flow, decreasing pain, and even drawing out infections.
Our therapists use one of the more gentle methods, gliding cupping, as a way of decompressing the soft tissues with lotion/oil to increase motion and decrease pain. A patient can feel gentle suction, stretching, or slow gliding of the cup. This is unlike the prolonged, static placement of the cups, as performed on some Olympic athletes. Our patients benefit by: increasing blood flow and removal of stagnant blood, softening/releasing scar tissue and adhesions, releasing trigger points and "muscle knots", improving tissue mobility/flexibility, and relaxing muscles. We have had success using cupping therapy with many conditions, like low back pain, pelvic pain, hip pain, stuck scars, constipation, and much more!
Written by Becca Ironside, PT
Vincent found our clinic by chance. He scoured the Internet, looking for a reason to explain the confounding pain in his pelvis. Vincent had a high-stress, corporate job wherein he sat all day long. He began to notice pain in his perineum while sitting. The longer he sat, the worse the pain became.
The final symptom which prompted Vincent to become desperate for help was testicular and penile pain during arousal. Vincent could no longer have intercourse with his wife without searing pain. He called a urologist and a gastroenterologist. He scheduled appointments for both specialists around his busy schedule.
The urologist prescribed a pharmaceutical named Flomax to improve Vincent’s ease in urination. The gastroenterologist recommended Miralax, a bowel aide which allows water to be retained in the stool, thereby promoting softer stool and more frequent bowel movements. Both of these agents helped Vincent with about one-third of his overall complaints; but he was still unable to sit at his desk without pain, and his sex life had taken a turn for the worse. Vincent’s wife was unhappy, though not as unhappy as Vincent. There has to be something out there to help me, he wondered. But what?
This was when Vincent initiated his full-throttle search on the Internet. He looked for stories of men with similar complaints. Vincent lives in Central New Jersey. There came a day when he found Connect PT online. The office was merely 14 miles from his home! He booked an appointment for the following week and crossed his fingers as he paced around his office, trying to stop the throbbing in his pelvis by willpower alone.
Upon his initial Pelvic Floor physical therapy evaluation, Vincent told his entire history to his evaluating therapist. She sat and nodded, and then proceeded to ask him a series of questions about his symptoms. To every one of the questions, Vincent longed to shout: YES! I have trouble maintaining a urinary stream! I have severe constipation! I cannot sit without pain! I cannot have sex anymore, because the discomfort is not worth the release!
The PT gave Vincent some relaxation exercises, a home program to stretch his own pelvic floor and even a link to a seat cushion which Vincent could use to take the pressure off of his perineum, rectum and tailbone. This would allow him to sit for longer periods of time with less pain, the PT said. Within a few months, Vincent was able to urinate more freely, have more consistent bowel movements, and was able to return to having sex with his wife.
How had all of this happened? Was it magic? No. But it seemed that way to Vincent. Vincent’s recovery had everything to do with his willingness to seek treatment and the newfound availability of Pelvic Floor physical therapy. His symptoms were far more common than he knew. Now, Vincent writes blogs about pelvic pain in order to share his experience with other men who may be suffering from similar complaints.
The greatest outcome of Vincent’s recovery was his decision to retire from his high-stress, corporate job. He still uses the special seat cushion which takes pressure off of his pelvic floor to drive across the country in an RV. Vincent and his wife have seen Yellowstone National Park, and they even take their English bulldog named Lola along for the ride. In sum, everyone is happier. Vincent, his wife and Lola. All because of one fortuitous Internet search and the prevalence of Pelvic Floor physical therapy.
“Looking back, I see that my symptoms really began to change when I began talking about this,” Vincent says. “Giving a voice to the pain, isolation and embarrassment has changed everything. I just want more people to know that they are not alone.”
Written by Karen Bruno, PT
Mindfulness is like that—it is the miracle which we can call back in a flash our dispersed mind and restore it to wholeness so that we can live each minute of life.
Mindfulness meditation is a practice to focus your attention on your moment to moment experience and to accept the present moment without judgment.
This technique draws you back to your center by bringing into the present moment the fragmented aspects of your mind-those thoughts that drift into the past and/or thoughts, fears and worries about the future. With non-judgemental awareness, these thoughts are free to come and go without gripping you and further dragging you down, resulting in a more alert, attentive and relaxed state of being.
The benefits of Mindfulness Meditation are bountiful. Mindfulness meditation is not considered a relaxation practice, however, you may have the experience of relaxation as a beneficial side effect. Please refer to the January 2018 e-newsletter for the list of benefits of meditation.
Some Basics of Mindfulness Meditation
To be done 20-30 minutes once or twice daily.
Sit in a comfortable position with your spine supported, head erect and feet flat on the floor.
Breaking it down
If you only have a few minutes, after focusing your attention on your breath to quiet your mind, you can choose one category, such as focusing on body sensations, or thoughts or sounds. Remember to be patient, loving, kind, forgiving and gentle with yourself. Even a few minutes of practice is a step in the right direction.
Meditation begins with the non-judgmental observation of life from moment to moment. When you find that the mind is being judgmental, for example, pushing away things it doesn’t like, simply observe that this is occurring. Meditation is an effortless and choiceless awareness of the totality of life expressing itself with and around you in every and any moment. It is a state of being, not an activity. So it is not something to do, rather it is allowing yourself to just be. THIS IS NOT A TUNING OUT PROCESS. Rather it is being fully present with a larger perspective grounded in a sense of being.
Written by Bryn Zolty, PT
If I just had a baby can I return to running? I’m leaking - can I do exercise that involves jumping? My doctor says I have a prolapse - can I lift weights at the gym? As pelvic physical therapists, we hear these questions every day. It is very common to wonder if after having a baby, a surgery, or if you have pain in the pelvis, if it is okay to engage in activities that can push pressure down into the pelvis.
While more research is needed to better answer these questions, there are a couple of studies available that have measured the pressure in the vagina with functional tasks, yoga poses, and other exercises in attempts to answer these questions. Here is a little of what they found with a group of women ranging in age from 20-51:
These numbers can surprise people. How can a crunch be so bad if the average pressure is 23.8 and a normal daily occurrence like coughing is 98? As a therapist, my focus is drawn to the large ranges within each activity. What is the woman doing differently to crunch at a pressure of 8 compared to the woman at a 75?
As therapists we evaluate how you move and conduct each of these activities. As pelvic physical therapists we look closer at your movement, alignment, breathing, coordination, and muscle tone in relation to the pelvis. All these factors play a role in the pressure your body places on the pelvic floor. This pressure is known as the intra-abdominal pressure. This is how one woman can have very low pressure on her pelvic floor while another woman has high pressure during the same activity. The key is how they complete the task.
Back to the question, can I do a crunch? Can I return to strenuous exercise? Our goal is to teach you how to do movements or activities properly while minimizing the negative impact on the pelvic muscles. A pelvic physical therapist’s job is to evaluate the movement or activity that gives you pain or makes you leak and improve it.
How do we do this? Let’s take a squat for example. If a patient comes in because she leaks urine while squatting, we would explore all the possibilities.
After having babies, surgeries, or injuries our bodies change. Some of these changes can lead to incontinence or pain. A pelvic physical therapist is a great clinician to discuss these changes along with your goals for fitness or everyday activities. Whether it’s cueing on alignment or movement strategies, breathing, releasing or strengthening, it is our goal to help you reach yours.
From the Glottis to the Pelvic Floor: Making Clinical Connections. Julie Wiebe, PT, MPT,BSc, and Susan Clinton, PT,DScPT,OCS,WCS,FAAOMPT.
Cobb WS, Burns JM,Kercher KW, Matthews BD, Norton HJ,Heniford BT. Normal Intra-abdominal Pressure in Healthy Adults. 2005; Journal of Surgical Research 2005; (129):231-235.
O’Dell KK, Morse AN,Crawford SL, Howard A. Vaginal Pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. International Urogyneocology Journal, 2007;18: 1481-1489.
Written by former staff physical therapist, Aisling Linehan, PT
Pelvic health therapists are sometimes known as women’s health therapists; however, it’s important to note many of them also treat men. Our pelvic floor therapists treat men as well as women. Pelvic therapy is effective and often life-changing for both genders.
Let’s use male pelvic pain as an example. When pelvic pain strikes, males often wait a few months for it to go away on its own. They finally visit their primary care doctor who commonly refers them to a urologist. Urologists do their best to work up patients for any harmful pathology like infection and cancer. For males with non-bacterial prostatitis, the tests for infection will be negative, and frequently prescribed antibiotics like Cipro may not help. Unfortunately, many men will continue to take it in hopes of future relief all whilst suffering from its many side effects. When urologists have sufficiently ruled out pathology but the pain remains, the patient is left wondering where to turn next. Many males turn to the internet to find that there are other people like them, in pain, alone and suffering but have found relief with pelvic floor therapy. Urologists are so effective at ruling out pathology that almost every male who ends up in a pelvic PTs office is suffering from a musculoskeletal issue.
Pelvic floor tone is assessed digitally through the rectum and electronically with biofeedback. It is important to note that a high tone pelvic floor can cause any combination of the following symptoms: urinary urgency, urinary frequency, constipation, penile pain, and testicular pain/pulling/burning/retraction. Many of these symptoms can be relieved with PT interventions that may include: soft tissue release for pelvis and hips, breath training, rib/diaphragm mobility, internal pelvic floor trigger point and myofascial therapy, perineal mobility, light stretching, and gentle core strengthening.
Pelvic floor therapy is a safe space. It is not scary or threatening. Many patients feel immediate relief knowing that we have treated and helped patients just like them. We are here to educate and make space for the healing to happen. Knowledge is power and the more you know about your body they better you can treat it. If you’re looking for help and education regarding pelvic pain, contact your local pelvic floor physical therapist for an evaluation today.
Written by Mary Ann White, PTA
Are you wondering how exercise can help you during pregnancy or what kinds of exercises are safe? Exercise is appropriate for most healthy women with uncomplicated pregnancies.
Staying safe while you exercise is a top concern. Walking, swimming, stationary biking, low-impact aerobics and pregnancy workout classes are appropriate during pregnancy. Remember to progress slowly and follow the guidelines below.
If you have gestational diabetes
Avoid activities that put you at risk for falling, injury or other complications
Stop exercising and consult your physician if you experience:
For more information, see:
Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
Theresa came to Connect Physical Therapy in late fall of 2017. She looked like she had it all – dark, glossy hair, olive skin and a neckline without wrinkles that belied her age of 57. Theresa has two children, is married to a man from Ireland and is gainfully employed by the State of New Jersey in Trenton. Theresa has an unmistakable air of confidence. This was surprising, given her reason for seeking help in our office for Pelvic Floor Physical Therapy.
During her first visit, Theresa confided that she had recently begun to experience fecal incontinence. It had come out of the blue, she said. A few months back, Theresa noticed severe urgency with bowel movements. She would feel spasms within her rectum and there was no warning before she would have to defecate. There were times when she could not make it to the toilet in time, and so she was forced to wear disposable pull-ups to manage her “accidents”. She had to plan her commute to work, stopping at least once in the cleanest of public bathrooms she could find, because she could not wait during traffic. Theresa’s problem was worsening. She could no longer go to social outings without scoping out for the nearest restroom. The humiliation was awful, she said.
“After I married my husband, who is from the outskirts of Donegal, Ireland, I traveled overseas to meet his family,” Theresa explained. “They live very simply, these people. They wear the same clothing most days, drive old cars with manual transmissions, and do not have the same access to healthcare that we do.”
“I am so fortunate to live in America,” Theresa continued. “My Irish in-laws call me ‘A spoiled Yank’. I used to love it when they referred to me that way. I have everything a person could want. Except that now I am terrified of being in public and have to wear adult diapers. I do not feel like a spoiled Yank anymore.”
I knew that Theresa was at the end of her tether. She had tried prescription medication, daily Imodium, altering her diet and kept her legs tightly crossed at all times to avoid what still happened. I explained to her what Pelvic Floor Physical Therapy was all about. That in this type of clinic, we would do an internal examination to discern if the muscles of her perineum might be driving the fecal incontinence.
“I have been through so much already. If you have to do an internal examination, so be it,” Theresa declared. After an exam of the musculature of Theresa’s pelvic floor, it felt as though her muscles were in moderate to severe spasm. These muscles control urination and defecation; they were firing so rapidly that she could not contain feces within her colon, and worked incessantly to force it out. The function of the large intestine is to pull water out of our foodstuffs and allow feces to become solid. This was not happening in Theresa’s case, because the food was not in her colon for enough time, and her stool was unformed and messy. This explained her chronic diarrhea.
The treatment plan for Theresa included deep breathing, relaxation of her pelvic floor muscles and some natural over-the-counter additives to bulk up her stool. “This sounds counter-intuitive to me,” Theresa said at first. “If I relax the muscles, then won’t more feces escape unplanned?” I smiled at her and explained that if she wanted to try something new, she would have to trust me.
It took almost three months of once-weekly treatment in our clinic, with a really good home program, for Theresa’s symptoms to subside. But subside, they did. She now has solid bowel movements twice daily and can control them wonderfully. Gone are the pull-ups and the fear of accidents. Her commute to work and social life have been restored to normalcy.
“I cannot believe how this treatment has helped me! I wonder if this would be available to my relatives in Ireland? I hope so. But at any rate, I feel like a ‘spoiled Yank’ once more,” Theresa remarked. Pelvic Floor Physical Therapy is gaining rank, accessibility and respect all over the world. It likely is available to her in-laws in Donegal, Ireland. The trick is to find ways to talk about these issues and overcome the embarrassment surrounding words like rectum, feces, and stool.
This is what we do, as pelvic floor physical therapists. One client at a time. For spoiled Yanks, people from Ireland and every other continent, men and women, young and older, there is help. We live in a time when anything is possible.
Written by Karen Bruno, PT
We often hear the term mind/body used in various wellness, medical and healing platforms. What this means is that there are powerful and complex interactions that take place between our thoughts, our bodies and the outside world and these factors can directly impact our health. Our thoughts, feelings emotions and attitudes can affect the health of our body and our physical body (what we eat, our posture, and how we move) can positively or negatively affect our mental and emotional states. Simply put, the body can affect the mind and the mind can impact the body. Meditation, a practice of focused awareness, is a mind/body technique that can mitigate the effects of stress on our bodies by bringing calm to our bodies through calming our minds.
Benefits of meditation closely resemble and often overlap with the benefits of deep breathing and exercise. Some benefits of meditation include:
People often get anxious about the thought of meditating, perhaps because they think they can’t do it, or they don’t have enough time, or for a myriad of other reasons. Meditation can take many forms and is practiced in a variety of ways. Even a few minutes of deep breathing, relaxation or meditation can elevate your mood, sharpen your focus and improve your physical and emotional state of well being. The following are two examples of simple ways to comfort your mind and receive the benefits of meditation.
Here is another quick meditation technique to expand your heart energy:
I wish you well. I wish you peace.
Written by Michelle Dela Rosa, PT
So what’s the answer ladies? Water and mild soap. That’s it! The perineum can be patted dry afterwards. Read more to learn about conditions that can influence pH.
Written by former staff physical therapist, Aisling Linehan, PT
Infertility is on the rise and as pelvic floor physical therapists we want to do our part to help our patients get pregnant. According to this study, 15% of couples will struggle with infertility. Reasons for infertility can be broken down to ovulation disorders (27%), male factors (25%), tubal disorders (22%), unexplained factors (17%), endometriosis (7%); and “other factors” (4%). Pelvic floor physical therapists specialize in manual & movement therapy. It makes sense that the type of infertility that we can help with is “mechanical”.
Release of fascial and ligamentous restrictions can decrease pressure on blood vessels, thereby optimizing the vascular phase and improving the efficacy of the lymphatic system. Better blood flow basically means better “detox” and waste management by the body. The body, in turn, is better able to perform important processes such as reproduction. It is also important to note that reproduction is not essential in keeping a person alive; thus, if the body feels under threat in any way reproduction is not a priority. Check out the study to see how pelvic floor PT can help you get pregnant.
Not sure if you want to try pelvic floor PT yet? Stop by on Thursday night to try our gentle relax and renew yoga class. Getting your body in a more parasympathetic state can help you mentally and physically prepare for bringing new life into this world.
Patient: 24-year-old female, 12 weeks postpartum after second degree perineal tear, nursing.
Chief Complaint: Painful vaginal entry 6 weeks postpartum, bleeding with bowel movements.
Past Medical History: Crohn’s disease, low thyroid, irritable bowel syndrome.
Physical Therapy Treatment: education on bowel health, manual pelvic floor and abdominal tissue release, perineal scar mobilization, pelvic alignment, vaginal dilators, hip stretches, core strengthening, postural education.
Results: Pain-free intercourse in 15 visits, 0 bleeding with bowel movements after the first 2 visits!