Connect Physical Therapy: It's time to Own Your Body
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Read about insights and research updates in
​orthopedic and pelvic physical therapy.

Matt and the hockey puck

9/6/2018

 
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.
Matt and the hockey puck
Matt took a few deep breaths. He sat on the bench for about four minutes, then resumed playing and felt almost no pain at all. It was not until he arrived at home and took a hot shower that the secondary shock wore off and he had no choice but to go to the Emergency Room.  A prominent urologist just happened to be on call, luckily for Matt, who informed him that his left testicle had been fractured. This meant that the casing of the testicle was damaged and that the contents therein were
extruding out of it into the space of the scrotum.
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
pelvic health.  

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.

vincent's story: pain with sitting

5/2/2018

 
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. ​
pain in perineum
There were other symptoms, and they were even more troubling. Vincent began to have difficulty urinating. He would have the intense urge to void his bladder, but upon rushing to the bathroom, nothing would come out. Then there was the constipation. ​​Days would go by, with no bowel movements. The discomfort and bloating in Vincent’s stomach made eating food feel like he was a beaver actively working to dam up the river of his intestines. So, he stopped eating for a few days. But that did not help and the constipation persisted. 
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.”

Theresa's story: a case study on bowel incontinence

2/7/2018

 
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.”
bowel incontinence
Theresa had gone to see a gastroenterologist for her new bowel problem. The GI doctor had ordered a colonoscopy, but it had revealed nothing. “My husband’s family in Ireland would not be able to get a colonoscopy as quickly as I did. They would have to stand in a queue. Even if they had the kind of medical emergency that I seem to be having.”

Theresa had gone for second opinions, seen several specialists, but there was no explanation for her fecal incontinence.​
“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.

A Physical Therapist's Perspective on Pelvic Floor Dysfunction: Eva

11/19/2017

 
Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
​
I met a woman named Eva* at the Pelvic Floor clinic. She came for physical therapy to address urinary leakage, which she has endured for over ten years. I had to glance at her date of birth to make sure of her age. Eva is 85 years old, and she looks spectacular. “What is your secret to looking so young and vibrant?” I asked her. “Maybe it is having good friends. Wonderful children and grandchildren. Or maybe it is just my good Danish genes,” she replied.​ 

​Eva told me that she began leaking urine several years ago, but her condition is getting worse. She told me that she cannot go to the beach anymore at Point Pleasant, which is her favorite thing to do. In her medical history, I learned that Eva had had three pregnancies with vaginal births. She does not drink enough water, mostly in fear of losing even more urine. Based on her age and prior history of childbearing, I was working under the assumption that Eva had weakness in her pelvic floor muscles. Maybe a little prolapse of the bladder.
Case study: Eva
It was not until I examined her a few minutes later that I learned I had been wrong to jump to this conclusion. It turned out that Eva had very tight muscles in her pelvic floor. This was preventing her from maintaining continence and these muscle spasms were forcing small amounts of urine to escape the bladder in an uncontrolled manner.

​Towards the conclusion of our first session of PT together, Eva asked me what else can be treated in our clinic. 
“A lot of young women come here with complaints of pain with sex,” I told her. Eva’s eyes opened wide. “Do you mean to tell me that there is treatment for that? I had two husbands and sex was awful with both of them. The pain was unbearable. I never understood what the big fuss about sex was all about.”

Here was a woman in her eighties who had lived with pelvic floor dysfunction her entire life. The painful intercourse made sense, given how much tension she was holding in her musculature. I devised a treatment program for Eva to allow the muscles of her pelvic floor to elongate. She was given a home program of self-stretching, diaphragmatic breathing exercises, and an activity known as the pelvic floor drop, which is the opposite of the famed Kegels we have all read about in McCall’s Magazine.

Eva has returned several times to our clinic. She has far less urinary leakage, is drinking more water (she has retrained her bladder to accommodate this), and practices yoga and deep breathing.  She is planning a month-long trip to Florida, wherein she will be able to go to the beach in a bathing suit encasing her lithe body without fear.

I learned something wonderful during my treatment of Eva. I rejoice in living in a time when help is now possible for these things that have plagued women for centuries. I also learned that it is never too late to change. Eva is 85. And if she responded so readily to this therapy, then anything is possible.

*The name and some personal details of this patient have been changed, according to the laws of the Health Care Portability and Accountability Act. But the symptoms of Eva and the outcome of her treatment are true. Pelvic Floor Physical Therapy works!

Case study: pelvic pain after repair of prolapse

2/8/2017

 
repair of prolapse
Patient: 66-year- old female with mesh repair of rectal and bladder prolapse 10 years ago.
​
Chief Complaint: “Knife-like” pelvic pain 10/10 with physical activity the following year, pelvic pain with urinary urgency, 6 voids at night.

Past Medical History: Diagnosis of interstitial cystitis 2 years ago, lumbar arthritis, thyroid condition.

Physical Therapy Treatment: Education on lifestyle modification for prolapse; breathing exercises; bladder retraining; manual release to pelvic floor and restricted internal scars; stretches for pelvis, hips, and low back; gentle core strengthening exercises.

Results: Pelvic pain 1/10 with physical activity, 0 discomfort with 2-hour drive, and 3 voids at night in 17 visits!

Case Study: Bowel Control

7/19/2016

 
Patient: 79-year-old female

Chief Complaint: Fecal incontinence during the day - good sensation with poor control of stool. Urinary incontinence with cough/sneeze or on the way to the restroom. Patient wears a pad every day.
bowel control
​Physical Therapy Treatment: proper voiding techniques, general healthy eating habits, nerve glides, bowel massage, pelvic floor biofeedback, manual therapy for pelvic floor, leg stretches, core abdominal strengthening.

Results: 14 visits - 0 loss of stool between bowel movements, 0 urine leakage with activity or urgency, 0 pads. Patient is able to walk 15 minutes per day for exercise.

Urine leakage with urgency after hysterectomy

11/9/2015

 
Patient: 42-year-old female
 
Chief Complaint: Urine leakage with urgency after vaginal delivery of 2nd child + emergency hysterectomy; 6 night voids
 
Past Medical/Surgical History: Repair of prolapse the following year + Oxybutynin with 50% decrease in symptoms; history of low back pain, irritable bowel syndrome
 
Physical Therapy Treatment: proper voiding techniques; lower body stretches; prolapse management; posture and breathing exercises; abdominal scar release

Results: 0 urine leakage with 1.5 hour urinary intervals, 0 night voids, 0 Oxybutynin in 12 visits!

Case Study: Painful Intercourse in Young Adulthood

8/3/2015

 
Patient: 21-year-old female

Chief Complaint: Painful intercourse with first encounter

Past Medical/Surgical History: Crohn’s disease, managed with diet; removal of gallbladder 2 years ago

Physical Therapy Treatment: Posture education; breathing exercises; pelvic and hip stretches; manual therapy for pelvic floor and review of techniques with partner; progressive vaginal dilator stretching

Results: 0 pain with intercourse in 14 visits!

Case Study: Male Pelvic Pain with Urinary Urgency

3/1/2015

 
Chief Complaint: Left groin/hip pain 7/10 after urethral procedure, disturbed sleep, day-time urinary urgency, bladder pressure and bloating. No night-time voiding.

Past Medical History: Type II diabetes, hypertension, umbilical hernia.

Patient: 55-year-old male who had urethral dilatation 3 years ago to improve urine flow.

Diagnostic Testing: Urine test last month negative, x-ray of hips negative.
urinary frequency
Physical Therapy Treatment: Manual therapy to hips; low back and hip stretches; posture correction; gentle abdominal and low back strengthening; home program.

Results: Left groin/hip pain 3/10 only after prolonged sitting, undisturbed sleep, 0 urinary urgency or bladder discomfort in 5 visits! No pelvic floor work necessary.

Case Study: Painful Intercourse after Menopause

6/10/2014

 
Patient: 76-year-old female, who reports going into menopause early (early 40s).

Chief Complaint: Painful intercourse that started 10 years ago; also difficulty initiating urination in social situations.

Past Medical History: Osteopenia, thyroid condition, low back pain.

Physical Therapy Treatment: Progressive stretching with vaginal dilators; manual therapy to pelvic floor and urethral tissues; urinary voiding schedule; relaxation techniques; hip stretches; core muscle strengthening.

Results: Patient is able to resume intercourse with 0 pain. 0 urinary hesitation or urgency with 3 hour urinary intervals, 1 void at night. 13 visits!

Case Study: Urinary Frequency

3/5/2014

 
urinary frequency case study
Patient: 35-year-old female, diagnosed with interstitial cystitis many years ago, controlled with diet.

Chief Complaint: Increased urinary frequency to every hour, sometimes 20-30x per day, 5-6x per night; low back pain. No change with diet noted. Tests rule out infection. 

​Past Medical History: 
Asthma, thyroid condition​
Physical Therapy Treatment: Biofeedback to pelvic floor; manual therapy to pelvic floor, low back, hips; posture education; hip stretching; core trunk strengthening; home program

Results: Patient voids once every 2 hours, 2x at night. Patient reports having control of urinary urgency. 0 low back pain. 10 visits!

Case Study: Prostatectomy

8/8/2013

 
prostatectomy
Patient: 63-year-old male who works in a lab, walks 1 mile per day for exercise.

Chief Complaint: Constant “dribbling” of urine after removal of prostate.

Patient voided every ½ hour during the day, and 2x at night. Patient used 2 pads daily, leaking 100-300 cc per day.

Past Medical History: Low back surgery, inguinal hernia repair, prostate cancer 

Physical Therapy Treatment: Biofeedback to pelvic floor; bladder retraining; pelvic floor exercise; proprioceptive muscle training; postural exercises; core strengthening; home program

Results: Patient voids once per hour, and 1x at night. Patient uses 1 thin pad, leaking 3-5 cc per day after 13 visits.

Case Study: Constipation

10/22/2012

 
​Patient: 40-year-old female with 8 year history of constipation.

Chief Complaint: Difficulty with bowel evacuation, normal stool consistency. Patient leans back and presses on stomach to evacuate.
bowel movements difficulties PT
Past Medical History: 2 vaginal births, insomnia since last birth 3 years ago.

Physical Therapy Treatment: Manual therapy to pelvic floor and abdomen; review of proper bowel evacuation and stool formation; breathing mechanics; postural education and exercise; LE stretching; core strengthening exercises; HEP.

Results: Complete bowel evacuation 1-2x per day without straining or altered mechanics after 8 visits.

Case Study: Chronic Pelvic Pain after Hysterectomy

8/4/2012

 
Pelvic Pain
Patient: 83-year-old female

Chief Complaint: 4/10 R posterior pelvic pain and rectal pain increasing in the evening, that started after hysterectomy 6 years ago

Past Medical History: surgical revision vaginally, local estrogen; gallbladder removal, irritable bowel syndrome

Physical Therapy Treatment: abdominal bowel massage; review of proper bowel evacuation methods and stool formation; manual therapy to gluteal muscles, pelvic floor, and hip adductors; nerve gliding techniques; TENS unit training for home; HEP

Results: 0 out of 10 pelvic and rectal pain after 13 visits


Case Study: Coccydynia

2/12/2012

 
Picture
Patient: 46-year-old female

Chief Complaint: 10 out of 10 coccyx pain that increases with sitting, or transfer to standing; no trauma

Past Medical History: Surgical block and injection to coccyx with only temporary relief

Treatment: Manual therapy to pelvic floor muscles, low back, sacrum; surface EMG biofeedback to retrain pelvic floor; postural education; gentle core abdominal strengthening exercises; and home program

Results: 1.5 out of 10 pain to coccyx while sitting or moving after 7 visits!

Sample Case Study: Pubic Symphysis Separation

11/9/2011

 
  • Patient: 25-year-old female teacher
  • Chief complaint: 6/10 low back pain and pubic pain from 7 months ago after delivering second child naturally; right leg pain started after fall down the stairs couple of weeks ago
  • Past Medical History: Bed rest during pregnancy, pubic symphysis separation during and after pregnancy, walking with the use of a walker for 2 weeks post-partum
  • Treatment: Gentle core muscle strengthening, ergonomic instruction on proper bending and lifting techniques for childcare, manual therapy to trunk and pelvic restrictions, trunk and leg stretching, sacroiliac belt fitting, postural education, and correction for abdominal diastasis (separation of abdominal muscles during pregnancy
  • Results: 2/10 low back pain, and 1/10 pubic pain after 6 physical therapy visits

Cast Study: Urinary Leakage

9/21/2011

 
  • Patient: 28-year-old female
  • Chief complaint: Urinary leakage only at night during sleep, for 1 year
  • Past Medical History: Healthy, no pregnancies
  • Pelvic Ultrasound: Negative
  • Treatment: Proper diaphragmatic breathing, trunk range of motion, normal voiding habits, pelvic floor muscle lengthening (the muscle between the pubic bone and tailbone, felt when stopping urine or gas), manual therapy to abdominal restrictions, postural education, core stabilization exercise and home exercise program
  • Results: 0 reports of urinary leakage after 4 physical therapy visits
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    • Michelle Dela Rosa, PT, DPT, PRPC
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