Connect Physical Therapy: It's time to Own Your Body
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    • Michelle Dela Rosa, PT, DPT, PRPC
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Read about insights and research updates in
​orthopedic and pelvic physical therapy.

Can you spread your toes?

10/3/2022

 
​By Donna Zamost, PTA
Massage foot
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.​​​
Toe tracing
Shoe tracing
Dance toes
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.
Tight shoes
Toe spread
Squished toes
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!​​

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. 
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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.  ​​
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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 ribs
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
Twisted crane pose
Fan pose
Fan pose
Goddess twist
Goddess twist
Seated crossed leg twist
Seated crossed leg twist
Seated straight 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. 

1 Women's Health in Physical Therapy. Jean and Glenn Irion.Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, ©2010

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

As more and more jobs are transitioning to remote or involve sitting for extended periods of the day, sitting posture is one of the biggest things to address to prevent future injury and or pain.
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
  1. Feet flat on floor
  2. Hips and Knees at 90-degree angle
  3. Elbows and forearms supported
  4. Back support
  5. Shoulders relaxed: no hunching forward or leaning back!
  6. ​Forehead & eyes level with top of computer screen
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Standing posture
  1. ​Feet flat on floor
  2. Chin tucked, shoulders back and relaxed
  3. Avoid hunching shoulders or rounding upper back!
  4. Balance weight over feet with low back and hips in neutral position. Avoid shifting weight on hips from side to side
  5. Core engaged
  6. ​Knees straight- no locking out!
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See a physical therapist to receive individualized recommendations and exercises for postural corrections and improvements!

The SI Joint: Dysfunction & Pain

8/12/2021

 
by Katelyn Sheehan, PT
SI Joint Dysfunction (black and white)
SI Joint Dysfunction (in color)
Do you have low back pain? Is the pain mostly on one side? Do you sometimes feel it move into your hip or groin? If so, dysfunction in your SI joint may be driving your pain.

What is the SI joint?
The SI joint, or sacroiliac joint, is the joint where your low back (the sacrum (S)) meets your pelvis (the iliac (I) bone). There are SI joints on both right and left sides of your back, directly next to the dimples in your low back. If you have pain on one side around the dimple of your low back, you should check in with a physical therapist to evaluate your SI joint.

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Photo 2
Photo 3
Photo 4
Why is the SI joint important?
The SI joint is an extremely stiff and complex joint that helps with shock absorption through the spine and pelvis. If the SI joint becomes inflamed or fails to move properly, it can cause pain to the low back, hip, and groin on the affected side. 

Both of our SI joints work together to dissipate shock, so dysfunction in one SI joint can cause dysfunction and pain in the other. Most people with SI dysfunction complain of discomfort on one side; however, the cause of dysfunction may actually originate from the other side! A thorough evaluation can help determine which side might be the real problem. 

How can the SI joint become inflamed?
The SI joint frequently becomes symptomatic if it has either too much movement or too little movement. Here are some examples: 

Too much movement
  • Repetitive movements (e.g. crossing your legs when sitting, digging, lifting, pulling weeds, etc.);
  • Falls (e.g. landing on the sacrum, landing on one side of your low back or pelvis, stepping off of a curb with one leg landing hard); or,
  • Pregnancy-related hypermobility:  the ligaments supporting the SI joint become more relaxed with pregnancy to help prepare the body for delivery.

Too little movement
  • Muscle stiffness and spasms around the joint; (including the glutes, back muscles, hip flexors, and hip rotators)
  • Other structural issues (e.g.  leg length differences, scoliosis);
  • Impaired movement patterns (e.g. walking with a limp, in a leg brace, or walking boot after an injury causing you to lift one hip more than the other); or,
  • Poor posture for prolonged periods of time.

How can Physical Therapy help?
First, your physical therapist will examine you for any structural impairments and risk factors for SI joint dysfunction. Then, they will examine how you move and what movements may be causing your pain. After this examination the physical therapist will give you a specific treatment program designed to help either stabilize or mobilize the SI joint depending on your specific impairments, and ultimately help to relieve your pain!

Postpartum rib flare

6/17/2021

 
by Bryn Zolty, PT

Rib Flare

Rib flare refers to an altered ribcage position. This means the rib cage is tipped up/forward, flattened and wide, or both. Rib flare has many potential causes.  For this article, we will focus on the postpartum individuals.

Ribs Tipped Up Flare
First, let's look at the rib cage position from the side to identify the ribs tipped up flare. Ideally, the rib cage would line up over the pelvis and the curve in your lower back is greatest in your lower back. You can feel the top of your hips and walk your hands around to your back, this is where your lower back curve should be located. See the arrow from her hips to her lower back.

The first picture (left) demonstrates fairly neutral (good) posture. Notice the horizontal arrow from the top of the hip bone to the low back showing the curve. Also, note the vertical line running through the middle of the shoulder, trunk, and hip. The line is fairly centered in these locations. The ribs below her bra line are tucked in the abdomen.
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The second picture demonstrates the tipped up rib flare.  Notice the curve in the spine compared to the first. The curve in the back is higher. It continues throughout the middle back and her shoulder blades sit further back. The ribs are tipped upwards and stick out further than her abdomen. Also, note the vertical line running through the shoulders, trunk, and hip. The trunk is more forward and not centered as in the first picture.
Trunk
This rib tipped up position, the second picture, in a postpartum population is common. Later in pregnancy as the baby grows, the ribs tip up to make room.  Women may lean back to maintain balance as their weight has increased forward.  Next, women carry around a growing baby and continue to lean back.   After standing in this position for months, your body begins to recognize this posture as straight. 
​

Postpartum, the front abdominal muscles are stretched and weakened. The muscles in the lower back have been in a shortened position and can become painful and overworked as their counter parts in the front need time to regain strength.  However, to do that, we need to restore posture. It is difficult to strengthen abs that are lengthened if the ribs stay tipped up! When this position is maintained for a long period of time, the back muscles can become tight and even maintain the tipped ribs when laying down. 
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Note in the picture the space between the floor and the back. The left rib cage here is sticking up. This individual will require some release work and stretching in addition to posture modifications. 

Infrasternal Rib Flare
​

Another type of rib flare is seen in a front view. This is the infrasternal angle, the angle formed by the ribs coming together under the breastbone. A normal angle is 90 degrees. Place your thumbs together in this space and see if they form a 90 degree angle. When this angle is greater than 90 degrees, there is a rib flare. 
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Commonly with a rib flare, the internal oblique muscles tend to be dominant, creating muscle imbalance. The internal oblique muscles flare the ribs wide. 

Here is the same individual lying flat looking at the front view to check for infrasternal rib flare.  Now you can see the left rib is more pronounced and wider than the right. This angle is greater than 90, and is asymmetrical.
​

In the picture below, she was asked to start to curl up her shoulders off the ground. Note the ribs pulling wide and as her internal oblique muscles contract strongly demonstrating her muscle imbalance.
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Rib flare does not get better on its own and needs individualized care to improve posture and muscle recruitment. So many functions in the body rely on the diaphragm and rib position.   Dysfunction can alter digestion, create back pain, increase your sympathetic nervous system, and decrease pelvic floor muscle flexibility. Muscle imbalance can create compensatory patterns and resulting pain and/or weakness. Many women tell us they want their core back and their stomach to look pre-baby. Rib flare can prevent abdominal muscles from contracting well and even push(pooch) out the lower abdomen if muscle imbalances exist. 

The key to treating rib flare is improving alignment and muscle balance. And not just muscle imbalance in your back and abdomen, but also shoulders, legs, feet, and pelvis. How you stand, sit, carry your kids, and exercise at the gym can all be part of improving rib flare.

At Connect PT we are happy to help evaluate and treat your posture, muscle coordination, and improve your strength!

Body Talk

4/8/2021

 
Body Talk
by Karen Bruno, PT

It has been recognized for a long time that there are interactions between the mind and the body. Our thoughts inform our emotions and that triggers a cascade of events in our bodies. (1) Emotions that are expressed freely and without judgement can uplift us, make us feel happier and improve our overall health. Repressing our emotions, especially anxiety and anger, can produce a physical reaction of tension in the body (Tension Myositis Syndrome). Prolonged tension can lead to pain disorders, stiffness and loss of function. (2)
If you are experiencing chronic pain, stiffness or discomfort, what is your body trying to tell you?  Here is a short, fun practice to begin dialogue and partnership with your body.
  • Allow yourself to acknowledge your body’s wisdom. 
  • Acknowledge anything that feels like discomfort or pain is really not discomfort or pain, but rather your body’s desire to call your attention to it and give you information.
  • Talk to the pain or discomfort. Acknowledge the part of the body from where the pain is coming and speak to it directly. 
  • You may choose to use a mirror and look in the mirror as you speak to that part of your body or you may talk to the body and say, ”Body part, I love you. I am grateful for what you are doing for me. Tell me what you would like me to know”,  and then listen. 

This may seem awkward or strange at first;  it may seem silly or even uncomfortable, but if you do this more and more, you shall receive the answers and your body begins to trust you and you begin to trust your body, thereby creating a partnership for health. Through practicing this over and over you may notice that the pain begins to subside and  may eventually be gone.

You may choose to combine this with a very clear intention that it is your intention to 100% enjoy your body fully, and that your body enjoys you inside of it fully and completely. This supports  your collaboration with your body for a maximum amount of enjoyment.

Although the pain may not leave immediately, recognize that the physical form takes longer to change, but the change starts once you make a connection and change your thoughts. It is new energy; it is new consciousness; it is new awareness. Your job now is to stay in a mode of receiving and know that you have started the process of feeling better, and while it might not be an overnight healing, it will be steadfast and continuous, and with ease and grace. We want this with ease and grace in the most gentle way for you.

According to Dr. John Sarno, in his book, Healing Back Pain, for a condition like chronic back pain, once you call out the emotion that your body is repressing, there is no longer any need for the pain and the body will no longer need to generate tension. (2) 

All of us here at Connect Physical Therapy are here to support you to feel your best. ​

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585554/
  2. Sarno, John (1991), Healing Back Pain, Grand Central Life and Style, New York

Reduce pelvic, hip, or low back pain during intercourse

2/23/2021

 
Penetrative sex positions for people with pelvic, hip, or low back pain
Many people with low back, pelvic floor or hip disorders experience pain with penetrative sex. Becca Ironside, PT, goes over how they can position themselves in four different sexual positions to decrease pain and improve satisfaction with their partners.

​Watch the video on YouTube.

Dolphin on the table & skier stretches

1/14/2021

 
Beat those winter blues by getting up to stretch with Marzena Bard, PTA. When you can't get to the gym, these easy stretches are great to begin and end the day or to break up sitting all day at the computer.
​
  1. "Dolphin on the table" is a feel-good stretch for anyone who has tightness in the back, shoulders, or hamstrings. It increases the length and blood flow of these muscles.
  2. "Skier" stretch is helpful for those with pelvic tension and pain. It helps to stretch the inner thighs and the entire groin area, which also improves blood flow to the pelvis.

Watch the video tutorial below.

Front lunge stretch

7/29/2020

 
with Karen Bruno, PT

Take a break from sitting at your desk or homeschooling by doing a Front Lunge Stretch with Karen. Sitting for long periods of time shortens the muscles and tissues on the front side of the body. Turn a chair sideways and perform this combination stretch for the upper body, lower body, and trunk. The Front Lunge Stretch can help with breathing, mobilize abdominal scars, assist with digestion, and facilitate pelvic floor lengthening to decrease pelvic pain.

Check out more exercises to break up sitting time on the Connect PT Patient Cheat Sheet.

Work smarter, not harder, from home

6/30/2020

 
by Michelle Dela Rosa, PT, DPT, PRPC

Kids and phone calls, cooking, and homeschooling...so where is the space to work from home? For some people, creating a proper work station at home has been challenging.

​At Connect PT, we're seeing all kinds of issues from wrist pain to neck pain to low back pain and tailbone pain after making this transition. We cannot assume the table that we eat at is set up properly for zoom calls or studying. If you're still working from home, we want to help make the transition easier. Let's break it down:
Problem #1
​
​
If you're like me, at some point in the day you're using a laptop. 
It's terrible for long-term use.

​Your head is forced to look down if you're using a table at standard height. That opens the gate for headaches, jaw tension, and upper back pain.
Office setup
Remedy #1
​

Place a thick book under the back of the laptop to elevate the screen.

​This allows you to pick your head up a little more while still allowing for proper wrist alignment.
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Ergo 1
Problem #2

​
Dangling feet or feet that can't rest on the floor comfortably gives little whole-body support when seated for long periods of time. 


​You'll end up needing to place more pressure on other structures like the low back or neck.
Ergo 3
Remedy #2

Place a low step stool or other firm support under the feet to keep knees in line with hips, which will automatically decrease pressure on the spine.
Problem #3

The chair I'm using is fixed in a reclined position. 


It's okay for eating, conversing, relaxing - not ok for computer work. This position puts lots of pressure on the tailbone when, contrary to popular belief, the tailbone is not meant for sitting!

PS - Watch out for children or pets who might accidentally rearrange your setup!
Ergo 5
Remedy #3

Fold up a pillow or small cushion to place behind your mid-back to allow for sitting on your "sit bones". Sitting up straight shouldn't feel like work!
Ergo 6

Interview with Becca Ironside, PT: "On the Sneaktip: The Male Pelvis Revealed"

6/8/2020

 
We are thrilled to announce to the Connect PT community the birth of a different kind of book about male pelvic dysfunction, written by our own Becca Ironside, PT, MSPT:

On the Sneaktip: The Male Pelvis Revealed
onthesneaktip
​Michelle: Becca, what makes this book different than other books about men’s pelvic conditions?
Becca: There are lots of books written for men about the pelvis; and they are fantastic and also very helpful to the guys that we treat. These books are typically written in a nonfiction format, but I am a reader of fiction. I resonate with people more than facts. I decided to write a book about the male pelvis from a fictional point of view. There are five characters within this story with different problems. I wanted to create personalities around their symptoms, to delve into the backstory of each person living with pelvic floor dysfunction and how it impacts their day-to-day lives. It is important to read nonfiction about how to address erectile dysfunction or pelvic pain, but another thing altogether to be inside a private treatment room with a man whose world is collapsing because of his pelvic pain or prostate cancer. I wanted to give the reader a glimpse into the mind of a man struggling with pelvic floor dysfunction in a very personal format.
Michelle: Can you tell us more about the actual conditions that these men have been diagnosed with?
Becca: I would be delighted to. One main diagnosis of men which is highlighted in this book is known as Chronic Pelvic Pain Syndrome. One of the reasons that I needed to write about this topic is because it is little known in the general population. Chronic Pelvic Pain Syndrome, or CPPS, is a cluster of symptoms which often include urinary burning and urgency, penile, testicular or rectal pain, constipation, pain with arousal and ejaculation and difficulty sitting due to these symptoms. In pelvic floor physical therapy, we treat men with this condition, though we are aware that there are many more men out there with such problems who don’t know where to turn.

One character in the story is named Tom; he is a successful sommelier (also known as a professional wine-taster, which sounds like a fun job if you ask me), with a wife and two daughters. Tom begins to have crippling constipation and he experiences pain in his pelvis after having sex with his wife. At first, Tom hides his pain and stops having sex with his partner, due to his great anxiety about the matter. But Tom has money and good medical insurance, so he is able to navigate through the medical quagmire to get the treatment he needs.

Kirk is another character who has Chronic Pelvic Pain Syndrome. But Kirk is only 24 and he is a drummer in a band. Kirk has searing urinary pain and pain having sex with the women he meets on tour with the band. Kirk attempts to treat his pelvic pain with drugs and alcohol (a very common finding for men with this diagnosis), but he has no medical insurance and is financially broke.

I wanted to show two vastly different outcomes for men with Chronic Pelvic Pain Syndrome with these two characters. They have exactly the same problem, but one has the means to get help for his condition, the other does not.
Michelle: What about prostate cancer? Can you tell us about how you created a character around this diagnosis?
Becca: Oliver is a biracial man raised in Alabama. His father is a white police officer and his mother is Jamaican. Oliver’s father teaches his son how to hunt wild turkey when he is merely ten years old. He then grows up and becomes a sharpshooter in the U.S. Army. Oliver is sent to Iraq and then Afghanistan and takes pride in his shooting abilities and time spent serving his country. When he comes home for Thanksgiving one year to visit his parents, he meets a woman named Talulah. They fall in love, Oliver returns home to the States and takes a job as a state trooper, the couple gets married and has a baby. Tada! Life is beautiful, right?
​

Oliver is then diagnosed with prostate cancer as a 42-year old. In working with men with prostate cancer, there are some pretty consistent variables in how they respond emotionally, and these variables can be seen through Oliver’s journey. Oliver is my favorite character in this book. Maybe because prostate cancer is the second most commonly diagnosed cancer in the U.S. and I wanted men to feel that they could read the thoughts of a guy who is being told the worst news of his life; but who then gets treated for his cancer and still has a great life thereafter.
Michelle: Got it! Next, how about men with erectile dysfunction who don’t have prostate cancer or pain with sex? Does your book assign this very common issue to a character?
Becca: Yes. His name is Rick and he is a plumber in Pittsburgh, PA. Rick owns the plumbing company, in fact, and his son Francis will be the first man in his family to go to college. The main fly in the ointment in Rick’s life is his eroding marriage to his wife Nicole. Their partnership is devoid of intimacy and Rick notices newly-developed erectile dysfunction as his marital communication worsens. Rick goes to a female urologist for bioidentical hormone replacement. It is through his conversations with his urologist that we get to see underneath his tough exterior to the vulnerability of a man who has erectile dysfunction.
Michelle: I see that this female urologist is also a character in the story. Can you tell us how she enhances the book?
Becca: The character of Dr. Sheila Ashtiju is based on a very skilled physician who treats patients from our pelvic floor clinic to improve sexual function. Through Sheila’s eyes, we are able to see how she treats men with bioidentical hormones to address erectile dysfunction. We are also able to get an outsider’s viewpoint on how men react to their pelvic problems from a skilled physician, who also happens to be a female with sexual secrets that she feels she must hide.
Michelle: Who is the ideal audience for this book?
Becca: I’ll tell you a cool side-story that may answer this question. I had a choice between two cover designs for this book. One was distinctly masculine, the background was dark-blue and the vibe mysterious. The other cover was white, clean and crisp, and is the one I ultimately chose. Before choosing between the covers, I walked around a local restaurant and asked everyone there which cover they preferred, even though they had no concept as to what the book was about. 90% of men chose the blue, masculine cover and 80% of women chose the crisp, white cover.

I stayed up all night worrying, but was counseled by a very good friend who steered me in the right direction. “Women drive healthcare in this country,” she advised. “Men often won’t go to a doctor until a female partner pushes them to. Choose the book cover that will appeal to the greatest number of people, but also a cover that women will want to read. Because this book is for people of every gender and has something for everyone.”
​

This book is for any person who has experienced erectile dysfunction, pelvic pain, prostate cancer and anyone close to those with these issues. I hope that answers your question about the ideal audience, Michelle.
Michelle: Any other pearls from the book that you’d be willing to ‘sneak out’ to the Connect PT community?
Becca: While I hope that the fictional characters are people with whom the reader can identify with in some way, I realized after writing that portion that a nonfiction/scientific explanation was necessary to illustrate why the characters got the treatments that they did. I have never written a book with nonfiction within it before, so it was a stretch to get through all those research studies. I remember doing it in my attic in July of 2019. I decided not to turn on the air-conditioning to really get to the grittiness of the matter.

After four weeks of sweating and gulping down coconut water in that attic, I had a bibliography. I wanted the readers to know that Chronic Pelvic Pain Syndrome is suspected to be present in 2-16% of the population. This is the NUMBER ONE diagnosis for men under 50 who come to a urologist’s office, yet very few people know this statistic. I also wanted to rationalize why the fictional character with prostate cancer was created as being biracial. Black men are 50% more likely to develop prostate cancer than white men. The nonfiction portion of the book is extremely important and reviews treatments for Chronic Pelvic Pain Syndrome, prostate cancer and erectile dysfunction. It is a nice compliment to the fiction.

And finally, I added a backstory on where the characters came from. It was in this portion of the book where I feel I was most able to honor men, to acknowledge their struggles in a world that does not allow for male weakness or vulnerability. This was the easiest part of the book to write; I waited until September as cooler winds blew and football season had arrived. I hope you can all get something out of this book.


For a sample of one of the many topics discussed in the book, check out Becca's latest video on Erectile Dysfunction & Physical Therapy Treatment.

Interview with Dr. Patrick Foye on tailbone pain

7/8/2019

 
By Michelle Dela Rosa, PT

I had the privilege of speaking with Dr. Patrick Foye, a longtime expert in the treatment of coccyx--or tailbone--pain. Below is a transcript of our interview highlights on the enigma of tailbone pain.

Dela Rosa: I'm here with Dr. Patrick Foye, who is the Medical Director and Founder of the Tailbone Pain Center at Rutgers New Jersey Medical School and Professor of Physical Medicine and Rehabilitation. Thank you so much for speaking with me today. In your experience, why has tailbone pain been challenging to diagnose and manage outside of the Tailbone Pain Center?​
Interview with Dr. Foye by Connect PT
Foye: I think that the biggest problem is that the vast majority of physicians unfortunately have a huge blind spot when it comes to understanding coccyx [tailbone] pain. We learned almost nothing about the coccyx in medical school. This leads to four main problems.
  1. First, unfortunately many patients suffer for months and years before anyone even figures out that the pain is coming from the coccyx.
  2. Secondly, most doctors do not really try to figure out what is causing the tailbone pain. Instead they label this as "coccydynia"; which literally just means coccyx pain, which is a symptom. We need to find the cause of that symptom.
  3. Thirdly, the doctors often do not take the pain seriously, telling the patient that it is “just“ your tailbone. They minimize the symptoms and are sometimes even dismissive, in a way they would not treat patients with pain at other body regions.
  4. Fourthly, doctors will incorrectly tell patients that there is nothing that can be done to treat tailbone pain, or that the only treatment is surgically amputating the coccyx (coccygectomy). Those ideas are completely outdated and completely wrong.

Dela Rosa: Your book Tailbone Pain Relief Now! describes the many reasons why people end up with tailbone pain. Are there 1 or 2 causes of tailbone pain that are more common than others?

Foye: Great question! By far the most common cause coccyx pain is when there is an unstable joint between the bones of the coccyx. Many medical textbooks and websites incorrectly state that the coccyx is a single fused bone. But that is rarely true. In the vast majority of humans, there are 3 to 5 individual coccygeal bones, with variability in whether there is fusion between any of those bones. Most people have at least a few coccygeal joints. And most people with coccyx pain have joint hypermobility (excessive movement) as the source of their pain.

The second most common cause of coccyx pain is a "bone spur"; extending from the lowest tip of the coccyx. When this happens at the bottom of the coccyx, there is thickening of the bone that projects backwards, often coming to a sharp focal point. It’s almost like a tiny icicle made of bone. This bone spur pinches the skin between the spur and the chair where the patient sits, and especially when they sit leaning partly backwards.

Dela Rosa: Thank you for clarifying the common causes of tailbone pain. In your book, you detail some of the seat cushions and medications that may help. People ask about injections for pain. As a pain management doctor, would injections be helpful for these causes and if so, could you describe how and what kind?

Foye: Sure it's a great question. Medications by mouth have a couple of big problems with them, which is why a lot of times medication given focally by a small local injection could be superior. 

When medications are given by mouth, number one they go through multiple places throughout the body. If you're taking medication by mouth, they can cause side effects in the stomach, the intestines, the liver, and the kidneys, so the side effects can be quite limiting. 

The second problem with medications by mouth is that because the medicine travels throughout the entire body, it gets diluted out. So only a minuscule amount of the medication actually makes it to the tailbone where the patient needs it the most. Many of these patients do respond to medication given locally at the site. Typically, that's done under fluoroscopic guidance. Fluoroscopy is like x-ray up on a computer screen, and using fluoroscopy we can target a specific location at the tailbone. I'm generally opposed to blind injections, which is where injections are done without any image guidance because 1) you can't guarantee where the medication is going to go and whether it's actually given at a place where it's going to be helpful, and 2) you also can get into problems if it's given in the wrong place - it can cause side effects. 

So back to your question, which was about the diagnoses like hypermobility or a bone spur... Absolutely those can respond very, very well to placing medication locally at the spot under image guidance. Often that's a combination of steroid which helps to fight inflammation, and also local anesthetic which can be given as a nerve block and can be very helpful when there's hyperactivity or hyperirritability of the nerves.

Dela Rosa: How is the x-ray your center performs different than how many other facilities perform the test?

Foye: Here at the Coccyx Pain Center, the biggest difference is that we take coccyx x-rays while the patient is sitting down, since that is when tailbone pain hurts the most. I have trained the radiology technicians here regarding how to properly perform this technique, which was first developed in France. Very few places in the United States have ever heard of this approach and even fewer are experienced at doing these x-rays properly. We have evaluated and treated thousands of patients with tailbone pain, many of whom fly in from around the country and internationally. And it is extremely common that patients had previous imaging studies that were read as being normal. But then they come here and our seated x-rays show that when the person sits down and leans backwards (putting their body weight onto the coccyx) they often have very dramatic dislocations or other abnormalities that would be completely undetected if the x-rays had not been done while the patient was sitting. It is a huge relief for patients to finally have an answer as to what is causing their pain. Then, when we have identified a specific cause for their pain, we can provide treatments for that specific cause, which is much more likely to be helpful than generic treatments done blindly without a diagnosis.​
Dela Rosa: Great thank you! Another follow-up question to the x-rays...I was amazed to learn that many x-rays that are meant to look at the tailbone don't even include it! So, what is your advice to a person with tailbone pain to ensure that the x-ray that they're getting (if they're not getting it with you), is accurately capturing the image of the tailbone? ​
tailbone pain interview foye connect pt
​Foye: A lot of this goes back to and starts with the general lack of awareness that physicians, radiologists and radiology technicians have about tailbone pain. Frequently, they lump it all in with low back pain. Lumbosacral pain is thousands of times more common than tailbone pain. A lot of the automatic checkoff boxes that people have on their radiology x-ray or MRI forms will have a box to check off for lumbar spine or lumbosacral spine, but they will not have a box to check off for the coccyx or tailbone just because it is thousands of times less common. So what happens is that the primary care doctor, or the orthopedic surgeon, or the pain management doctor, will check off the box and order lumbar or lumbosacral x-rays or MRI, and then that doesn't even include the tailbone at all. 

The next problem then is that the study gets done and the patient is told that there's nothing wrong, and that there's no explanation for their pain when really the images did not even include the symptomatic area, or worse yet, it shows an incidental finding of the lumbar spine that may not be causing any symptoms at all. But now they start down the treatment path of epidural injections, and even spine surgery and other things for a part of the body that wasn't even causing the problem. So basically back to your question about what the patient can do: 1) look at the orders, look at the x-ray or MRI orders, make sure that the ordering physician has specifically explicitly requested imaging of the coccyx, and 2) when you go into the radiology center, make a point of talking to the radiology technician and being crystal clear with them that this is not your lumbar spine, that this is not up in the small of your back at the belt line, that the pain is specifically down at the coccyx, and make sure that the radiology technician is going to include that part of the anatomy within the study. It really does require a certain amount of self-advocacy by the patient unfortunately to fight this uphill battle against the ignorance that's out there.

Dela Rosa: I'm just curious, have people come to you from outside of the US? Or are you mostly seeing people domestically?

Foye: Most of my patients travel in from out-of-state and about a third of my patients fly in. It's maybe 5% or less that are international. Within the last six to 12 months, I've had patients from Japan, Sweden, Africa, the UK, New Zealand, and I think two from Australia. Which really just gets back to that there's this unmet need out there and patients who are not able to find local clinicians who will either take them seriously or that know the appropriate testing and treatments to provide.

Dela Rosa:  How do you work with pelvic floor physical therapists in the treatment of tailbone pain?​

​Foye: As a physician specializing in Physical Medicine and Rehabilitation (PM&R), I'm a strong advocate for the role of physical therapists in treating patients who are suffering from painful musculoskeletal conditions. Historically, a big problem was that very few physical therapists were comfortable or experienced in treating pelvic floor problems. Fortunately, that has been improving in recent years.

The pelvic floor is often described as being like a muscular sling, or hammock, which supports and holds up the pelvic organs. The back end of that sling has attachments to the coccyx. Pelvic floor physical therapists and I often collaborate on figuring out the "chicken and the egg" phenomenon. By that I mean that we assess whether a patient is having tailbone pain due to pulling and tugging onto the tailbone caused by tightness and spasms of the muscles that attach to the coccyx. Or, sometimes it could be just the reverse: a painful condition at the coccyx itself might be causing reactive muscle spasm and guarding of the pelvic floor. If evaluation and treatment at one location is not providing adequate relief, then it often makes sense to collaborate and to consult each other, to help the patients find the answers and relief that they deserve.​

What's new: cupping therapy

6/22/2018

 
By Bryn Zolty, PT
Cupping therapy
Cupping therapy has added another element of therapeutic release for our patients at Connect PT. Cupping has been around for over 3500 years in ancient Egyptian and Chinese Medical texts. It is a method of placing or sliding cups on various body parts using heat or suction to create a negative pressure to mobilize the tissue. 
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!

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

Did You Know: Exercise's Lesser Known Impact

10/30/2011

 
People who exercise greater than 1 hour per week have a lower risk of neck, back, and shoulder pain, as demonstrated by a recent article published in the American Journal of Epidemiology (June ’11).

Exercise, Low Back Pain, Neck and shoulder pain

What does low back pain and urinary incontinence have in common?

10/14/2011

 
Urinary incontinence is defined as the involuntary loss of urine. The urethra is the tube that carries urine to the outside of the body. The factors that must be present for stability in the low back and pelvic girdle are also required to close the urethra properly. These include:
  • Proper function of bones, joints, and ligaments
  • Proper function of muscles and fascia
  • Proper motor control (timing)
A recent multi-centered study in Holland found that 52% reported low back pain with pelvic dysfunction (difficulty voiding of urine or stool, incontinence, and/or sexual dysfunction). Of the 52%, 82% reported that symptoms began either with low back pain or pelvic pain. Physical therapy can help both of these conditions by restoring joint mobility, correcting alignment, restoring timing of the stabilizing muscle system, and retraining functional motions.
(Stress Urinary Incontinence: A Consequences of Failed Load Transfer Through the Pelvis? by Dianne Lee, BSR, FCAMT, CGIMS & Linda-Joy Lee BSc, BSc(PT), FCAMT)
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  • Home
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