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.

Tips for better digestion

8/29/2019

 
By Karen Bruno, PT

You can support digestion in many ways. Engaging the part of your nervous system that controls rest and digest, known as the parasympathetic nervous system, is beneficial to assist your mind and your nervous system to be in a state of calm and homeostasis, and signals to your body that it is ready to digest.

​Do these techniques to shift out of fight or flight (a function of the sympathetic nervous system) to rest and digest, to lower stress, pain and discomfort, and encourage ease in nourishing your body.
Tips for better digestion
  1. Take 10 deep breaths before eating a meal. This stimulates your parasympathetic nervous system to calm your mind, bringing you into a more relaxed state so your body knows that it is safe to digest. As you get the smell of the food, your pancreas activates and the digestive enzymes begin to work. Your body is ready to receive the food into your stomach and maximize nutrient absorption.
  2. Chew your food more. Digestion starts in the mouth. The digestive enzymes get stimulated in your saliva. It starts your digestive tract to prepare your stomach to receive food.The mind-body connection is a two-way street – so when your gut is happy, your mind will also be happy.  Chew your food 30-40 times, or, chew until the texture of the food in your mouth changes. Mindfully eat and notice how your senses change: does the food start to taste different? Did you notice that different areas of the tongue perceive different tastes? Do you taste and discern salt, sweet, sour, bitter and pungent?
  3. Eat smaller portions. Try eating only until you're 80% full and notice how you feel. Satiety signals can take up to 20 minutes to reach the brain and decrease your appetite.
  4. Make sure to move after a meal. This helps digestion. Avoid slumping in a chair. This compresses your digestive organs and abdominal cavity. You could walk in the house, do some stretching or other gentle movements and activities to keep the parasympathetic nervous system active. 
  5. Hydrate. Sip water throughout the day rather than drinking a lot at once. Avoid drinking too much water with meals as this dilutes the stomach acid. 
  6. Sit in a neutral upright position. Support your feet on the floor or a foot stool. Sit with your weight placed evenly on your sitz bones (ischial tuberosities), with your knees at or below the level of the hips, and  lengthen your spine. You can lengthen your spine by lifting up tall through the center of your head as you feel a long line between your tailbone and the top of your head. Relax your shoulders.You may need to place a pillow behind you to support your back. Avoid slumped sitting posture with your head forward. This will restrict digestion and can create head, neck and jaw pain while chewing. Good posture keeps your muscles, joints and digestive system in correct alignment for more efficient function and comfort. 
  7. Employ mindful reflections. Take a moment to reflect on the food and the gift that it is to you. You can silently express gratitude and appreciation and intend that this food nourish your body. Digestion starts in the mind and in the senses. Take a moment to smell your food and to be present. This moves your nervous system into rest and digest mode so you can absorb nutrients better. 
  8. Practice self-compassion throughout the day. Placing your hands over your heart or anywhere else on your body is a soothing gesture that is comforting to the nervous system. Stroking the fur of a pet is another way to regulate your nervous system and activate the release of oxytocin, a hormone that gives us a feeling of connection and love. ​

By lowering stress levels and promoting relaxation you can digest and absorb nutrients better, boost comfort, decrease pelvic and abdominal pain and ease digestion. This helps to heal your gut. 

References:
  • Pelvicsanity.com
  • Mindful eating one mind dharma 
  • Gut and Bowel Plan
  • Centerformsc.org


What the research says: mindfulness for bowel health

6/12/2019

 
Recent studies support the benefits of mindfulness for bowel health. A 2014 study of 53 patients reported that mindfulness-based stress reduction (MBSR) “had a significant positive impact on the quality of life…” on people diagnosed with ulcerative colitis compared to a control group (1).

Another study the same year examined 24 people with irritable bowel syndrome (IBS) and compared them to a control group. Authors concluded that mindfulness-based therapy was more effective than cognitive behavioral therapy (CBT) to decrease symptoms in those with IBS at a 2-month follow-up. (2)
(1) Jedel, S., Hoffman, A., Merriman, P., Swanson, B., Voigt, R., Rajan, K. B., & Keshavarzian, A. (2014). A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion, 89(2), 142-155.

(2) Zomorodi, S., Abdi, S., & Tabatabaee, S. K. R. (2014). Comparison of long-term effects of cognitive-behavioral therapy versus mindfulness-based therapy on reduction of symptoms among patients suffering from irritable bowel syndrome. Gastroenterology and Hepatology from bed to bench, 7(2), 118.

Sleep solutions

3/7/2019

 
​By Karen Bruno, PT, DPT
sleep solutions blog article photo
Many of our patients report that they have difficulty getting a restorative night’s rest and they are not alone. In the United States, 50-70 million adults have a sleep disorder (1).  Insomnia is one of the most common sleep disorders, with short term issues reported by about 30% of adults and chronic insomnia reported by 10%. 3–5% of the overall proportion of obesity in adults could be attributable to short sleep (1). Sleep disorders are a common complaint among people with pelvic pain and chronic diseases (2).
According to a recent article published in the American Journal of Physical Therapy, “Research continues to reveal that sleep is not a period of physiologic inactivity; rather, it represents a critical period of recovery that supports cardiovascular, neurologic, and other life functions. Sleep is a basic human need, and recent attention on sleep by researchers and media are changing sleep attitudes and behaviors. Sufficient sleep was often viewed as a luxury, and reduced sleep time was often equated with increased productivity; however, attitudes are shifting to prioritize sufficient quality sleep.  Quality sleep is recognized as a positive health behavior, and it has been recommended to consider sleep as another vital sign,  as sleep can give insight into the functioning and health of the body (3)."

You may have noticed that getting a good night’s sleep helps you to feel better both physically and mentally and this helps you function better during your waking hours.  Basically, getting a good night’s sleep is a game changer that enhances the quality of your life. “Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory.  Impaired sleep can lead to obesity, mood disorders, constipation and heart disease” (3).

  1. https://www.sleepassociation.org/about-sleep/sleep-statistics/​
  2. https://academic.oup.com/ptj/article/97/8/826/3831304
  3. Siengsukon CF, Al-dughmi M, Stevens S. Sleep health promotion: practical information for physical therapists. Phys Ther. 2017;97(8):826-836. 

 
Tips for Healthy Sleep
There is good news! There are many natural ways to improve the quality of your sleep and restore your sleep health. Scroll through the list below and try one or more of the tips, and see how they work for you.

  • Decrease stress - Try diaphragmatic breathing to help you wind down and de-stress. Breathing full breaths in through your nose for 4 seconds and exhaling through your mouth or nose for 8 seconds is calming to the nervous system.
  • Create your bedroom space as a peaceful sanctuary - remove electronics, TV’s, exercise equipment and anything that may remind you of any form of work. Reserve your bed for sleeping and intimacy.
  • Get to bed in enough time to enable you to get 7+ hours of sleep. Create a relaxing bedtime routine. Read a book or take a bath to help wind down.
  • Establish regular sleeping and waking hours
  • Avoid light-emitting electronic devices at least 30 minutes to 2 hours before bedtime; use amber glasses at night when watching TV or working on a laptop.
  • Find the right temperature for your bedroom. The general recommendation is to keep the bedroom temperature between 60-70 degrees.
  • Sleep in complete darkness. Use of an eye mask may be beneficial to keep light out. Use earplugs or a white noise machine to block out noises.
  • Consider applying a hot pack to your abdomen. This can be very calming. Keep the hot pack on for no more than 20 minutes. If you tend to have cold feet, wrapping a hot pack around your feet for 10-20 minutes can be warming and relaxing.
  • Consider using essential oils. Lavender, Roman Chamomile and Vetiver provide relaxing effects and calm the nervous system. You can diffuse them, put the oils on your pulse point, rub them on the bottom of your feet, lightly spray them on your pillowcase or add them to an Epsom Salt bath and take the bath before bedtime.
  • Find a comfortable, supportive, neutral sleep positions. Use of a neck roll or a lumbar roll, or a pillow between your knees when you are on your side as positioning supports.
  • Avoid taking naps to catch up on sleep.
  • Exercise can have a positive effect on deep sleep. Find the time of day that works best for you. Stretching, strengthening, yoga, aerobics or a combination of activities may be right for you.
  • Avoid alcohol, caffeine and other inflammation-causing foods, like sugary snacks, refined carbohydrates, or processed meats, late at night.
  • Support through vitamins and supplements may be useful. Please check with your doctor, nutritionist, pharmacist or herbal practitioner for what may be right for you. Some common sleep nutrients include ashwagandha, valerian, chamomile, passion flower, lemon balm, melatonin, L-theanine and 5-HTP or Tryptophan.  GABA is helpful if sleep is disturbed by anxiety. Taurine and phosphatidylserine help to lower cortisol. Magnesium and magnesium glycinate are helpful in insomnia.
  • Move your energy through easy Energy Medicine exercises.


Energy medicine is a safe and natural way to manage your energies to meet the stresses and anxieties in your life by optimizing your energies to help your body and mind function at their best. This approach acknowledges your unique complex nature and how your whole body is connected. From the energy medicine perspective, sleep problems are seen as an energetic imbalance that can be resolved by activating the body’s natural healing ability to restore balance. 

I hope you will join me on Wednesday, March 20, 2019 at 6 pm in our Hamilton office to learn some of these easy and gentle self-care Energy Medicine techniques. Get a jump start and sign-up by calling 609-584-4770 for this free presentation.

What the research says: abdominal adhesions in gynecologic surgery

8/1/2018

 
By Michelle Dela Rosa, PT
abdominal adhesions or scarring
A longitudinal study published in the International Journal of Obstetrics and Gynecology discusses how the presence of adhesions in abdominal gynecological surgery is associated with cesarean delivery (n = 15,479). Repeat cesarean, age, obesity, and infection increased the risk of pelvic adhesions after cesarean section. Pelvic physical therapy after cesarean section can teach women how to mobilize scars effectively to minimize the potential for adhesions in the future.
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.

Can I do a crunch?

4/3/2018

 
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:​
Can I do a crunch?
  • Crunch AVG pressure: 23.8, range 19-76, with an exhale AVG 12.4 range 8-75
  • Downward facing dog AVG pressure: 39.1 range 26-72
  • Exercise machines AVG 37 range 20.3-182.3
  • Jumping AVG 171 range 43-252
  • Coughing AVG 98 range 49-130
  • ​Bearing down with breath hold AVG 101.7 range 45-131
​​*​Units of pressure used in the study are in cm of water. This is the height in cm of water displaced by pressure. (O’Dell et al.2007) (Cobb et al. 2005)
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.  

  • If a weak pelvic floor is causing your leaking, we would teach you techniques to strengthen/engage your pelvic floor and prevent leaking. This could be done by performing a pelvic contraction, a breathing pattern to encourage activation, or even using a high tone phonation!
  • Conversely, leaking can also be caused by a tight/tense pelvic floor. In this situation, we could trial lengthening/releasing the pelvic floor during the squat.
  • ​Alternatively, leaking could be caused by too much pressure on the pelvic floor and not necessarily lack of strength. It is possible that a change in alignment of the head/neck, ribs, or pelvis could increase pressure higher than the pelvic floor can support.  According to the study holding your breath and bearing down causes an average pressure of 101.7. It may be your breathing pattern might need to be adjusted!

​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.
​

References/Citations

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.

Infertility is on the Rise

12/18/2017

 
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”. ​
The study also states: Many of the issues that cause a woman to have difficulty with conception can be traced to scar tissue, fascial restriction, and congested lymphatics. The manual and movement work we do with our patients can help with scar tissue, fascial dysfunction and poor lymphatic drainage. The body gets tight and stale with our everyday routine and mundane movement patterns. These changes in physiology require manual work and movement therapy.
Infertility is on the rise
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.  

Help, my gut is in a rut!

10/16/2017

 
​Written by Michelle Dela Rosa, PT

​
What can I do to calm this bloated belly? What can I do to get things moving? What can I do for all this abdominal pressure and gas?

These are common questions we hear at Connect PT. One possible remedy that can be performed at home is what we call a bowel massage. The technique can help constipation, diarrhea, or any associated abdominal discomfort.
bloated belly physical therapy
​Start by lying on your back. Use a fist, heel of your hand, or fingers to apply gliding pressure on the left side of the belly from the left ribs down to the pubic bone. This works on the descending colon. Next, use the same pressure to glide just under the rib cage from right to left. This works on the transverse colon. Lastly, glide from the right side of the pubic bone straight up toward the right ribs. This works on the ascending colon. Each glide should be performed 10 times on the descending, transverse, then ascending colons. Use light to moderate pressure to comfort; nothing should hurt!
 
You can use a heating pad on the abdomen to soften the tissues prior to the massage. It can feel nice to do the massage before bed as you are winding down, but it can be performed anytime. So take some time out, slow down, and get those bellies feeling happy again.

What the research says: does mode of delivery affect perineal trauma and painful intercourse?

10/12/2017

 
​Written by Michelle Dela Rosa, PT
Picture
1500 women who had never given birth were recruited during their first and second trimesters of pregnancy from six maternity hospitals in Australia. Researchers studied data from baseline and postpartum questionnaires about pain with intercourse (dyspareunia). 98% resumed intercourse by 18 months and 24% reported dyspareunia. Women who had an emergency cesarean section, vacuum extraction, or elective cesarean had an increased risk of reporting dyspareunia at 18 months postpartum, compared to women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear.

McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015;122:672-679.

What the research says: pelvic therapy for prolapse

9/10/2017

 
​Written by Michelle Dela Rosa, PT
pelvic therapy for prolapse
There is help for pelvic organ prolapse, or laxity in the vaginal or rectal walls. Pelvic floor muscle training in women with prolapse is effective in improving symptoms.

In a randomized controlled trial, 447 females with newly diagnosed prolapse (stages 1-3) were randomly assigned to receive one-on-one pelvic floor muscle training OR education in modifying lifestyle.

​Women in the pelvic muscle training group reported significantly less pelvic organ prolapse symptoms at 12 months than those that just received education. They reported improvement in: activities of daily life, sexual activity, bladder function, and bowel function.​​
It takes time to strengthen pelvic muscles, but our therapists often see muscle training instrumental in avoiding corrective surgery and in other cases, helpful in preparing for surgery. If you've been diagnosed with prolapse, speak to your doctor about physical therapy for pelvic muscle training. If you've had therapy in the past, we're here for you too for "refresher" sessions or ways to improve your current program.

What the research says: effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence

5/3/2016

 
A prospective study by Filocamo and colleagues in 2005 investigated the effectiveness of early pelvic floor muscle training (PFMT) after radical retropubic prostatectomy (RRP). After catheter removal, 300 men were randomized equally into either a structured PFMT group or a control group that did not receive exercise. Incontinence was assessed by the 1-hour and 24-hour pad test, as well as the ICS-Male questionnaire.

By 6 months, almost 95% of the PFMT group achieved continence as compared to 65% of the control group. The authors concluded that an early supportive rehabilitation program like PFMT significantly decreases continence recovery time.

Filocamo M, Marzi VL, Del Popolo G, Cecconi F, Marzocco M, Tosto A, Nicita G. Effectiveness of Early Pelvic Floor Rehabilitation Treatment for Post-Prostatectomy Incontinence. European Urology. 2005 Jun:48(5)734-8.

What the research says: are healthy muscles supposed to hurt?

12/30/2015

 
Written by Michelle Dela Rosa, PT

A 2013 study by Kavvadias and colleagues assessed pelvic floor muscle tenderness in 17 asymptomatic female volunteers who have never been pregnant (mean age 21.5 years). Authors concluded that in women aged 18-30 who have never been pregnant, no lower urinary tract symptoms, and no history of low back or pelvic pain that tenderness “… should be considered an uncommon finding.”
pelvic floor muscle tenderness
Other studies like Montenegro et al. (2010) have also reported a low prevelance of pelvic muscle tenderness in healthy volunteers (4.2%), and Tu et al. reported a high prevalence of tenderness (75%) in women with chronic pelvic pain.

Kavvadias T, Pelikan S, Roth P, Baessler K, Schuessler B. Pelvic floor muscle tenderness in asymptomatic, nulliparous women: topographical distribution and reliability of a visual analogue scale. International Urogynecology Journal. 2013 Feb:24(2):281-6.

Montenegro M, Mateus-Vasconcelos E, Silva J, Nogueira A, Dos Reis F, Neto O. Importance of pelvic muscle tenderness evaluation in women with chronic pelvic pain. Pain Medicine. 2010 Feb:11(2):224-8.
​

Tu F, Holt J, Gonzales J, Fitzgerald C. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. American Journal of Obstetrics &Gynecology. 2008 Mar:198(3):272.e1–272.e7.

What the research says: yoga for low back pain

9/7/2015

 
Marzena yoga
Yoga can offer safe and effective treatment for the rehabilitation of low back pain. Cramer et al (2013) showed “… strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness …” in a systematic review and meta-analysis of yoga and low back pain in 10 randomized controlled trials. There were no reports of serious adverse effects.
Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clinical Journal of Pain. 2013 May:29(5):450-60.

What the Research Says: Kegels with Verbal Instruction

5/7/2015

 
Written by Michelle Dela Rosa, PT.

Bump et al (1991) assessed whether or not verbal instruction was enough to perform a proper pelvic floor muscle contraction, or Kegel. The study measured urethral pressure in 47 women at rest and during a pelvic muscle contraction following standardized verbal instruction. Although almost half the women performed with “an ideal effort” for urethral closure, 25% performed with maneuvers that could lead to incontinence. The authors concluded that simple verbal or written instruction is not the best approach for pelvic floor muscle training.
A recent study by Scott et al (2013) measured bladder base elevation with transabdominal ultrasound in 52 healthy men (mean age 22.6) during a pelvic muscle contraction in lying and standing after standardized verbal instruction. 6 participants were unable to contract the muscles in either position, 17 were unable to contract lying down, and 14 were unable to contract in standing.
What the research says kegel
We cannot be certain that verbal or written instructions alone are enough to facilitate a proper pelvic muscle contraction, even in a young, healthy person. Physical therapists with pelvic floor training can help people who are not using the muscles properly, which could lead to significant consequences.

Bump RC, Hurt WG, Fantl JA, Wyman, JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug:165(2):322-7.

Scott OM, Osmotherly PG, Chiarelli PE. Assessment of pelvic floor muscle contraction ability in healthy males following brief verbal instruction. Australian and New Zealand Continence Journal. 2013 Autumn:19(1):12-7.

What the Research Says: Predictors of Pregnancy-related Pelvic Pain

5/1/2014

 
pregnancy-related predictors
Written by Michelle Dela Rosa, PT.

Pregnancy-related pelvic girdle pain (PPGP) can significantly limit movement both during and after pregnancy. 
​
The International Association for the Study of Pain researched predictors of pelvic girdle pain in the working mother.
In 548 Dutch working women, almost half reported pelvic girdle pain at 12 weeks postpartum. Pregnancy-related predictors for pain included: history of low back pain, elevated somatization, 8 or more hours of sleep/rest per day, and uncomfortable postures at work. Pregnancy and postpartum-related predictors for pain included: disability and pelvic girdle pain at 6 weeks, elevated somatization, higher birth weight of the baby, uncomfortable postures at work, and number of days on bed rest. The authors discussed that a woman with PPGP should be cared for to prevent more serious postpartum disability (Stomp-van den Berg et al, 2012).

Another study looked at the type of delivery and pelvic girdle pain in 10,400 women with singleton pregnancies. A planned cesarean section was associated with 2-3x the rate of pelvic girdle pain at 6 months postpartum. The authors recommended vaginal birth for women with PPGP, unless there is a serious medical reason (Bjelland et al, 2013). In a study done by the same lead author, postpartum women had high recovery rates from pelvic girdle pain, but those who reported significant emotional stress during pregnancy had an independent correlation with continued pelvic girdle pain (Bjelland et al, 2013).​

​A final study looked at the relationship between exercise and PPGP. Pregnant women who exercised more than 2x per week reported a lower rate of pelvic girdle pain, and those who exercised 1-2x per week reported less low back pain and depression. The authors concluded that exercise during pregnancy could lower the risk for pelvic and low back pain (Gjestland et al, 2013).

Bjelland EK1, Stuge B, Engdahl B, Eberhard-Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study.  BJOG. 2013 Jan;120(1):32-40.

Bjelland EK1, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol. 2013 Apr;208(4):298.e1-7.

Gjestland K1, Bø K, Owe KM, Eberhard-Gran M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med. 2013 May;47(8):515-20.

Stomp-van den Berg SG1, Hendriksen IJ, Bruinvels DJ, Twisk JW, van Mechelen W, van Poppel MN. Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study. Pain. 2012 Dec;153(12):2370-9.

What the Research Says: Nocturia

6/2/2013

 
Written by Michelle Dela Rosa, PT.
"Nocturia" is defined as waking one or more times at night to void, according to the International Continence Society. New evidence demonstrates how the condition is associated with significant health risks and mortality. One study looked at patterns in 692 older men and women, and found that those who voided 3 times or more per night increased their risk of falls 28% over a 3 year period. The participants classified as fallers were more likely over 85-years-old, female, diagnosed with diabetes, taking diuretics, and found to have an abnormally slow walking speed. ​(Vaughan et al, Int J Clin Pract. 2010 April; 64(5): 577–583.) ​
Nocturia
Another study from Japan showed that almost half of their 784 elderly participants reported nocturia 2 times or more per night. These individuals were at greater risk for fracture and mortality. (Nakagawa et al, J Urology. 2010 October; 184(4): 1413-18.) 

Simple advice like decreasing caffeine, alcohol, or any fluid near bedtime may help improve nocturia. Physical therapists can help patients with other behavioral strategies and techniques after a thorough evaluation. Other factors to consider include: sleep disorders, diabetes, poor bladder storage, kidney dysfunction, or cardiac issues.

What the Research Says: Pregnancy and Delivery is Not Always the Culprit for UI

11/18/2012

 
Written by Michelle Dela Rosa, PT.
pelvic health blog
Pregnancy and delivery is not always the culprit for urinary incontinence (UI).

​An article on the MONASH University website concludes that “up to 1 out of every 8 healthy women who have not carried or birthed children have urinary incontinence”, which significantly affects quality of life. 
1000 healthy, young women (age 16-30 in Melbourne, Australia were surveyed about continence. 6.2% of women reported urinary leakage with stress, 4.5% with urge, and 1.9% with both stress and urge. Women were also more prone to UI if they reported a history of bedwetting beyond 5 years of age. ​

Pelvic Rehabilitation Recommended as First Line of Defense for Stress Incontinence

8/4/2012

 
Written by Michelle Dela Rosa, PT.

​An article in Advances in Urology was published by Dr. G. Willy Davila of the Cleveland Clinic Florida that describes non-surgical management of female stress urinary incontinence (SUI). He reviewed the literature for prospective trials and included only studies that followed participants for at least 12 months. The article confirms earlier research reviews that identify pelvic floor rehabilitation as a low cost, low risk treatment, with 60-77% of patients showing improvement in SUI symptoms.

(G. Willy Davila, “Nonsurgical Outpatient Therapies for the Management of Female Stress Urinary Incontinence: Long-Term Effectiveness and Durability,” Advances in Urology, vol. 2011, Article ID 176498, 14 pages, 2011. doi:10.1155/2011/176498)

stress urinary incontinence

Research: Incidence of Painful Pelvic Floor trigger points

2/12/2012

 
Written by Michelle, Dela Rosa, PT

A new study has highlighted the incidence of painful pelvic floor trigger points among patients diagnosed with interstitial cystitis (IC), a condition characterized by pelvic pain and urinary urgency/frequency. A retrospective chart review was performed on 186 people diagnosed with IC. 78.3% had myofascial pain with at least one trigger point, and 67.9% had multiple trigger points. 
Picture
These results demonstrate the need to screen patients with IC for pelvic floor dysfunction and painful muscle trigger points, and refer them to specialists like physical therapists who are skilled in treating pelvic pain.

Research: Chronic Pelvic Pain

12/12/2011

 
physical therapy pelvic pain
Researchers reviewed high quality studies from PubMed (1984-2006) that focused on the treatment of chronic pelvic pain (lower abdominal pain lasting for at least 6 months). They found evidence of musculoskeletal system disorder in most women with chronic pelvic pain. 
They concluded that teamwork between physicians and physical therapists is becoming more necessary to formulate lasting and effective improvements in women with chronic pelvic pain.

​
(Montenegro, M., et al. Physical therapy in the Management of Women with Chronic Pelvic Pain. Int J Clin Pract 2008: 62(2) 263-269.)

What the Research Says: Visceral Manipulation

10/30/2011

 
Written by Michelle Dela Rosa, PT.

New research presents visceral manipulation as a modality to reduce adhesions post-operatively. 
Researchers employing an experimental animal model reported significantly less adhesions in the 
group that received VM after an adhesion-producing surgery (as compared to controls). The authors 
believe that VM encourages tissue mobility and decreases fibroblast invasion of tissues in animals as 
it would in humans. They suggest that patients may benefit from VM in post-surgical care and patient 
education by preventing/treating abdominal adhesions.

Bove, G.M., Chapelle, S.L., Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model, Journal of Bodywork & Movement Therapies (2011), doi:10.1016/j.jbmt.2011.02.004
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