Connect Physical Therapy: It's time to Own Your Body
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    • Michelle Dela Rosa, PT, DPT, PRPC
    • Karen A. Bruno, PT, DPT
    • Becca Ironside, PT, MSPT
    • Bryn Zolty, PT, DPT, PRPC, BCB-PMD, PCES
    • Katelyn (Kate) R. Sheehan, PT, DPT, ATC
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Read about insights and research updates in
​orthopedic and pelvic physical therapy.

Ultrasound imaging for constipation

12/20/2020

 
Get a glimpse of Connect PT's rehabilitative ultrasound with Bryn Zolty, PT. We can use the ultrasound to teach proper pelvic muscle coordination and help conditions like functional constipation.
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Watch the overview video below.

Taping for diastasis recti: criss-cross method

10/12/2020

 
Every pregnant woman has an abdominal diastasis, or diastasis recti, at the end of their pregnancy. It's a massive stretch on the abdominal wall that makes the connective tissue at the center very thin. Some heal in the first six weeks postpartum, but many need more time. We're here to help women that need help strengthening their belly after baby.

Watch Bryn Zolty, PT demonstrate the criss-cross method with kinesiotape to support the diastasis and help activate your abdominal muscles correctly.

Planks for prolapse

9/30/2020

 
By Bryn Zolty, PT

​Planks are one of the most well-known core exercises. Doing a plank incorporates many muscles to make us strong and support our joints. 
Typically an individual starting off with planks would try a modified plank and build up to a full plank. A modified plank means less difficulty when you are starting out so you can maintain a nice neutral spine, avoid holding your breath, and build strength. Two common modifications would be starting on your knees or placing your elbows on a higher surface than your feet as seen below in the Common Progression. After this position becomes easier, you can hold longer or perform more repetitions. Next you could try a full plank. Planks can continue to be progressed to have your feet above your elbows, your elbows on exercise balls, use exercise bands and more.  
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Now let's add prolapse to the situation. Pelvic organ prolapse can feel like heaviness in the vagina and even progress to the organs (bladder, uterus, vagina, rectum) coming out of the body. These symptoms increase with gravity. The more upright you are, the more symptoms you may have. So with a prolapse, we may consider reversing the progression. We may start with your body inverted - check out the picture with the feet on a chair and elbows on the ground in step 1 of the Prolapse Progression. We also encourage you to monitor your breathing. Holding your breath can increase symptoms. Consider what happens when you breathe in and fill your system with air, and then hold your breath and strain in a position. This can push these organs down. In addition, you could consider adding a kegel, or pelvic floor squeeze, to help support the organs. Your progression might look like the reverse of the Common Progression! As you gain better control of the pelvic muscles and breathing, you may be able to progress to being more upright with less symptoms. Good Luck! Contact us if you need help modifying your exercises, breathing, or help with pelvic muscle strengthening so you can exercise with confidence.
Planks for prolapse

Self-compassion and pain management

9/9/2020

 
By Karen Bruno, PT

Can self-compassion really help when you are in pain?
Let’s explore this. First, what is self-compassion? Self-compassion is giving yourself kindness, forgiveness and understanding when confronted with personal failures or discomfort. Basically, it means giving yourself the care and gentleness that you would give to a beloved friend or a child who is in need of support. In the words of Dr. Kristen Neff, a self -compassion expert and teacher, "Instead of mercilessly judging yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?" (1)  It is an acceptance of your humanness even when things don’t go your way.
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So, what does self- compassion have to do with chronic pain? Recent research suggests that self-compassion is associated with better outcomes, such as lower levels of depression, pain-anxiety, physical and psychosocial disability, and higher levels of pain acceptance. Higher levels of self-compassion supports engagement in meaningful activities and use of pain coping strategies. (2)

What does that mean for you?
  • Lower levels of depression, sadness and anxiety.
  • Less physical and psychological stress.
  • Higher levels of pain acceptance and engagement.
  • Improved ability to perform meaningful activities and use pain coping skills.
  • Better overall outcomes, function and quality of life.

Self-compassion has been found to be beneficial in situations related to the ineffective way we respond to things, how we talk to ourselves and the behaviors we engage in. So, when you notice yourself  worrying, thinking or talking negatively, isolating yourself, or beating  yourself up, choose to use a better approach of treating yourself with care, gentleness and kindness. (3)
 
What can you do?
  • Meditate. Practices such as mindfulness, breath meditation or any other physiological quieting methods help us to reduce tension and train us to tune into our needs to better take care of ourselves. Here is a link to some guided meditations: https://self-compassion.org/category/exercises/
  • Consider treating yourself the way you would treat a close friend or a small child. How might you respond to them with kindness and gentleness?
  • Remind yourself that you are worthy of kindness and compassion.
  •  Take a self-compassion break. What do you need to hear? What do you need to give yourself? How can you encourage yourself and be patient, kind and forgiving to yourself?
  • Explore self-compassion through writing. Start by writing about your concerns.  Next, write yourself a letter from the perspective of a loving friend. The last step is to let yourself receive those kind words, allowing love and compassion to soothe and comfort you.
  • Practice supportive touch.
    1. Putting your hands on your body and taking some conscious breaths can be relaxing. 
    2. Place your hands over your heart and breathe comfortably. Notice the rise and fall of your chest as you breathe. Do this for as long as needed to calm your nervous system. 
    3. If it is convenient, put your hands over the area of pain and breathe love and nourishing oxygen into the region. 
    4. Place one hand over your heart and one hand over the abdomen. Breathe gently and consciously- 4 seconds in and 4 seconds out. This is a great way to relax as you drift off to sleep.   
 
This PDF download summarizes the relationship between self-compassion and pain.
 
Self-care is also an integral component of self-compassion.
We have heard it before from the airlines, "“put your own mask on first, then help someone else." Remember that you are your own best advocate and as you care for yourself, you model for others how to care for themselves, you teach others how you want to be treated, and you harness the resources to be of service to others. Just do it! You are worth it.
 
"Life is full of disappointments, failures and setbacks. None of those things can permanently stop you. You have the power within you to overcome anything that life throws at you. There is nothing more powerful than a made up mind. Surround yourself with people who remind you that you matter, and support you in ways that matter most to you. No person, situation or circumstance can define who you are. Don't give up, cave in or stop believing that it's possible. It's not over until you win."
-Unknown

Notes 
  1. Website: selfcompassion.org
  2. Paper: The relation of self-compassion to functioning among adults with chronic pain. Eur J Pain. 2019 Sep;23(8):1538-1547. doi: 10.1002/ejp.1429. Epub 2019 Jun 11.
  3. Audio: Integrative Pain Science Institute podcast

Poll results & managing stress with breathing techniques

8/28/2020

 
In our last newsletter, we asked you to share how you are managing stress during this new norm. 

Drum rolllll...
"Exercise" and "meditation/prayer" tied for first!
Managing stress
​We get a ton of questions every day about breathing and spend a lot of time teaching different breathing techniques, which can help with both exercise and meditation/prayer.

Learn about what we usually see and also what we're looking for, as we breathe with Marzena Bard, PTA, CYT.

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.

Exercise of the season: open up the chest with a foam roller

7/18/2020

 
We love teaching this exercise to release tight pectoral muscles at the front of the chest. These muscles can be tightened by leaning forward over a computer, taking care of small kids, hunching forward to type on a smartphone, or just not being mindful about posture. A simple way to start loosening these muscles is by using a foam roller or rolling up a beach towel vertically.
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  • Lie on the foam roller or rolled towel so it lines up with your spine vertically, resting your head at one end.
  • Bend your knees and keep your feet flat for balance.
  • Place your arms in 1 of the 3 positions pictured below, palms facing up.
  • Feel a comfortable stretch across the chest.
  • Focus on breathing and letting go of tension. Start with holding a position for 30 seconds, working your way up to 2 minutes.

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
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​
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.
Picture
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

heartmath meditation for covid

6/17/2020

 
by Karen Bruno, PT, DPT

Restrictions, social isolation, financial concerns and disruption to our “normal” have impacted everyone. Here is a short process to assist you in connecting inwardly and connecting with others to boost your spirit, lift your confidence, support your immune system and build resilience. Through connecting to our heart’s intelligence and guidance, we can practice caring and assisting one another to uplift, inspire and support ourselves and others.

Here is my intention for you: may you take good care of yourself; may you be happy; may you be full of love; may you be blessed with health and vitality; may you live a life of peace and harmony; may you experience true joy and fulfillment; may you be free from suffering of every kind; may you live your life with ease and grace; may you live your life to the fullest extent and may you share that with all others.

The following  process is from the Heartmath Institute Global Coherence Initiative. 
Care Focus – Rise of the Human Spirit

1. Breathe feelings of peace and love through your heart area for a few minutes to set a calm and genuine tone.

2. Feel your heart connecting with others who are sending compassionate care to all who are suffering the challenges of this virus. See the power of the collective amplifying the effectiveness of your care.

3. Let’s send our most sincere appreciation, love and compassion to all the front‑line providers and those helping behind the scenes while risking their lives. See them surrounded by love, compassion and resilience as they serve selflessly.

4. Now, envision these times inspiring deeper connections and more harmonious cooperation among people for the good of the whole. See humanity transitioning into the crucial importance of love, compassion, cooperation and heart‑felt service, for creating the new world that we now stand at the door of.
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5. Let us send all the families and friends who have lost loved ones our deepest compassionate care and heart warmth, for they bear the most suffering and pain that is being experienced. Then honor and appreciate all the souls who have lost or are losing their lives as we share this. They are all heroes. Desire the highest best for them on their next journey.​

*Karen leads our individualized meditation program, which can be done in person or via telehealth.

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.

In the Community: Spring 2020

5/21/2020

 
In the Community Michelle Dela Rosa
April 2020

​
Michelle Dela Rosa, PT, DPT, PRPC spoke about the benefits of pelvic physical therapy for constipation in people with Parkinson’s disease, in an interview by Dr. Jill Farmer of Global Neurosciences Institute. The interview is posted on YouTube for Parkinson’s Awareness Month.
​April through May 2020

​Marzena Bard, PTA, CYT brought yoga to our homes over Zoom twice a week, offering Chair Yoga and Relieve Stress & Rebuild Strength Yoga to help the community stay active and connected despite sheltering at home.

Connect PT's exercise hack for the obturator

3/20/2020

 
By Marzena Bard, PTA

If you have a tight obturator internus, here are two go-to exercises for a release of that sneaky muscle.
exercise hack for obturator
Fan Pose
Keep your feet wide apart, turning your toes inward. Exhaling gently, hinge in the hips forward. Place both hands on a yoga block in front of you. Take a breath and exhaling again, lift up one arm up towards the ceiling. Stay there for a few deep breaths. Repeat on the other side.   
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Frog pose 
Position yourself on the floor with knees wide apart and feet to the sides. Be gentle and don’t feel you have to achieve the angles that are presented in the picture. Place your hands flat on the floor, about shoulder-width apart.  You may add a slow, unwinding, rocking movement back and forth, coordinating it with your breath. Inhale rock back, exhale rock forward.   
exercise hack for obturator

relax and renew meditation

2/4/2020

 
relax and renew meditation
Only have 5 minutes? 
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Listen to this relaxation meditation that uses the nourishing breath to help build a healthier state during this winter season.
  • Listen to the meditation online
  • Download the audio file ​

Q&A for men: fourth edition

1/14/2020

 
Picture

Varicoceles, circumcision, rectal spasms, oh my!

Hear Becca's answers regarding these hot topics in men's health in her 4th Q&A for men. 

​Question from Dave: I have blue veins on one side of my scrotal sack. They have been there for a while. Is this normal? I don’t have any pain or anything, the veins just make my testicles look a little strange.
Answer from Becca: What you have, Dave, is called a varicocele. This is similar to having varicose veins in the legs, only it is happening in your left testicle. Varicose veins occur when the valves of veins get damaged and are not as good as circulating blood back to the rest of the body thereafter. The cause of varicose veins in any part of the body is largely unknown.  
Having a varicocele, or a varicose vein in the testicles, is seen in 10-15% of men.  Varicoceles usually arise in men around puberty and it is very typical that you see this only on your left testicle, Dave, as they are more prevalent on this side of the scrotum. The awesome news for you is that varicoceles rarely present with any actual symptoms that would impact your sex life or cause pain. If you do have symptoms down the road, they would most likely involve infertility or poor sperm quality. That said, the incidence of this is not common with the presence of a varicocele. And if you did want to get treatment for pain or infertility should they arise, there is surgery available.
​
Otherwise, my suggestion would be to acknowledge that you are in good company with other men and that your varicocele is not a sign of anything that you did or did not do. The blue veins will remain, but think of them like a cool tattoo that you didn’t have to pay for and carry on with your sex life!

Question from Alex: I am 28 years old and I live in the United States. My parents never had me circumcised, because they didn’t believe in it. Yet I always felt like there was something wrong with me when I took a shower in the locker room after football practice. Many of the women I have slept with have never seen an uncircumcised penis before. What is the point of circumcision and why am I so unusual for not having one?
Answer from Becca: Alex, this question could not be asked at a better time in history. I’ll explain why. The fact that you live in the United States and are not circumcised reveals how we perceive this medical procedure. We live in a country with some of the highest rates of circumcision in the world. Israel’s rates are higher than America’s, which makes sense because the removal of the foreskin is a religious celebration in Jewish culture shortly after the birth of a male child. Men born in Muslim countries are also commonly circumcised, though this usually happens at an older age of approximately ten years. But why are the circumcision rates so high in the United States, if we are not performing this surgery in accordance to religion?

The reason that many cultures have historically embraced circumcision is because it was perceived as keeping the penis “cleaner”. This argument it not scientifically based, because if a young boy learns how to pull back the foreskin of his penis and clean it properly, there aren’t documented increased risks of things becoming dirty or infected. Americans appear to embrace circumcision for their baby boys because of what you mentioned about your locker room experience as a teenager, Alex. Parents believe that circumcision is the social norm, that it is “the right thing to do” to avoid the shame of men later in life.

The purpose of the foreskin is to protect the head of the penis. From an anatomical standpoint, it exists for a reason. When it is surgically removed, as it is in circumcision, this actually decreases sensation to the head of the penis. Imagine a part of your body that is routinely exposed to the outside air and friction against surfaces. Like your hands. Your hands will get dry and cracked in cold weather and your sensitivity to touch will decrease on your fingertips. Wearing gloves would protect your hands and improve the nerve sensation. When the head of the penis is rubbing up against boxers all day, as it will in a circumcised guy, that skin might toughen up with that friction and sensation may decrease. In an uncircumcised man, the head of his penis is protected by the foreskin, thus potentially enhancing the sexual response.

The trend of circumcising boys in America seems to be dropping. The Center for Disease Control reported a steep decline in circumcision rates to merely 30% of male births in 2010. I hope that this trend will dispel the myth that the uncircumcised penis is somehow “unclean” or “unsanitary” and help the next generation feel more confident about being “uncut” down there.

To sum things up, I have a friend who is Hungarian named Katalina. She had her first sexual experiences in Hungary, where the circumcision rate is quite low. When she moved to the U.S. and she saw her first circumcised penis, Katalina thought, “What is this odd-looking thing? Why would anyone allow surgery to his penis? I mean, it is beyond the guy’s control if he got a circumcision as a baby, but STILL!” Hearing Katalina say this in her Hungarian accent was priceless. Let that be a message to you, Alex, and to all the other men out there! This decision was made for you. There is no right or wrong answer to the circumcision question and there is little medical evidence to support the idea that cutting off the foreskin of the male penis has much benefit. Whether you are circumcised or not, rock on with your bad selves! And if you have a baby boy one day, consider all these aspects before you make this decision for him

Question from Juan: I have spasms in my rectum. They are so uncomfortable that I can barely sit. These spasms get worse after I have a bowel movement and last for 2-3 hours. I am at the point where I am severely constipated, because I now avoid going to the bathroom. I have been to a gastroenterologist, who can find nothing wrong in testing. Is there any treatment available for this?
Answer from Becca: Juan, I feel your pain. This is a tough condition, but fortunately for you, you are alive at a time where pelvic floor physical therapy for men is becoming more widely available. The reason that you have rectal spasms is likely because the muscles of your saddle region are too tight. Just like having neck spasms and having difficulty turning your head, spasms in the pelvic floor or saddle region will make it so you cannot open up your rectum to get poop out without discomfort. It is often that simple.

The fact that you are constipated is consistent with the rectal spasms. This is because the human brain is very clever. It wants to protect the body from pain, so your intestines will hold onto that fecal matter to prevent the rectal spasms from overwhelming your nervous system. This contributes to the cycle of pain and spasm and it can become a never-ending loop of constipation.

So, what can be done? A pelvic floor physical therapist can assess your saddle muscles to see how tight they really are. Then, stretching within the rectum can be performed with a gloved finger to allow them to relax. It sounds pretty crazy, I know, but if you can get over the fact that a medical professional is in your bum, you will find that this treatment is extremely beneficial. I have treated many men like you. Once the indignity of the initial exam has been conquered, most patients report a sense of quiet in their pelvises when they are receiving the appropriate treatment. They report decreased pain in the rectum over time and have more regular bowel movements.

The action plan for you, Juan, is to find a pelvic floor physical therapist. I have a good feeling that this will allow your pelvis to return to a calm state and facilitate more consistent and pain-free bathroom relief.

Commitment to concrete goals

1/6/2020

 
By Michelle Dela Rosa, PT

It's the year 2020, and we're all hearing about new goals and unrealized dreams. I'd like to run in a 5K this year. I want to cut sugar from my diet. I'm going to spend more time with my family... We've treated thousands of people at Connect over the last 11 years, and I'm so proud to say that we have witnessed so many people's success stories, your success stories.

One common thread that runs through the most successful stories is that these people made different choices. Choices that have led to actionable change. Running a 5K means more than signing up for the gym. Commit to exercise 5 times a week. Bring on the savory! Instead of just avoiding your favorite sweet treats, meal plan for the week to include new and easy to make recipes. How will more time magically appear for your kids, parents, friends, or significant other? Set a time limit on social media, or eliminate an app altogether :)

Make choices that are going to lead to tangible, positive results. Each result should take you one step closer to your goal. This is how we create a plan for you to reach goals in physical therapy, and it's what we'd love to see for you outside of therapy.
​
​PS - Life is always going to "get in the way." Keep calm and carry on.

Here's my 3-year-old trying to break my commitment to exercise in the family room!

I have an obturator internus?

12/4/2019

 
By Bryn Zolty, PT

​
I hear this question all day. You are in the majority if you have no idea where this muscle is! I didn't know I had an obturator internus muscle until becoming a pelvic therapist.  ​

The reason most people do not know the obturator internus is because this muscle is the lateral border of the pelvic floor. ​
obturator internus
The obturator internus sits inside the pelvis and travels around out the back of the pelvis to the femur (thigh bone). This muscle rotates the hip out, moves the leg wide when it’s forward, and stabilizes the hip.  ​
obturator internus
obturator internus
The obturator internus can become tensioned or spasmed from overworking, muscle imbalances, injuries, and postural changes.  

Some symptoms of obturator internus muscle tension include:

  • Hips that feel tight and your feet always seem to be rotated out
  • Lateral hip pain, can be mistaken for IT band syndrome/bursitis
  • Pain in the tailbone
  • Pain in the groin
  • Sit bone pain

The obturator internus has many pain referral sites. So symptoms can vary from one day to the next.

Other symptoms that would indicate that you should be checked for tension in the pelvic muscles include:

  • Urinary urgency
  • Urinary frequency
  • Urinary incontinence 
  • Painful intercourse 

I commonly see high-level athletes hold tension in the obturator internus muscle. Gymnasts, horseback riders, spin class cyclers, runners, and dancers tend to have spasms here. In any post-operative hip surgery in which rotation is limited, as with a hip replacement, this muscle can be a source of pain or contribute to the onset of urinary incontinence.

I find that many patients have gone to traditional PT and had no relief. Some have had X-rays, MRI, and injections. 

During an internal pelvic floor evaluation, when the muscle is pressed on by the therapist, it often reproduces the pain the patient has been experiencing. Many patients are relieved to find out where the pain is coming from and that it is easily treated.  

I think back to my orthopedic treating days and wish I could have sent all of my patients with hip pain not finding relief with traditional methods, and referred them to a pelvic PT. Besides a Gynecologist or Urogynecologist, a pelvic PT is the only person checking manually to see if the obturator internus is a source of pain.

I have a special interest in the obturator internus because of personal experience with symptoms. Always having a tendency towards muscle tension, after pregnancy and abdominal diastasis weakness, my usual exercises resulted in pain. Pain in the hip, painful sitting, and when enough tension builds I am scared to sneeze! But these muscles can be stretched and released, and the muscle imbalances restored.  

If you have any of these symptoms, seek a pelvic physical therapist. A quick evaluation of the pelvic muscles can rule in or out the obturator internus and a treatment plan can be made for you.

Biofeedback: A Tool in the Toolbox

10/28/2019

 
By Bryn Zolty, PT

As rehabilitation therapists we all learn techniques to evaluate and treat patients.  Often we refer to all these techniques as tools in our toolbox. Like a good carpenter, we strive to have a toolbox full of techniques so that we can provide the best care for each patient.  We all have our favorite tools. With clinical experience and evidence based research, therapists may pick one tool more often for the job than another. However, I feel strongly that a tool will work better if you have been properly trained and had lots of practice with that tool.  This applies to the use of biofeedback, specifically in this case, for pelvic muscle dysfunction. It is a tool in our toolbox. Not the only one, but one of my favorites. And a tool supported by medical evidence.  
I thought it was a great tool from the first time I was exposed to it during a pregnancy and postpartum course.  As students in the course, we tried birthing positions to see if our muscles could relax. Relaxation of your pelvic muscles is highly desirable in order to have tissues that will stretch as a baby is being delivered.  A better position means less injury to mom, less problems with incontinence and prolapse later. But everyone had a different position in which they could relax. This meant that we could not teach one position to everyone, but use our biofeedback tool to determine which position worked for each person.  This is patient-centered care because we treat each patient as an individual. ​

​I was introduced to biofeedback in other pelvic courses, but again, just enough to see different ways it was helpful.  I had my clinic get one and immediately started using it. I used it to teach patients how to kegel or relax. Then I saw that you could take a 5 day course, mentoring hours, an exam, and be certified through the Biofeedback Certification International Alliance (BCIA).  In fact, parents of children with pelvic dysfunction, were asking for a biofeedback certified practitioner. After going through this certification process, I understand why they want the certification. It shows them that I didn’t just get exposure of a machine, but have shown to be proficient in its use.
Biofeedback: a tool in your toolbox
Through the mentoring process I learned many more uses for biofeedback for pelvic floor dysfunction.  I learned to teach the patient how to use their muscles during tasks, functional movements, strengthening, coordinating a bowel movement breath, and more! These are things I have always taught, but now the patient and I could actually observe the muscle recruitment during the teaching.  I could adjust my cueing and teaching to fit that person.  

Not many patients walk into the office complaining that they have problems with their pelvic floor just laying in bed.  But lying on your back is the only position many therapists use the biofeedback in. I use the biofeedback in a toileting position, during the movement that makes them leak urine, and in poses to relax or strengthen.  It helps patients find out what their body is doing during the task that is most meaningful to them. Again, this is patient-centered care.    

What is biofeedback?

Biofeedback is a tool to help a patient change behaviors or responses. More technically, it is electromyography, EMG.  It measures muscle recruitment. That means if done correctly, it measures a targeted muscle when you activate it. If I put the surface electrodes (small stickers) on a muscle and ask you to squeeze or contract, the graph on the computer will show if you are able to contract the muscle.  In pelvic floor biofeedback we have the option of surface electrodes or internal sensors. This is always a discussion with the patient to find out what method they are most comfortable with.   


Am I appropriate for biofeedback?

Often a patient is told at a doctors appointment that they need biofeedback.  I receive many scripts that request biofeedback for muscle training. The doctor may have concerns about the patient performing the correct program.  Also, many gastrointestinal doctors have done testing that shows that there is incoordination of the pelvic floor during attempted bowel movements. This means the patient squeezes their muscles when they should relax, making it difficult to evacuate stool. 

Your first visit with a therapist is an evaluation.  One of the many things we look for is your ability to coordinate your muscles.  This means we have you contract, relax, and isolate muscles. If you are having difficulty with verbal and physical cueing, you may be appropriate.  

Research shows that almost half of patients being told to kegel will actually push and bear down instead of squeezing and lifting.  It is also common that patients will contract their abdomen at the same time and have difficulty isolating the pelvic floor. Also, a cause of constipation can be pelvic floor activation when the muscles should be relaxing.  

A pelvic physical therapist has special training to perform internal pelvic floor evaluations.  This internal evaluation provides us with valuable information to help you with your dysfunction.  However, it is so important for a therapist to present all the options for evaluation and treatment.  Not everyone needs or is comfortable with internal vaginal or rectal muscle evaluation. I like to inform each patient of all the information I can gather from each technique and let them decide.  It is their care, their body, and their decision. Surface EMG can offer the patient and therapist a look at activation and coordination and help their symptoms without any internal contact. Some patient populations that may benefit from biofeedback because internal contact isn’t possible include:
  • Pediatric cases
  • Cultural reasons
  • Victims of abuse/trauma
  • Severe pain
  • Fear
  • Immediately post op or post partum without clearance for internal
  • On pelvic rest
  • They do not want internal

Pelvic floor therapists need to be incredibly sensitive.  Our patients share with us things their family may not even know.  We need to build trust before many patients feel comfortable, if ever, with internal evaluation.  This does not mean they do not get therapy! I see a huge relief in many of my patients when I explain that they do not ever need to have internal treatment.  I tell them what I could do instead, and the pros/cons. Many of them choose biofeedback.  

What is a session like?

Prior to the biofeedback session, I discuss all the options.  First we discuss sensor options. Most of my patients choose the surface electrodes, but internal sensors are an option that can then be used for biofeedback and if stimulation is part of their plan of care.  If you are a child or have severe internal pain, the surface electrodes are used. These are placed peri-anally. That means on either side of the anus.   

I usually have my patient put their pants back on, or a gown if they prefer for the session.  We move around and the more comfortable a patient is the better the session. I will cue the patient through long or short squeezes, coughing, relaxation, bowel movement breathing, or whatever it is that we identified in the evaluation or we find on the biofeedback that needs to be addressed.  I try different cues, screens or tones to get the desired outcome. I often find that the patient can achieve the goal on their own by monitoring the screen. If you figure out a problem on your own, you usually remember it better! Many patients need just one session to get started, some patients require more.  It all depends on the patient because patient-centered care is so important.   

Are there side effects? Can I get hurt?

Patients need to know that the biofeedback detects your muscles’ activity.  No electrical charge goes into you during biofeedback. The machine will not hurt you.  Squeezing muscles repeatedly can create muscle soreness. Just like after a workout at the gym.  If increased resting tension is seen on the biofeedback and pain is associated with kegels, then I focus on muscle relaxation, physiological quieting, body scans, posture, etc.  But it is possible that you are sore from exercising the muscles.   

Courses and certification

There are several organizations that offer coursework for therapists.  My path took me to Herman and Wallace for most of my pelvic floor training.  I recently took a more biofeedback focused course from Biofeedback Training and Incontinence Solutions.  I have been fullfilling my mentoring requirements through Tiffany Lee from Biofeedback Training and Incontinence Solutions.   For information on coursework and mentoring, visit www.pelvicfloorbiofeedback.com.  The BCIA offers certifications in different fields of biofeedback including pelvic muscle dysfunction.  They require didactic course completion, mentoring, certification exams, and hours. Their website includes information for therapists hoping to become certified, as well as a board certified practitioner database for patients to locate certified therapists at www.BCIA.org.

Q&A for men: third edition

9/23/2019

 
Picture

While drawing from her clinical experience, Becca Ironside, PT answers specific questions from men about their urinary, bowel, and sexual concerns.

​This is Connect PT's second edition of the Question and Answer series.

​Question from Kirk: I am an avid bike guy. I go outdoor trail riding on weekends, over 60 miles, if the weather is good. On my weekdays, I do spin classes to stay in shape. I have begun noticing a dull ache in my testicles that won’t go away, even if I skip a day of riding. I went to my urologist because of my testicular pain. After some tests and an ultrasound, she said there is nothing wrong with my scrotum, but that I should lay off the bike riding. It is my favorite way to blow off steam after a long week at the office. Is bike riding related to my testicular pain? If so, do I have to stop altogether?

Answer from Becca: Kirk, I understand how distressing it is to have undiagnosable pain in your pelvis. While working in a pelvic floor physical therapy clinic, we treat men like you all the time. Your testicular pain may be caused by tension in the small muscles of the saddle region of your body. The nerves and soft tissues of the groin are delicate and often get upset when they are compressed, as they would be during prolonged sitting on your bike seat. In your particular case, these bodily structures are also being jostled around quite a bit, especially during your trail rides on bumpy terrain. Spin classes also present a particular strain on the saddle area, as you are likely raising your butt off the seat for increased resistance and then slamming your body right back down to a sitting position a few moments later.

Bike riding is your passion, and I wouldn’t want to rid you of something you like, especially if it is helping you “blow off steam after a long week at the office”. There are a few modifications that may help ease the pressure off your testicles and decrease your pain. Firstly, buy a seat for your trail bike that is specially designed for people with pelvic pain. There are many from which to choose, and they will often have a hole cut out of the seat, so that your pelvic floor will not be in contact with any surface while you ride. Secondly, when outdoors, try to bike on level surfaces for now. The rugged land of the trails is like riding a Jeep in the jungle. What you want to do to rest your pelvic floor muscles and scrotum is to travel on level terrain (cement), which will feel like riding your grandfather’s Cadillac with superb suspension. I know, it won’t be the same, but bear with me. Your testicles need this rest right now. Thirdly, if you are going to do spin classes, buy your own bike seat designed for pelvic pain sufferers, install it before a class, and avoid the alternating standing/sitting repetitions that spin classes are famous for.

In time, your testicles will heal and you may get back to the point when you can resume trail riding. Also, if you have the time, find a pelvic floor physical therapist. The tight muscles of your pelvic floor can be stretched and any possible soft tissue restrictions within your scrotum can be addressed as well. By doing this, you will be sending your testicles on a much-needed vacation and they will thank you for it in the future.

Question from Lou: My partner and I are fairly certain that we are done having children. I am considering having a vasectomy but am worried that something might go wrong. Can you tell me about this surgery and what I might expect if I get it in the future?

Answer from Becca: I understand that this is a major decision, Lou, and you are not alone in the vast number of men who consider this procedure and are held back by trepidation about what the long-term implications might be. Let’s start with the anatomy or plumbing in how all this works. The sperm of a male is stored in tiny little coil, called the epididymis, that is located directly above each testicle. That sperm waits until it is needed, and then travels from the epididymis down a long tube called the vas deferens. The sperm then mixes with seminal fluid and is ejaculated through the penis. (This is a highly simplified explanation, but you get the idea). The procedure known as the vasectomy entails cutting both of the long tubes that serve as a conduit of the sperm to the ejaculatory fluid.

The surgery involves one or two small incisions in the scrotum. The vas deferens is cut and a small piece may be removed, leaving a gap between the two ends. The physician then sears the ends of the tube, and ties little knots on each end. This is then performed on the opposite vas deferens. Afterwards, there may be one to two small scars on the scrotum which heal rapidly. Then, voila! This surgery is a 99% effective form of birth control.

​The recovery time after a vasectomy is quite short. You will need a few days of rest and some ice on the groin. After undergoing this surgery, many men are satisfied that they 1) no longer have to use condoms if they have a single sex partner and 2) do not have to burden their female partner with the more tricky forms of birth control, which do not offer as high a protection against pregnancy.

​There is a small risk of side-effects for this surgery, including the formation of a granuloma (a small lump of scar tissue where the vas deferens has been cut), though this is often not pain-producing. The sensation and quality of ejaculation will usually remain completely unchanged. I hope that I have answered your questions, Lou, and best of luck in making your decision!

Question from Sergio: I am in my mid-thirties and have a very high-stress corporate job. On the days when I work 12 plus hours, my girlfriend often wants to have sex late at night. I find that I take longer to finish and that my ejaculation is more like a dribble than the forceful explosions that I usually have. Is something wrong? What should I do about this?

​Answer from Becca: Sergio, this is a great question and a common cause of concern for men. It all boils down to the lives that we live today. Many men have high-stress corporate jobs. Which means they are under tremendous pressure for long hours, they are often sitting, and their tension is traveling down to the muscles upon which they sit. This is the perfect description of mild pelvic floor tension. Just as some people carry their muscular tension in their shoulders or low backs, you are storing it in your pelvic floor, Sergio. And these days, with the way that we work and live in our society, your need for increased time to ejaculate and the decreased power of your ejaculation are both incredibly common.

While it wouldn’t hurt to see a urologist to rule out any other problems, these sexual issues are likely caused by tightness in your pelvic floor muscles. In order for arousal to take place, the muscles of the pelvic floor should lengthen and allow blood to pool within the testicles and penis. If these muscles are tight, they may not be allowing enough blood into these tissues and erections may be less rigid. This would cause a delay in ejaculation, resulting in increased time to finish the job. Furthermore, that decreased blood flow into the groin would result in less pressure generated to create the “forceful explosions” that you typically experience, Sergio. A weak dribble of seminal fluid at climax may often result.
​
In summary, there doesn’t seem to be anything wrong here, Sergio, except that you are living in the world today. My suggestion would be to practice some form of stress reduction at the end of these long workdays. It could be as simple as listening to some calming music during your commute home. You might want to do some simple stretches on the floor or spend time with your girlfriend without rushing into sex late in the evenings. Finally, you could reschedule sex for early mornings or weekends. This would assist your pelvic floor in being more primed and relaxed to achieve the quality of arousal and ejaculation that you deserve.

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


A holistic view of pelvic floor health - Connect PT on the "Stay Healthy Mercer County" podcast

8/2/2019

 
Sit back and tune in to our own Michelle Dela Rosa, PT as she speaks on the "Stay Healthy Mercer County" podcast by Adapt Performance and Rehab. Learn what makes pelvic physical therapy different from other kinds of therapy, how there's help for pelvic pain, and that men have a pelvic floor too!

Click here to listen to the podcast episode.
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