Wynne Tezak is a physical therapist in Alpena Michigan (way up in the boonies). She is obsessed with, ahem, specializes in pelvic health. Through extensive community education she has been able to lure many unsuspecting citizens into taking control of their own bodies and health. Thanks to the EPIC scholarship Wynne and her fabulous PTA Sarah Schnell were able to attend the World Congress on Abdominal and Pelvic Pain, where they filled their brains to the brim and made valuable connections with leaders in the field.Read More
Though Kelly has left us, she's not forgotten... Here's her blog on her (almost) experience with Goat Yoga.
Chronic low back pain is a huge problem in the United States, and despite our best efforts, we haven’t really found an effective treatment for it… until now. Allow me to introduce the latest health and wellness technique: GOAT YOGA. It is yoga… with goats.
Why do so many people have chronic low back pain? It’s obvious. It’s because they aren’t doing enough goat yoga. “Can’t I do regular yoga?” you ask. NO. NO. ABSOLUTELY NOT. It’s not rocket science, people! It’s clear that the health benefits are from the pitter patter of tiny goat hooves on your aching back. Trust me, if you don’t have a furry grass-muncher sniffing your ear while you down dog, you’re not doing it right.
The theory is...
the goats have the perfect body weight to fur ratio to stimulate your muscles…and stuff. And also relax them if that’s your problem. While it’s true that nobody has checked out these claims “scientifically”, I can tell you that I am 100% certain that goat yoga will cure you. If it doesn’t, you probably aren’t committed enough to goat yoga.
To get the maximum healing properties out of goat yoga, you should go at least four times per week for the rest of your life. Goats from the farms of Wisconsin are best, but any regular old goat will do in a pinch. Just don’t expect as good of results. Make sure the goats are in a healing mood. If the goats aren’t in a healing mood, you need to come back later when they’re ready to radiate positivity.
Make sure your instructor is GOAT YOGA certified. If they are not, you will get nothing out of the class and probably feel worse for a long time, possibly forever. Make sure you ask to see their Goat Yoga certificate for the 18 courses they had to take to become a Goat Yoga instructor. If they try to tell you that they don’t need the certification to release a goat into a field while you’re doing yoga, they are SERIOUSLY MISLED and you need to get away before all of your discs slip.
By the way, I am a certified Goat Yoga instructor and would love to take your money I MEAN CURE YOUR BACK. Sign up now!
PS: Goat Yoga actually does not make any of these claims and I made this whole thing up. Goat Yoga is probably really fun and silly!! Try goat yoga if you want, or don’t.
**It came to my attention today that I prematurely called her 'Dr. Kelly Newman'. My apologies for this error. I do know that Kelly has completed all of the didactic and clinical work for graduation, as well as passed her boards and secured her first job as a physical therapist with a clinic that will not disappoint her. We're super proud of her ability to critically think, and not be seduced by things like certifications and 8-step training programs. So, Kelly, we're really proud (even though you're not a doctor just yet) of what you're going to contribute to our profession. Please continue to have fun, love what you do, and DTS. Love, Sarah and Sandy
Most people can agree that having a pelvic floor that does its job is desirable, many people struggle with knowing how to optimize their pelvic floor muscle function.
The opinions about how to do a pelvic floor contraction, how many you should do, and why you should do them vary dramatically.
So what is a lady to do? There are an abundance of items that offer to help improve pelvic floor strength, cure incontinence, and give you better orgasms! Sounds like a win-win-win ! So why aren’t we all continent and having fantastic orgasms? This post will address the various products that are out there for ‘pelvic floor strengthening’. These products range from vaginal weights, Ben Wa Balls, vaginal barbells, electrical stimulation machines, to biofeedback machines.
While some of these products work wonders, some women discover that the device they’ve chosen don’t work for them. Why might this be? I propose 3 simple possibilities:
1) The device is not addressing the issue that needs to be addressed.
2) The device is being used improperly.
3) The device is not being used.
The pelvic floor muscles are just that: muscles. To function properly, the muscles need to be properly innervated, have good coordination ( the ability to contract and relax), and adequate strength.
I’m skeptical by nature about ‘new’ products, and the idea that they can really help a woman improve her pelvic floor function. (Notice I said ‘function’, NOT strength). I’m skeptical, but I have my reasons - I've been a pelvic floor Physiotherapist for over 10 years now. I've watched products come and go. I've also helped clients sort through the products online, trying to find the one that would make working on their pelvic floor fun and effective. I've also chatted with those people later, and even if their pelvic floor issues have resolved, they admit that they've not used the product that they had invested so much time and money in purchasing.
Any of the devices I mentioned, both the weights and the biofeedback, can be used improperly. Weights don’t work well if you don’t know how to contract your pelvic floor properly. Biofeedback typically works one of two ways – via EMG (electromyography ) or using pressure. Both of these devices typically involve inserting a sensor (hard plastic or a air-filled balloon), which is then connected to a handheld monitor via a cord or tube. If the set up already sounds a bit complicated, it can be. Getting the sensor positioned properly, making sure all of the wires are connected, and get the monitor into a position where you can see it, and then start to actually do your pelvic floor contractions can be time and effort intensive for some people.
Once everything is situated and you’re ready to work, you need to consider what information you’re actually seeing about your performance. EMG biofeedback units will show you the relative change in the electrical activity in your pelvic floor muscles. This sounds high tech, but unfortunately it’s not as scientific as it may sound. These units utilize surface electrodes that are inserted into the vagina (or rectum). This means that the information is general – it’s not necessarily the muscle activity of the pelvic floor, but a general report of the activity in the area. There are several ways to get inaccurate readings, which may lead women to believe they are performing better (or worse!!) than they actually are.
Pressure Biofeedback has challenges as well. There are many variables that can skew the readings of a vaginal pressure biofeedback – holding one’s breath or pushing down (instead of contracting the muscles) can all give the appearance of a pelvic floor contraction.
Even if these devices were highly accurate in giving feedback regarding pelvic floor muscle function, the cumbersomeness of set up and multiple components to keep clean would challenge even the highly motivated consumer.
So is there a product out there that I would recommend to my friends and clients? There is now! I’d like to introduce you to Elvie!
Again, I tend to be a skeptic. I was given an Elvie to try from the brilliant ladies at the Women’s Health Foundation.
I opened the box, and I’ll be honest – it’s adorable. Simple packaging, and the device itself is sleek and elegant. Elvie comes in a little storage container, which is also the way you charge the device. I was impressed so far….
But how does it work?
I charged it up, and downloaded the app to my iPhone. There were just a few steps to set up the app, and I was ready to give this a go.
I settled into a treatment room, and started to follow the instructions on my phone. Once the Elvic is inserted, it sets about connecting to my phone via Bluetooth. NO WIRES!! I can move around comfortably without worrying about yanking anything out or breaking expensive equipment. I can even stand up and move around a bit!
I’d like to speak for a moment about the comfort of Elvie. It’s covered with a medical grade silicone (so no latex!), and was so comfortable. The size for me was comfortable, and many women would be able to accommodate the device as is. However they also include a silicone ‘custom sizing’ sleeve in every unit. More on that later.
Comfort and convenience? Check
Not scary or hard to use? Check
But does it actually work?? In my opinion – yes. Very well, in fact.
I was taken through a set up phase, and then my first work out. I appreciated the fact it was assessing both endurance holds, as well as ‘quick flicks’. We were off to a good start, but it got better….
During the long holds, I tried to cheat. When a contraction is done properly, there is a red gem that is lifted. It sets your ‘goal’ during the set up, so you have a target to hit. I wanted a good grade, so I did my best on the first few reps. Now to see if I could fool Elvie…. I squeezed my knees together. I pulled in my ads. I held my breath. I pushed down. The only way I could make that gem move was by doing a proper contraction.
I was further impressed when I moved onto the agility portion of the training. Reminiscent of Space Quarks (a video game of my youth), red gems streamed across the screen, and it was my job to contract at the right times to hit those gems. It was a really good challenge, but the feedback I got was amazing…. Guess who wasn’t relaxing all the way between contractions? This girl. Guess who encouraged me to relax more? Elvie.
My most consistent complaint about pelvic floor contraction (or Kegels) is that the emphasis tends to be on the contraction. The other units don’t really give accurate feedback on relaxation, and there are no norms. I love that Elvie takes into consideration that the relaxation is just as important as the contraction in a healthy pelvic floor!
At this point, I was very impressed with Elvie. So impressed that Sandy and I agreed to meet with a representative, Hannah, from Elvie. What I learned about the product and the company only increased how excited I am about this product. My 2 favorite points? 1) Elvie comes with a ‘custom sizing’ sleeve, for women who may need a slightly larger device to stay in place. The sleeve is included with each unit. The thoughtfulness of this almost brought me to tears. Hannah explained that there were 2 women in the testing groups who were more comfortable with a slightly larger device. They developed the sleeve, and decided to include it with every unit, rather than creating a situation where a woman would have to request a larger size. Pelvic health can be awkward for some women, so I’m grateful they’ve removed one barrier for women to get a device that fits appropriately.
2) During my attempts to cheat the results on Elvie, I did not know that if I cheated enough, Elvie would recommend consulting a pelvic health physiotherapist for some assistance before continuing the program. How amazing that a device has been developed that not only figured out a different way to measure pelvic floor strength and coordination, but to also to recommend whom to seek help from. You’re not sick if your pelvic floor doesn’t work well. You just need a person who is an expert in pelvic floor function to help guide you, and that person should be a pelvic floor physiotherapist.
Has the Elvie been extensively studied in pelvic health? Do we know long-term outcomes? Not yet. But they are gathering data, and working with health organizations in the UK to improve pelvic health on a larger scale. The design is elegant, clean (literally and figuratively), the set up and use is intuitive, and the method by which the pelvic floor performance is assessed is advanced far beyond what other pelvic floor biofeedback units have to offer. I can say happily that is this is the first device for pelvic health that I’m truly excited about on every level!
You can learn more about Elvie on your own at their website. If you'd like to see one in person, they were nice enough to give us a demo unit to have at Entropy! Shoot me an email, and I'm happy to show you how it works! We've even been given a code to give you $20, if you decide to try one out yourself! A pelvic floor therapist can help you learn what you need to do to address any of your pelvic floor concerns, and if you need any other interventions before using Elvie. We're happy to offer guidance, if you feel like you need some! Good luck!
Thanks for reading,
I recently had the good fortune to be one of the participants to attend Low Back Pain- Patient Experience Start to Finish at Entropy Physiotherapy & Wellness in Chicago, IL. My co-worker Sarah and I were so excited for the inaugural presentation of this course lead by the venerable, Jerry Durham and the energetic, Jeff Moore. And we were very excited to see Entropy and the culture Sarah and Sandy had created.
Anyone who knows me well and my history may find it odd that I ended up at such a course. I am an SCS, a sports guy, and have spent the vast majority of my career in an ortho/sport setting. In 2009, I left the employment of a company who was the preferred provider for a major league baseball team, parlaying that gig into a business of coordinating off-season training and overseeing post injury rehab for MLB and college baseball players. At that time, I had also interviewed for the minor league rehabilitation coordinator position for an MLB team, so by all accounts my career path was crystal clear… I was going to be working in professional baseball. If you’d told me then that I’d eventually sit in a class and learn the nerve density of a certain part of the female anatomy (and how that somehow connected to a low back and patient experience course) I would have called you nuts.
But this speaks to the winds of change that are blowing in health care. Jeff said it best, declaring that the time is now! Different professional worlds are colliding as PTs and other providers are collaborating to address the changing landscape of direct referral, payment models, and population health. And at the center of this movement is a renewed focus on the patient experience and establishing a therapeutic alliance between patient and provider: Relationship-Centered Care.
This is the essence of “Physical Therapy 2.0”. For me, this weekend exemplified change and a sense of momentum incomparable to any other professional course I’ve attended. It was truly transformative. Ask any of the folks in attendance and I believe they would all say the same. Regardless of how we were each interpreting the experience, there was a state of collective flow where we were all vibrating at the same frequency. Whether it was opening a business, moving across the country, or trying to disrupt the medical industrial complex, there was a communal sense that we were all pulling for one another. Jeff’s daily motivational recaps had us so charged up I mimicked flipping the table over, but I was seriously amped and just ready to treat people. Ann Wendel connected the dots even deeper noting that we are patients too. We have a personal and professional connection to relationship-centered care. As a profession we are positioned best to lead this change.
Jerry took us through a great customer experience journey and emphasized taking the patient/customer through an emotional experience.
Sarah and I drove home with non-stop chatter. Solidifying the vision of what our model of care can become. WE had been taken through an emotional experience and it will have a great impact on how we move forward with our clinical practice. We felt we had gotten so much more from the course than we ever imagined. We finally had a name for what we were discussing all those hours and trying so hard to describe before we realized there were other like-minded PT’s out there having the same thoughts and feelings. We felt a kinship in the room and had the support of everyone there.
Seven years ago I treated mostly athletes. Now I treat people. Not TKA’s, or ACL’s, or LBP, but PEOPLE! ! I never landed my professional baseball job and I live in a place I never thought I’d end up but I’m more excited, energized, and focused than ever to be part of a profession as awesome as Physical Therapy, and so prepared to take on the coming wave of change. Thanks to Jerry and Jeff for leading the charge this weekend. Thanks to the group of early adopters who were ready to see things differently and to do their part. Thanks for their collective mentorship and guidance. Finally, thanks to 2 pelvic health specialists who opened their doors to welcome this change and to help us all think outside the “box” (pun TOTALLY intended).
Until next time,
Jason Robinson is a Board Certified Sports Physical Therapist, Performance Enhancement Specialist, Certified Strength and Conditioning Specialist, and overall functional movement expert and enthusiast. Jason employs his movement-based practice in a variety of settings. He is currently a Senior PT for Midwest Orthopaedic Institute (MOI) where he sees patients with a wide range of orthopedic and sports-related injuries. He is also an adjunct lecturer for Advances in Clinical Education teaching a course titled Rehabilitation Across the Lifespan, which highlights concepts to help people recover from injury and move robustly and eloquently throughout life. He has an extensive background in baseball having worked closely with the Texas Rangers Baseball Club and still coordinates off-season training for both amateur and MLB clients. He is also a consultant to the Northern Illinois University Athletic Department serving as the team Physical Therapist for baseball, softball, and volleyball.
My opinion and views have changed quite a bit over the last 10 years about Continuing Education. I’ve always loved learning, and for years I couldn’t tell you how many CEUs were required in Illinois because I attended every course I could. I always had more than enough, and it was never about just ticking off a box.
It was a bit fortuitous this morning as I’m working on the schedule and website for Entropy Physiotherapy and Wellness’s Continuing Education offerings that 2 pertinent tweets popped up in my Twitter feed.
The first one was from David Pulter (@orth_DavidP), sharing this piece from the PT Journal published in 2001! The Editor’s Notes by Jules M. Rothstein laments the quality of CE offerings, comparing CE purveyors as ‘modern-day revivalists, moving from community to community with zeal and a polished act that seduces the listener’. What is the most depressing part of that statement (other than the fact it’s true in many cases) is that after each course, 40 disciples leave that course and spread information that is enthusiastic but often poorly researched at best, and implausible or misleading as a less beneficial outcome.
I feel confident saying that, because Sandy and I have both experienced the process of getting ‘approval’ for courses we host at Entropy Physiotherapy. We’ve attempted to get the courses approved through ProCert. I was at first rather excited about what appeared to be a rigorous process. However, my hopes were dashed as we looked over the example they gave to assist in filling out the complicated forms. The example course? Using therapeutic ultrasound. Yep, ultrasound.
While there are still administrative hoops to jump through to make the CE courses at Entropy ‘count’ towards fulfilling our licensure requirements, everyone needs to be aware that the ‘stamp of approval’ is NOT an indication of quality. The processes are in place to be sure that the therapists taking the courses understand what will be offered. These processes have nothing to do with the level of evidence or plausibility or even quality of the course. Those determinations are up to the individual therapist to make.
This leads me to the latest blog by Adam Meakins. ‘Who is fit to teach?’. It’s a great question. In my time as a Physical Therapist, I’ve certainly gone through some phases here. I started out as a wide-eyed believer. Obviously if someone was able to get 40 people to pay $450 for a course, they must know what they’re talking about, right? I didn’t question much back then.
But now I’m old, and I question everything. So what do I look for when I’m going to be spending my money on continuing education? I’m looking for someone who is well versed in the latest evidence (even better if they’re involved in the research!), and someone who is willing to have an honest discussion about what we know and what we don’t know. I’m not looking for someone who is a ‘guru’…. Because those don’t actually exist unless you suspend your ability to critically think.
So who IS fit to teach? Adam doesn’t limit it to the people with the highest degrees, the most publications, or largest social media presence. The best teachers have passion, personality, respect, and are able to present their material while having fun. The best teachers inspire challenging questions and critical thinking. The best courses do not provide rigid protocols or elaborate rituals, instead they give the clinicians skills to thoughtfully evaluate and treat a person with unique goals.
So what is the point of this post? Mostly to say learning is good. But not all learning experiences are created equal, and sometimes all you learn is what not to do.
Entropy Physiotherapy has solved our continuing education frustrations by collecting clever speakers from all of over the world, bringing them to centrally located Chicago, and hosting small classes in a comfortable environment. We would love to hear your thoughts on what we're doing, and how we could do better!
Note from Sarah- Today is the first day in 2 months that Nate Mancillas won't be heading to work at Entropy. We will miss him, and this post made my eyes water just a bit. Luckily Ryan Smith will be there to soften the blow... Here are Nate's thoughts on his time with us at Entropy.
When I first began my clinical at Entropy Physiotherapy I didn’t know what to expect. If I had to guess before I began I would have thought my experience would just be anatomy, internal manipulations, and incontinence. While my time here did entail some of those things, it was so much more
I was able to attend continuing education courses that I felt were just as, if not more in some cases, beneficial than days spent in the clinic. I got to interact with world-class therapists and researchers and learn from them first hand. I was given the opportunity to network with them and connect with them outside of a clinical or conference setting.
I was given the best education on pain science a student could ask for. I learned the what, where, when, and why, and how of pain in my 10 weeks. I admit I still have a long way to go on pain science, but this clinic has taught me I need to educate others on pain, which is an awesome starting point.
Beyond all of these great things, I got to learn from two of the best physical therapists in the world. The way Sarah and Sandy run their business, treat their patients, and represent the profession of physical therapy is among the best I have ever seen. They treated me with respect and kindness. They were never condescending and always willing to answer my questions. I haven’t even mentioned how funny they are, but I never went a full day without a good laugh.
With all this glowing praise, you might think this was a cakewalk, but it was quite the opposite. I had my lines of thinking challenged and anything I would say had to be backed up by evidence. If I could not provide this evidence, I would need to do a bit of digging on the topic and come back with a suitable answer.
I would not trade my time at Entropy for anything. Even though I am sad to leave, I know that my time here has been invaluable and I am a better physical therapist walking out than I was walking in. Thank you Sandy, Sarah, and Ryan. I’m sure I will see you again.
Follow Nate on Twitter! @NateMancillaSPT
When you are experiencing pelvic pain, or pain of any kind, you may go through a range of emotions and more than likely will have a lot of questions ranging from “Why am I in pain?” to “Is this going to get better on its own?”. These are not easy questions to answer, and finding support and the right person to ask them to can be very difficult. The following are great resources that you can use in a variety of ways. You can use them to vent about issues, get advice on a range of topics, or offer your support to others dealing with pelvic pain. Just remember that these websites are not run by health care providers so be sure to consult with a medical professional before beginning any sort of treatment recommended.
Reddit calls itself “The front page of the internet” and is described as a “social, news, entertainment network”. If you just browse the site casually you may not think it is the best place to share your experiences with pelvic pain. However, if you dig a little deeper you can find communities like “Chronic Pain” or “Pelvic Floor” full of supportive people who are happy to share advice on things such as tips for staying warm in cold weather to advice on post surgery recovery.
You most likely have a Facebook page, and while it is great for staying up to date with friends and family it can also be a great way to connect with others living with pelvic pain. Like Reddit, there are many groups whose, members offer support and advice on pelvic pain related topics. Groups may even have meet-up events so you can connect face to face with others with pelvic pain.
Twitter is another social network that allows you to connect with others in similar situations. Using hashtags (the # symbol) you can see who is tweeting about things relating to your pelvic pain. Popular hashtags for those who have pelvic pain include #pelvicpain, #pelvichealth, #pain, and many others. You can reply to people who use these hashtags with advice, questions, or just to offer your support. Just make sure to keep it brief as 140 characters goes quick! Make sure to follow @SandyHiltonPT, @SarahHaagPT, and @EntropyPhysio once you get set-up.
The internet is a great place to find support, if you find the right communities. The communities mentioned here is not an exhaustive list, but it does include places whose members are active and helpful. Make sure to contact Sandy or Sarah at Entropy Physiotherapy so they can answer any questions you may have and help you resolve your pelvic pain.
Nate Mancillas SPT, MS
Warm red leather with great traction and no concern for rain or snow, my favorite boots sit in the corner of the closet, the soft tops sagging into pouty folds. They were benched last winter after a rough year of ankle sprains, soreness and nagging foot pain. “I’m good as long as I don’t wear heels or my boots.”
The new normal isn’t normal.
- Give up the favorite boots or heels and that foot pain is gone.
- Don’t turn your head as far and your neck doesn’t hurt.
- Move the dishes to the lowest shelf and reaching isn’t a problem.
- Take the elevator instead of the stairs and then you won’t be out of breath.
- Stop running and that little leak of incontinence is gone.
Clever adaptations and life can go on undisturbed. Silently and surely losing out on things you once did, things you loved to do that kept you feeling strong and healthy.
The signs of the inevitable decay with age?
NO! Absolutely not.
Let’s turn this around and create a NEW NORMAL where you take back the things you love!
When you notice that you’ve stopped doing something to avoid a pain, pinch, stab or ache you take that warning sign as a chance to change instead of to avoid? What if you design a plan that identifies the challenge and sets clear, measurable steps for reclaiming what you love to do?
What if you find the sore spots as opportunity to improve and erase them, while still doing what you love to do?
Run Climb stairs Play tennis Lift weights Reach the high shelf Get up and down from the floor Wear those gorgeous boots! Dance Laugh
Don’t give it up. Make a plan. If that’s hard, intimidating or if someone (including you) has told you it’s not possible, please give Sarah or Sandy a call… we’d love to help you change the story! Resilience is great… thriving is even better!
Thanks for reading,
Physical Therapy, or physiotherapy if you’re not from the United States, is a branch of healthcare that specializes in helping people have less pain, increase function and safety, and prevent injuries. If you’ve never experienced Physical Therapy in any way, it can be hard to guess what is in store for you. That’s not surprising, because the profession of Physical Therapy covers every age, and a number of settings. Physical Therapists work in outpatient clinics, hospitals, in people’s homes, and on sidelines at sporting events. Some of us use our hands, others use exercises, some even use needles! We use a multitude of techniques, for a wide variety of issues.
So what do you need to know about going to Physical Therapy?
What to Expect:
- For your first visit, you’ll have an evaluation with your physical therapist.
- This will include a medical history, a history of the problem you’re there to address, as well as a physical exam.
- You should feel like your physical therapist has listened to your concerns and beliefs.
- Expect lots of thinking and learning!
- You’ll learn about your condition, and what the plan of care will be.
- Your PT should be able to answer these five important questions:
- What is wrong?
- How long will it take to get better?
- What can you do for yourself to help get better?
- What can the PT do to help you get better?
- How much will it cost?
- Expect teamwork!
- Your PT isn’t your boss. Your PT is your teammate in helping you reach your goals.
- Expect to get better!
- If you’re feeling worse or no change, make sure to communicate that to your PT.
- Expect homework
- Going to PT should be fun and productive! But you’ll need to be working more than 2-3x/week if you’re going to have lasting change!
- Expect to feel empowered and independent!
- Going to PT is about you getting back to your life, not becoming really good at coming to PT, or the program your PT came up with.
What to NOT Accept:
- Do not accept coming to PT and then being left alone!
- You should be under the care of a Physical Therapist or a Physical Therapy Assistant when you’re taking the trouble to attend (and pay!) for your visit.
- If you can do all of your exercises on your own, you are either done with PT, can do them at home on your own, or need to be given the next exercise!
- Do not accept confusion or a lack of understanding why you’re doing what you’re doing…
- Whatever you do in therapy, or as part of your home program, should make sense to you!
- If for any reason you don’t understand why you’re doing what you’re doing, it’s the job of your PT to help you understand!
- Do not accept being bored.
- If you’re doing the same thing over and over, and you don’t feel like you’re progressing – Say something!
- Do not accept ‘Just lying there’
- Manual therapy is great! But to regain function, you’re going to have to move!
- Manual therapy can support movement and give you relief and confidence to move, but it is the movement that is the magic.
- Do not accept getting WORSE!!
- Lots of people come to PT for help with pain. It’s illogical to think you need to hurt more to hurt less, so if your PT tells you hurting more is ok, it’s perfectly acceptable to disagree! There are other PTs out there who can make you hurt less!
- Whatever you do in therapy, or as part of your home program, should make sense to you!
- You should be under the care of a Physical Therapist or a Physical Therapy Assistant when you’re taking the trouble to attend (and pay!) for your visit.
Physical Therapists are not all the same, and sometimes you don’t meet your dream therapist on your first visit. It’s ok to ‘break up’ and look for that therapist that will make your dreams come true. The most important thing to remember about going to physical therapy is that your Physical Therapist is there for YOU.
Having a baby is usually a joyous time of celebration.... We see it all the time in movies: a new mum wearing her skinny jeans with a perfectly happy baby perched on her hip, heading to the park or out around town. This is what it's supposed to be like, right? New mothers are all too aware that this isn't actually the way it is... Bits of you hurt that you didn't know existed. Picking up the baby, not to mention the diaper bag, can be a challenge! Holding your bundle of joy to feed him or her, as well as snuggle and comfort them can leave you with achy shoulders or tender wrists.
Getting back to exercise can also be a challenge! Once you manage to find time to go exercise, you may find that your muscles aren't working like they used to, or that maybe you feel a little pressure in your pelvis with exertion. Maybe you're noticing that little leak of urine that maybe your mom or your friends mentioned... There is much of this that is common after having a baby, but it's not normal.
There is help. Even if your doctor told you 'it's normal, and will get better on it's own', a Women's Health Physical Therapist can help you manage or eliminate any of the uncomfortable bits of motherhood.
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P.S. It's never too late!! Even if your baby has a baby of their own, if you've been dealing with issues since pregnancy or the birth of a baby, there is help! Contact the Experts at Entropy Physiotherapy today!
Hey Fellas! This one if for you! Prostatitis is one of those diagnoses that may be given to a man who is experiencing discomfort 'down there'. Men with this diagnosis have described their discomfort as pressure, burning throughout the saddle region, of 'like sitting on a golf ball'. Functional complaints range from decreased stream when urinating, urinary frequency or urgency, 'never feeling empty', as well as various forms of sexual discomfort and dysfunction.
Usually the diagnosis of prostatitis is made by a urologist. A very common course of care is a combination of antibiotics and Flomax. The antibiotics are to treat any infection that may be causing the inflammation. The Flomax is to relax the smooth muscles in the urinary tract to improve urine flow. When this works - it works!! Unfortunately when it doesn't work men are left wondering what they can do... or resign themselves to just dealing with their complaints on their own... or taking antibiotics again and again. The worst thing is when you're doing the things you're supposed to be doing and it doesn't help.
If you'd like to read more about prostatitis, you can check out this blog post.
If you'd rather, you can check out this short video.
[embed width="320" height="240"]https://youtu.be/eA_GYqAbFOo[/embed]
I appreciated your kindness in making sure I had my seatbelt on. And the humor about directions (you were right, it was the Northeast corner). Your conversation about weight loss and getting shorter as we age was fun (keep moving and Pilates is a fine choice if you like it).
But that thing just as you stopped at my place – we need to pull that apart, and I hope you do come to read this. For the rest of you, it went like this:
Cabbie: You’re a PT? Do you know anything about stiff muscles and trigger points? Because I’ve been told that I have this thing wrong in my neck that is Myofascial trigger point something or other and that it will take a lot of treatment to get better.
Me: I know a bit about that, what else did the person say?
Cabbie: Do you know ____________ ? She told me I need Saline solution injected into the trigger points and maybe cold laser. But it’s expensive and she said it would take a long time to help and I’m not sure.
Me: No. Don’t do that. There’s not good evidence for it, and there are better (more effective) ways to get you feeling normal – and most importantly, things you can do for your self so that you don’t need multiple visits for lots of money.
<I wrote the clinic information on the back of my receipt – I hope you do call!>
Cabbie: Can it really get better without injections? She said the trigger points are making it so the muscle is touching some nerves and that is bad.
Me: Please call me! I HOPE the muscle is touching those nerves, since they run through the muscles and are hardy things. I can help you, without injections and teach you how to take care of yourself.
He drove off, and I am sitting watching the sun set thinking how wrong and indefensible it is for health care practitioners to be selling such unfounded stories to people who should instead be helped honestly and kindly. Saline injections have no evidence to support their use. There’s compelling evidence that we should all toss the term Trigger Point (Travell and Simons did NOT do proper study and there’s a recent chapter about pelvic trigger points where the author clearly states that Simmons and her “extrapolated” the pelvic trigger points… ) See this and this and this.
I promised him that I could help him learn to take care of himself and that if he didn’t see positive change in 6 visits or LESS, that we would not keep going. It’s Easter. Let’s hope for a miracle and a shift in health care away from celebrating passive treatment and words designed to create passive (and fearful) patients – let’s aim for active change and self-empowerment. I’m all for gentle, kind manual therapy to unstick the stuck spots – and for teaching people how to do that for themselves. For cabbies (and everyone else).
It was a crisp 22* F (-5* C) and the local Starbucks had a small walk –up window open for hot drinks and food. There were three baristas closely tucked inside with a space heater, coats, gloves, smiles, music and laughter. The milk and cream station was boldly out on the icy sidewalk. Renovation had started that day, complete with piles of material visible through the windows as I walked past with my latte. Aren’t we all “Open During Renovation”? I mean, it’s not like we get to stop when it’s hard to keep going, we just get to rest a little. But we persevere through and do the work and renovation as we go.
Staying open during the construction was a brilliant plan, I stopped there for coffee because of the perseverance and good cheer of the frozen baristas. Renovations are messy. They usually take longer and cost more than you think they will. And the end result often looks nothing like you planned. Eventually though, it’s over.
I imagined how it works inside us – construction happening in our own renovations as we try to stay cheerful and open. I had this picture of a brain with a little walk-up window, some scaffolding, and tiny baristas doing their best with bottles of cortisol, dopamine, serotonin, pro-inflammatory mediators “What are you ordering today?”
For me, I prefer an Extra Shot of Dopamine and Serotonin, usually getting those with an order of Hope and Possibility. Laughter is my favorite anti-inflammatory*. I’ll take a Grade Latte with a double shot of Resilience!
What if that’s really how it works? Physical Therapists like to tell people to keep moving. Moving sometime hurts, or you just can’t do it “one more time”. Rest a bit, take a couple of easy breaths** and give moving easily another chance. You are stronger than you feel. You are resilient, and resiliency gets better with practice (everything does, even feeling crappy). The flare-ups and dark-downs are not permanent, though they may feel like they are when you are in the midst of them.
The Frozen Baristas at the local Starbucks may have felt like they would be stuck in that little walk-up forever, the charm may have worn off as they lost feeling in their fingertips… but the newly polished store is once again fully open and shining!
What will you order today?
* Poetic license. It’s not quite that simple…
** Why Breathing? Persistent pain and challenges that go on too long can make it hard to feel or pay good attention to your body. You may have become accustomed to the tension and guarding you’ve used for so long that you don’t realize anymore that you are doing it. It’s become normal. Or maybe you’re not bracing or guarding anything at all – but to keep going through your own renovation you’ve stopped feeling or even being aware of a part of you, you’ve “put it somewhere else” so that you could keep going. Both of these are great short-term tools – but they aren’t supposed to be permanent! Breathing mindfully can help you take an imaginary walk to and through parts of yourself that need some kind awareness and timely attention.
This is an update of a blog we posted last year.... It's exciting that we didn't have to change much, as Neil will be returning to Entropy in July 2016!! If you missed him last year, don't miss him again! Neil O'Connell will be popping across the pond this July to hang out in Chicago, and come have a chat at Entropy Physiotherapy. Sandy and I have invited Neil to come and help us understand how to not just read, but interpret 'evidence' correctly. You don't have to go far into Twitter, Facebook, or any number of blogs to see 'evidence' thrown around to support a chosen view. But how can you tell if the evidence is sound? Reading the whole article is a good place to start, but understanding what makes a study strong is a whole other level. Neil will help us understand how to tell if that study is any good, if it can support the claims the conclusion makes, and how to apply the study to true 'evidence based practice'.
Also, there will be a headstand competition... Neil kicked my butt in Buenos Aires (I will NEVER again underestimate my opponent), and he totally called me out by name on CynicalPT's blog. So in case you needed another reason to come have a great weekend at Entropy, you can see the rematch of the year: Dr. Neil O'Connell vs. Sarah the PT in a headstand challenge! I've had another year to train.... So this one will be epic.
You can sign up now and reserve your spot! We're keeping the course small, so there's plenty of time for arguing/debating the finer points of evidence in the world of PT!
See you there!!
Pelvic Pain can be hard to deal with. The amazing amount of information (both good and bad, accurate and inaccurate) can be overwhelming. How do you wade through everything and find the help that is right from you? Here are a few suggestions that you may find helpful. Remember: If you feel scared or hopeless, you’ve just not yet found the right person to help you.
Healthcare can do better....
This weekend I had the good fortune to attend a wonderful course, Comprehensive Management of Bowel Dysfunction. As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging. And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.
As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam. That’s right, even the rectal exam.
It got me thinking about what my patients go through on their quest for health. The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful. Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?
In our clinic, we’ve started referring to these as ‘medically induced conditions’.
We unfortunately see this often. Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments. Why does this continue to happen?? Is it necessary to ‘get worse before you get better’? Is it necessary to endure further testing? Here are some thoughts and questions for patients and clinicians to ponder. I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions. I hope it makes patients speak up if they’re being hurt.
- If you poke anything hard enough, it’ll probably hurt. This goes double for poking into any orifice.
- Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person. Especially if the person has already told you, ‘it hurts if this bit gets poked’.
- Testing should be done to help rule out red flags, or to help direct the plan of care.
- Patients should understand why they’re having a test, and understand how the results will impact their plan of care.
- Clinicians should take the time to make the healthcare experience better. Make the patient comfortable. Take the time to explain what you’re doing. Take the time to answer the questions. Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
- If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them. Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
- If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.
I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions. There are a lot of us who also fancy ourselves to be wonderfully qualified: specializations, advanced degrees, conference and course attendance trying to acquire new knowledge, new skills, and new evidence to educate those patients. Professional development (heck, learning in general) should be life-long. However that knowledge should not replace common sense and good manners.
Even after 3 kids. Even after menopause. Even if you didn’t know how awesome it is.
As a pelvic health therapist, it amazes and saddens me that in 2014, women are still ashamed, self-conscious, and confused by their lady bits.
I’d like to address a few of the myths and inaccuracies that I’ve heard, in and out of the clinic…
1) It can be a challenge to see your vagina. – The vagina is essentially a hallway from your uterus to the outside world. It’s a hallway that can stretch. A lot. If you can see your vagina without trying, you might want to see a physician… Vaginal prolapse can happen, and it would need to be addressed.
2) The parts you can see vary much from person to person. And I’ve never seen an ugly one. - The first thing most of us run into if we’re to take a peek at our genitals is the labia majora. If we separate those, we’ll be able to see the labia minora, clitoris, as well as the vaginal opening. These bits do change with arousal, childbearing, and age. If you’re curious about what ‘normal’ is, I recommend the documentary The Perfect Vagina.
3) The vagina is not the same as your pelvic floor. – The pelvic floor muscles are a group of muscles that are located in the bottom of your pelvis, spanning from your pubic bone, to your tailbone, and out to each ‘sits bones’. The pelvic floor has 3 openings for us ladies: (starting from the front) An opening for our urethra to urinate, an opening for our vagina (for sex and childbirth), and finally our anus for defecation. The pelvic floor also plays a role in respiration and core stability. Bladder, bowel, and sexual function can all be impacted by pelvic floor muscles that are not functioning up to par, which brings us to my next point.
4) Having a baby can greatly impact the function of your pelvic floor muscles. There’s much to say about this…
- If you give birth vaginally, you’re pelvic floor muscles stretch more than any other muscle at any time in your life. It is one of the wonders of the world that a woman can pass a child through her pelvic floor, and more often than not, regain fairly good bowel and bladder control quickly, and resume sexual activity in as little as 6 weeks.
- If you give birth via C-Section, you did not get the ‘easy way out’. Studies show that pelvic floor dysfunction (bowel, bladder and/or sexual dysfunction) are just as high in women 12 months after a C-section as they are in women who have a vaginal delivery.
- Some women recover more quickly than others. Some women just think they’ve recovered. There are several common things that women experience after childbirth, such as incontinence or painful intercourse. These are certainly common, but should not be considered ‘normal’, and therefore ignored. There is much to be done to improve these symptoms, and I’d seek out a qualified pelvic health therapist to get an assessment as soon as possible.
5) Even if you haven’t had a baby, it’s ok to get help for pieces that don’t seem to be working as well as you’d like. - Sometimes things aren’t as good as you’d like. Yep. I’m talking about sex. Lack of enjoyment, lack of desire, lacking the ability to have orgasms… These can be more complicated, but not impossible to address. Identifying the different pieces that may be contributing to the situation is key. There are physical, medical, mental and emotional issues that can contribute in various ways to sexual dysfunction. Understanding what your bits are, and what they’re supposed to be doing can go a long way in decreasing fear and anxiety relating to sexual dysfunction/lack of enjoyment.
If you find yourself in a situation where you don’t love your vagina, get help. Don’t assume nothing can be done, and don’t suffer in silence. If you’ve not had a physical lately, I’d recommend you check in with your gynecologist. If you feel like you can’t talk to them, or feel like you’re not being heard, don’t give up. We’re happy to offer some suggestions on a starting point for you to start your journey to better sex.
The need for pelvic health for men and for women is getting more attention, including a recent blog post from the Women’s Health Foundation that talks about Accidental Bowel Leakage (ABL). It is great to have more discussion about what is “normal” and what can be done to get or stay healthy. Physical Therapy plays a huge role in health care as the best option for muscle and body awareness training.
The post by the Women’s Health Foundation outlines the basics of bowel health and emphasizes that 90% of people can be helped with lifestyle changes in diet, bowel habits and retraining the pelvic floor. But, what if some of these changes actually cause worsened problems or don’t adequately address the issue? There is more that can be offered through a visit to a pelvic health physical therapist, think of us as all of the above PLUS unique and individual education. A pelvic health physical therapist provides all of the above information and is trained for including a careful internal assessment of the pelvic floor to make sure that you have good control and awareness of the pelvic musculature. We also check to make sure that you can relax the muscles. Biofeedback may be helpful for learning a general awareness, but it does not replace a qualified internal assessment. Your difficulty may be more complex than simple activation of the muscles and could require sensory retraining and/or desensitization as well as coordination.
A specially trained pelvic health physical therapist also has the ability to work with retraining of functional bowel habits with specialized techniques such as the use of a rectal balloon catheter for sensory-motor reeducation and provide individually designed home exercises, toileting postures and functional activities geared specifically to regain function.
Finally, pelvic health physical therapy can also address other factors related to bowel disorders including stiffness of the spine and thorax which increase intra-abdominal pressures, mobility and pain issues of the abdomen and pelvis as well as coordinated care of urinary dysfunction (which is also closely correlated). Education on fiber and water may not be as simple as just increasing consumption as this can cause pain and bloating in many instances. Increasing exercise may also require intervention to help the knees, hips or back move much more efficiently to achieve these goals. The great news is that a physical therapist can provide this care and integrate the education into treatment and work closely with the medical team for truly integrated care.
If you are a physical therapist interested in advanced bowel care, we have the course for you!
Physical Therapy Comprehensive Management of Bowel Dysfunction
September 12 – 14, 2014
Instuctors: Susan C. Clinton PT, DScPT, COMT, MHS, OCS, WCS
Susan George PT, DPT, MS, OCS, WCS
Prostatitis is one of the most common diagnoses that men are given if they’re having a new onset of pain “down there” or urinary issues. ‘Prostatitis’ literally means ‘inflammation of the prostate’. There are two basic types of prostatitis, acute and chronic. Identifying which kind is present is important in determining the best course of treatment.
Acute bacterial prostatitis is an infection of the prostate. Like any other infection, symptoms can come on suddenly, including chills and fever. Other symptoms might include pain in the bladder or when urinating. Acute bacterial prostatitis is best treated by your doctor with antibiotics.
Chronic prostatitis has a few manifestations. First, chronic bacterial prostatitis is characterized by gradual onset, and recurrent urinary tract infections. The other is chronic pelvic pain syndrome or nonbacterial prostatitis.
Most men who begin to experience discomfort or dysfunction in their nether regions will head to their doctor to remedy the situation. As stated earlier, if the pain or dysfunction is caused by an infection, medical intervention is necessary. However, there are times where the medical intervention does not end up relieving the man of his pain or during the course of medical intervention it is determined that there is not an infection present. So what can be done for the patient with pain but no infection?
This is the type of ‘prostatitis’ where pelvic physical therapy may help. Physical therapists are experts in treating pain, and identifying ways to manage or eliminate it. Chronic pelvic pain syndrome is a condition where a man may or may not have any inflammation in his prostate. Or if he does, it may or may not actually be contributing to his complaints of pain or dysfunction. Understanding the behavior of the pain, as well as the function of the anatomy in the area (low back, pelvic floor, hips, bladder, bowel and sexual function) can help develop a better understanding as to why the pelvic pain is persisting. Understanding all of the potential contributors to a man’s complaint of ‘pelvic issues’ is key to providing the most effective intervention.
There is a fourth type of prostatitis called ‘asymptomatic inflammatory prostatitis’. This type of prostatitis doesn’t have any symptoms of pain or dysfunction, but ‘signs of inflammation are found when the patient is being evaluated for something else’. If there are no symptoms, and no infection, there does not need to be any treatment for this condition.
Anytime a patient (male or female) comes to me with 'chronic UTIs', I always ask if they were confirmed with a culture. I've seen too many people get treated for 'repeated' infections with no cultures. Does the person have burning with urination and frequency and the patient and doc are assuming infection? And if there is pain due to something else (pelvic floor dysfunction, non-relaxing pelvic floor, etc), a painful bout of urination could make that pelvic floor freak out more. Or if they're already sensitized to pain in that area, then an infection (which hurts) could contribute to ramping up any symptoms in that area. Often prostatitis is more often an assumption than an 'I had a positive test for prostatitis'. A guy has pelvic pain, he is almost certainly going to be diagnosed with pudendal neuralgia or prostatitis, with very little differential diagnosis done.
|Acute Bacterial ProstatitisAcute Infection! See doctor, get medication and everything should be fine.||Chronic Bacterial ProstatitisRecurrent infections, antibiotics still likely to help, but may take longer|
|Chronic ProstatitisCharacterized by pain and discomfort. I wonder if this is really ‘inflammation of prostate’ or if it is a pain syndrome blamed on the prostate. Antibiotics don’t usually help, maybe Pelvic PT can!||Asymptomatic Inflammatory ProstatitisNo symptoms to complain of, but inflammation if found incidentally. Not typically treated.|
If infection has been ruled out or treated, but symptoms of pain or dysfunction persist, consider consulting with a skilled pelvic floor therapist. A skilled pelvic floor therapist can assess your pelvic floor muscles for tenderness, ability to contract and relax, as well as assessing other potential contributors to your pain. Physical therapists can also help with function. Unfortunately most of the advice I found online for men experiencing pelvic pain were to just avoid all things that might exacerbate their symptoms, like sitting or riding a bike. While I don’t suggest doing things purposefully to exacerbate pain, understanding the cause of the pain and addressing it will allow you to keep doing the things you love.
This morning a potential patient called to cancel her evaluation, because Entropy Physiotherapy is a cash practice, and not covered by her insurance. It surprises me how much this still stings. We created Entropy Physiotherapy to provide expert care at an affordable, transparent price. So I decided to do a little recon work, and see if our efforts to make good care affordable were successful.
I called my insurance company to verify my benefits. I got through to a representative fairly quickly, but it still took me more than 25 minutes to have him answer 4 simple questions:
- What are my in-network PT benefits?
- What are my out-of-network benefits?
- How do they know if in-network PTs are any good?
- Do I have different deductibles to meet for in and out of network services?
He had to go look up some of the info, but I actually ended up getting a lot of good answers. I’ll do all of the math on another post, but the good news is I have coverage to some degree in and out of network, after meeting my deductible. The bad news is that in-network ($1000) and out-of-network ($2000) deductibles are separate.
For any readers who don’t know, the appropriate deductible needs to be met before the insurance company will pay anything. So I’d be having $1000 come out of my pocket, even if I stayed in-network. That’s a hefty chunk of change. This led me to 2 more questions:
- How does an insurance company choose the physical therapists to send their members to?
- How long will I be in treatment before I meet my deductible?
The nice man at my insurance company could only answer one of those 2 questions. He said that any provider could go online and fill out the paperwork to become an ‘in-network’ provider. There is a process, but nowhere is ‘interview’ or ‘review of CV’ listed. They appear to check and make sure you’re a real person with a license to practice.
I wasn’t’ terribly surprised by this, because Blue Cross Blue Shield of Illinois recently implemented a ‘tier’ system for reimbursement, which currently only applies to private physical therapy practice. Clinics are arranged into tiers based not on outcomes, or on patient satisfaction, but rather how many visits they saw patients on average. I’d like to think that my therapist would make the best decision for me for my outcomes. But the hands of the therapist may be tied by how many visits my insurance would be willing to pay them.
As for the cost of a visit, he had no idea. He did suggest I see a massage therapist. And that he thought it was great I running, because it would make my knees stronger, which would help my hips
I decided to find out just what a Physical Therapy evaluation would cost me if I hadn’t met my deductible….
I called 3 different Physical Therapy clinics that were in-network for my insurance. As a consumer, I’d like to know what I’m paying for any product or service. As a PT, I’m painfully aware that I’ve had several jobs where I had no idea what my patients were being charged for my services. So just how much is a Physical Therapy evaluation? Nobody had any idea. I was told it would depend on what needed to be done. … I said just an evaluation…. They still said they didn’t know, but they could guesstimate for me. Answer from Clinic #1: $327, but likely I’d only be responsible for $275 after the insurance discount. Answer from Clinic #2: $300-$400, but likely only $150 after insurance discount. Or $114 if I paid cash). Answer from Clinic #3: $250-$350, and we should know in about a month what my financial responsibility would actually be.
I’m asking as a Physical Therapist and as a consumer: Why can’t we find how much a treatment will cost? There doesn’t seem to be anything else I consume where the price is a complete mystery. I know how much my dinner is going to cost, as well as how much the bottle of wine will cost. I know how much my haircut with Ryan is going to cost, and because he’s awesome, I’m willing to pay a little more than I would for a haircut elsewhere. All very upfront, and I can make my decisions based on what I can afford and what I find value in. How do we expect patients to accept a randomly selected therapist and sign papers stating that they will be responsible financially for anything that insurance won’t cover (without knowing what services cost, or what insurance will or won’t cover). In my opinion, we shouldn’t expect anybody to agree to be financially responsible for an unknown amount, and consumers of healthcare shouldn’t accept that ambiguity.