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.
Chronic Pain Subreddit
Pelvic Floor Dysfunction Subreddit
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.
American Chronic Pain Association
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!
What if….
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,
Sandy
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!
- Whatever you do in therapy, or as part of your home program, should make sense to you!
- 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!
- 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.
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.
Dear sir,
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).
Sandy
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!!
And Neil, I’ve been practicing….
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.
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