Dr Maureen Mason is an integrative physical therapist with a holistic practice. Her specialty credentials include Doctorate in Physical Therapy (DPT), Women’s Health Specialist, (WCS), and the 900 hour medical training in Professional Yoga Therapy (PYT). She strives to optimize client health with the big wheel of mind, body, and spirit care, and she offers clients meditation and mindfulness training, with attention to the application of breath awareness throughout the day. She has a passion for helping women over the perinatal and menopausal transition times. She is a specialist in interventions for male and female clients in pelvic self –care, regarding bladder, bowel, GI, pain management, and sexual health.
She is an enthusiastic educator with student mentoring, in-services, frequent blogging, and teaching in aspects of integrated PT care as well as practitioner self- care.
She is a member of the American Physical Therapy Association, Professional Yoga Therapy Institute, the National Institute for Clinical Application of Behavioral Medicine, American Urogynecology Association, and the Academy of Integrative Health and Medicine. She offers yoga therapy and physical therapy in San Diego at Function Smart Physical Therapy, as well as for private clients in a home- based settings.
Rosemary is growing abundantly in my southern California garden. Rosemary has many health benefits, see references below for some of the science behind Rosemary and why it’s good for you.
If wild harvesting, choose a plant to use that is young and not in hot sun all day, as the leaves will be more fragment and it will not have the bitterness of older plants.
Ingredients Rosemary leaves 1-2 tsp 1 cup water
Directions Boil water, add rosemary and steep 10 minutes, then strain and serve.
You may add clove, honey or other ingredients as desired.
Reserve a telehealth or in-person visit with me for information and practical help now.
Pelvic Organ Prolapse, known as POP, is a condition that women may experience.
POP is a lowering, or descent of the pelvic organs and their support systems (the muscles, and ligaments) in the pelvic area.
It is present in 20% up to 65% of women and is more likely to occur, after menopause, ages 65 and up. POP can be present at any age, but not cause any trouble. Medically speaking, it is “asymptomatic”.
Most conditions are mild and symptoms do not cause much bother.
However, there may be a bulge beyond the vagina leading to distress and bother, such as difficulties with bladder and bowel storage and emptying, and problems with sexual health and fitness as well. Annoying sensations which can be experienced by women with POP can include feelings of pressure, heaviness, and discomfort in the pelvic area, as well as changes in bladder, bowel, sexual, and fitness functions. These symptoms can come and go depending on how much exertion is needed for daily work and fitness, and the women’s ability to have awareness of manage the pressure in to the pelvic floor.
Ideally, the pelvic floor muscles engage or turn on with optimum force to match the required strength, such as lifting a child, a suitcase, or a barbell.
The reasons why POP develops can include:
genetics with a tendency towards looser ligaments and muscles
vaginal or cesarean childbirth, involving myofascial stretching
birth of a large baby, over 8 1/2 pounds
chronic coughing, chronic straining, with pressure downwards into the pelvis
lifestyle and fitness activities with pressure downwards into the pelvic with an inability to counteract these pressures well. (Some lift heavy items and workout with no POP)
hormonal changes with nursing, and with the menopause transition, aging, with increasing incidence from youth to older years
surgeries and injuries to the support systems in the pelvic area
obesity
How you can help to reduce the downward pressure into the pelvic area:
learn how to control your core muscles
learn specialty pelvic exercises for fast, and slow, sustained contractions, which are needed for different types of activity. You may be able to exercise to your full capacity with a progressive program to match your needs.
learn hypopressive exercises which use all the breath and the ribcage to help lift the pelvic region, organs and pelvic floor muscles
see a pelvic therapist, who can help you fire up your pelvic floor muscles, provide manual and visceral therapy to release stiffness and scar tissue.
use intermittent decompression exercises, which eliminate gravity and use gravity assistance.
use specialty pelvic health equipment to help your prolapse
learn partner communication to help comfort and pleasure with intimate activities
Medical Help can Include:
Screening by a gynecologist or urogynecologist.
Surgery may be an option for care, and you want the best preparation to achieve surgical success.
Medical instruction in the use of a pessary, a support device, and hormone replacement therapy.
For more information on exercise, pressure management, and POP:
Chapter 8
References womenshealth.gov/pelvicorganprolapse 3.28.23 Bo K, Angeles-Acedo S, Batra A, et al, International urogynecology consultation/Conservative treatment of a patient with pelvic organ prolapse; Pelvic floor muscle training, IUJ 2022,:33 Crowle A, Harley C, Biotensegrity focused therapy for pelvic organ prolapse: A nonrandomized prospective clinical case series, Journal of Women’s health physical therapy 2021, 45(3). Hage-Fransen MAH, Wiezer M, Otto A, et al, Pregnancy-and obstetric-related risk factors for urinary incontinence fecal incontinence, or pelvic organ prolapse later in life; A systematic review and meta-analysis, ACTA Obstet Gynecol Scand 2021:100 Weintraub AY, Glinter H, Marcus-Braun N, Narrative review of the epidemiology, diagnosis, and pathophysiology of Pelvic Organ Prolapse, IBJU 2018,:46(1)
True/False
Similar changes can happen in the pelvic floor muscles in the perinatal time frame as well as the perimenopause time.
Answer:True!
Hormone changes can have a profound effect on the pelvic floor muscles and women need to know how to navigate these life stages.
Pregnancy and birth can alter the function of the pelvic floor muscles (PFM), while the demands for lifting, carrying and and other aspects of infant and toddler care create increase challenges.
Pain with se*ual activity (dyspareunia) is common, but shocking to those who are not prepared for this.(It is temporary for most).
PFM work with postural muscles for “trunk control” and these muscle groups are weaker in most postpartum women at 8 months.
Women need a program, and plan instead of being expected to “bounce back”.
The direct impacts of pregnancy and birth on muscle integrity, abdominal and pelvic organ positioning, and bladder and bowel functioning can create symptoms that impact quality of life. (I know-I had challenges, totally unexpected!)
Perimenopausal changes from declining estrogen, progesterone and testosterone can alter PFM function as well.
Specific changes can entail reduced PFM strength and elasticity, less lubrication, tendency to dryness and increased urinary tract infections (UTI), and dyspareunia.
In association with PFM weakness, pelvic organ prolapse (POP) can occur, or worsen, requiring medical screening and treatment.
Modern media portrays the negative side of this life phase, perimenopause and menopause, however it can be a vibrant and fruitful phase of life well.
Women need to have self care and lifestyle habits for health, if not already in place, to help pelvic health, and overall health.
Adding a few new positive health practices per month can create renewed energy, focus, quality sleep and sustainable fitness, and help with the aforementioned pelvic health challenges as well.
True/False
Perinatal and Perimenopausal pelvic floor muscle problems are easy to fix with kegel exercises.
Answer: False!
Research studies find that women often have an incorrect effort and may breath hold, bear down, and contract global muscles (ie gluteals, adductors, abdominals) vs. the PFM.
Verbal instructions such as “do kegels” do not work for accurate PFM contractions for many women.
We should not be “clenching” the PFM all the time (more on that in another post).
There are many methods to train the PFM that can help them work with other core muscles during activities.
If possible, have a session with a Pelvic Health Physical Therapist and learn the multitude of ways to optimally relax, contract, and co-contract with other muscles when needed.
Targeted strategies for bladder health, dyspareunia, POP care and fitness training can help meet your lifestyle goals and optimize your function.
Check in for the bladder care, bowel care and and yoga/fitness offerings on this site, your Centralstationwell.com
Schedule with me in San Diego, in person or via Telehealth as needed,
858 598 4915
Mason Home Fitness, Central Station Well
4241 Jutland Dr Suite 103
San Diego CA 92117
Warmly,
Maureen
ps The Pelvic Rehabilitation Guide Across the Lifespan
is now available on Amazon; This textbook has health pearls for the
general public seeking pelvic health information and treatment strategies, as well
as content for health -care professionals. Need to know information. Health care aware, health literacy.
This month, our November, thanksgiving time, it is good for our hearts to consider all that we are grateful for. Yet also, it is a season of change, and loss,from leaves falling from trees,and less light, to possible bereavement-of some relationships, or loss of our own physical functions, and possible loss of family and friends as we cycle through more seasons in life.
So before gratitudes, it can help to sit in silence. If some sadness or loss has not been given space, attention, or reflection, allow this now.Breathe into your heart. The heart loves, and also can suffer with loss.Let your mind, body and spirit fully open to the richness of your emotions. Perhaps you may want to journal, to call someone, to cycle through memories, and also to consider joyful times from your memory banks.
I like to consider that everything is impermanent, though we strive for stability and hold on fighting change, losses, and the inevitable roller coasters of life. In The Book of Awakening, author Mark Nepo sums up his folly at resisting things,resisting change. Mark reflects on the totality of being in the present, in the wonders of life, every moment, and the resilience of the human spirit. Which leads me to gratitude.
Many people do not have enough food, so help, however you can.
And sitting at a meal, give thanks for your life, your breath, your being alive, and thanks for your home, chair, table, the light that surrounds you, your plate, and silverware.And each item on your plate, from seed to plant, the corn, rice, wheat, potato, from egg to turkey, meat or seafood, the grapeseed to the wine, you can do this.Thank the farmer, grocer, trucker, cook, and dishwasher.
Cultivating gratitude can help our heart, help our digestion, and help our joy in life.
Gratitude as a practice, such as a daily gratitude reflection at bed time, or upon awakening, can help you feel calm and peaceful, and joyful,priceless emotions.Check out mindful.org for some tips on how to practice gratitude.I have foundational practices for gratitude that I will share with you in my next few posts, but remember the meal based one (above) beyond Thanksgiving!
Health is Wealth,
Maureen
This blog is a shout out for critical keys for health and performance, with fitness, nutrition, and lifestyle tips and insights! Many gyms are closed per COVID, but even when they re-open, having A HOME PROGRAM is an asset for consistency and time management.
Phase one: STRENGTH TRAINING: We will guide you through a process to increase your strength, starting with the top 10 strength training exercises. The truth is there are foundations for each of these to optimize performance, in the kinetic chain…the kinesiology foundations in how your body moves. You can follow this program and build a home routine of functional fitness for all you want to do in life.
1.Pushing
2.Pulling
3.Lifting
4.Carrying
5.Reaching
6.Squatting
7.Lunging
8.Single Stance
9.Rotations
10.Multiplanar
Functional Fitness, Safe Fitness*: Intro
Have you heard this term, functional fitness? If you can do cross-fit box jumps, and that is part of your fitness, do you use your muscles that way in your life? Yes! if you are a ninja warrior competitor, or special ops person, or practice bouldering, jumping, and extreme sports
But…often people are doing maximum exertion tasks in fitness that may cause strain or sprains, which can keep a Physical Therapy office busy.
Weekend warrior fun can also overtax and strain individuals, reflect-have you done something sporadically that caused a strain and you went into it with gusto and bravado and paid for it afterward?…this happens to most people. Especially as we age, because our connective tissue is stiffer and we are weaker, over age 25 or 30 people start to lose strength!
Functional fitness is that which mimics tasks we need most in our daily lives; if you are a dog walker you need a strong voice, core, and shoulder and trunk muscles to work with wild puppies and tame older dogs who may lunge at lizards. If you are a mom or dad with a toddler you need to be able to lift, push, pull, and carry your child who weighs 18 to 30 plus pounds. (Grandparents can have challenges with child care as they have lost that strength so get on board if that is you).
If you are a gardener you need total body strength for pruning, strength, and balance for climbing ladders and inclines, and the ability to squat, lift, and carry plants, rocks, and soil. Core power and arm strength are needed to shovel, dig, and work a pitchfork. Consider what you need to do for your home life, for your work, and your fitness pursuits, your goals. Are you having physical difficulty with any tasks? If so, consider having an analysis of your strength, flexibility, and stamina, and sports training as needed, Physical Therapy (PT) fills that niche.
Upper and lower body strength training with core work (deep back, pelvic and abdominal muscles) is the foundation for functional fitness, combined with task-specific training simulating what you want to perform regularly, for work, leisure, recreation, and competitive challenges. Your choices to strength train include bodyweight resistance, free weights, bands, and straps such as TRX, weight training machines, pilates and yoga, and blingy workouts like vibration plates and even blood flow restriction training. Whew! That’s a lot of info. Let’s keep it simple to start; bodyweight resistance.
Example #1: Functional Fitness
Shoulder: Pushing; Shopping carts, strollers, wheelchairs, doors. Prep for plank, press up, and down dog.
Wall Push Up
The wall push up is a stepping stone to be able to push with power, or simply do push-ups, as you are only moving a partial amount of body weight with the wall push up. (In life we sometimes need to really push harder on one side, such as wonky shopping cart, or stroller with a wheel stuck on a sidewalk crack.) Also, if planks make your shoulders sore, check out the basics:
Tips are to:
A. Keep the shoulder blades pulled down and back. This keeps the trapezius from being a bully.
B. Keep the shoulders open versus hunched forward. This keeps your pectorals from trying to do it all, and it keeps you “superhero” vs hiding your chest.
Repetitions
Beginner: Start with 5 reps, with only a slight angle of lean. Work up to 10 reps.
Intermediate: 2-3 sets of 10, with a greater angle of lean towards the wall.
Advanced: Vary your speed, your angle, and the percentage of weight on the Left and Right arms.
Limitations can exist such as wrist tendonitis, strains, or sprains along the arm, neck discomfort, and inability to hold the neck and trunk in alignment. See your health care provider, including your PT, for medical screening and a program to help you be able to strength train.
Pectoral Stretches
Often the front of the shoulder is too tight to be able to hold the shoulders down and back during a wall push up; the pectorals and internal rotators are active all day with hunched over computer work, and the spine may become rounded too-so shoulder openers against the wall can help. The keys here are to keep the spine tall, and avoid arching the back to meet the wall…It is actually a progressive exercise. Start low, slide arms up to the point that you cannot stay in alignment, and work your way “up”, and slowly back “down”. Keep it pain-free. If standing is too difficult, then try this lying on your back.5 to 10 reps slowly is a good start.
Photo: External Rotation (Below)
The small external rotators sweep from the edge of the shoulder blade to the top and side of the humerus, and they keep it pulled down in the socket and balance with the internal rotators. The external rotators work with other muscles to prevent the humeral head from jamming up into the top shelf (acromion) of the shoulder blade…to keep you pain-free. Here is a quick strength training for them to help your shoulder power; side-lying external rotation. Start with no weight to test it out, then ½ pound, increase as comfortable. (Follow the guides for repetitions).
Photo: Shoulder dips
The big muscles such as the lats (latissimus dorsi) that connect the shoulder to the trunk and spine can use some training to help shoulder power. Shoulder dips are great for this! This can be done with yoga blocks, or any other prop or surface that is stable and supportive. You can start by just pushing down and check out your power and stability, or lack of (been there!).
Eventually you may be comfortable lifting your body up with a little clearance, if sitting. This is also great to stretch out the trapezius!
TRAINING GUIDE SAMPLE
You can set a goal for how many you want to be able to do, such as 2 sets of 10; give yourself time and be safe, be consistent, and a general warm up such as walking before -hand can help your muscles work better.2 times a week is a minimum strength training workout, and 3-4x a week is optimum.
A foundation for your ABILITY TO BUILD STRENGTH is your blood level of vitamin D; it is receiving attention for its critical role in health, and D deficiency is a risk factor for strength loss. Vitamin D is a building block for many metabolic factors including bone density maintenance and also the production of sex hormones. Do you know your “D” levels? Mine was low, and I certainly feel more energetic and stronger since I raised the level.(Low levels are <25nmol/liter, vs high >50nmol/liter levels).
Use it or lose it. Strength powers up with training. If you are struggling with tasks, consider that a warning sign that you may be losing strength and stamina. Each decade people tend to lose muscle mass and strength, between 1 and 5% per year!… and therefore there can be a decline in function with the loss of the ability to reach up in cupboards, squat down, lift, push and pull items, as well as weight gain (belly fat ) and declines in flexibility balance. Not fun. I get paid to teach programs via insurance in PT, but not everyone can attend therapy, so I will offer the keys in this blog for maintaining function and thriving with fitness, at all ages!
Look to the next blog here in the series for a continued outline of functional fitness top 10 exercises! This is an introduction to the shoulder here, but the shoulder moves 360 degrees and is a wheel that can be overworked easily, so think about progressive fitness…building blocks. I will also show the kinesiological foundations for how to do these safely.
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*Medical disclaimer: This website information should not be taken as medical advice, but rather as health and wellness tips for your benefit. See your MD or health care provider for your medical needs. Read our terms, conditions and privacy policy to be informed of how this site is offered to the public and professionals for your education, as well as information we may collect on you, and your privacy rights in using and interacting with this site.
Camargo P, Alburquerque-Sendin F, Avila MA, Haik MN, Viera A, Salvini TF, Effects of Stretching and Strengthening Exercises, With and Without Manual Therapy, on Scapular Kinematics, Function, and Pain in Individuals with Shoulder Impingement; A Randomized Controlled Trial, Journal of Orthopedic and Sports Physical Therapy 2015, 45(12)
Keller K, Engelhardt M, Strength and muscle mass loss with the aging process. Age and strength loss, Muscles, Ligaments and Tendons Journal 2013; 3(4)
Saeed, M, The HoIisitc RX, Your guide to healing chronic inflammation and disease, Rowman and Littlefield., 2017
Visser M, Deeg, D JH, Lips P, Low Vitamin D and high Parathyroid Hormone Levels as Determinants of loss of Muscle Mass (Sarcopenia): The Longitudinal Aging Study Amsterdam,
J Clinical Endocrinology and Metabolism 2003, 88(12); 5766-6772
Yoga is…different for every person practicing, and every teacher presenting. Yoga can be an extreme, boot-campy, and energy exhausting session for those that desire an intense workout.
Yoga can be restorative, calming and quieting, centering into person, time, and place with the senses calmed and soothed, for those seeking respite from the storms of life.
We are in a world of abundance with yoga practices and please realize that you can customize your yoga to your needs in a class or home program.
It is humorous that the original writings on yoga outlined the practices in light of achieving enlightenment and union with the Divine, yet in our modern world, we often strive and strain for the physical goals to attain physical beauty, or to look like a pretzel in a unique pose.
“Yoga…is a holistic way of life leading to a state of complete physical, social, mental, and spiritual well-being and harmony with nature. This is in contrast to the purely economic and material developmental goal of modern civilization, which has brought social unrest and ecological devastation.” Direct quote Taneja DK, 2014
The safest practices do no harm and improve health measures such as improving strength and flexibility, lengthening the DNA strands (telomeres!), and reducing stress chemicals in the body such as cortisol and pro-inflammatory cytokines. Also, psychological variables improve with yoga, such as improved mental status and reduced worry, rumination, and perceived stress.
Consider how you feel during and after your yoga, and whether you feel competitive with yourself or others (e.g. coveting and striving) and engage in postures that may be violent to your body or if you feel content and have a regular practice for self -care. These items are foundational considerations in yoga; check out the Yamas and Niyamas listed at the end of this blog. The truth is, I strained my Achilles tendons badly in yoga, and they took a year to recover.
Asanas
Asana (yoga poses) can be done in a few short segments during the day for those desiring adaptable, shorter programs. Asana can be practiced throughout the day. Movement can be stress-reducing, burning off the stress chemicals when we want to fight, flee, or freeze. Practicing the poses can be centering, grounding, energizing, or calming, depending on your movements. Given a longer time window, the poses and can be held longer and grouped inflow sequences as desired.
Pranayama
Pranayama, the attention to and practice of breath control, has great benefits for health! You can notice when you have a stress reaction and hold your breath, and then consider re-booting to diaphragm breathing to soothe your nervous system. You can also use so many types of pranayama to attain different results, such as warming, charging up, or calming and quieting. Techniques can be sprinkled throughout your day.
Meditation
In this zombie apocalypse of COVID, The Corona Virus, The Pandemic, we have an epidemic of stress. But you can also cultivate your sense of peace, with sensory control and an awareness of your perceptions and mindfulness. And you can cultivate a connection to the divine- Samadhi. There are many forms of meditation and your process may blend with a religious practice in the form of passage meditation where one silently recites scripture or a favorite passage. I use techniques including creative visualization, counting my breath cycle and expanding the inhalation-hold, exhalation, and pause, recitation of scripture(passage meditation), and other mind-body-spirit techniques I will share in future blogs and Vimeos for your benefit.
How to Fit in Yoga – The Scoop!
I am enjoying life more by integrating yoga into my lifestyle, via routines and habits that I have developed during yoga studies in college, workshops, with my PYT (Professional Yoga Therapy Institute) training, and attending mindfulness-based stress reduction (MBSR) classes. Here is a sample from a typical day…which sometimes goes bust and only ends with a side bow and back bow before bed, and nod to gratitude no matter how the day transpired.
Waking up… I start my day with my own style of meditation, with mindful self-compassion, and also seeking wisdom, insight, and compassion in my life at home with family, in the community, and at work. I practice a few Asanas, and Pranayama, ideally facing the sunrise!
When I have a rich morning mind- body -spirit practice, my interactions with the world have more vibrancy, with a sense of a moving meditation throughout the day. My client care can be unique, fun, and engaging. And I am more aware of my body, my breath, and my own emotional reactivity and ability to be flexible, to let things go, rather than carry around a mounting pile of problems throughout the day.
Midday… Asanas are my power up workout mid-day or afternoon, from the mountain and warrior series I II III, to modified triangle, plank, cobra, squat, bridge to single leg bridge, to happy baby, and so on; more to come to help you explore and refine a practice! Do you have a favorite few poses or flows?
Bedtime…can be a great opportunity to move into the calming, relaxing, bending poses, and the use of low light and soothing music creates a wind-down atmosphere. Cat -camel to child’s pose, and meditation in the optimum position of comfort with blankets and yoga blocks for comfort can allow mind -body- spirit centering.
I practice meditation in a longer segment at bedtime vs morning, with an easy seated pose, thunderbolt (kneeling but on a pillow), or in corpse pose, Shavasana. This helps me to float into bed relaxed and calm, having done a “download of the day” and finally a “gratitude wrap up” after the practice.
I have listed some examples of how you can practice 3 ten-minute yoga sessions amid work, self -care, family care, and other time demands. Choose your own combo of Asana, Pranayama, and Meditation. If you are feeling stressed, or even burnt out (where did you go?), or not of optimum strength or flexibility, stepping on the yoga train for health can provide great benefit to you.
Look to this blog for expert tips on building or refining your own practice.
Finally, Here is the big picture on the 8 Limbs of Yoga, to encourage a practice beyond the physical:
1. Yama: Practice of universal morality, including non-violence to self and others, truthfulness, not stealing, restraint, and not coveting.
2. Niyama: Personal observances, including tapas: practices, seeking purity, and self-education and contentment.
3. Asanas: Body postures
4. Pranayama: Breathing exercises, and control of prana
5. Pratyahara: Control of the senses
6. Dharana: Concentration and cultivating inner perceptual awareness
7. Dhyana: Devotion, Meditation on the Divine
8. Samadhi: Union with the Divine
References
Conklin Q A, Crosswell A D, Saron C D, and Epel E S, Meditation, stress processes, and telomere biology, Current Opinion in Psychology, 2019, (28)
Eswaren, E, The Mantram Handbook, Nilgiri Press, Blue mountain meditation center 2008
Garner, G, Medical Therapeutic Yoga, Biopsychosocial Rehabilitation and Wellness Care,
Handspring Pub.Edinburgh,2016
Horowitz E, Elgelid S, Yoga Therapy, Theory and Practice, Routledge Press, 2015
Lau C, Yu R, Woo J, Effects of a 12-week hatha yoga intervention on cardiorespiratory endurance, muscular strength and endurance, and flexibility in Hong Kong Chinese adults; A controlled clinical trial, Evidence-Based Complementary and Alternative Medicine, NY, 2015, 1-12
Miller, B S, Yoga, Discipline of Freedom, The Yoga Sutra Attributed to Patanjali, Bantam Books 1995
Nepo, M, The Book of Awakening, Conari Press, 2011
Schutte N S, Malouff J M, Keng, S-l, Meditation and telomere length; a meta-analysis, Journal of psychology and health, 2020
Taneja DK, Indian Journal of Community Medicine: Official Publication of Indian Association of Preventative and Social Medicine, 2014, 39(2)
Everybody has…a pelvis, with so many functions “down there”.
Pelvic health problems are often not reported to health care providers, and suffered in silence. There is a big list of pelvic health conditions and associated problems that can be addressed by physical therapy.
I started off in Physical Therapy (PT) to work with sporty things, simple pain problems, and the MUSCULOSKELETAL system. I saw a few “high groin strains” nobody else would treat (gasp, near the “privates”, working near the groin makes many PT’s uncomfortable!). I attended to musculoskeletal treatment of the adductor (inner thigh muscle), hamstrings and hip flexor muscles and these patients recovered well. And I thought the muscle system ended when you reached the pelvis!
And then the postpartum moms with neck, back, hip and pubic pain began to appear on my schedule, some of whom had bladder leaking, which I knew nothing about. And then the big HMO director asked me to take a course on BLADDER TREATMENT and the course instructor Kathe Wallace teased us at each break asking if we REALLY NEEDED TO GO or were going “just in case”. So I found out you can have a sense of humor and really help people with “private” problems.
I began to provide pelvic rehabilitation with bladder continence and urgency treatment programs. I talked about “winking” the pelvic muscles at a lecture I gave for the therapy staff, only to be winked at by colleagues after that talk. Well, the eye is a sphincter or a circular muscle, and the pelvic muscles have sphincters at the outlets, as well as deeper sphincter-like supports. (Note: it’s not all about tightening or “winking). This further developed my sense of humor with the topic of pelvic PT.
And then the HMO MD’s began to send me PELVIC PAIN cases, which I knew little about, and began self -study and a search for more courses. This is a huge topic, pelvic pain! And then the BOWEL problems began to show up for evaluation, with constipation, or loss of control, fecal incontinence, and that required several courses to understand the foundations and to provide care programs.
PELVIC ORGAN PROLAPSE is another problem that is in the arena of hidden problems, and it involves mild to severe hernia like changes in the support of the pelvic organs, and can be often helped by pelvic PT. The bladder, uterus, bowel or all three can be lowered in the body after pregnancy and birth, with some women noticing changes in pressure (a bulge sensation)and in pelvic functioning.
SEXUAL HEALTH problems also began to be referred for care, with pain, discomfort, and all the relationship concerns this created for the patients and required specialty course work to develop screening, evaluation, and treatment protocols.
Conservative care in the medical treatment of pelvic health concerns with bladder, bowel, pain, and sexual dysfunction is appropriate for those without “red flags”, indicating more serious conditions. Severe pain, inability to eliminate or total loss of control of bladder or bowel and other factors require immediate medical attention.
Conservative care with PT does the least harm, and involves full health history screening, physical examination and impairment assessment, habit training, muscle synergy, assessment, functional control of tightening and relaxing, fluid and fiber management, and nutritional training. Biofeedback, real time ultrasound, electrical stimulation, manual therapy, and progressive therapeutic exercise programs are standards of care. Some patients may receive treatment before, or after surgeries to support optimum function.
Pelvic health is vital health, with natural body functions ideally comfortable at rest and in motion. As a pelvic health specialist, I have devoted the majority of my career to providing care in this area, including education, empowerment, yoga for pelvic health, and all aspects of physical therapy.
This blog is an adaptation of a talk I provided at the Academy of Integrative Health and Medicine’s annual conference. That conference in 2017 led to a request by Handspring Publishing for me to write a book on Pelvic Rehabilitation, which is in the works for 2021 publication. Stay tuned for brief blogs that will be developed more in the textbook!
References
Bo, K, Berghmans B, Morkved S, Van Kampen M, Evidence based physical therapy for the pelvic floor, Churchill Livingstone 2015
Faubion S S, Shuster L T, Bharucha A E, Recognition and management of nonrelaxing pelvic floor dysfunction, Mayo Clin Proc 2012, 87(2), 187-193
Menon H U, Handa V L, Vaginal childbirth and pelvic floor disorders, Women’s Health 2013, 9(3)
Ramanayake R P, Basnayake B M, Evaluation of red flags minimizes missing serious diseases in primary care, J Fam Med Prim Care 2018, 7(2), 315-318
