The Muscles No One Talks About

Did you know that the concept of joint movement being controlled by muscles and ligaments applies to our bladder and bowel movements as well? These activities are controlled by a group of muscles conveniently called the pelvic floor muscles. They sit between the coccyx and the anterior pelvis and have a role in our normal micturition, excretion, and sexual functions. These muscles are susceptible to under or over activity just like any other muscle and can alter the normal flow of our bowel and bladder movements causing incontinence, constipation, leakage, and perineal pain. Dysfunction of these muscles are often seen after childbirth, surgical/traumatic/emotional events, pelvic organ prolapse, and diabetes. More so, pelvic floor dysfunction can be caused by repetitive tasks involving heavy lifting, straining, and advanced age.

Treatment for pelvic floor dysfunction does not have to involve surgery or medications; physical therapists are able to specialize in the treatment of pelvic floor dysfunction and assist those with varying diagnoses stemming from the pelvic floor muscles. Research has confirmed that conservative, physical therapy interventions demonstrate the best possible outcomes for those suffering from pelvic floor symptoms more so than surgical or pharmaceutical interventions. Male or female, there is no reason someone should continue suffering from leakage, incontinence, or pain within their perineum and a Doctor of Physical Therapy is the best professional to help you overcome these dysfunctions and improve your quality of life!

Jennifer Santamaria PT, DPT

1.Bo K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother . 2013;59:159-168. (a)

2. Bernards A, Berghmans B, Hove M et al. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. Int Urogynecol J. 2014;25:171-179.

3. Bo K, Hilde G, Jensen J, Siafarikas F, Engh ME. Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparious pregnant women. Int Urogynecol J . 2013:24;2065-2070. (b)SOWH PH1B4 Physical Therapy Treatment of Underactive Pelvic Floor Muscles and Prolapse.E Miracle©Section on Women’s Health, American Physical Therapy Association 2016.131

4. Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol .2010;203(2):170e1-7.

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Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Imaging (MRI) results showing degeneration in the low back are common in asymptomatic individuals (people without pain). Examples of degenerative findings include disc degeneration, disc bulging or protrusion, and facet degeneration. These findings are normal age-related changes (usually unrelated to pain) and are likely an incidentally finding.

Normal MRI findings in the low backs of “pain-free” individuals:

45% of 20-40 year olds
75% of 40-60 year olds
Over 90% of 60-80 year olds
…have disc degeneration

30% of 20-40 year olds
55% of 40-60 year olds
Over 75% of 60-80 year olds
…have disc bulging

25% of 40-60 year olds
Over 65% of 60-80 year olds
…have facet degeneration

Have questions about your MRI findings or what’s causing your low back pain?
A physical therapist can help answer those questions and get you moving again!

Reference: Brinjikji, W. et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Propulations. Am J Neuroradiol. 2015 April; 36(4): 811-816.

5 Ways to End Back Pain Today Without Medication or Surgery

1. Maintain good posture and monitor your computer health.

A) Keep feet flat on the ground. Knees should be at a 90 degree angle.
B) Sit up straight. Avoid tension in and around neck and upper back.
C) Keep your eyes level with your screen. Remember the top of your head should level with the top of your computer screen.
D) Keep forearms parallel. Your elbows should be at 90 degree and your arms resting on you chair’s armrest.
E) Keep your shoulder blades settled and resting on your ribs.
F) Keep your mouse close to your keyboard so you don’t have to reach for it.
G) Rest eyes from time to time. Look away from the computer and take frequent breaks.

2. Wear proper shoes.

A) Sorry ladies, but avoid high heels.
B) Limit flip flops and shoes with no arch support. Add an orthotic if necessary.
C) Consider a gait analysis or professional shoe fitting.

3. Purchase a new mattress every 5 years and find a sleeping position that limits or abolishes your pain.

A) Consider side sleeping with a pillow between your legs.
B) Do not sleep on your stomach

4. Stretch, strengthen and move daily.

A) Switch positions often to avoid prolonged standing, sitting or walking.
B) Walk at least 10-15 min daily.
C) Stretch your back, hip and legs daily.
D) Strengthen your body.
E) Remember if you don’t move it, you lose it.

5. Give physical therapy a try!

A) Be sure you are getting one on one care with a licensed physical therapist for at least a portion of your full session.
B) Be sure you receive manual hands on treatment. 99% of patients benefit from manual hands on techniques to improve muscle and joint mobility as well as reduce pain, be sure you are not missing out.
C) Be sure your physical therapist thoroughly explains what he or she believes is your problem and outlines a full treatment plan for you. If you have questions, ASK.

4 Myths About Physical Therapy

Four Myths About Physical Therapy

1. Physical therapy is painful.
If I had a dollar for every time I’ve heard someone say, “does physical therapy stand for physical torture?” I would be a rich man. Physical therapy should in fact very rarely be painful. Contrary to popular belief, Physical therapy is intended to reduce or abolish pain and not create or increase one’s level of pain. Yes, there are times and treatments that may cause brief periods of discomfort or residual soreness, but you should experience very little pain at the time of treatment or anytime after your session. If you do experience an increase in pain, it is important to communicate this to your therapist immediately.

2. Physical therapy treatments provide only temporary changes.
There is nothing further from the truth. Physical therapy does in fact result in long term changes in pain, mobility and function. In addition, Physical therapy can allow you to stop taking pain medication and reduce unnecessary injections or surgeries. Now, lets be clear, a few hours of physical therapy a week is not enough. You must supplement your physical therapy with a complete, individualized home exercise program and a daily commitment to your health.

3. Any healthcare professional can perform physical therapy, or all Physical Therapists are the same.
There are many different healthcare providers claiming to be able to perform physical therapy. However, did you know that to become a licensed Physical Therapist in the United States, you must hold a Doctorate Degree. A Physical Therapist completes 7 years of education. All Physical Therapists complete a rigorous Doctoral program and are equipped to begin to treat patients, however, Physical Therapists vary in their skill sets, post doctorate educational levels and certifications as well as experience. We highly recommend you seek a licensed Physical Therapist that performs hands on, manual physical therapy and holds a Board Certification or regularly participates in continuing education. Don’t be afraid to ask about your therapist prior to your evaluation.

4. A Doctors referral is necessary prior to seeing a Physical Therapist.
In most cases, a Physicians referral is not necessary to be evaluated by a Physical Therapist. Although some insurances require a referral, many do not and often an initial evaluation is allowed prior to obtaining a referral. If you are not using your insurance, a referral is not necessary for the first 12 visits or 45 days, whichever occurs first. Laws vary from state to state, so be sure to consult your local physical therapy office.