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Jul 29, 2014

Hip

In this study investigators tested the hypothesis that following hip arthroscopy, the number of patients who developed pudendal neuralgia would exceed 1%. Development of pudendal neuralgia symptoms following hip arthroscopy was assessed in 150 patients (female = 79, male = 71) who were operated on in one facility by a single surgeon. Indications for the surgery included post-trauma foreign-body, osteochondromatosis, and labral lesion resection. The Nantes criteria were utilized for diagnosis, which includes as "essential" criteria the following: pain in the region of the pudendal nerve; pain that is worsened by sitting, relieved by sitting on a toilet seat; pain does not interrupt sleep, pain with no objective sensory impairment and that is relieved by a pudendal nerve block.

 

The operated hip was placed in a position of 30 degrees of adduction, internal rotation and flexion. The hip was operated on with a single anterolateral approach in most cases, with a second anterolateral approach needed in eight cases. Study results include an incidence rate of 2% in the population of 150 patients. 3 of the patients (2 female, 1 male) were diagnosed with pudendal neuralgia presenting in all 3 as "pure sensory" with symptoms of perineal hypoesthesia and dysesthesia on the operated side. The 3 cases resolved spontaneously within 3 weeks to 6 months. Two cases of sciatica following hip arthroscopy were documented, and these cases resolved without intervention other than a short course of analgesics. The patients also presented with gluteus medius insertion tenderness.

 

Although the study also aimed to determine risk factors for development of pudendal neuralgia following hip scope, the small number of patients who developed symptoms made the analysis for risk factors difficult. The authors also point out that the one-way surgical technique (not the standard surgical technique) also may have created some bias in the study. In conclusion, although the cited study reported a low incidence of pudendal neuralgia onset following hip arthroscopy, larger numbers have appeared in the literature, and according to the authors, surgical risk factors for developing nerve complications following a hip scope include the amount of traction placed on the joint, the length of surgery, and appropriate pelvic support bilaterally. The take-home point for pelvic rehabilitation providers is that patients are at some risk for pelvic nerve dysfunction following hip arthroscopy, and we have a role in educating providers and in screening patients for such conditions.

 


Jul 28, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Catherine Kerman, MPT, SCS, PRPC

 

Cathy Kerman

What/who inspired you to become involved in pelvic rehabilitation?

Our continence expert, Kim Crosby, lured me into the field when I was a student in the fall of 1995. She was so PASSIONATE about helping the women she treated. We had a gigantic Hollister biofeedback and e-stim machine… I think it filled up half of the treatment room! She gave me chapter after chapter and article after article to read. Soon after I was hired she had her second child and became a full-time mom. All of a sudden I was the “Director.”

 

Two years later I was lucky enough to attend our Therapeutic Associates “Women’s Health” retreat taught by Kathe Wallace. I think she got a good laugh in 2012 when I showed her my old binder during the PF1 class I hosted!


Jul 25, 2014

This post was written by H&W instructor Narinder Clemons, PT. Narinder will be instructing the course that she wrote on "Meditation and Pain Neuroscience" in Illinois this September.

 

Nari Clemons

In a recent study (May 2014), a total of 115 meditators and 115 controls were compared. Cases showed higher a quality of life on the bodily pain subscale, higher internal and less external health locus of control, and higher life satisfaction than controls.

 

One very interesting aspect of this study is that patients did not necessarily report a change in ratings regarding the perception of their health or change in medications. This brings to mind the importance of patients being able to frame their illness within the context of their life. Certainly, with our tool box of manual skills and education for patients, we can change some factors regarding the patients’ health and pelvic conditions. However, for some conditions, therapists cannot change the underlying disease process, such a Crohns, interstitial cystitis, fibromyalgia, etc. If we have tools, such a meditation instruction, that can help the patient to have a higher internal locus of control, we can give patients motivation to participate fully and to have hope, even if it is a condition they have been dealing with for years.

 


Jul 24, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Deanne Wade, PT, PRPC, BCB-PMD

 

Deanne Wade

WHAT MAKES YOU THE MOST PROUD TO HAVE EARNED PRPC?

I am very honored to finally have the opportunity to have earned a designation that sets what I do as a pelvic therapy practitioner apart from other specialties. As with many in this area, I was known as the local “women’s health” practitioner for quite some time. In reality, I work with men, women and children. This certification provides validation of my 17 years of experience in this specialty area.

WHAT PATIENT POPULATION DO YOU FIND MOST REWARDING IN TREATING AND WHY?

As a student 24 years ago, I would have told anyone who asked that I would never want to treat patients with chronic pain. I had planned to be an acute care practitioner. Through a series of employment changes and opportunities, I began working with women with “chronic pelvic pain”. What motivated me to continue to pursue treating not only chronic pelvic pain, but any type of pelvic diagnosis was the impact I could make so quickly on quality of life. It is one thing to help a patient recover from an injury and return to everyday activity, but it was incredibly rewarding to hear a patient tell me that this treatment “changed my life.” I was provided with story after story of patients who had restored intimacy in their marriages or who were no longer embarrassed to leave the house for fear of urinary or fecal incontinence. Pelvic rehabilitation changes lives and I love being a part of that.


Jul 21, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Pregnancy" in New York this November.

 

yoga

Research has long confirmed the effects of maternal health on fetal development and outcomes. But scientific inquiry into the genesis of disease processes in an adult with no apparent risk factors has been uncharted territory until the last few decades.

 

The interrelationship between maternal stress and fetal “programming” was considered as early as the mid-1980’s, beginning with the suggested connection between poor nutrition in early life and adult disease. But the developmental origins of adult health and disease were not studied until the mid-1990’s, with little understanding of the etiology until the last two decades.

 


Jul 18, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Eve Baron, PT, PRPC

 

What advice would you give to physical therapists interested in earning PRPC?

At the time I took the PRPC exam, I was working in a private practice, which specialized in pelvic floor physical therapy. My coworkers and another pelvic floor PT had a study group which met 4-5 times, and we went through all the H & W manuals for PF1-3. We shared anecdotes about patients that enabled me to remember certain diagnoses and clinical findings. In addition, reviewing anatomy in a group setting is always beneficial because often someone has an acronym that you weren’t aware of that can be very helpful.

 

What/who inspired you to become involved in pelvic rehabilitation?

Many years ago while working in an acute care setting, I was working with an older woman, who had given birth to many children. I cannot remember the exact number, but I remember thinking, “Wow, that’s a lot of kids.” I was assisting her in using a bedpan and was horrified to see what I know in retrospect was a rectovaginal fistula. She said “That’s been happening for ages. I tore real bad when I had my last baby.” I remember thinking how pitiful it was that a woman had to go through the rest of her life with that condition and how underserved women were that had traumatic births. At that time pelvic floor physical therapy was in its infancy, but I knew I wanted to be a part of it. It took me 10 years to take my first course, but it was, and is, the path for me.


Jul 18, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Labor and Delivery and Postpartum" in Washington this August.

 

yoga

You may or may not realize that the United States has a very poor track record for postpartum care. In fact, the US has the worst track record for not only postpartum care, but for maternal and infant mortality and first-day infant death rate in the developed world (Save the Children 2013). Between 1999-2008, global mortality rates decreased by 34% while the US’s rates doubled for mothers (Coeytaux et al 2011).

 

In After the Baby’s Birth, maternal health advocate Robin Lim writes,

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive, particularly to women suffering from painful physical and/or psychological disorders following childbirth."


Jul 16, 2014

This guest post was written by H&W instructor Debora Chassé Hickman DPT, WCS, CLT-LANA. Debbie will be instructing the course that she wrote on "Lymphatic Drainage for Pelvic Pain" in California this October.

 

PRR: How did you come up with the idea to perform manual lymph drainage on patients with pelvic pain?

Debora Chassé

Physical therapist colleagues approached me 3 years ago asking if I could come up with a solution using lymphatic decongestive therapy for pelvic congestion. Pelvic congestion is a diagnosis involving varicose veins in the lower abdomen and pelvis causing chronic pelvic pain. After conducting research on pelvic congestion I found there were only medical treatments to reduce the symptoms. The cause of pelvic congestion is due to blood in the veins that drain the ovaries by backing up causing an abnormal dilation of the vessel. As I began looking at the symptoms related to pelvic congestion with other pelvic pain diagnosis, I saw a correlation between those symptoms and lymphedema.

 

Patients with pelvic congestion have increased swelling, increased inflammation in a dependent position and uterine wall thickening. Lymphedema symptoms consist of chronic swelling, increased swelling of limb in a dependent position and increased thickening of connective tissue. Crisostomo et al. (2013) conducted research shows manual lymph drainage increase venous blood flow in the lower extremities. I conducted a case study to determine if manual lymph drainage would decrease symptoms of pain in patients with pelvic congestion. Following 5 days of consecutive manual lymph drainage, her symptoms decreased 50%.


Jul 13, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Deborah Benson PT, MEd, COMT, PRPC

 

Deborah Benson PT, MEd, COMT, PRPC

Describe your clinical practice:

I work in an outpatient orthopedically based manual therapy practice, but work largely with chronic pain patients.

How did you get involved in the pelvic rehabilitation field?

I initially became interested when I started having chronic pelvic pain and urinary leakage myself. I had treated everything I knew how to treat, but continued to have problems. I took the Herman and Wallace Pelvic Floor I class and found that pelvic floor muscle over-activity was part of the “missing piece” for treatment of my problems and some my orthopedic patients who had plateaued. Once I started incorporating assessment and treatment of pelvic floor muscle dysfunction, some of my patients became even more functional.


Jul 11, 2014

This post was written by H&W instructor Steve Dischiavi, MPT, DPT, ATC, COMT, CSCS. Dr. Dischiavi will be instructing the course that he wrote on "Biomechanical Assessment of the Hip and Pelvis" in Virginia this August.

 

Dischiavi

In an outpatient sports medicine clinic the traditional model of physical therapy evaluation typically includes the therapist reviewing a patients chart and subjective symptom questionnaire of some sort. Then the therapist will bring the patient to an area to begin a subjective history and then onto a physical exam. After these procedures have been completed the therapist will typically assign a working clinical diagnosis and then begin treatment. In short, I would like to suggest a paradigm shift to this traditional model of thinking. Instead of starting the exam on a table with a static assessment of the structures involved and identifying the pain generator, I suggest the therapist begin with a specific set of movements used as an evaluative tool to identify movement dysfunction within the anatomical system as a whole.

 

All human interactions on earth occur between ground reaction force and gravity, our bodies are mostly just stuck in the middle of this constant battle and typically we succumb to whichever power exposes the weakest link in our biomechanical chains. One of the reasons the biomechanical chains in our bodies are so pliable and vulnerable to constant ground reaction force and gravity acting on them is because we are basically bones or struts suspended in a bag of skin all connected by soft tissue. Suggesting that without skin, fascia, and connective tissue supporting us, we would collapse to the ground in a pile of bones! Ingber (1997), suggested this concept, known as tensegrity, was the “architecture of life.” So in summary, the tensegrity structures are mechanically stable not because of the strength of the individual bones, but because of the way the entire human body distributes and balances mechanical stresses through the use of polyarticular muscle chains called slings. There will be more on slings in the upcoming blogs.

 


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Upcoming Continuing Education Courses

Athlete and the Pelvic Floor - Columbus, OH
Aug 02, 2014 - Aug 03, 2014
Location: OhioHealth Neighborhood Care Rehabilitation

Pudendal Neuralgia - San Diego, CA
Aug 09, 2014 - Aug 10, 2014
Location: Comprehensive Therapy Services

Biomechanical Assessment - Arlington, VA
Aug 16, 2014 - Aug 17, 2014
Location: Virginia Hospital Center

Yoga as Medicine for Labor and Delivery and Postpartum - Seattle, WA
Aug 16, 2014 - Aug 17, 2014
Location: Pilates Seattle International

Pediatric Incontinence - Greenville, SC
Aug 23, 2014 - Aug 24, 2014
Location: Proaxis Therapy

Pelvic Floor Level 1 - St. Louis, MO (SOLD OUT!)
Sep 05, 2014 - Sep 07, 2014
Location: Washington University School of Medicine

Meditation and Pain Neuroscience - Winfield, IL
Sep 06, 2014 - Sep 07, 2014
Location: Central DuPage Hospital Conference Room

Visceral Mobilization Level Two - Boston, MA
Sep 12, 2014 - Sep 14, 2014
Location: Marathon Physical Therapy

Coccyx Pain - Nashua, NH
Sep 13, 2014 - Sep 14, 2014
Location: St. Joseph Hospital Rehabilitative Services

Visceral Mobilization of the Urologic System - Scottsdale, AZ
Sep 19, 2014 - Sep 21, 2014
Location: Womens Center for Wellness and Rehabilitation

Care of the Postpartum Patient - Maywood, IL
Sep 20, 2014 - Sep 21, 2014
Location: Loyola University Stritch School of Medicine

Pelvic Floor/ Pelvic Girdle - Atlanta, GA
Sep 27, 2014 - Sep 28, 2014
Location: One on One Physical Therapy

Assessing and Treating Vulvodynia - Waterford, CT
Sep 27, 2014 - Sep 28, 2014
Location: Visiting Nurses Association - Southeastern

Pelvic Floor Level 2B - Durham, NC
Oct 03, 2014 - Oct 05, 2014
Location: Duke University Medical Center

Male Pelvic Floor - Tampa, FL
Oct 04, 2014 - Oct 05, 2014
Location: Florida Hospital - Wesley Chapel