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Oct 23, 2014

PelvicHip

What are the roles of hip labrum innervation in both nociception and proprioception? Canadian researchers tackled this question by studying hip joints that were harvested during total hip replacement or hip resurfacing surgery. Twenty labrums were harvested and the structures in the labrum were divided into four quadrants including antero-superior (AS), postero-superior (PS), antero-inferior (AI), and postero-inferior (PI). The mean age of the subjects was near 60. The authors reported the following:

 

• Labral innervation is from a branch of the nerve to the quadratus femoris and the obturator nerve.

• All labrum samples had abundant free nerve endings according to the authors. These nerve endings are responsible for nociception transmission.

• Three different types of nerve end organs were noted: Vater-Pacini, Golgi-Mazonian, and Ruffini corpuscles. These nerve end organs operate to provide proprioception through their roles in pressure, deep sensation, and temperature.

• The free nerve endings and nerve end organs were observed more often in the AS and PS zones.


Oct 22, 2014

How long do hot flashes last in a woman's life? One recent study asked this question by following 255 women from premenopause to natural menopause. The authors found that moderate to severe symptoms of hot flashes continued on average 5 years after the date of the woman's last period. Unfortunately, up to 1/3 of the women continued to report hot flashes 10 or more years after menopause. Results also found that risks for hot flashes were higher in women who were African-American or in obese, white women. Higher education level was found to be protective against hot flashes.

 

The Mayo clinic states that while the exact cause of hot flashes is not known, there are several factors that may influence their occurrence. Changes in reproductive hormones in addition to hypothalamic shifts create a sensitivity to even slight changes in temperature. Women can experience a wide range of menopausal symptoms, with hot flashes ranging from sudden feelings of warmth that occur a couple times per day to profuse sweating that can occur up to one time per hour.

 

Menopause.org is a helpful resource for our patients, and lifestyle changes are offered such as avoiding stress, breathing techniques, and creating strategies to maintain body temperature within a limited range. Hormonal treatment and non-hormonal options are also described on this site, and while certain hormonal options may be contraindicated for some patients, there are therapies such as sleeping medications that may improve quality of life for a woman who is suffering significant sleep disruption. Decisions to utilize hormonal drug therapy may depend on many factors, such as benefits to risk ratios, if the patient has her uterus, and age of the patient. Many nonprescription options are also available, with conflicting or little evidence to support many of the claims. Regardless of the remedy that a patient may take for her menopausal symptoms, keep in mind that all medications or supplements should be reported to the physician and/or pharmacist so that drug interactions can be screened. Even herbal supplements can have a negative impact on other drugs that a woman is taking, so she should always fully disclose her medications, supplements (including teas!), creams, and other natural remedies.

 

If you are working with more women in the perimenopausal period, you may have questions about the hormonal changes and effects on rehabilitation. Faculty member Michelle Lyons will offer her new continuing education course called Menopause: A Rehabilitation Approach. At this course she will systemic changes in menopause, bone health, perimenopausal pelvic floor issues, sexual health, weight management, and procedures such as hysterectomy. The next opportunity to take this course is in February in Orlando - what a great time to head to the sunshine!


Oct 21, 2014

This post was written by H&W instructor Jennafer Vande Vegte.

 

Jennafer Vande Vegte

Biofeedback is a truly wonderful tool for a pelvic floor physical therapist. Using surface EMG can really help a patient learn how to control a muscle (typically the pelvic floor) that has been under improper voluntary or involuntary control, sometimes for many years. A recent article on biofeedback in medicine looked at the effectiveness of using biofeedback to treat a number of medical conditions (not just for pelvic floor function) and reviewed pertinent research. Using biofeedback for the treatment of urinary incontinence got the best rating (Level 5) as efficacious and specific. Treatment for constipation met Level 4 criteria for effectiveness while treating urinary incontinence in men, vulvar vestibulitis and fecal incontinence received a Level 3 rating as probably efficacious. (Frank et al., 2010)

 

It is wonderful when we have evidence that what we do as therapist works. But another question we might have is "HOW does it work?" Emmanuel and Kamm (2001) saw that biofeedback for constipation was effective in retraining faulty pelvic floor function but also noted that many patients undergoing treatment for elimination disorders also saw their transit time and bowel movement frequency improve. They theorized that this may be a response of the extrinsic autonomic nerves sending signals from the brain to the gut. They used mucosal laser Doppler flowmetry to show whether treatment changed extrinsic innervations, if autonomic changes were gut specific (or if there were cardiovascular changes as well) and whether gut transit was affected.

 


Oct 20, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Debra Goldman P.T., M.A. PRPC

 

Debra Goldman

Describe your clinical practice:

My clinical practice includes men and women with pelvic pain, nerve entrapments, incontinence, sexual dysfunction and much more. It’s dedicated to helping men and women holistically restore their bodies’ ability to move and function without pain. My motto is, recover, restore, move forward. In other words, don’t be a lifelong patient. The whole body approach I use helps me to determine if their pelvic floor dysfunction is related to a structural problem in the back, hips or the way they exercise, just to name a few. I do a thorough examination of the spine, hips and pelvis and pelvic floor to assess joint and soft tissue restrictions, specific weaknesses and faulty movement patterns. My treatments integrate manual therapy, specific exercise and mind-body retraining.

 

How did you get involved in the pelvic rehabilitation field?


Oct 20, 2014

This November, Herman & Wallace is thrilled to be offering a brand-new course instructed by Carolyn McManus, PT, MS, MA, called Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA. We sat down with Carolyn to learn more about her course.

 

Carolyn McManus

The constant flood of information in today’s interconnected, wired world trains the mind in distraction and away from the immediate experience of life. Many people spend hours gazing down at quickly changing images on the small frame of an electronic device and only notice the body when it has its aches and pains! Mindful awareness offers us a skillful way to pay attention, build body awareness, touch life fully and provides a healing antidote to information overload.

 

Mindful awareness invites us to rest the mind in the present moment with openness, friendliness and curiosity. This is not our natural tendency and requires training. Often we are caught in a struggle with the present moment, perceive it as flawed, find fault with ourselves and constantly drive ourselves to run, do and achieve. When mindful, we still have our plans, goals and to-do list, but this is not an obstacle to resting the mind here and now. We can stop the struggle with the present moment, touch life fully and open to the potential for ease and insight in the midst of things just as they are. New perceptions and an experience of aliveness can occur that can never happen when we are lost in distraction. Danna Faulds expresses this beautifully in her poem "Walk Slowly":

 


Oct 16, 2014

PelvicHip

Avulsion fractures refer to a forcible separation, or tearing away of bone due to a sudden and powerful contraction of muscle. This injury is most common in adolescents, with the as yet developing growth plates being a likely location of avulsion. A systematic review of the literature published in 2011 describes the pathology of pelvic avulsion fractures as "highly prevalent" among adolescent athletes. Additionally, patients who have mature skeletons and who have a history of prior surgical interventions to the bones are also at risk for pelvic avulsion fractures.

 

Avulsion fractures appear to occur most commonly during the eccentric phase of muscle activity during sporting activities. Pre-existing pain in hip or pelvis may be present, but is not a reliable predictive sign of subsequent fracture. Included in this review article were 48 case reports and case series of which 88% related to physical activity and the remaining 12% related to previous surgical procedures. Within the cases related to physical activity, the mean age of fracture in subjects was 16.8, with 84% being male. Activities in which subjects were involved involved included soccer, gymnastics, and running sports. In the cases related to surgery, mean age of fracture was 56.4, and 100% were female. All of the surgery-related cases presented in the literature were treated with conservative measures. Conservative care described included a period of bed rest for 3 days progressing to walking with crutches until the patient was able to walk without significant pain.

 

Symptoms reported by patients who have suffered an avulsion fracture of the pelvis may include reporting a popping sensation, local pain, and difficulty walking. Having had a bone harvest from the iliac crest may also predispose a patient to a subsequent avulsion fracture. The authors state that surgery may be considered when there is greater than 2 centimeters of displacement of the avulsion or if the ischial tuberosity is involved.

 


Oct 15, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Jamie Besante DPT, PRPC

 

Vicki Lukert

What patient population do you find most rewarding in treating and why?

I find my generation and my younger clients the most rewarding because I have seen myself in them and they are so brave. They knew something wasn’t right with their bodies and they stood up and asked for help and solutions. I have seen many clients with years of dysfunction, pain and suffering and to be able to prevent this in my younger clients means so much. I always say I sleep so easy at night because I feel that I have done my best to help as many people as I can that day.

How did you get involved in the pelvic rehabilitation field?

While earning my entry-level doctorate in physical therapy, we had a brief lecture on “Women’s Health” physical therapy that resonated with me as a young women who suffered from pelvic dysfunction. I asked to complete one of my student affiliations in Women’s Health and I fell in love with the field, treating both men and women.


Oct 10, 2014

pregnant yoga

Do women who participate in yoga during pregnancy feel more optimistic, more powerful, and more well? Yes! This is the reply from a study involving 21 women who enrolled in a yoga class for six weeks. While twelve of the women had previously practiced yoga, none were currently practicing. The format of the class involved the following components: checking in (sharing the prior week's experiences), centering (visualization and breathing exercises), warm-up (neck rolls, shoulder exercises, and side stretches), yoga flow (yoga standing positions such as sun salutation), standing postures (balance, wall positions), mat work (seated postures and hip exercises), Savasana (modified to left side lying), and meditation.

 

Outcomes tools utilized in this study included the Life Orientation Test-Revised for measuring optimism, the Power as Knowing Participation in Change Tool version II for measuring sense of power, the Short-Form 12 Version 2.0, and the Well-being Picture Scale. Participants in the study were also given a journal to document time spent practicing yoga, and how they felt after practicing yoga, both physically and emotionally. The authors conclude that yoga as a self-care practice can be used to promote self-care and well-being in women who are pregnant.

 

Why are feelings of power, well-being, and optimism valuable for women who are pregnant? The authors discuss the literature which has suggested higher levels of adaptive coping in women with high-risk pregnancies, and the concept that optimism is associated with physical health. Previous studies about using yoga during pregnancy have proposed benefits to the mother both during her pregnancy as well as during labor and delivery. The authors of the study also describe power within the perspective of Rogers' science of unitary human beings, with sharing of interesting philosophical concepts such as resonancy, integrality, and diversity of the human-environmental field.

 


Oct 09, 2014

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

 

Vicki Lukert

Describe your clinical practice:

I work at the University of Florida Health Rehab Centers at Magnolia Parke and Medical Plaza, an outpatient clinic which is part of the large teaching hospital in Gainesville, FL. I head up the Pelvic Health team which consists of seven therapists. We treat pelvic and abdominal conditions in females, males and children. It is very exciting to be a part of such an enthusiastic, knowledgeable and creative team. Due to the fact we are a teaching hospital we get to see some of the most complex patients imaginable which come from all over.

 

How did you get involved in the pelvic rehabilitation field?


Oct 09, 2014

Earlier this year, the Food and Drug Administration issued a warning about serious side effects of laxatives if not used according to the label or when used in the presence of certain comorbities. Sodium phosphate laxatives, according to the label, are to be taken as a single daily dose, and for no more than three days. In addition to the warning to contact a physician if the patient has kidney disease, cardiac conditions, or dehydration, the FDA advises patients to ask their physician before taking the drug with age older than 55, or when taking certain medications. These medications include: diuretics, angiotensin-converting (ACE) inhibitors, angiotensin receptor blockers (ARBs), and nonsteroidal anti-inflammatory drugs (NSAIDs).

 

Laxatives are grouped into different classes and have varied effects on a person's gastrointestinal system. The following is adapted from the Mayo Clinic's website and describes the main types of laxatives.

 

Laxative Type
Action
Brand Example

Oral osmotics Draw water into the colon to improve passage of stool Miralax
Oral bulk formers Absorb water to form soft, bulky stool Metamucil
Oral stool softeners Add moisture to stool Surfak
Oral stimulants Trigger rhythmic contractions of intestinal wall Senekot
Rectal stimulants Trigger rhythmic contractions of intestinal wall Dulcolax

Because laxatives can interact with medications, asking about medication lists (including supplements and herbals) is important for pelvic rehabilitation providers. Even the teas available at the grocery store that are marketed to help with digestion and specifically, constipation, may work well and may interact with a patient's medications. If you are interested in learning more about laxatives, constipation, and promotion of bowel health with rehabilitation techniques, sign up for the Bowel Pathology and Function continuing education course. This course, written by faculty member Lila Abbate, has been well-received and aims to further the knowledge of therapists who are treating patients with bowel dysfunction. The next course is coming up next month in California!


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Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Boston, MA (SOLD OUT!)
Oct 24, 2014 - Oct 26, 2014
Location: Marathon Physical Therapy

Bowel Pathology and Function - Torrance, CA
Nov 08, 2014 - Nov 09, 2014
Location: HealthCare Partners - Torrance

Pelvic Floor Level 1 - San Diego, CA (SOLD OUT)
Nov 14, 2014 - Nov 16, 2014
Location: FunctionSmart Physical Therapy

Mindfulness- Based Biopsychosocial Approach to Chronic Pain - Seattle, WA
Nov 15, 2014 - Nov 16, 2014
Location: Swedish Hospital - Cherry Hill Campus

Yoga as Medicine for Pregnancy - New York, NY
Nov 16, 2014 - Nov 17, 2014
Location: Touro College

Pelvic Floor Level 2B - St. Louis, MO
Dec 05, 2014 - Dec 07, 2014
Location: Washington University School of Medicine

Pelvic Floor Level 1 - Omaha, NE (SOLD OUT!)
Dec 05, 2014 - Dec 07, 2014
Location: Methodist Physicians Clinic

Pelvic Floor Level 3 - Derby, CT
Dec 12, 2014 - Dec 14, 2014
Location: Griffin Hospital

Pelvic Floor Level 1 - Oakland, CA (SOLD OUT)
Jan 09, 2015 - Jan 11, 2015
Location: Samuel Merritt University

Care of the Postpartum Patient - Santa Barbara, CA
Jan 10, 2015 - Jan 11, 2015
Location: Human Performace Center

Sexual Medicine for Men and Women - Houston, TX
Jan 23, 2015 - Jan 25, 2015
Location: Women's Hospital of Texas

Pelvic Floor Level 1 - Maywood, IL
Jan 23, 2015 - Jan 25, 2015
Location: Loyola University Stritch School of Medicine

Sacroiliac Joint Evaluation and Treatment - Seattle, WA
Jan 24, 2015 - Jan 25, 2015
Location: Pacific Medical Center

Menopause: A Rehabilitation Approach - Orlando, FL
Feb 21, 2015 - Feb 22, 2015
Location: Florida Hospital Sports Medicine and Rehabilitation

Care of the Pregnant Patient - Seattle, WA
Mar 07, 2015 - Mar 08, 2015
Location: Pacific Medical Center