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Jun 30, 2014

This blog was written by Carolyn McManus, PT, MS, MA, who will be presenting at the APTA's Virtual NEXT conference in North Carolina. Carolyn is instructing a new course with Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA.

 

Carolyn McManus

We all know a highly stressed patient will have a more complicated and prolonged healing process than a non-stressed patient. Recent research is finally illuminating possible mechanisms causing the amplification of pain by stress. For example, stress has been shown to enhance muscle nociceptor activity in rats. (1) In this study, water avoidance stress produced mechanical hyperalgesia in skeletal muscle and a significant decrease in the mechanical threshold of muscle nocicpetors, a nearly two fold increase in the number of action potentials produced by a fixed intensity stimulus and an increase in conduction velocity from 1.25 m/s to 2.09 m/s! Researchers suggest these effects are due, at least in part, to catecholamines and glucocorticoids acting on adrenergic and glucocorticoid receptors on sensory neurons.

 

I always talk about this study with my patients who have persistent pain. It helps them understand that pain can escalate, not because of tissue damage, but because of the effects of stress hormones on their nerves. They understand that if they persist in escalating their stress reaction they will limit their healing potential. There is more research on this topic and strategies to help patients self-regulate their stress reaction that I look forward to discussing in my upcoming course in November.

 


Jun 29, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Erin Glace, MSPT, PRPC

 

Erin Glace, MSPT, PRPC

How did you get involved in the pelvic rehabilitation field?

Honestly, I would have to say that pelvic rehab found me. I was convinced that I would specialize in pediatrics my entire career, but I started a private practice in 1994 with another therapist who convinced me that we should start a “niche” practice that included treating incontinence. When we started to see pain patients, I was hooked. These were women who had suffered for so many years and the rewards of helping them to heal was so tremendous that I couldn’t look back and jumped in with both feet. It is always amazing to me when I am treating a patient and they ask me-“Why did you choose this type of therapy?” My answer is always- “patients like you!”

What role do you see pelvic health playing in general well-being?

Pelvic health is so important for general well being. I think we are only just discovering how important these “deep muscles” are to our overall health.


Jun 26, 2014

In Turkey, the rate of daytime urinary incontinence (DUI) was studied in primary school-aged children. A questionnaire was completed by parents of 2164 students. The Dysfunctional Voiding and Incontinence Symptoms Score Questionnaire was utilized and includes 14 questions about daytime and nighttime symptoms, voiding and bowel habits, and quality of life.

 

The population studied included approximately half boys and girls, with nearly half living in rural versus urban settings, and of a mean age of 10 years old. The overall prevalence of DUI was 8% (8.8% in girls, 7.3% in boys), and decreased with increasing age in this study population of children in 1st through 8th grades. 57.8% of those who did experience involuntary loss of urine were wetting less than 1x/day, 26.6% were wetting 1-2 times/day, and 15.6% were wetting greater than 2x/day. Urge incontinence was reported in nearly 59% of the children with DUI.

 

Independent risk factors for DUI included age, maternal educational level, family history of daytime wetting, urban versus rural setting, history of constipation or urinary tract infection (UTI), and urinary urgency. The authors conclude that "…educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status." In this study, one of the strategies used to increase the survey response rate was to send medical and public health residents to the schools to speak about the study on 2 occasions.

 

Despite the numbers of therapists who have previously trained with educators such as faculty member Dawn Sandalcidi in her coursework for pediatric bowel and bladder function, the number of therapists focusing on pediatric pelvic health remains small while the need is great. Therapists who wish to expand community reach to pediatric urologists and pediatricians, and to serve the children who may unfortunately become adults who have bowel and bladder dysfunction, have the opportunity to attend the Pediatric Incontinence and Pelvic Floor Dysfunction continuing education course in Greenville, South Carolina this August.


Jun 25, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Lori Waterman PT, DPT, OCS, PRPC

 

 

Describe your clinical practice:

I work in a very small, physical therapist-owned clinic in Olympia, WA with two other female physical therapists who treat pelvic health conditions. We accept insurances, and have the flexibility to make our appointments either 30 or 45 minutes, depending on the needs of the patient. We utilize our manual skills and therapeutic exercise mostly; however, we also do have surface EMG biofeedback, electrical stimulation and my personal favorite, rehabilitative ultrasound imaging (RUSI) for retraining muscles.

What role do you see pelvic health playing in general well-being?

Pelvic health is critical to well-being. If someone has pain with intercourse, or fecal incontinence, or urinary incontinence, they don’t just feel inconvenienced, but ashamed and fearful. These functions are ‘supposed’ to just happen fairly routinely, except with more control of when and where (and with whom) they should happen! When the control is lessened, or when something that is supposed to be pleasurable is intolerable, there is confusion and shame and disconnect. At our most basic levels of identity and well being, pelvic control and comfort are so important.


Jun 24, 2014

This post was written by H&W instructor Jennafer Vande Vegte, MSPT, BCIA-PMB, PRPC. Jen will be instructing our "Pelvic Floor Level 2B" course in Illinois this July.

 

Jennafer Vande Vegte

My job as a pelvic floor therapist is rewarding and challenging in so many ways. I have to say that one of my favorite "job duties" is differential diagnosis. Some days I feel like a detective, hunting down and piecing together important clues that join like the pieces of a puzzle and reveal the mystery of the root of a particular patient's problem. When I can accurately pinpoint the cause of someone's pain, then I can both offer hope and plan a road to healing.

 

Recently a lovely young woman came into my office with the diagnosis of dyspareunia. As you may know, dyspareunia means painful penetration and is somewhat akin to getting a script that says "lower back pain." As a therapist you still have to use your skills to determine the cause of the pain and develop an appropriate treatment plan.

 


Jun 24, 2014

In women with pelvic pain, is a pudendal nerve block effective, and how does the effectiveness correlate with findings of the history and clinical exam? These were the questions posed by a study published in 2012. Sixty-six patients were given a standardized pudendal nerve block, with Visual Analog Scores (VAS) and presence of numbness recorded prior to and up to 64 hours after the block. Inclusion criteria for the study involved having spontaneous or provoked pain in the distribution of the pudendal nerve, and patients were excluded if significant psychosocial issues, neurogenic or neuromuscular disorders, contraindication to sedation or allergy to utilized medication was present. A detailed history and physical examination was completed.

 

The pudendal nerve block was administered transvaginally and digitally, under sedation, in a lithotomy position. Following data collection, the researchers found that the presence of a positive Tinel's sign (palpation medial to the ischial spine for assessment of pain reproduction), a prior history of vulvovaginal candidiasis, or symptom worsening in the sitting position was associated with a return of the pain prior to the numbness wearing off. 92.4% of the subjects reported a "positive" response to the block, with varied lengths of time of symptom reduction. Nearly 87% of the subjects reported a reduction in one or more symptoms. This study only studied subjects for 64 hours, therefore it is not possible to discuss from this research the long-term implications of a pudendal nerve block in women with pudendal neuralgia. The authors did find a correlation between prior traumatic events including birth injuries, herniated discs, and fractures of the coccyx, pelvis or sacrum.

 

What does this research tell us about the role of pudendal blocks in the assessment and treatment of female pelvic pain? As already mentioned, the brevity of the data collection (only up to 64 hours) in addition to application of a non-guided block limit the ability to extrapolate this information to any long-term results. However, the correlations to clinical history and the return to pain prior to numbness ending may provide useful information as further clinical research is completed. The numbness was found to have inconsistent effects on a patient's symptoms such as bladder, bowel, sexual dysfunction, or sitting, and further research could measure the effects of a block on these functions. If you would like to discuss pudendal blocks with experts on pudendal dysfunction, sign up for the remaining spots in our August San Diego course!

 

Learn more about the Pudendal Neuralgia Assessment and Treatment course that we are holding at Comprehensive Therapy Services later this year.


Jun 23, 2014

This post was written by H&W instructor Dawn Sandalcidi, PT, RCMT, BCB-PMD. Dawn's course that she wrote on "Pediatric Incontinence" will be presented in in South Caroline this August.

 

Dawn Sandalcidi

I will never forget the morning I was called by one of my referring pediatricians to tell me an 11-year-old boy with fecal incontinence hung himself because his siblings ridiculed him. If you ever ask me why I do what I do, I will tell you so that nothing like that would ever happen again.

 

When we think of pediatric bowel and bladder issues we primarily focus on the physiologic issue itself and treating the underlying pathology. I think it is imperative to teach a child that she/he did not have a leak but their bladder or bowel had a leak. It makes the incident a physiological problem and not a problem of the child.

 


Jun 23, 2014

A systematic review from July of 2013 addressed how interpersonal factors modulate pain. Four primary findings of the research that are found to affect pain-related responses are as follows: the degree to which social partners were active (or perceived to be able to be active), the degree to which participants could perceive the specific intentions of the social partners, the pre-existing relationship between the subject and the social partner, and individual differences in relating to others (including coping styles).

 

Some patients are negatively impacted by a partner who is attentive to pain, with increased reports of pain, worse pain outcomes when together versus alone, and with longer lasting pain states. On the other hand, some patients respond favorably to a partner's support, with lower reports of pain states when offered support such as holding the hand of a partner. Because each person's relationship and response to the pain within the context of the relationship varies, the impact of a partner on perceived pain is also varied. The authors, after describing details and evidence of pain modulation research, conclude the following: "Specifically, interpersonal exchanges affect precision or salience by socially signaling the safety or threat of the impending stimulus itself or the environment in which the stimulus occurs."

 

How can we take this information to heart within the pelvic rehabilitation practice? One of the ways that we offer support to a couple is by inviting a partner to attend a clinic session where he or she can learn to assist in application of soft tissue release techniques. The partner has the opportunity to be validated in both the gratitude that the therapist offers to the patient and partner for attending, and also in the fact that pelvic pain is commonly encountered. Because pelvic pain can interfere with a couple's intimacy, having such validation about the physicality of pain, when present, may be useful in a relationship. When a partner learns how to be of help in the healing process, this may also affect the factors mentioned in the cited research article, specifically, how partners are perceived to be able to be active or perception of specific intention.

 

It has been my clinical experience that partners are very specific in intention once being trained in how to help with pelvic pain, and that intention is to be a part of the healing process. It has also been an observation that if a partnership is struggling with their relationship, that issues can surface once asked to engage in pelvic muscle rehabilitation. This might mean that a patient chooses to pause rehabilitation and enter psychological counseling or other healing work. It also might mean that the patient chooses to not request help of the partner in the clinic or at home for the time being.


Jun 20, 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

Physical therapists often see women during pregnancy and postpartum, but what can physical therapists do to foster better birth outcomes?

 

A 2012 study conducted in Norway underscores the importance of childbirth education, which can take place as part of patient education and counseling in physical therapy. The study looked at 2206 women with intended vaginal delivery in order to assess the association between fear of childbirth and duration of labor. Labor duration was found to be significantly longer in women with fear of childbirth, with the rate of epidural analgesia, induction, and instrumental vaginal delivery also being higher in fearful women. The authors posit that “anxiety and fear may increase plasma concentrations of catecholamines, and high concentrations of catecholamines have been associated with both enervated uterine contractility and a prolonged second stage of labour.” (Adams et al 2012).

 


Jun 20, 2014

This post was written by guest blogger Laura E Nimon OTR/L, CLT-LANA. Laura will be attending Ginger Garner's course that she wrote on "Yoga as Medicine for Labor and Delivery and Post Partum " in Seattle this August.

 

 

From the time a woman hears the words “You’re pregnant” she becomes flooded with information regarding what she should/should not do to have a healthy pregnancy—but how much is accurate, and why is a healthy delivery not further discussed?

 

Over the last decade yoga has become a highly recommended form of exercise to maintain/improve flexibility and cardiovascular status in a gentle and safe manner. There is a plethora of information and sales directed to pregnant women and these women should be wary consumers as not all classes or home videos are safe due to the hormonal changes experienced in pregnancy that can exacerbate a prior joint condition or create one if an exercise is done improperly.

 


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