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Aug 03, 2014

Hip

Posttraumatic Stress Syndrome, also known as PTSD, is an unfortunate consequence of many women's birth experiences. While there are known risk factors, there is not currently a standardized screening method for identifying symptoms of PTSD in the postpartum period. One recent meta-analysis of 78 research studies identified a prevalence of postpartum PTSD as 3.1% in community samples and as 15.7% in at-risk or targeted samples. Risk factors for PTSD included current depression, labor experiences (including interactions with medical staff), and a history of psychopathology. In the targeted samples, risk factors included current depression and infant complications. Other authors have explored the relationships between preterm birth and PTSD, preeclampsia or premature rupture of membranes, and infants in the neonatal intensive care unit. 

 

 

One of the main concerns of failing to identify and treat for PTSD in the postpartum period is the potential negative effect on the family. High levels of anxiety, stress, and depression may impact not only the mother's health, but also may affect her ability to meet her new infant's needs, or complete usual functions in work and home life. One study suggested that "…maternal stress and depression are related to infants’ ability to self-sooth during a stressful situation." Clearly, healthy moms promote healthy families, and each mother deserves the attention that her new infant often receives from the world! 

 

 


Aug 01, 2014

This post was written by H&W instructors Nari Clemons, PT and Dr. Shawn Sidhu, MD, psychiatrist. Nari and Shawn will be instructing the course that they wrote on "Meditation and Pain Neuroscience" in Illinois this September.

 

Shawn Sidhu

We caught up with Dr. Shawn Sidhu, MD, psychiatrist on why he thinks it is good for himself and his patients to have a meditation practice.

Why, as a physician and father, do you meditate?

 

Meditation can do a lot of things for different people. Some people say that it helps them to stay grounded. Others comment that it helps them to focus and organize their mind. I’ve also heard that people feel more in touch with their emotions and their thoughts when they’ve been meditating regularly, even for brief periods of time. While I feel that all of the above are certainly benefits of meditation that I have experienced, the single greatest thing that meditation does for me is to help increase my level of awareness as it pertains to my surroundings. In other words, when I am able to meditate, my observational skills improve significantly. This is incredibly important for a Child and Adolescent Psychiatrist. Those of us who work in mental health must first observe our patients, and really see them clearly through multiple layers if we are going to have any chance of helping them and getting to the root causes of their suffering. Only after observing clearly and effectively can we begin to think about treatment. On days when I don’t meditate and I’m not as in touch with my inner self, I lose a great deal of awareness of the outside world as well. My patients notice it, too, and will comment that I am not as in tune with them or not as engaged on days when I do not meditate. So in a sense meditation sets a great foundation from which I can really reach patients and their families in a meaningful way.


Jul 31, 2014

Hip

While many of the Herman & Wallace Pelvic Rehabilitation continuing education courses focus on study of the pelvic floor muscles, the inclusion and consideration of the trunk, breathing, form and force closure, and posture are also needed to truly understand the pelvis. Our professional education does not prepare us well in regards to understanding the pelvic floor and pelvic girdle, and the foundational concepts that provide clinical meaningfulness come from a variety of research camps. If you feel that you were never provided this foundational information about the pelvic girdle and trunk, and wish to better apply practical concepts in movement and muscle facilitation (or inhibition), you might be looking for the Pelvic Floor/Pelvic Girdle continuing education course that is coming to Atlanta in late September.

 

The course covers interesting topics such as pelvic floor muscle activation patterns in health and in dysfunction, use of load transfer tests such as the active straight leg raise, orthopedic considerations of pelvic dysfunction, pelvic floor muscle (PFM) exercise cues, risk factors for pelvic dysfunction, and treatment of the coccyx. If you (or a friend you want to take a course with) is not quite sure about internal pelvic floor coursework at this time, the good news is that this course addresses pelvic dysfunction using an external approach. Experienced therapists can appreciate the research-based approach to muscle dysfunctions that can cause or perpetuate a variety of symptoms, and newer therapists have the chance to learn how to integrate pelvic floor/pelvic girdle concepts into current practice. A biofeedback lab introduces use of surface electromyography (sEMG) as well.

 

There is still time to sign up for the September course in Atlanta, the only remaining opportunity to take the Pelvic Floor/Pelvic Girdle continuing education course this year. Bring a friend, or a colleague, and work together to combine external and internal approaches to pelvic dysfunction.


Jul 31, 2014

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

 

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

Our hospital-based system was getting a growing number of pelvic floor referrals, and I offered to help fill the need. I was mentored by our current Women’s Health therapist and began the gradual process of learning through the Herman and Wallace courses. I thought I knew what I was getting into, thinking I would be better able to help my low back and SI patients, but I was blown away by all the NEW information I received. I learned as much about my bad bladder and bowel habits as I learned about helping my patients. The pelvic floor hadn’t even been mentioned in my college anatomy class and I was very impressed by the intricacy of the anatomy “down there.” After Pelvic Floor I, I needed to keep learning to satisfy my curiosity and be able to help the increasingly complex patients I was encountering.

 

What has been your favorite Herman & Wallace Course and why?

Pelvic Floor I was amazing just for the sheer amount of new material, and of course, having Holly teach us to practice saying “vagina” in front of the mirror to decrease our discomfort was priceless.


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 Nari 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.


Upcoming Continuing Education Courses

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

Pelvic Floor Level 2A - St. Louis, MO (Sold Out!)
Oct 10, 2014 - Oct 12, 2014
Location: Washington University School of Medicine

Chronic Pelvic Pain - New Canaan, CT
Oct 10, 2014 - Oct 12, 2014
Location: Philip Physical Therapy

Peripartum Special Topics - Houston, TX
Oct 11, 2014 - Oct 12, 2014
Location: Texas Children’s Hospital

Pelvic Floor Level 3 - Maywood, IL
Oct 17, 2014 - Oct 19, 2014
Location: Loyola University Stritch School of Medicine

Lymphatic Drainage - San Diego, CA
Oct 18, 2014 - Oct 19, 2014
Location: FunctionSmart Physical Therapy