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Jul 08, 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.

 

Note: This post is for colleagues, patients, and friends whose greatest desire is to have a healthy baby via natural childbirth. In this article, natural childbirth refers to an unmedicated delivery of your baby, assisted with natural, non-pharmaceutical means. While not all women have the luxury of natural childbirth, and some choose other means, please know that Ginger’s course supports all women and their personal decisions about birth.

 

yoga

My first natural birth was December 27, 2005. After a long, hard labor that started on Christmas, my son Michael arrived safe and healthy into my arms.

 


Jul 07, 2014

Last week in our blog, you learned about Susannah Britnell, a physiotherapist who works in a multidisciplinary pelvic pain treatment setting. I learned of her clinic when I came across this journal article) about developing an interdisciplinary clinic for patients with endometriosis and pelvic pain. Below is Part 2 of the questions that she was kind enough to answer for us so that we can hear more from her perspective!

 

Susannah Britnell

What do you find rewarding as a therapist in working in this setting?

Working with people in pain can be challenging but also extremely rewarding. I really value being able to help women realize what they can do, how they can shape their current life experience and their future. We provide tools and strategies that they can put into practice successfully. I love being able to be a part of moments when there is a shift in thinking, an opening of opportunity, when women who have seen nothing but barriers and hopelessness realize that there could be the possibility of positive change. I really find satisfaction in helping women perform daily activities, manage bladder, bowel and sexual pain concerns and increase overall activity and participation in life.

 

What would you say is powerful for the patients in terms of having the team available?


Jul 06, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Jennifer Edwards MSPT, COMT, CCI, PRPC

 

Jennifer Edwards MSPT, COMT, CCI, PRPC

How did you get involved in the pelvic rehabilitation field?

I was actually dragged kicking and screaming! When I was in PT school, one of my professors specialized in pelvic floor rehab & my friends & I would joke, “Why doesn’t she just go to medical school to become a gynecologist if she wants to looks at vaginas all day?!” Fast forward to 2005, when my co-worker, Lucie & I were both pregnant (We actually had our babies on the same day)! When we returned from maternity leave, Lucie was only working half-time & was feeling overwhelmed with her heavy caseload of pelvic floor patients, so she begged me to take the coursework to learn how to treat this patient population. Once I got over the nervousness of participating in the first lab at PF1, I realized what an important area of physical therapy this is and how much I could help my patients by addressing important ADLs that are often ignored.

What makes you the most proud to have earned PRPC?

I am a single mom and I work full-time managing and treating patients. I have also been out of school for 14 years and I was really out of practice when it came to studying. But, I was very disciplined and tried to study daily for at least 30 minutes, as well as studying when working with my patients. I used every opportunity to review things I’d studied by explaining things in detail to my patients and/or student I had at the time. Earning the PRPC represents all my hard work and knowledge gained over the past 7 years and validates me and my expertise in this field.


Jul 03, 2014

In patients with lumbar disc herniation, how many patients have sacroiliac joint dysfunction? Answering this question was the aim of a study published in the Journal of Back and Musculoskeletal Rehabilitation in 2013. From an outpatient clinic at a university hospital, 202 patients with lumbar disc herniation (paracentral or intraforaminal) on imaging and clinical findings suggesting lumbosacral nerve root irritation were included. Excluded were patients who pregnant, had prior lumbar surgery, osteoporosis, fractures, diabetes, severe hip DJD, and neurological deficits. Clinical examination tests for SIJ dysfunction included seated forward flexion test with palpation of the PSIS, Patrick-Faber test, long-sitting test, Gillet test, Sphinx test, and palpation tests for sacral base asymmetry. Pressure provocation tests were applied to the sacrum and the pelvic innominates, palpation to long dorsal sacral ligament and lumbosacral junction. "Positive" sacroiliac dysfunction diagnosis meant that the patient had a cluster of at least 4 anatomical and 2 provocative tests. Patients ranged in age from 19-70 years with a mean age of 42.

 

Greater than 72% of the patient sample with known lumbar disc herniation also presented with sacroiliac joint dysfunction. Females, patients with recurrent pain, those who performed heavy work, and patients with a positive straight leg raise test were more likely to have sacroiliac joint dysfunction. Of the 72% of patients who were diagnosed with SIJ dysfunction, nearly 60% were female. No correlation was found between the presence of sacroiliac joint disease, working hours, duration of low back pain, or body mass index and the rate of SIJ dysfunction. The authors conclude that sacroiliac joint dysfunction has a "…high possibility of occurrence in low back pain" and should be included in the clinical examination and decision-making process. They also point out that while the differential diagnosis of back versus SIJ pain is well-defined in manual medicine texts, the medical books do not highlight screening of the SIJ when presented with a patient who has back pain.

 

If you would like to learn skills to perform differential diagnosis of the sacroiliac joint, sign up for the Sacroiliac Joint Treatment continuing education course taking place this July in Baltimore with Peter Philip.


Jul 02, 2014

pelvis

A recent publication of a case series proposes that clinicians use intranasal calcitonin, a medication prescribed for acute vertebral fractures in osteoporotic patients, for acute coccyx pain. This medication is administered as a nasal spray, has been demonstrated to have analgesic properties, and is theorized to have effects of beta-endorphin production, and inhibition of prostaglandin and cytokine production. Nasal calcitonin, a synthetic drug, is reported to have fewer and mild side effects when compared with the injectable form of the medication.

 

 

Of the 8 subjects treated and described in the case series, all had a fall on the tailbone, either landing hard into a chair on onto the stairs or floor. Some were seen within 3 months of injury date, and others were treated after 3 months from injury. The authors report that in the subjects who were treated acutely, 3 of 5 had at least 50% improvement in pain, without injections or surgery. The subjects treated in a chronic pain condition had similar levels of improvement but with the addition of coccyx injections for treatment.

 

Based on the lack of a control group, the small number of subjects treated, and because the mechanism of nasal calcitonin is unknown as far as effects on fracture healing in the coccyx, we would not, as rehab professionals, look to our referring providers to add nasal calcitonin routinely in the management of acute coccyx fracture. This article may, however, lead to interesting conversations with referring providers who are in a position to consider the addition of calcitonin for the proposed analgesic effect and potential bone healing augmentation. (The authors do suggest using the smallest effective dose for the shortest duration required.)


Jul 02, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Hollis Herman, DPT OCS WCS BCB-PMD IF AASECT PRPC

 

Hollis Herman, DPT OCS WCS BCB-PMD IF AASECT PRPC

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

The postpartum mothers of the kids I was treating, Elizabeth Noble, Linda Gallagher, and Kathe Wallace. I would go to nursing conferences 35 years ago and be the only PT in the audience who thought urinary incontinence was a musculoskeletal issue rather than just a medication prescription. The midwives upstairs from the office would say they could not insert a speculum in a postpartum woman and I thought “it was a muscle/tissue problem” rather than infection.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

Bladder, bowel, sexual function and reproduction are daily vital activities. As physical therapists we have the anatomic, physiologic, musculoskeletal, neural, visceral and functional knowledge to help these patients. We can put it all together and make sense of their symptoms and diagnose patients individually. We are a vital team member in Sexual Medicine, licensed to observe, evaluate and treat. We have the musculoskeletal knowledge to connect the dots for why muscles are over or under active. Most of us do not use speculums so we are able to visualize the entire region and find where there is dysfunction.


Jul 01, 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

Years ago when my oldest daughter was 4 years old and in Pre-school I received an urgent call at the office that she had an accident. Immediately my head began to race, “What hospital is she in?” “What did she break?” Then the director informed me she wet her pants. I collapsed in my chair with a huge sense of relief and I began to ponder “Did she have an ‘accident’ or did her bladder leak?

 

Merriam-Webster defines an accident as:

 


Jul 01, 2014

Earlier this year, when I came across this journal article about developing an interdisciplinary clinic for patients with endometriosis and pelvic pain, I was pleased to see that rehabilitation is included in this team setting. Upon reaching out to Susannah Britnell, physiotherapist, she agreed to answer some questions about her clinic and about her passion for pelvic rehab. Below you can read her responses to my questions. Stay tuned for Part 2 that will be published next week!

 

Susannah Britnell

How long have you been working in the interdisciplinary clinic?

 

I’ve been working at the BC Women’s Centre for Pelvic Pain and Endometriosis in Vancouver, BC, since October 2012. We are a provincially funded program for women with chronic pelvic pain from all over the province of BC, Canada.

 


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.


Upcoming Continuing Education Courses

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 (SOLD OUT!)
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

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

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