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Aug 22, 2014

hip joint

What structures may be implicated in posterior hip pain in the athlete? This question is addressed in a comprehensive article that can be accessed here. Complaints of posterior hip pain are increasingly common, and the differential diagnosis can include a variety of conditions and structures. The differential diagnosis of posterior hip pain may include hip extensor or hip rotator muscle strain, femoroacetabular impingement, proximal hamstring rupture, piriformis syndrome, and referral from the lumbar spine or sacroiliac joint, and systemic conditions such as cancer or infection, according to the article. To this list, could we add sciatic and other nerves in the buttock and pelvic floor, ischial injuries or ischial bursa irritation? With lists that include both systemic dysfunction and a variety of potential neuromusculoskeletal causes of posterior hip pain, the therapist must have a comprehensive ability to apply clinical reasoning, expert interview, and solid clinical examination and evaluation skills.

 

Posterior hip pain is only one type of hip pain, and one complaint within the world of pelvic pain. How does the therapist keep sharp tools for diagnosing musculoskeletal conditions, other connective tissue dysfunctions, as well as screen for disease conditions and other dysfunctions that can mimic hip or pelvic pain? Herman & Wallace has increased our offerings of courses towards differential diagnosis of hip and pelvic pain, including Biomechanical Assessment of the Hip & Pelvis, taught recently by Steve Dischiavi. (Stay tuned for Steve's upcoming course schedule!)

 

Another continuing education course that offers excellent opportunity to fine tune your skills in Differential Diagnosis of Pelvic Pain is coming up in October in Connecticut. The course is instructed by Peter Philip, who completed his Doctor of Science degree on the topic of Differential Diagnostics of Pelvic Pain. In addition to learning detailed anatomy and palpation skills, the participant can take away from the course a better understanding of embryology, the somatic and autonomic nervous system, and pelvic conditions that may be caused by or influenced by pelvic pain. The course will include both internal and external pelvic muscle examination techniques. With seven labs scheduled in this continuing education course, the participant will have abundant opportunities to practice instructed skills.


Aug 21, 2014

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

 

PRPC

How did you get involved in the pelvic rehabilitation field?

Initially, I had an interest in women’s health because I grew up around a family full of laughter and women who crossed their legs a lot. I thought, ‘This isn’t right, there must be something that can be done about this’. I also experienced pelvic pain myself due to excessive running, and became more and more intrigued about how to address these problems without surgery or medications. The answers doctors or Dr. Google (the internet) always had were frightening – cancer, cysts, surgery must be needed... None of that resonated with me, so I pursued a clinical rotation in women’s health and was very fortunate to connect with Heather Jeffcoat PT, DPT. She inspired me to further pursue women’s health and specifically pregnancy/postpartum and pelvic pain education. Heather was pregnant at the time of being my CI which was great learning experience. She also taught me what a positive impact physical therapy can have on a women’s health and well being, their intimate relationships and comfort during and after pregnancy.

 

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


Aug 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 Pregnancy" in New York this November.

 

yoga

The power of language is inarguable. The spoken word affects how we see, perceive, and interpret the world around us. Language can also influence our actions and behavior, especially toward people around us.

The power of language in health care is not only important, but critical in prenatal health. The language a provider uses can help or harm a mother’s confidence and even her beliefs about birth.

 

Action to recognize and respond to the importance of language in general health care began with People First Language (PFL) movement. PFL advocates for mindful use of language that identifies the person first, rather than identifying the person based on their disability. Advocacy groups first started the movement for children’s sake. Mother’s who had given birth to children with Down’s syndrome wanted their children to be recognized as people first, rather than by their disability.


Aug 18, 2014

baby

According to the American Cancer Society, approximately 233,000 new cases of prostate cancer will be diagnosed this year, and nearly 30,000 men will die from the disease. The diagnosis and treatment of prostate cancer in the United States has experienced significant shifts in the past few years, making management of cancer survivors challenging.  One of the big changes in prostate cancer screening took place in 2011; the US Preventive Services Task Force recommended against routine prostate specific antigen, or PSA testing due to the level of potential harm such as psychological distress and complications from the biopsy. You can read a prior post about that here. New guidelines for providing care to prostate cancer survivors have been published by the American Cancer Society so that providers can better identify and manage the side effects and complications of the disease and recognize appropriate monitoring and screening of survivors. 

 

 

In patients younger than 65 years of age, radical prostatectomy surgery is the most common intervention for prostate cancer. Long-term side effects of radical prostatectomy commonly include, according to the guidelines, urinary and sexual dysfunction. Urinary incontinence or retention can occur following prostatectomy, and sexual issues can range from erectile dysfunction to changes in orgasm and even penile length. Other common treatments, such as radiation and androgen deprivation therapy, are also related to urinary, sexual, and bowel dysfunction, as well as a long list of "other" effects. 

 

 


Aug 18, 2014

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

 

Describe your clinical practice:

I’ve worked at Kirk Center for Healthy living in Lockport, Illinois for the last 3 and half years. We see both men and women with pelvic floor dysfunction, GI problems, and orthopedic condition. It is a small privately owned facility where we have two sites; Lockport and Oak Lawn. We see patients on an hourly basis and we get to work with them one on one. All of us here are manually based therapists and we incorporate independence and best practice. We incorporate manual techniques predominately using visceral manipulation and would like to be proficient in vascular, manual articular, and neural work.

 

How did you get involved in the pelvic rehabilitation field?

I had interests in gynecology/obstetrics before going to PT school. And while at PT school I had an opportunity to go on an internship where they had pelvic floor therapists. At Loyola, I learned a lot about pelvic floor issues. It was so fascinating and exciting.


Aug 15, 2014

baby

Concepts in "core" strengthening have been discussed ubiquitously, and clearly there is value in being accurate with a clinical treatment strategy, both for reasons of avoiding worsening of a dysfunctional movement or condition, and for engaging the patient in an appropriate rehabilitation activity. Because each patient presents with a unique clinical challenge, we do not (and may never) have reliable clinical protocols for trunk and pelvic rehabilitation. Rather, reliance upon excellent clinical reasoning skills combined with examination and evaluation, then intervention skills will remain paramount in providing valuable therapeutic approaches. 

 

 

Even (and especially) for the therapist who is not interested in learning how to assess the pelvic floor muscles internally for purposes of diagnosis and treatment, how can an "external" approach to patient care be optimized to understand how the pelvic floor plays a role in core rehabilitation, and when does the patient need to be examined by a therapist who can provide internal examination and treatment if deemed necessary? There are many valuable continuing education pathways to address these questions, including courses offered by the Herman & Wallace Institute that instruct in concepts focusing on neuromotor coordination and learning based in clinical research. 

 

 


Aug 14, 2014

Hip

In a recent study examining demographic and obstetric factors on sleep experience of 202 postpartum mothers, researchers report that better sleep quality correlated negatively with increased time spent on household work, and correlated positively with a satisfactory childbirth experience. Let's get right to the take home points: how are we addressing postpartum birth experiences in the clinic, and how can we best educate new mothers in self-care? You will find many posts in the Herman Wallace blog about peripartum issues, and you can access the link here

The authors recommend that healthcare providers "…should improve current protocols to help women better confront and manage childbirth-related pain, discomfort, and fear." Do you have current resources with which you can discuss these issues (and a referral to an appropriate provider) when needed? In our postpartum 

course, we highlight the challenges a new mother faces due to the commonly-experienced fatigue in the postpartum period. According to Kurth et al., exhaustion impairs concentration, increases fear of harming the infant, and can trigger depressive symptoms. Issues of lack of support, not napping, overdoing activities,, worrying about the baby, and even worrying about knowing you should be sleeping can worsen fatigue in a new mother. (Runquist et al., 2007) 

 

Back to what we can do for the patient: investigate local resources. This may include knowing what education is happening in local childbirth classes (and providing some training when possible), respectfully inquiring of new mothers how they are doing with sleep and demands of running a household (and business or work life), and finding out what support/resources the new mother has but is not accessing. Patients are often hesitant to ask for help, or may feel guilty in hiring someone to help clean for the first few months, feeling that she "should" be able to handle the chores and tasks. Educating women about results of the research and about potential improvements in quality of life can help the entire family. 

 


Aug 14, 2014

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

 

Marci Marshall

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

Thinking “out of the box”…I always say to my patients that there are many pieces to a puzzle and we just have to find the right pieces to fit together for them to be on the path to healing. I believe that pelvic rehabilitation requires a multidisciplinary approach. There are many complementary services; such as, dry needling, visceral therapy, massage therapy, acupuncture, mindfulness meditation and yoga that need to be considered. Be open to try something new and to explore as many avenues as feasible. It is so important to give patients back some control in their lives in a positive and empowering manner.

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

Myofascial Release for Pelvic Dysfunction taught by Ramona Horton, MPT. Her techniques helped to further refine my ability to load tissue in multiple planes and allow the tissue to direct me to the restrictions both externally and internally. I found that my fingers could be “softer” and I just needed to “feel & follow” to be just as effective! She provided me with a new tool to put in my tool bag! She is a very captivating instructor and provides a wealth of information!


Aug 13, 2014

This post was written by H&W founder and instructor Kathe Wallace, PT, BCB-PMD. Kathe's book, “Reviving Your Sex Life after Childbirth, Your Guide to Pain-Free and Pleasurable Sex after the Baby” is available now

 

Kathe Wallace, PT, BCB-PMD

In June 2013 the APTA House of Delegates adopted a landmark new vision of the profession of physical therapy: "Transforming society by optimizing movement to improve the human experience." I grinned from ear to ear realizing that the movement of the entire body and the muscles of the pelvic floor are a key experience of human sexuality. Patients with multiple types of dysfunction benefit from physical therapy for the improvement of sexual function, an essential part of the human experience. Evaluating and treating sexual dysfunction is an important part of a pelvic rehabilitation physical therapy practice.

 

I am excited to announce the publication of my book “Reviving Your Sex Life after Childbirth, Your Guide to Pain-Free and Pleasurable Sex after the Baby”. This book demystifies the rarely talked about problem of pelvic floor health targeting the post-partum woman, where many problems begin. It provides information every woman (from 6 weeks to 60 years postpartum) should know about the common birth-related changes in the pelvic floor muscles and pelvic region. It contains specific graphics for performing perineal and abdominal scar massage techniques and using dilator and pelvic floor massage tools for pelvic floor stretching. Readers will learn techniques for pelvic floor control, release and PELVIC FLOOR PLAY™.

 


Aug 12, 2014

c-section

Insights in fascial mobility and dysfunctions are provided in this article by Gil Headley, and instructor who spends a significant amount of time working with anatomical dissections. Visceral fascia, according to Hedley, contains 3 layers: a fibrous outermost layer, a parietal serous layer, and a visceral serous layer. Fascial layers are, for the most part, designed to be able to slide over one another. Dysfunction can occur when there is a fixation in the connective tissues that prevents such sliding. A disruption in visceral fascial mobility may impair the necessary functional movement of the organs. Consider the mobility of the lungs and the heart when neuromuscular functions cause air or blood to expand and contract within the organ spaces. Bringing the concept to pelvic rehabilitation, what impairments are encountered when the bladder cannot easily fill or contract, or when movement of the bowels tugs on fascial restrictions? How are the tissues of the vaginal canal influenced by restrictions in tissues above, behind, or below the structure?

 

Examples of causes of adhesions may include (but not are limited to) inflammation from infections or disease, post-surgical scarring, dysfunctions caused by prior adhesion or limitation, and intentional therapeutic adhesions (think of a prolapse repair). While fibrous adhesions, once palpated, may be manually pulled apart, this is not the recommendation of the article author. Unfortunately, such an approach can result in further opportunity for inflammation and adhesions. One method of improving tissue mobility is to manually facilitate "…movement towards the normal range of motion of the fixed tissues with gentle traction…" timed with deep breathing. This technique may improve the ability of the organs and tissues to slide upon one another, and also may help in prevention of further movement restrictions. Would this type of intervention always require hands-on care? The author provides an example of a patient providing gentle traction by reaching to a pull-up bar, performing deep breathing and various trunk rotation positions following a thoracic surgery.

 

Visceral mobilization techniques may be a part of a patient's healing approach, and these techniques may be therapist-directed, patient-directed, or both. The Institute is pleased to offer two upcoming visceral mobilization continuing education courses next month instructed by faculty member Ramona Horton. Visceral Mobilization of the Reproductive System takes place in Boston, and Visceral Mobilization of the Urologic System is being hosted in Scottsdale.


Upcoming Continuing Education Courses

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 (SOLD OUT)
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

Visceral Mobilization of the Urologic System - Fairlawn, NJ
Jan 16, 2015 - Jan 18, 2015
Location: Bella Physical Therapy

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

Breast Oncology - Phoenix, AZ
Feb 21, 2015 - Feb 22, 2015
Location: Spooner Physical Therapy