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Herman & Wallace Blog

Can Patients Use Internal Trigger Point Devices Safely?

The team associated with what was formerly called "The Stanford Protocol" for pelvic pain has evaluated the use of an internal wand by patients. This trigger point wand was designed to help the patient apply appropriate amounts of pressure as it has in its design an algometer for measuring pressure. 113 of 157 enrolled (mostly male) patients completed 6 months of wand use, the authors point out that those who dropped out of the study did not withdraw due to adverse affects from using the wand. Patients were instructed in use of the wand and carefully supervised prior to using the device on their own. They were instructed to use the wand several times per week. Visual analog scale measurements were taken at baseline and at 6 months. The baseline median sensitivity was 7.5 and decreased to 4 at 6 months. Over 95% of the patients reported that the wand was very or moderately effective in relieving pain.

This pilot study addresses some very important concerns. Although it is a pilot study, this work addresses the need for research to support aspects of pelvic pain therapy programs. Very importantly, it addresses the issue of how much pressure patients are using when applying self-trigger point releases with a device. We have all met patients who, despite our best coaching, apply so much pressure with any self-treatment that the symptoms meant to be alleviated are worsened, usually accompanied by the phrase, "I don't know what you did last time, but..."

Until such a device used in this study is available to clinicians, it will be difficult to gauge how much pressure a patient is applying with a device such as a wand. As in this study, patients who wish to use a trigger point tool should be carefully instructed in safe techniques for use of such a device. These trigger point tools may continue to be helpful in self-care and home program participation by the patient.

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Improving Urinary Continence Improves Sexual Function

As reported in Female Pelvic Medicine & Reconstructive Surgery, women who were successfully treated for stress urinary incontinence also noted improvements in sexual function. Women in the study were treated with a pessary, with behavioral therapy for incontinence,  or with a combination of these treatments. Behavioral therapy included pelvic muscle strengthening and continence strategies. At 3 months, sexual function was assessed using short forms of both the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and the Personal Experiences Questionnaire (SPEQ).

The researchers found that in those women who experienced improved urinary continence, sexual activity was one of the activities in which a reduction of urinary leakage occurred. Patients also reported less restricted sexual function due to fear of leakage.

Interestingly, patients who experienced both urge incontinence and stress incontinence (versus stress incontinence alone) reported a lower level of sexual function at baseline.
It is well documented in the literature that urinary incontinence impairs quality of life in women, and this includes sexual health. The American Urological Association (AUA) recommends that medical providers ask questions about urinary incontinence and about level of bother of symptoms. The AUA also recommends that providers use validated surveys to assess a patient's function. As physical therapists, we can include screening questions on our intake forms, provide more detailed continence questionnaires, and discuss these sensitive issues with our patients to ensure that we are getting the best information about our patient's function.

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Leaking? Drink more green tea

Behavioral modification training for patients who have urinary issues commonly involves education about dietary triggers. The IC-Network lists green tea as "probably problematic" for triggering increased symptoms. Researchers in Japan, however, have reported an inverse relationship between urinary incontinence and drinking green tea.

Researchers at Curtin University in Western Australia and at the University of Tokyo completed dietary intake questionnaires for 300 Japanese community dwelling women aged 40-75 years. A urinary continence questionnaire was also completed (International Consultation on Incontinence Questionnaire- Short Form).

In the 27.5% of women who experienced urinary incontinence, less green tea was consumed on a daily basis versus those who did not leak. Average consumption of green tea for those who did not report incontinence was over 3 cups (757 ml). This relationship was not identified to be in effect for coffee, black or oolong tea.

Perhaps an important message to take from this research is that in our clinical experiences patients rarely respond equally to the same dietary factors. Some of our patients cannot, despite vigorous logging of food and beverage intake, find a consistent association between certain foods or fluids and their bladder symptoms. Even though some of our patients may benefit from reducing coffee and teas, we can appreciate that at least in Japan, where this information was gathered, a diet that includes green tea may not necessarily contribute to bladder issues.
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Recently published JAMA article on the effectiveness of physical therapy and Biofeedback in treating post-radical prostatectomy male urinary incontinence

In a study from the Center for Aging at the University of Alabama, Birmingham and the Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, researchers determine that physical therapy, bladder control strategies, and biofeedback significantly reduced the incidence of urinary incontinence in post-radical prostatectomy males when compared to a control group.

Check out the abstract of the study here.

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Radio Show on Interstitial Cystitis and Pelvic Pain

The Institute is sponsoring a radio show hosted by Dr. Melanie Barton and featuing Amy Stein, MPT, BCB-PMD. Amy will talk about Interstitial Cystitis and Pelvic Pain and the role of physical therapy in treating these problems

Tune in on April 28th or visit Dr. Melanie's site to download the podcast.

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Internet Scam Targeting Physical Therapists

Recently, the Institute was made aware of an internet scam that is targeting physical therapists, including members of our teaching faculty. A bogus website called ComplaintsBoard has listed many PTs, including several respected Herman & Wallace faculty members, on a list of convicted sexual abusers. This site contains a similar list of doctors and lawyers that it claims have criminal records, meaning that patients or clients seeking professionals may find false and damning histories on internet search engines. The site then invites those whose names are posted to pay money through a different website to clear their records.

Clearly, this is the work of scam artists that are tarnishing the reputations of physical therapists. It is unclear who these perpetrators are, but they have targeted a number of respected professionals, including members of our faculty. Herman & Wallace is dismayed to see the character of professionals with whom we work and respect being attacked for profit. The APTA has been made aware of this, and is seeking legal action. If you find your name on such a list, please contact the APTA.

The Institute would like to make our community aware of this problem and to show our support of our faculty and our colleagues.

Please understand that, because we do not want to increase the web traffic to these scam sites, thereby increasing their efficacy, we will not be posting direct links to these sites.

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Demographic Trends in Urinary Incontinence

Earlier this month, Datamonitor released a report on Urinary Incontinence in the 7 major global markets (The US, Japan, France, Germany, Italy, Spain, and the UK). Check out the highlights here. The whole report is pretty expensive, but they touch on a point that we have long emphasized: the prevalence of urinary incontinence will grow over the next ten years, with the most cases occurring in the United States.

Demand for innovative and effective treatments for urinary incontinence will continue to increase for years to come. Therapists with extensive clinical experience treating urinary incontinence will be well positioned for this demographic trend.

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Recently Published Peer-Reviewed Article on Postpartum Pelvic Floor Wellness

On April 18th, a group of German and Italian researchers published this article on the impact of episiotomy on pelvic floor dysfunction. The paper found that "Episiotomy appears to be a protective factor for women's wellness. Women who had episiotomy and who experienced perineal symptoms have a better psycho-physical health status in the 12.79 months follow-up."

Available for download is a 15 page PDF of "Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: a retrospective study". The PDF contains research highlights (including Abstract, Background, Methods, Results and Conclusion)

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Upcoming Continuing Education Courses

Pediatric Incontinence - Duluth, MN (Postponed)

Oct 23, 2020 - Oct 25, 2020
Location: Polinsky Medical Rehabilitation Center

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Oct 23, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Parkinson Disease and Pelvic Rehabilitation - Remote Course

Oct 23, 2020 - Oct 24, 2020
Location: Short Form Remote Course

Pelvic Floor Level 2A - Braintree, MA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Peak Physical Therapy

Pelvic Floor Level 2A - New York, NY Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: 5 Point Physical Therapy

Pregnant and Postpartum Rehabilitation Special Topics - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC (POSTPONED)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Troy, NY Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: The Green Room Physical Therapy

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - Greenville, SC Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Peripartum Advanced Topics - Somerset, NJ (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 2A - Minnetonka, MN Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Viverant

Pelvic Floor Level 2A -Decatur GA Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - East Norriton, PA Satellite Course

Oct 24, 2020 - Oct 25, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH Satellite Location (Sold Out)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Pelvic Floor Level 2A - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Athens, GA Satellite Course (Rescheduled)

Oct 24, 2020 - Oct 25, 2020
Location: Thrive Integrative Medicine

Pelvic Floor Level 2A - Tampa, FL Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Optimal Performance and Physical Therapies

Pelvic Floor Level 2A - Monroe, LA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Ouachita Physical Therapy

Manual Therapy Techniques for the Pelvic Rehab Therapist - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Goodyear, AZ Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: STI Physical Therapy & Rehab

Breastfeeding Conditions - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Manual Therapy for the Abdominal Wall - Remote Course (Postponed)

Oct 25, 2020
Location: Short Form Remote Course

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center