The presence of Pelvic Floor Dysfunction strongly predicts Low Back Pain
This makes a lot of sense when we think about the role of the pelvic floor in core stabilization of our low back and also the connection between muscles in the pelvic floor and the hip!
Should I be doing more KEGELS?!
Maybe...but it's not always that simple. In research conducted by Vandyken, in which they investigated women with both pelvic floor dysfunction and low back pain, they found that a large majority of them had overactive pelvic floor muscles. This is a situation in which the muscles are holding more tension more often than necessary. A small majority had weakness. And some actually had pelvic organ prolapse.
So what does it all mean? What's the bottom line?
What all of this research is suggesting is that if you are seeking physical therapy for low back pain, especially if you are a woman, you may benefit from a therapist who can both assess and treat your low back pain AND your pelvic floor!! This is our speciality!
I want to address a somewhat common scenario in many of my patients including people with knee and hip pain.
The story goes something like this. Progressively more aggravating pain that leads to a doctor's visit and an x-ray of the knee or hip (or maybe back/neck).
Resulting diagnosis of arthritis with a recommendation that it may eventually require a joint replacement, but not yet because you're too young or not in enough pain. And that's the end of it.
So now, the plan is hurry up and wait to inevitably get worse. If you've experienced something similar, I want to offer you some hope! While some conditions do eventually require surgery, many do not. And often, there is still room for improvement in the mean time.
By using specific techniques to improve space in arthritic joints, treating surrounding soft tissue (muscles, ligaments and connective tissue), and finding the best strengthening exercises that don't hurt, I've seen many patient's get back to or continue doing the things they want to do without significant pain!
Here's a video where I talk about some mindsets that keep people from getting the help they need!
3 things to stop doing if you have joint pain of arthritis
I discussed previously the role the hip plays in knee alignment and pain. Briefly, if your hip is weak, then it cannot maintain proper knee alignment and this may result in knee pain.
I'm demonstrating 3 exercises here to improve hip strength. Most of my knee patients see these exercises at some point in their rehabilitative program!
Sidelying Hip Abduction
Bridge with Band
Standing Hip Abduction Extension
Pain at the inner or medial part of the knee is a common complaint in active adults including hikers and runners.
People often complain of tenderness to the touch and also pain and limitations going up and especially down hills or stairs.
When people go looking for answers to this problem, they often end up getting an explanation of what hurts. Medial ligament strain...bursitis (swollen fluid filled sac)...tendonitis (swelling of a tendon)....etc.
In my experience this naming of what hurts in a fancy way as I like to think of it, is not all that helpful in getting to the root of what is causing the pain.
AKA tummy rubs. We’re always fans here of simple things you can do for yourself. To finish up this series of improving overall health including our mental health with movement, we’re talking about the “I LOVE YOU” massage.
We can’t really talk about health without mentioning the gut! We’re learning so much about our gut brain connection these days and the role that bacteria play in this.
Healthy and regular bowel movements are an important part of keeping this system on track. And while our diet plays a huge role in the health of our gut, so does movement.
There are times though when in spite of our best efforts, our bowels can get a bit sluggish. Massaging the tummy along the tract of the large intestine can help stimulate peristalsis (the action that moves the poop through the tube) physically, as well as by stimulating our parasympathetic nervous system.
That’s right, the one that’s known for working on body functions in our rest and digest state.
This is a great tool to use regularly to give both our nervous system and our gut some love!
Ever feel like you have to work out hard when you work out?
Maybe you skip an exercise session because you don’t have enough time to do something hard, or get sweaty, or make it to the gym?
This kind of thinking could be robbing you of lots of great opportunities to reduce negative stress responses and improve your overall health.
We have known intuitively that we feel better, have better mood when we move. But we haven’t always been able to make the connection to why.
Our hormonal stress response has been linked to our cerebrum and thoughts through the adrenal glad. This is one of the reasons psychotherapy can be helpful for people with stress management.
But did you know that our motor and sensory cortexes also influence our adrenal glands!
Just a 20 minute walk can help to burn off inflammatory stress hormones!
And the muscles attached to our spine (you know-our core muscles) have the most neural connections to this response.
So, yes moving your spine and doing even simple core movement type exercises can be a great way to stay healthy!
Here are 2 of my favorite exercises to connect your mind and spine:
Exercise doesn’t always have to be hard especially when it comes to our mental health!
Increased sympathetic drive can create stress and strain in our bodies and minds. It can be an underlying cause of increased neck and back muscle tension, increased symptoms of bowel or bladder urgency, increased heart and respiratory rates, and increased pain and inflammation including pelvic pain.
One of the quickest and easiest (and FREE) ways to dial down our sympathetic (or fight or flight) tone is to become intentional about our breathing.
Breathing techniques to calm the nervous system often get termed “diaphragmatic breathing.” But honestly, all breathing is diaphragmatic breathing.
The diaphragm is a large central skeletal muscle that is primarily under involuntary control by the phrenic nerve. The autonomic (automatic) nervous system is controlling it’s behavior most of the time. As skeletal muscle though, we are able to exert voluntary control over it.
By changing your breathing rate and depth, you can reversely affect your autonomic nervous system!
There are lots of different methods for doing this. But just simply bringing your attention to your breath can be helpful along with thinking about taking a few deeper breaths.
Try it now and see how you feel!
In honor of International Women’s Day, let’s talk about how mental and emotional stress can affect the body and also how we can use our body to affect our stress response!
One of the ways we understand how humans operate in different states in different situations is through the autonomic nervous system. This nervous system helps regulate our automatic responses like breathing, heart rate, and certain hormonal responses.
The autonomic nervous system includes the sympathetic, otherwise known as our fight/flight/freeze response and the parasympathetic nervous system know more as our rest/digest response.
We need both of these responses, but spending an excessive amount of time in one or the other, especially in the sympathetic nervous system, can be detrimental for our health. Being able to transition easily between these responses has been linked to longevity and health.
This concept has gotten a lot of press recently in the form of heart rate variability. Increased heart rate variability is thought to be an indicator of robust autonomic nervous system flexibility and overall health and longevity.
Heart rate variability refers to a phenomenon in the cardio-respiratory axis in which breathing in is associated with the sympathetic nervous system and a slight increase in the heart rate, and breathing out is associated with the parasympathetic nervous system and a slight decrease in the heart rate.
So, while your heart rate is the average number of beats per minute, the heart variability is a calculation of the amount of change within the rate per minute. You need a special device that reads your heart rate very accurately and that links to a sophisticated program to run lots of math.
Whether or not you choose to measure or track you HRV, we know that there are actions that we can take to improve our HRV, health of our nervous system and overall stress.
One of the simplest ways to tap into our autonomic nervous system is through the diaphragm and breathing. Breathing is typically moderated through the ANS and increases with increased stress be it mental or physical and decreases in relaxed states and with sleep. We also have volitional control of our breathing, and by changing the rate of breathing and can exert influence on our relative autonomic state.
Being intentional about slower, deeper breaths helps us access our parasympathetic nervous system and can reduce muscle tension, reduce our heart rate, and decrease stress hormones in the body.
This can be a powerful tool to help us both mentally and physically.
Over the next several posts, we’ll explore some more strategies to manage our bodies stress response through our bodies.
Did you know that when you sleep, your brain suppresses certain bodily functions like urinating, so that you can get deep sleep. Deep sleep is when your body does much of its recovery and healing. It’s also the one time that certain parts of brain health and maintenance get performed.
So it’s pretty important!
It’s not unusual for people younger than their 70’s to occasionally wake once a night to pee. As we age, up to 2 times a night might be acceptable. However, waking frequently to urinate, 2 or more times for most people can be a sign that something else is going on.
You could have an overactive bladder if you’re going frequently throughout the day and night. This could be due to infection, bladder irritants, or a kind of habitual up-training of the bladder in which you feel like you have to go more often than you really do.
If however, your daytime frequency is appropriate for your amount of fluid intake (Hint: a physcial therapist can help you determine this!), then waking at night to pee could a sign of a problem with your sleep due to airway dysfunction such as sleep apnea.
Sleep apnea is a condition in which the body is not getting enough oxygen through the night. Over time, it can cause a multitude of systemic health problems due to the stress of this lack of oxygen.
When we are not getting enough oxygen at night, we don’t enter deep stages of sleep, night-time urination is not suppressed, and we may wake more often due to the need to urinate.
If this is happening to you, talking to your doctor about a sleep study is an important step to ensuring that you are getting quality sleep and protecting your long-term health.
Leaking urine can feel uncomfortable and embarrassing and even prevent us from doing things we might otherwise enjoy.
Did you know that leaking urine can be from different causes. Those causes are classified with different names.
In a previous blog post, I discussed STRESS incontinence. This happens more with running, jumping, coughing, sneezing, and sometimes even just standing up from a chair.
Today, I’m talking about URGE incontinence. This is much like it sounds. You leak when you feel the urge to pee.
Normally, when your bladder fills with urine it happens slowly. And as it fills the bladder begins to stretch. When it reaches a particular stretch level, it will send you a signal. This feels like the urge to pee.
Typically, the first urge is more of a hey, there, FYI type message. The bladder is not usually at capacity or full at this stage.
As the bladder fills more, you may get another stronger message. By the third message, the bladder typically really does need emptying and should no longer be ignored.
For people with urge incontinence, the bladder starts insisting on emptying too soon after the urge signal, before you have time to get to the bathroom.
Many people try to solve this by going to the bathroom as soon as they feel an urge. This strategy can occasionally backfire, as the bladder gets emptied more and more often and becomes sensitized to stretching. This can eventually increase the urgency of urination and the leaking.
This can be a tricky dance to master, but with education and practice, you can often take back control from your bladder and give yourself more time to get to the bathroom before leaking!
A trained physical therapist is a great place to start If you’re having this kind of leaking. They can assess some of the causes and make a plan to resolve it!
Write something about yourself. No need to be fancy, just an overview.