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Pelvic Health Physical Therapy in Chronic Illness, March 2019

hi I’m Mary Sue Rominger and I’m a
volunteer here at the Bateman horne Center welcome and thank you so much for
joining us tonight we will post a video of tonight’s presentation on our youtube
channel within a few days so if you miss something or want to hear the
presentation again you can go to the video and do so we do plan a Q&A at the
end of the presentation so if you will hold your questions until the end that
would it be appreciated and those on Facebook live you can use the comments
section to ask your questions we are so pleased tonight to have dr. Lauren
Johnson speaking out our education meeting dr. Johnson graduated from the
University of Utah with the Doctor of Physical Therapy degree and a bachelor’s
degree in exercise science with a minor in nutrition she is currently the
director of the pelvic physical therapy and wellness clinic here in the Salt
Lake area and she also serves as a board member of the student-run pro bono
physical therapy clinic at the University of Utah her passion for
pelvic physical therapy developed back when she was the physical was a physical
therapy patient herself and she will be talking tonight about getting to the
bottom of pelvic health please welcome dr. Lauren Johnson okay
so thank you so much for having me I’m really excited to be here understand
what it is so I’m going to be discussing kind of
pelvic health in general and specifically pelvic health physical
therapy and how it can relate to any CFS and fibromyalgia
so to begin my kind of learning objectives and what I want people to
understand from this presentation is what is pelvic health physical therapy
who are pelvic health physical therapists and what our service
certifications kind of what diagnosis we see as public health physical therapist
what to expect when you’re seen by one of us because sometimes that can be a
little bit wondering what’s gonna happen and then
know kind of the association of pelvic health with MFC or mecfs and
fibromyalgia so to begin it’s always interesting to
kind of take a poll of how many people even knew that pelvic physical therapy
was a thing okay so a lot of times people come in and see me and they say I
had no idea even existed I had no idea that you were in a profession I had no
idea that physical therapists kind of specialized in the realm of pelvic
therapy so I like to tell people it is just like other physical therapy we work
with muscles bones tendons ligaments we work to rehab them um the only
difference is it’s in a little bit of a more sensitive area of our bodies and
there’s just high emotions tied to this region so what is public health there
are three systems physiological systems in the pelvis and the abdomen and they
are the reproductive system the urinary system and digestive system in order for
us to have optimal public health these systems have to be kind of integrated
and working cohesively so my job is to make sure and help that those systems
are working together and find any dysfunction that the current they are
kind of housed within our abdomen in our pelvic region in the musculoskeletal
system and the nervous system so there’s a lot of things that can be happening in
this region and in our bodies to be causing dysfunction and so we try to
find sources physically that might be causing any of the dysfunction that
we’re finding so who are we what how do we become a pelvic physical therapist so
you might hear to be called different terms there’s a public health physical
therapy there’s pelvic physical therapy and then the oldest term is kind of
woman’s help to the therapist but our association has quickly understood that
women’s health physical therapist is kind of eliminating eliminating half of
the population because men have pelvic floors men have
other functions that are dysfunctions that can occur in the pelvic region as
well and so they’re working to change that name currently so we graduate from
accredited doctor at the physical every programs so we go through an undergrad
and then it’s a three year doctorate program after we finished at seven
minimum years then we go on to post doctorate specialized training and that
can go from years to whole lifetime of training you hope that your pelvic
therapist has a passion in order to continue to stay on top of the most
current education and research and then we can sit for a certification so two of
the certifications that we have is Women’s Health certified specialist and
pelvic rehabilitation practitioner certification that really lets you know
that that therapist has really specialize in pelvic health physical
therapy and it is very very very important that if you’re going to be
seeing someone’s for these conditions that they have these certifications or
these specialists or specialized areas so that you know they’re going to be
getting the best care ways that you can do that is carbon Lois is one of the
Institute’s that give them that provide a lot of our continuing education
courses and we have our American Physical Therapy Association so they are
nationally kind of our Institute’s and there are ways of finding people in our
therapist in your area for that and then you can always ask local clinics here
most everyone knows all the physical therapists know kind of who the public
for physical therapists are because we’re kind of limited there’s not many
of us so most people know what’s happening anywhere we’re looking at so
what do we treat this is just a small list of what we do and treat a lot of
people are a little bit surprised to name kind of the most common things that
we see we see incontinence we see constipation and irritable bowel
syndrome we have interstitial cystitis or bladder
pain we do Pinel neuralgia dyspareunia so any pain with intercourse tell bone
pain chronic pain endometriosis a pelvic girdle joint pain that’s
occurring vulvodynia volver vestibuli this pelvic organ prolapse separation of
the abdomen and that normally occurs with pregnancy any pelvic pain both men
and women chronic prostatitis erectile dysfunction we work with scar tissue
mobilizations and management there and then premium postnatal care so pretty
extensive but then there’s even more than what we treat so the most daunting
thing is what are you going to expect coming and seeing a pelvic floor
physical therapists okay a lot of people are like I know where you work so what
does this entail so I want you guys to have a very comfortable idea of what it
you should expect when you come and see one of us and what should happen so the
basics are you’re gonna come for an evaluation will then examine you well
hopefully if you’re going to someone great they’ll educate you and what they
find and maybe reasonings behind that they’ll then jump into treatments
they’ll give you a plan of care a home program and then eventually be a
discharge so the biggest thing is do not be nervous again we are like other
physical therapists we just specialize in a more sensitive area so the
evaluation this is critical we want to know who you are we want to know your
story we want to know everything you’ve been through because what you stay will
give us the big picture of what’s happening what your body has gone
through what your body’s currently experiencing where you are and then how
emotionally that is being portrayed so we’re gonna mask your symptoms how long
have they been happening how intense are they where are they what makes them
worse what makes them better you know what medications are you on have you
noticed any side effects from those surgeries and procedures right what have
you tried what have you attempted what have you diagnostically been through and
what do they know that’s going on what do they not know what’s going on what is
your lifestyle right we all have lifestyles and there’s postures that
we’re in current like consistently there’s movement patterns that we get
into because we might work in a warehouse we’re constantly lifting and
twisting you know what’s going on are you pretty sedentary because of fatigue
and pain you know those are all kind of behaviors that then present physically
and then what have you tried and a whole slew of other questions my biggest thing
is my patients tell me their story and they tell me exactly kind of what’s
occurring and that really leads my treatment so I try to get a really good
picture of what’s happening to give you the best individualized care the next is
examination this is the part that most patients get anxious about okay it is
really not bad the number one thing is know you’re in control we should not be
doing anything that you do not feel comfortable with and the biggest thing
is we want you to feel safe and comfortable we want to remove any
threats that you might be experiencing because the body’s going to respond if
you do not feel comfortable and safe but our whole goal is that we’re gonna look
at your Anatomy both externally and internally and I know the internal part
is the intimidating part but it really is not bad and we want to look at your
abdomen your trunk your puppet floor muscles the lower extremities what’s
happening are their tight muscles are there tissues that are irritated is
there scar tissue is there posturing that’s occurring
right then we’re gonna look at how you move what seems very functional and what
seems dysfunctional test why did you develop that pattern of
dysfunction was it because you have pain on your left hip so you don’t want to
sit on that side so you’re always sitting to this side which then causes
your trunk to rotate this way right we look at why these things are occurring
and then we want to know what causes your pain and what relieves it so we
might try some different tests and measures and see is this painful yes or
no is that relieve your pain yes or no this gives us a really good big picture
of what’s occurring the next part is education okay
knowledge is power I want you to know what’s going on with your body I want
you to what I find you knowing why these things
are occurring are going to help you change any habits or patterns that might
be occurring so I’ll tell you what I found with your Anatomy were there
tissues that were tight and tense and causing pain was there a a joint that
seemed to be too unstable or stuck and not moving properly does it seem like
every time you go from a sit to stand you kind of always link to your right
right there’s all of these functional individual movements that I might find
and then how is your body making compensations or modifications for these
things you know when our bodies are extremely smart and intelligent machines
but they often will compensate to just keep us going and doing what we need to
and we often push through pain we push through a lot of things and our bodies
do that but it will compensate in some way and eventually it usually develops
paint and then we’ll teach kind of techniques what are we going to do right
the other thing is is I want you to have a big comprehensive treatment I don’t
want to be the only healthcare provider because there’s so much going on with
people’s overall health so based on what I find what you’ve told me I might find
it necessary to refer you to positions nutritionists psychologists sex
therapists or any other health care provider that I feel like will give you
a bigger whole picture and better health care treatments so treatment itself I’m
going to just briefly skim over these because we’re going to go into a little
bit more in depth later in my presentation but the big ones are kind
of manual therapy this is where we kind of have hands-on you know we are doing
some soft tissue mobilizations we might be mobilizing a joint to get it to move
better or teach it how to move again because it’s learned to be like moving a
awkward pattern or position that’s not cohesive to the joint and how your
muscles and bones lie but we use kind of dry needling and that
a little bit intimidating but there’s been huge research and success for
chronically ill and chronic pain patients we’re gonna teach you exercises
now again we’re not going to go out of the limits of your body some people have
been told that they feel like a physical therapist stands for pain and torture
okay I’m sure some of you guys have experienced that but our goal is that
it’s pain-free okay so anything that would give you mobility wise strength
wise endurance wise should be pain-free and it should be tolerable and we’ll get
into that more later on therapeutic activities right we teach you techniques
on how to be functional maybe you need to compensate in some ways in order to
do certain activities around your home we’ll teach you how to do those how do
you conserve energy doing those things so that you can do them and then the
last is neuromuscular re-education this is does your body know where it’s at
does it know how it’s moving are you aware of what’s happening internally is
there coordination there so the plan of care is pretty basic
hopefully the therapists will then tell you what frequency they want to see you
and the duration now that can change in a doubt based on how you respond to
treatments the biggest thing is this should be both the physical therapist
and the patient involvement right if you feel like they want to see you three
times a week but that’s going to completely exhaust you
you need to vocalize that right you know your body better than that therapist so
let them know what you feel like is doable and not it needs to be a cohesive
and a joint effort between the therapist and the patients and then they’re gonna
give you a home program and again we’ll go into all of these a little bit later
when we get into it but it should include kind of mindfulness of your body
pain reduction techniques exercises mobility to just kind of help you keep
moving and while you’re not with us that you’re kind of continuing that program
the last is we our ultimate goal is to discharge you right we end up loving our
patients but we still want you to be able to do this and depend
on your own we want you to have a good quality of life and we want you to feel
like you have improved function and you’re able to do the things that you
love and you desire and how you end up doing that is by continuing usually your
home exercise program to at least maintain where you’ve been but most
people continue to progress even after they’ve been out of therapy
so what what does this all mean now right how does this even correlate to
mecfs and my outside row or myofiber fibromyalgia so I want you to look over
this list again and pinpoint what are you experiencing there might be one on
here there might be seven on here right there’s a lot of these diagnoses that
have been related and correlates with chronic fatigue so this is they don’t
fully when looking at research they don’t fully know the exact numbers okay
and understand the relationship between chronic pelvic pain and my fibromyalgia
and any CFS but they know they’re higher rates so some of the statistics that we
were able to find okay is that there are public conditions that are significant
here in this patient population compared to controls who do not have these
syndromes going on so one of them is women with mecfs are four times more
likely to have a hysterectomy that’s that’s pretty high okay then the average
age of menopause for again any CFS women with ten years earlier think of the
control we know that there are a lot of side effects from going to early
menopause and so that can kind of cause some effects in the long haul then with
mecfs or two times more likely to have proper chronic prostatitis and then men
with mecfs have two times higher risk of developing erectile dysfunction
so that is just a small snippet of what I’ve found but there’s so much more out
there that court let their higher prevalence of pelvic health issues in
people with mecfs and fibromyalgia and then chronic pain in and of itself which
many of these health conditions will produce pain increases the symptoms
right that you’re all experiencing so if we can help reduce the pain that is
occurring in the pelvic and abdomen region then we can reduce overall pain
that you’re experiencing so one thing that we need to get into before we talk
about treatment is kind of the pain cycle
okay there’s neuroscience about pain and what occurs in our body and when we
experience pain what happens in triggers it is a vicious cycle
so first off the body experiences pain there is a reactive reflexive muscle
spasm right and inflammation that occurs to that area that you’re experiencing
pain then that contracts those muscles which puts pressure on the nerves the
nerves don’t like to be squished so it sends signals to the brain there’s pain
there’s something wrong now the body reacts okay over time the
muscles tense and tighten that creates imbalances so say you have pain in your
right hip well your body is going to be contracting that side so then your left
side has to really compensate for it there’s reduced circulation and blood
flow and all of these other things that occur okay because of that and our like
I said our bodies are amazing machines they’re going to cope to keep you going
so how they do that is by compensating it might be that you develop a limp on
your left side because of the pain it might be that you can’t lift your arm
this high so then you’re always reaching across your body which then is causing
torsion and tweaks through the back in some way it copes but it’s going to
alter the joint mcann and the joint position those altered
joint mechanics and positions increase energy expenditure and consume your
energy so leading to more fatigue because it takes more for you to sit and
stand than someone without pain or these coping strategies that your body has
become accustomed to over time those muscles shorten and weaken okay and then
you lose function you start saying I can’t do this anymore I can’t do that
anymore with that the body to suggest and you
almost get into a mental state where you feel anger frustration and hopeless it
is not fun then because of that there’s more pain that occurs you stop moving as
much okay you deep it’s called movement avoidance you avoid certain movements
because you’re avoiding that then more movement avoidance a curse okay it’s a
cycle that occurs and we’ve got to break it and that’s where us pelvic floor
physical therapists try to step in reduce these coping strategies that your
bodies produce to help you live with better function and energy and reduce
pain so one thing that I so it’s sometimes hard to kind of wrap your head
around but say a man experiencing pain in my left hand
okay the body’s and natural instinct is let’s not move that hand because it’s
painful so my body will clamp it and close it okay it doesn’t want it to move
well in the long haul if I keep my fist tight like this it’s gonna become
dysfunctional it’s gonna start to hurt I can’t open it anymore
I can’t use it to open a water bottle or to write or to open a door then if we go
in and we start trying to work on it if I eventually get my hand back open
through stretching okay and jump mobilizations it’s gonna be weak because
it’s been like this for so long it doesn’t know how to function so then we
try to get coordination back through those muscles gain strength and then
move on to true function so the painting cycle is really what
we’re trying to break so what happens when we experience pain okay our body
goes into chronic holding and contraction of our muscles so often with
my patients who are experiencing pelvic pain they have a non relaxing abdominal
and pelvic floor muscles right that causes pain that causes trigger points
and one thing is our bodies are much more protective over this area of our
body because there’s openings to our body right they know we’re vulnerable it
does not our body does not want things to enter or exit that shouldn’t be that
are harmful because of that it is gonna be much more protective in nature and
much more reactive so they’re gonna close and tighten much more quickly and
they’re gonna be slow to learn that things are safe again the biggest thing
is when you’re in pain what is the biggest thing you want to do you want to
curl up in the fetal position right you don’t want to move you want to protect
yourself and you don’t want to have pain so our body protects vital organs
so that’s your abdomen and your pelvic region much more strongly than other
parts of our body so you’re gonna get even more of a response in these regions
and also emotion is tied to here so what effects do you have again if you think
of the fist if you are having a non relaxing abdomen muscles or pelvic floor
muscles okay it’s gonna get tight and tense there’s gonna lose mobility you’re
gonna lose your strength so eventually going to lose function and specifically
in the pelvic region that usually results in anything urinary sexual
function and bowel function right so we’ll go back to the list but all of
that list that you saw that’s all can be affected because of
the pelvic floor muscles being too tight so the muscles get tight and tense it
reduces your mechanical efficiency which increases the energy needed to move this
can also then cause friction between the muscle and joint causing
what happens when you’re in pain you activate the parasympathetic nervous
system okay that’s your fight and flight that is protect that is closed down and
clamp right so we’re trying to get out of that parasympathetic nervous system
that then increases more pain okay then because of the tightness you lead
to incarnation and dysfunction of those muscles which then affects the the three
systems that we talked about and then it ends up with expending more energy you
end up more fatigued so what do we do for treatment for non relaxing pelvic
floor muscles the first one is breathing patterns okay if you think about how you
breathe and if you take a second to take a nice deep breath where are you feeling
that breath is it all chest driven or is it through your abdomen most people in
pain do short chest breaths short shallow chest breaths
our goal is that we bring that belt or that breath down into your belly in your
public region there is a nerve that pierces through your diaphragm so when
you do diaphragm it breathing it stimulates the vagus nerve that is your
parasympathetic nervous system that is your rest and digest that is getting you
out of the sympathetic nervous system of the fight and flight that overall can
calm the body that will reduce pain but it will not eliminate it
so diaphragm breathing it also will increase oxygen and the energy available
so step one is look at your breathing okay no more short shallow chest breaths
nice big slow diaphragm ik breath calm the body mindfulness mindfulness is huge
how often when were in pain do want to check out of our bodies right this body
is not working how I want it to work I do not like it it is my enemy right now
I want to get out of my body so often when we’re experiencing pain a lot of us
check out we say we don’t want to experience this anymore so I’m gonna
think about this no I’m not going to think about that but bringing yourself
back into your body being aware recognizing where is this pink
from why might it be coming right what can I do to do it and am i tense in
tight fat tense and tightness is going to lead to more pain so instead trying
to relax and calm the body now everyone is like Lauren relax everyone tells me
that relax right way harder said than done so we do guided down trainings to
really teach you how do you do that properly and right okay it’s not an easy
task biofeedback does your body know what it’s doing right there are times
that I’m palpating a pelvic floor right and someone I tell them relax and
they’re like I am but there’s no movement
okay that’s because they have learned to be tight and tense
they might relax a little bit and to them that feels relaxed but really
there’s a whole new level of down training and relaxation that they need
to experience so can you be aware of that internally can you be aware of when
your body’s clenching and tightening first when it’s relaxing and softening
okay what is the difference between that so we use there’s AMG devices that read
the pelvic floor muscles there’s external palpation that we do but really
kind of giving your body some feedback on what’s really occurring because you
guys have probably been in these patterns for a long time years and years
and years so you’re gonna feel like that’s normal I don’t know that’s normal
right so we retrain how the body needs to function and move by giving you
feedback and manual therapy okay we put your hands our hands on you we want to
feel what those muscles are doing where are they tight where is it not
moving right right there’s so much with joint mobilizations with soft tissue
work that we can relax the muscle teach those muscles how to move and glide the
joints the soft tissues the organs right constipated patients you’re right you
get just so backed up so we teach kind of GA mobility and massage we get that
stool to move get the bowels to be stimulated so it
does help with this whole process there’s a lot that we can do hands on
and then mobility we want the pelvic floor and the abdomen to move right
those areas need movement those organs are not meant to be SQUOZE right they
need to have movement and mobility now we live in a world though that is a lot
of appearance base right no one wants to have a gut so we all suck in we want
flat bellies well why do you think that happens over and over like with time
over and over by sucking in that’s kind of like putting a corset around your
organs that need mobility and movement so we teach that do you need to relax
your abdomen do we need to relax the pelvic floor
some people think they’re constipated but really they go sit on the toilet and
the pelvic floor muscles are so tense and tight you’re pushing against closed
door right you’re trying to get that stool to come out but the doors are shut
so how do you get the public forward to relax and open in order for the stool
come out some of the things that we can teach and mobility is really really key
in our body there’s a really funny saying that they say like motion is
lotion for our body if we’re moving and giving it mobility it’s happy so a more
general and broad like treatment plan is our step one as we need to restore a
range of motion okay because a pain will be tense up and tighten because of that
you’re gonna have alter mechanics altered and like energy expenditure so
we need a first restore normal range of motion it needs to match your other side
right we do that by the tension reduction
techniques mindfulness breathing possibly hands-on mobility work if you
have had abdominal surgeries or pelvic surgeries there might be scarring so we
need to get in and move that scar make sure it’s mobile so it’s not keeping
things out here to each other movement overall some gentle stretching it
doesn’t need to be painful and then functional movements what do you need to
do throughout your day do you need to be able to unload your dishwasher well how
can we teach you to move most energy-efficient and safe way for
your body to be able to do that task right that might be the one test that
you’re able to do for the day is unload a dishwasher so we need to let you do
that efficiently step two is in coordination once your
muscles are moving how they should we need to teach them how to coordinate and
move again after you’ve had a trauma or tension of the muscles they’re gonna say
I don’t know how to work or function so we retrain weari coordinate all of it
and it’s done through several different steps
the last is strengthening sadly there are too many physical therapists out
there that that’s their first step they think you’re weak we just need a
strengthen you okay well because of the dysfunction that you’re experiencing
with the movement and the joint mechanics you’re gonna be strengthening
a dysfunction okay we do not want to strengthen a dysfunction so it needs to
first range of motion coordination motor control and then move into the last step
of strength so things to avoid right is this push crash pattern how many people
are like it’s a good day today so I’m gonna do it all right because the last
seven days we’re not good days so you go go go go go go and then you crash right
you need we teach pacing strategies you’ve got to remove stress and the
musculoskeletal system you need to have energy conservation you need to only go
as far as your body’s gonna allow it’s not fun to push that boundary and then
be in bed right so we keep that but the hardest thing is really coming to grips
with where your body truly is for some people that is simply getting out of bed
right getting from your bed to the couch that might be it your bed to the toilet
that is okay right that’s where you’re starting we will then help you pace and
learn how to be able to have more energy get the body moving better so that
there’s been strategies okay you want to not prevent
movement right avoidance of movement is a negative it only leaves some more
avoidance but it needs to be grated movement exposure you need to learn that
I can do this that wasn’t so painful I could handle it
slowly slowly flowing slowly right we exposed you to more and more that your
body can tolerate and then we never want to impose a physical load on the body
that it can’t tolerate that is when you’re gonna crash and your body’s gonna
say no I hurt I’m in pain I’m done so my goals of the physical therapist is to
make everyone’s planned individualized okay if you are coming and I’m like this
is your protocol and I give it to everybody that’s not gonna be successful
I learned that by knowing your true story I know that by examining your
anatomy knowing what’s going on okay looking at how you move how you function
and really where are you starting right we are so minimal and want the bodies to
have success and to learn that these things are safe again so very
individualized okay pain free treatment it should not be pain and torture pain
free that will give the body a better experience and it will not learn to
tense and tighten and be and again that fight and flight we want to re-educate
breathing patterns and how you move right we want to make sure that you’re
moving in positive ways in ways that the body is finding pain free movement that
it doesn’t feel like it’s taking everything in you to do those things but
we want to find that balance so the autonomic nervous system we’re gonna get
you out of fight and flight we want to get you in rest and digest right get
those signaling outs to get the body to calm down there’s really good
information on like neuroscience and pain neuroscience we want to restore the
health accessories for improved mind emotion the kennel mechanical efficiency
and energy proficiency that’s our goal and then we want to overall just expand
the person’s functionality right in the loading on their system so we want you
to be able to do more of what you love and what you enjoy and bottom line is we
want you to be empowered right we want you to feel that these things are doable
and that you’re capable and this isn’t gonna put you in bed for weeks on end
okay that is the biggest biggest biggest thing and we want you to get back to
what you love right we want you to have good good good quality of life so that’s
kind of all the information it’s very much just an overview of what’s going on
I didn’t get into too much of the pelvic diagnosis and treatments and that can
happen more if you choose to see one of us pelvic helps by breast this is a
minor information but then I think we’ll open it up to any questions that might
have arisen so it’s very much individual like you
guessed it all has to do with where the patient is starting but honestly within
weeks patients are feeling like they’re able to do more and that more might be
simply doing one more activity for the day but it does not take long as long as
they’re kind of following the instructions and we’re finding ways of
getting the body to move and a more happy and positive and pain-free way
that people are feeling like they’re able to do more than what they’re doing
so I know it’s vague because it’s very individual but it’s not as long as you
would think yes we treat that all the time so any public pain any experiencing
so yeah so what was asses do I work with postmenopausal women who they’re tissue
integrity might be a little bit low and sensitivity and pain that way that
correct yeah to the point that you don’t have medical examinations and the answer
is yes so there are several reasons why you might be experiencing some of that a
lot of it is hormone driven right but because of that the tissue of like the
vaginal opening in the vulva region become softer and more pliable so they
become more sensitive at the same time so what we do is we work to see where
are you kind of hormonal e right but then we do some manual therapy through
those tissues to allow them to stretch in a graded manner so that you’re not in
pain and to become more pliable to then be
able to tolerate a medical examination may be bad no penetrative sex right any
of those other things that you might be wanting but again it’s in a pain-free
way I think a lot of women get intimidated being like the last time I
tried to go get a gynecologist exam like it was not tolerated
so again pain-free so that we don’t send off that whole spiral and that pain
cycle but yes we do work with I work with women like that all the things but
the question is would therapy possibly prevent the need for a bladder sling yes
so you’re probably referring to a bladder prolapse okay and you’re
referring to the surgery where they tack the bladder up in order for that
prolapse to the bladder to be sitting in a more neutral position so again it’s
variable but there has been a research to show that pelvic floor physical
therapy can change the grade of prolapse by at least one grade and then there
have been over and over again where women were experiencing maybe stress
urinary incontinence or pressure syndrome or symptoms down in the public
region and with public floor retraining they’re able to better give support to
the bladder to prevent to the symptoms that you’re experiencing with prolapse
to ultimately like prevent surgery so it’s pretty incredible and I and then
the other thing is if you end up needing a surgery if pelvic floor does not work
you end up needing a surgery the the results afterwards are greater and they
last longer because often some people think you just
have prolapse because you had babies right that’s like the general idea but
you might be bearing down and straining and pushing and what’s happening in your
abdomen are you tense and tight leading to more pressure downwards you might
have a distant regret you actually buried down and vice-versa
so there’s so many other causes and reasons that prolapse occurs so you want
to see pelvic floor therapist to analyze that and to figure out what you’re doing
so that if you ultimately do end up with surgery that surgery lasts a lot longer
because sadly there’s a five-year failure rate for those bladder slings
and you don’t want to be doing that over and over and over again it’s not a fun
surgery for sure might help people experiencing
yeah so do I need to repeat that question or was it hurt okay so how can
we kind of help with conservation IDs so specifically IBS I think is a little bit
more common and what we look at again microbiome is a huge and upcoming
research right now and it’s massive and big and that’s where we coordinate with
physicians to see what’s going on there but what our goal is is what might be
happening mechanically structurally with the bowels okay is it because of
tightness and the irritation that’s causing more inflammation is there a
reason that the bowels aren’t moving well and so we need to get some
myofascial releases of the bowels we look at the stool right most often it’s
too soft so what are you doing diet wise right what are you doing nutrition wise
what is the consistency how are you excreting that stool what’s happening
what’s bloating most people when you’re bloated you want to fight against the
bloat right it’s uncomfortable so you tense and tighten that causes more
irritation so instead learning to how again talking
about mobility of those bowels that you get it’s how do you get the abdomen to
be mobile and moving but we do work a lot more with dietitians nutritionists
and physicians to find out what might be more of the cause and the reason behind
that and there are also trigger points that happen through the abdominal
muscles so we’re releasing those to kind of reduce pain and irritation from
what’s occurring because of the IBS and the bloating symptoms and so there’s a
lot there also the pelvic floor again it’s it’s so funny that everything kind
of ties back to a lot of the non relaxing pelvic floor muscles but when
you’re kind of worried about like oh my gosh like I have gas or I’m gonna lose
this bowel movement you’re constantly trying to contract to prevent that from
happening so at least a more dysfunction so really learning how the reflexes of
the rectum and how does we retrain that right to be able to know like is this
gas stool you know what’s happening here so a lot of it is we look at the abdomen
and palate and how are they functioning and how are
they responding to the IBS in addition to specifically with let’s work on the
actual stool itself so another question on Facebook are there any discussion on
creating an mecfs and fibromyalgia protocol to serve as a guide for
physical therapists nationwide that you’re aware of so there is I cannot
remember his name but he is kind of working on research right now to really
set like a very standard protocol for physical activity with this patient like
population and what he’s trying to do is he looks at he has you do certain
activities and exercises he’s tracking your heart rate your respiratory rate
and like I think temperature everybody and based on how you present that first
day then he very much does a graded exposure expenditure kind of log and
he’ll give you exercises where you will be meeting those limits and then he
gradually progresses it so there’s just the beginning of that happening I think
what’s hard about it is everyone is in such a variable place and starting point
but that’s how he’s trying to make it very standard by first doing that
testing day one finding out where you are and giving you your individual
specific like this is your heart rate zone this is how much you should be
exerting with your breathing right and so it’s starting but it’s not full I
think so yep yep so it’s really helpful
yeah yeah that and that honestly that that Institute is wonderful yeah so she
she brought up that it’s the work well foundation out of California correct and
they’re the ones doing it so if you type that and Google that and he will pop up
it his name is just blanking me right now but he’s got there’s a wonderful
like short article about it and he goes into it all he also talks about like the
activity pacing the and that’s where I got that like whole push crass crash
right protocol all those things what does prenatal treatment okay no it
does not need to pain so very interesting enough some of the prenatal
work okay is dealing with people with infertility issues even so everyone
thinks about what’s happening hormonal II right what’s happening that like with
may be possible sperm but we look at mechanically what’s happening with your
organs itself are they so during your monthly cycles your organs should drop
down lower to the vaginal opening one is during ovulation because it shortens the
distance that sperm needs to travel the others during menstruation right so that
the lining of the uterus can be shed so what happens it may be possibly in your
cycle you’re not getting that movement for whatever reason maybe there’s
scarring maybe there’s something else blocking it so we look how are the
ovaries moving how’s the uterus moving right are they dropping and moving so we
do do some work with infertility work to determine that the other thing is you
don’t need to have pain but maybe just determining what is your pelvic floor
and how’s it functioning you might deal with constipation you might deal with
urgency you might deal with things like that and then we we will treat you
through see people are always surprised that
there’s a very specific way that you should push during delivery right people
are like what like people just tell me to push but you need to push the pelvic
floor is relaxed and the pressure is coming down because the pelvic floor
does not like pressure so when you’re pushing the public floor actually
contracts because it hates it so you learn the proper push from the abdomen
but keeping the pelvic floor relaxed so we really treat so much like we need
like posturing right how are you sitting how are you moving then in your
pregnancy that is a huge change in how your body is moving because you’re
getting this belly and so there’s big strain on the back and the hips and your
hips are wedding so we teach you like how to keep stability through all of
that and then how to go into your delivery really really prepared and then
more important like not more importantly but even more is postpartum right that
is trauma having a baby especially like either vaginally or cesarean and so I
laugh and I get on a little bit of a soapbox that people come like after
they’ve sprained their ankle right but people don’t come see a pelvic or a
physical therapist out there they have a baby and like their whole pelvic floor
stretched and possibly torn muscles and those muscles need to be taught how to
contract again when to relax again to get motion and movement through there
and learn to be functional again so that whole process with being a woman and if
you go through that I mean it’s vital to kind of be seen before during and
afterwards to really make sure that you maintain as much function as possible I
know so many people are like why do those like why does my kind of car just
not tell me this and you know what’s funny is in Europe and a lot of the
Scandinavian countries it’s mandatory it’s mandatory for women during that
process to see a pelvic floor physical therapists I’m slowly it’s becoming more
and more known here in the nation so yeah I regret cost
all the time and it’s funny and when they send their patients to me because
they’re like you know I don’t know where this public for physical therapy is I’ve
had patients go and they kind of have success like go see what you think and
then pretty soon more and more patients are going back to them being like can
you send everyone and so it’s turned into like you’re a heaven-sent for us
like you get our women to stop peeing after they have babies to have pain-free
intercourse again to be able to jump on a travel to do all of these things that
a lot of women see as now the new normal after having a baby and which that is
not normal it’s common but it shouldn’t be the new norm those things are all
it’s all possible to have a rehab in order to fix those things all right any
last questions all right well I think we’ll wrap it up thank you thank you it
was a really this was just really valuable information and I know there
were several of us talking before your presentation about health we just we
didn’t even know that there was there was such thing as the public physical
therapists so this has been really good information than I opening and I noticed
will help a lot of people so it was really a pleasure to be here thank you
thank you

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