Top Five Reasons Why New Moms Should Visit a Physical Therapist

1. The Specialty Knowledge of a Women’s Health Physical Therapist is Very Different to an Obstetrician’s

It’s important for all pregnant and postpartum women to understand that the role of a Women’s Health/Pelvic Floor Physical Therapist (or as we call it in Australia, Physiotherapist!) is very different to that of an Obstetrician or other perinatal health providers, such as midwives. You see, to optimize your health during pregnancy and postpartum, you need to be seeing both of us.

As you likely know, it is the responsibility of your perinatal healthcare provider to ensure your baby is healthy throughout your pregnancy and is delivered safely, whilst keeping an eye on your health. As a result, their main focus is the baby. On the other hand, a Women’s Health Physical Therapist is focused on the health and wellbeing of you, the mother. Our mission is to make sure you are educated and empowered with all the information you need to have the best pregnancy, birth and recovery possible.

Our role actually starts when you are pregnant. I always recommend pregnant women to have several sessions with a Women’s Health Physical Therapist (who has postgraduate qualifications) to learn:

  •      Pelvic floor exercises

  •      How to exercise safely during pregnancy

  •      How to prevent and manage pelvic pain

  •      How to best prepare your body for childbirth

  •      Early postpartum recovery – so you can optimize your recovery in the first few weeks at home.

After having your baby, the ideal time to have an appointment with a Women’s Health Physical Therapist is 6 weeks postpartum. Regardless of how you gave birth, this is necessary for all women.

2. You Need a Full Assessment of Your Pelvic Floor and Deep Abdominal Muscles

The pelvic floor is one of the areas Women’s Health Physical Therapists specialize in. We do comprehensive pelvic floor assessments via a vaginal examination to assess the strength and state of your pelvic floor following birth.

Commonly, Obstetricians/GPs do not perform vaginal examinations at your 6-week check, so it is up to you to book an appointment with a Women’s Health Physical Therapist to have a pelvic floor assessment. Even if they do perform a vaginal exam, their purpose is not necessarily to check your pelvic floor function, but to see that a tear/episiotomy is healing.

Women’s Health Physical Therapist’s can also use a real-time ultrasound machine to teach you how to activate your deep abdominal muscles (transversus abdominis) postpartum. These muscles work with your pelvic floor muscles to stabilize your spine and pelvis, and are the key to rehabilitating your abdominal muscle separation.

3. You Can Prevent and Manage Common Women’s Health Issues

Since childbirth is a risk factor for developing prolapse and bladder leakage, Women’s Health Physical Therapists help to both prevent and treat these issues. In fact, the evidence shows that pelvic floor exercises during the perinatal period both prevent and treat prolapse and incontinence. This is why they are so important! Since many women (43% in one study*) do a pelvic floor contraction incorrectly, a Women’s Health Physical Therapist will teach you the correct technique.1

Another common postpartum issue is painful intercourse (dyspareunia). This can result from perineal injury during childbirth (tear or episiotomy) and the development of scar tissue. Left untreated, the pelvic floor muscles can increase in tension and dyspareunia can often worsen. Painful intercourse is not just something you have to put up with because you birthed a baby; it is both preventable and treatable. Women’s Health Physical Therapists can:

  •      Teach you how to best prepare your body for childbirth

  •      Teach you how to best care for your pelvic floor in early postpartum

  •      Provide treatment to improve scar tissue and muscle tension

  •      Educate you on self-management strategies

4. You Deserve Individualized Care and Support

Since every body and birth is different, Women’s Health Physical Therapist’s provide individualized education and treatment according to your symptoms and preferences. In the session, we will ensure you feel comfortable to talk about the birth of your baby, and how your pelvic floor, abdominal muscles, bladder and bowel are recovering. We can then ensure we are giving you the best care possible.

We are very aware that motherhood is unknown territory for many women and can be daunting, tiring and emotional. We offer a safe space for you to be completely vulnerable, and talk about any issues you are having, physically and emotionally. Your health and wellbeing is our priority, and we will support you in any way we can.

5. Guidance on the Safe Return to Exercise Postpartum is Key

Returning to exercise after having a baby needs to be done slowly and safely. With social media these days, new moms can feel pressure to look Insta-fit straight after having a baby. But this is completely unrealistic and unsafe! Instead, it’s important to appreciate what your body has just gone through during pregnancy and childbirth, and make decisions that are safe for your pelvic floor and recovery.

Women’s Health Physical Therapist’s will help guide you through what exercise is safe for you according to your birth and recovery. Since every woman has a different birth, recovery, pelvic floor strength, abdominal separation, fitness levels and goals, this is likely to differ from woman to woman. However, there are some general guidelines that should be followed.

For example, prioritizing rest and recovery in the first 6 weeks postpartum, as this is when most of the healing takes place in your body. During this time you can focus on optimal posture, gentle pelvic floor and core muscle activation, stretching, and gentle walking.

With these 5 reasons in mind, my advice to all new moms is to prioritize an appointment with a Women’s Health Physical Therapist. You won’t regret it!

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A Look at Orthopedic Physical Therapy

If you have an injury or illness that affects your bones, joints, muscles, tendons, or ligaments, you may benefit from the skilled services of a physical therapist trained in orthopedic physical therapy.

These days, medical professionals are ultra-specialized, and physical therapists are no exception to this trend. Some physical therapists specialize in helping patients who have orthopedic conditions—those injuries that cause impairments or dysfunction to various bony and soft tissue structures of the body.

Conditions in Orthopedic Physical Therapy

Orthopedic physical therapy focuses on treating conditions affecting the musculoskeletal system, which is made up of your joints, muscles, bones, ligaments, and tendons. Orthopedic injuries and conditions may include:

  • Fractures

  • Muscle strains

  • Ligament sprains

  • Post-operative conditions

  • Tendonitis

  • Bursitis

An injury to a bone, joint, tendon, ligament, or muscle may cause pain, limited functional mobility, and loss of strength or range of motion. These impairments may prevent you from enjoying your normal work or recreational activities. The focus of orthopedic physical therapy is to help your injury heal properly and improve your strength, range of motion, and overall functional mobility.

After surgery, you may have specific limitations that your surgeon wants you to adhere to. Your orthopedic physical therapist can help guide you through your post-operative rehab program to get you back to your normal lifestyle quickly and safely.

Any condition that causes pain or limited functional mobility as a result of an injury to bony or soft tissue structures in your body may benefit from the skilled services of orthopedic physical therapy.

Tools of the Trade

Your orthopedic physical therapist uses specific tools to help you during your rehab. These may include:

  • Therapeutic modalities like heat, ice, ultrasound, or electrical stimulation

  • Assistive devices, such as walkers or canes

  • Orthotics and prosthetics

  • Exercise tools and equipment

  • Evaluation and assessment tools

  • Mobilization or soft tissue massage instruments

While your PT may use various instruments and tools to help you move better and get better, exercise is often your main tool to help you recover fully and prevent future orthopedic problems. Exercises in orthopedic physical therapy often involve:

  • Strengthening exercises

  • Stretching and flexibility exercises

  • Exercises to improve range of motion

  • Balance exercises

  • Functional mobility exercises

  • Endurance exercises

  • Plyometric and jumping-type exercises

Your orthopedic physical therapist can teach you the right exercises for your specific condition that can help you regain your normal mobility. The exercises you do in an orthopedic physical therapy may also be done at home as part of a home exercise program.

Finding an Orthopedic Physical Therapist

So how do you know that a physical therapist can treat your musculoskeletal or orthopedic condition? The best way to find out is to just ask. Call your local physical therapist and ask if he or she treats your specific orthopedic problem.

The American Physical Therapy Association recognizes certain physical therapists who have passed a rigorous examination related to their area of expertise. Physical therapists who are clinical specialists in orthopedics have proven to be experts in evaluating and treating musculoskeletal conditions. These physical therapists have the letters "OCS" after their name, which stands for an orthopedic clinical specialist. To find an OCS, visit the American Board of Physical Therapy Specialties website.

Even if a physical therapist is not an OCS, he or she still may practice orthopedic physical therapy and be able to help you recover after a musculoskeletal injury or surgery. Asking a few friends or a trusted doctor for a recommendation to an orthopedic physical therapy clinic may be all that is necessary to get on the road to recovery.

First Steps to Take If You Need an Orthopedic PT

If you have had orthopedic surgery or have suffered a musculoskeletal injury, you should check in with your doctor and ask for a referral to an orthopedic physical therapist. Your doctor can help find the best PT for you.

In the United States, you have the right to seek physical therapy without a referral, a process known as direct access. Each state has a different set of laws governing direct access; check your own state's law to know the rules and regulations surrounding your ability to refer yourself to PT. Your local physical therapist can also help you obtain access to his or her services.

A musculoskeletal injury may cause you to hurt and have difficulty with basic functional mobility. Remember, orthopedic physical therapy may be challenging, but sometimes your body needs to be pushed a bit to get on the road to recovery.

It is normal to feel anxious about going to see a physical therapist after an orthopedic injury. What will happen? Is it going to hurt? These questions are common, and most people start to feel at ease once they meet their physical therapist and start working toward their rehab goals in orthopedic physical therapy.

Not all physical therapists are the same, and you may require a PT that is specially trained to manage your condition. Finding the right physical therapist can help you have an optimal outcome with your rehab after an orthopedic injury. A physical therapist with the right training geared to your specific condition can help you quickly an safely return to your optimal level of health and functional mobility.

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Simple Exchanges for Thanksgiving Dishes to Relieve Arthritis

The traditional fall foods of the Thanksgiving meal can be a minefield when you're trying to manage rheumatoid arthritis. Some favorite Thanksgiving Day foods are full of hidden fat and calories and aggravate the inflammatory condition. On the other hand, healthy eats for rheumatoid arthritis (RA) may actually help fight inflammation and make it easier to maintain a healthy weight.  With these seven swaps for healthy Thanksgiving Day foods for RA, you can savor the flavors without sacrificing your joint health.

Swap Out Pecans for Apples in Pie

Maintaining a healthy weight is important for people with rheumatoid arthritis because extra weight puts more pressure on already stressed joints, says Eric L. Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minnesota. That doesn’t mean you have to skip dessert entirely, however.  Instead, skip the high-fat, high-sugar Thanksgiving Day foods like pecan pie filling and opt for a fruit-based dessert for nutritional benefits as well as fewer calories. Fall foods like apple pie can have fewer than half the calories of pecan pie.

Swap Out Gravy for Cranberry Sauce

Thanksgiving Day gravy is traditionally made from fatty turkey drippings, which means it’s high in saturated fat. Saturated fats are high in omega-6 fatty acids, which are tied to increased joint inflammation and obesity.  “You don’t need much, so use gravy sparingly,” says Bethany Thayer, MS, RDN, the director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit, Michigan. “Or use cranberries or some fruit puree on meat to give it some moisture and some nutrients as well as antioxidants.” Antioxidant-rich fruits and vegetables are healthy RA foods because they help fight inflammation, according to the Arthritis Foundation.

Swap Out Sweet Potato Casserole for Roasted Sweet Potatoes

Sweet potato casserole is a fall food that’s loaded with extra sugar and fat — an easy contributor to holiday weight gain. “If you’re making sweet potato casserole and adding brown sugar, marshmallows, and butter, what you’ve done is taken a healthy sweet potato and added bad things to it,” says Thayer.  Sweet potatoes on their own are a good source of fiber and inflammation-fighting antioxidants, according to the Arthritis Foundation. Try cutting them into cubes, dusting them with seasonal spices like cinnamon and nutmeg, and roasting them in the oven for a healthier Thanksgiving Day side dish.

Swap Out Fried Onions for Almonds in Green Bean Casserole

The classic recipe for Thanksgiving Day green bean casserole calls for cream of mushroom soup and a fatty fried onion topping. Both are unhealthy foods for RA because they're high in saturated fats that can trigger inflammation.  To lighten up this Thanksgiving favorite, Thayer suggests using reduced-fat or fat-free soup and topping the dish with slivered or sliced almonds for a healthy crunch. Nuts like almonds, walnuts, and pistachios are a good source of heart-healthy fiber, unsaturated fats, and antioxidants. The omega-3 fatty acids found in some nuts are also thought to reduce the risk for RA and fight inflammation.

Swap Out White Bread for Whole Grains in Stuffing

Stuffing is another Thanksgiving favorite that can be made healthier with some simple swaps, Thayer says. Rather than using white bread and lots of butter in the stuffing, choose whole-grain bread and low-sodium chicken broth to moisten it. Add some dried fruit and chopped vegetables to the mix to add even more nutrition and flavor. Including more fruits and vegetables in traditional Thanksgiving Day foods is a healthy way to add more inflammation-fighting antioxidants.

Reduce the Fat in Macaroni and Cheese

Macaroni and cheese is a high-fat side dish that appears on many Thanksgiving tables. “If Thanksgiving isn’t Thanksgiving without it, then just watch your portion size,” says Thayer.  But you can make macaroni and cheese healthier by using whole-grain pasta and cutting back on the cheese or using reduced-fat cheese. Adding pureed cooked carrots or cauliflower to macaroni and cheese is another way to incorporate more healthy foods for RA symptoms into a traditional Thanksgiving Day food.

Swap Out Turkey for Salmon

Although Thanksgiving Day turkey can be a lean source of protein, eating it with the skin on and under an avalanche of gravy can quickly pile on extra fat and calories. It may be a hard sell to get rid of the turkey entirely at Thanksgiving, but Thayer suggests offering salmon as a new holiday tradition or along with the turkey. Fatty fishes like salmon and tuna are good sources of omega-3 fatty acids, which have been shown to have potent anti-inflammatory properties.

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Top 4 Reasons New Moms Should Take The Initiative to Seek Post Pregnancy PT

Pregnancy and childbirth exact an enormous toll on a woman’s body. It is transforming and beautiful, but when a mother does not get the physical and emotional support she needs, the effects can be devastating. 

I am a new mother, three times over.  Each time after I have given birth, I have benefited enormously from physical therapy afterwards. I could not stand strong, fit, and wholly healed without it.

I am also a physical therapist, myself, and feel that every woman should know her rights to receive physical therapy as a new mother. One of the many fields of specialization in physical therapy is women’s health.  I bet you didn’t know that. That’s okay. Most doctors don’t either. 

A physical therapist (PT) in women’s health is dedicated to helping women get their bodies back after birth. They can treat a myriad of issues, including pelvic and back pain, incontinence, and other ailments.  The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The sad fact, though, is that most new mothers will never get the therapy they desperately need after giving birth. 

But I am passionate about turning the tide. All too often, women in general, not just new mothers, do not receive the health care they need.

A Prime Example of Falling Through the (Medical) Cracks

I have had patients and friends who have suffered from pelvic pain, sexual dysfunction, painful scarring, chronic incontinence, and lower back pain for so long that it has severely altered their quality and enjoyment of life.

A friend recently came to me asking for advice for another girlfriend.  Let’s say her name is Teresa.  Teresa had just undergone major abdominal surgery (think C-section) and was having awful abdominal pains and even headaches. 

Knowing that the two are related, based on her surgery type and plan of care, I immediately asked if the surgeon had referred her to physical therapy.  Of course, the answer was no. Her plan of care did not include any post-operative physical therapy.  In fact, when I asked Teresa directly, she said her doctor (a woman, mind you) had never even mentioned needing physical therapy. 

I was upset by what I felt was an oversight by the physician to refer Teresa to therapy, but mostly I felt a surge of urgency to help her.  This woman needed therapy immediately, yesterday, even.  She was floundering, depressed, in pain, and alone at home six weeks after major surgery on her reproductive organs due to a cancer scare. She had no idea how to get better (she had been a marathoner) now that she had this huge scar (larger than that of a C-section) across her abdomen.  Even coughing caused pain, and the related headaches and back pain were terrifying. 

But it was not the doctor’s fault, not really.  Doctors are educated very little, if at all, about PT services in medical school. A good friend with an MD sister said this when asked if she had learned about PT in medical school: “sure, we had education about what PT’s do in medical school. It was a single lecture, on one day, it was optional, and it covered all allied health care services.” 

Physical therapists spend a similar amount of time in earning their degree in physical therapy (7-8 years) as doctors do in medical training. There really is no way a single optional lecture in medical school can prepare physicians to know what PT’s do and how to refer for physical therapy.

The Take Home Message 

Be your own advocate in health care. Before going into surgery or giving birth, educate yourself about what to expect and what you will need for your body to heal fully. 

The biggest mistake a mother can make in seeking maternity care is assuming her doctor knows best. The doctor may not even know PT’s treat women’s health issues, much less how to refer to PT for prenatal or postpartum rehabilitation. 

There is good news though. Here are the tools you need to get physical therapy after giving birth:      

First, BEFORE you give birth, ask your doctor is he/she refers to physical therapy after giving birth. If you already have low back or pelvic pain during pregnancy, then you should get a referral for physical therapy now.  Do not wait until after giving birth.  

When asked why you need it (physical therapy), you can give them these four reasons:

1. Managing Urinary and Fecal Continence

No mother wants to leak urine or worse, feces, after giving birth. But the reality is that if you have given birth, or are about to, you have an increased chance of doing just that. Women who are obese or have had multiple children are at an even higher risk: about four times higher.  The risk of incontinence also increases with age, even if you have never had children. 

The good news is that physical therapists treat incontinence (both stress and urge related) without invasive methods.  No surgery and no drugs. A 2003 study in the International Urogynecology Journal revealed almost half of 144 mothers studied experienced urinary incontinence during and immediately after pregnancy. Eight weeks out, 38% still were suffering from urinary incontinence, and 6 women reported both urinary and fecal incontinence. This study, and many others which support its findings, found that “there is a need for a strategy to prevent and treat urinary incontinence during these periods.” 

More good news is another study reporting that pelvic floor muscle exercises, are “quite effective in the augmentation of the pelvic floor muscle strength and consequently in the treatment of urinary incontinence.”  New mothers should seek physical therapy to remedy a weak or damaged pelvic floor.

2. Prevent Scar Tissue Adhesions & Pelvic Pain

Pelvic pain is more common than ever, in part because of the US’s astronomical rate of C-sections. The reported C-section rate is currently 33%, the highest in US history.  Scarring is a natural part of the healing process, but when left to heal on their own after C-sections or abdominal surgery, incision sites (or tears or episiotomies from childbirth) can cause permanent pain. 

Low back pain, sexual dysfunction, and painful intercourse are all reported side effects of unabated scarring. When an incision or tear interrupts the skin, the body responds by laying down connective tissue which assists the body in healing, from the inside out, so to speak. However, the layers of tissue between muscles, and the layers of muscles themselves can all scar together, leaving a lumpy, painful, and even unsightly mess. Scarring can cause permanent pain if left untreated, which is why I recommend women seek PT after surgery, or if they have suffered a perineal tear or cut from an episiotomy. 

3. Manage Low Back Pain

Over 80% of Americans suffer from lower back pain, and I would dare to guess that an equal or greater percentage of pregnant women suffer from some type of back pain.  The good news is that a physical therapist can determine why and how the back pain occurs and can help manage it during and after pregnancy. 

Aquatic therapy, manual or massage therapy, electrotherapies, yoga, Pilates, and therapeutic exercise are all ways that a PT can help you feel your best during and after pregnancy. Not all back and belly pain in expectant mothers is a direct result of pregnancy though. There are many reasons for back pain, which go far beyond the standard round ligament pain. 

Sometimes pain can arise from deep pelvic muscle imbalance, pelvic mis-alignment, spinal issues, or mis-alignment in pubic symphysis, sacroiliac joint, or the lumbosacral junction. The point is, physical therapists are the experts in evaluating, diagnosing, and helping you manage your pain and discomfort in this area.

4. Wellness for Future Pregnancies and Daily Life

Physical therapists are also experts in the field of fitness, prevention, and wellness.  Because PT’s are experts in knowing how the body works, they can design a personalized treatment plan to fit your needs. Whether you are a marathoner, an avid gardener, or a couch potato looking to make better lifestyle choices, a PT can help you get your body back, and/or prepare it for future pregnancies.

Pre-surgical physical therapy is often utilized and covered under insurance for surgeries of the knee or shoulder, for example. Most women will report that giving birth, either vaginally or by C-section, is one of the most physically demanding, “marathon-like” events of their life. However, very few women receive physical therapy to prepare their bodies for and recover after childbirth. This unfortunate oversight must end.

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Nutrition is an Essential Component to Recovery with Physical Therapy Treatment

As physical therapists it is our job to consider all potential contributors to a patient’s recovery. While we do a great job of accounting for the physical components of rehabilitation, such as strength, flexibility and prior level of function, we often overlook the importance of a less obvious component: nutrition. Nutrition plays a pivotal role in the healing process and can either enhance or hinder a patient’s recovery from musculoskeletal injury. While it is not in our scope of practice to design nutritional plans, we should possess a baseline knowledge of nutritional influences in musculoskeletal healing. Physical therapists have arguably more contact with patients than any other healthcare provider throughout the recovery process. We are therefore in a great place to remind our patients of the importance of adequate nutrition.

Addressing the Fear of Weight Gain

If you work with athletes or active patients, you have likely had your patients express to you that they are fearful of potential weight gain when rehabilitating an injury. Patients who may have run five or six days per week are now forced into a period of relative inactivity. Their weight concerns are valid, but under-eating is not the answer. While active patients may require fewer total calories than they took in prior to injury, they should not be eating as though they are sedentary. A caloric excess when injured can result in increased fat deposition, but inadequate caloric intake will accelerate muscle loss. The balance is delicate.

During recovery from a musculoskeletal injury, nutritional needs are similar to those required during muscle growth. When injured, or after surgery, we can burn anywhere from 5-50% more calories per day. Our metabolism essentially spikes in order to aid the healing process. Therefore, limiting calories will prolong the rehab process and will also decrease protein stores, which inhibits the body’s ability to repair an injury.

Since under-eating decreases lean mass of healthy tissues and decreases muscle protein synthesis, patients will accelerate muscle atrophy if they eat at a caloric deficit. Basically, your patients will get weaker and will have more difficulty rebuilding strength if they under-eat when injured. So next time your patients ask you about restricting their intake during the rehab process, make sure to remind them that under-eating will only prolong recovery and make it more difficult to return to prior level of function.

Tackling the Inflammatory Phase with Proper Nutrition

We are all familiar with the phases of healing: inflammation, proliferation and remodeling. While most of us are well versed in the musculoskeletal changes that occur during these phases, it is important to understand how nutrition can influence the healing process. Let’s first take a look at inflammation.

In the inflammatory phase our goal is to control inflammation and prevent excess inflammation. Make note that it is NOT our goal to completely stop inflammation. Inflammation is a normal and necessary step in the healing process. Excess inflammation, however, will impair blood flow and potentially cause cell damage to the healthy tissue around the injury.

During the inflammatory phase, we can take control of inflammation with dietary fats. Dietary fats protect against inflammation because they signal the movement of blood flow and promote the function of immunity cells. To combat inflammation, patients should increase consumption of the essential fatty acid, omega-3. Omega-3 is known as an essential fatty acid because our bodies cannot make it. In order to use this inflammatory fighting nutrient, we must increase consumption omega-3 rich foods, such as olive oil, fish oil, avocado, pecans, walnuts and almonds.

It is also important that patients limit consumption of omega-6 fatty acids, such as vegetable oils, fried foods and processed foods. This is not to say that we need to eliminate all sources of omega-6, but we want to even out the ratio of omega-3 to omega-6. The ideal proportion of omega-3 to omega-6 fatty acids should be 1:1, although most of us consume a ratio of 1:10 per day.

Fruits and vegetables will also aid in controlling the inflammatory process because they are rich in antioxidants. When in doubt, choose brightly colored produce. Some examples include broccoli, which contains sulforaphane and many help cartilage breakdown; citrus fruits, which contain vitamin C, which supports collagen and proteoglycan synthesis; and red grapes, which contain resveratrol, which suppresses pro-inflammatory cytokines. Additional inflammatory mediators include turmeric and garlic, which patients can add as dietary supplements.

Use Protein to Combat Muscle Loss

We’ve moved on to the later phases of proliferation and remodeling. Our goal now is to prevent atrophy and promote soft tissue repair for return to function. As physical therapists we know all too well that our patients will experience muscle disuse atrophy during these phases. We have a lot of tools at our disposal to get them stronger, but what if there was a way to decrease the severity of muscle atrophy? Protein may be the answer.

Musculoskeletal injuries are often accompanied by anabolic resistance, which is the reduced ability of the muscle to synthesize protein. When the body is in a state of anabolic resistance, it has a limited ability to build muscle even with adequate protein intake. This causes muscle size and strength to decrease. Inevitably, function declines and we and our patients have a lot of work to do.

The news is not all bad though. Nutrition is an effective intervention to attenuate this cascade from muscle disuse to muscle atrophy.  When considering energy requirements, our patients must be especially mindful of protein intake due to the potential of anabolic resistance. However, as mentioned earlier, many athletes will decrease overall caloric intake when injured due to a decline in physical activity. Once again, it is important to remind patients that this will only accelerate muscle loss during injury. The second figure below depicts a more hopeful recovery process. As you can see, nutrition can enhance the rehab process by contributing to improved muscle strength and function.

Many athletes or active patients were conscious of protein intake prior to injury, and should continue to be mindful of protein stores during rehabilitation. Impairments in muscle protein synthesis rates are a major cause for disuse atrophy. In order to support muscle mass, patients should be eating an adequate amount of protein. Energy balanced diets with a moderate (1.0 g/kg/BW) compared to a low (0.6 g/kg BW) protein intake prevent a decline in body protein synthesis, thus allowing patients to maintain more strength. It has also been suggested that injury dietary strategies should optimize the anabolic response to each individual meal. This means that we should space protein intake evenly across the day every 3-4 hours to keep muscle synthesis rates elevated over a 24 hour period.

While “eat more protein” is good advice, we can give better advice when we consider the digestible properties of different types of protein. Whey protein is more rapidly digested than soy or casein and it has a greater anabolic response and is thus a more effective source during injury. We should also be aware of the role of amino acids. Leucine is a branched chain amino acid that has a unique ability to stimulate muscle protein synthesis. Therefore, supplemental leucine will be beneficial. Omega-3 supplementation is another effective way to minimize muscle disuse atrophy, as it has been shown to enhance anabolic sensitivity to amino acids, thus making it easier for our bodies to use protein.

Bridging the Gap Between Physical Therapy and Nutrition

Gaining knowledge on the role of nutrition in the rehabilitation process will allow us to be more effective practitioners and will enhance patient recovery. Of course, if a patient has specialized dietary needs then it is best practice to refer to a trained nutritionist. However, for basic nutritional questions and concerns, we can serve as a source for our patients.

Thomas Edison once predicted that “the doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.” As future leaders of healthcare, physical therapists should start to consider the influence of nutrition on our practice in the same way that many other healthcare practitioners have begun to do. A patient’s nutritional choices have a direct effect on our work in the clinic. In order to truly optimize patient performance, we must consider the influence of nutrition on healing.

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A Case of Astounding Recovery from Paralysis with PT

Spinal cord stimulation and physical therapy have helped a man paralyzed since 2013 regain his ability to stand and walk with assistance. The results, achieved in a research collaboration between Mayo Clinic and UCLA, are reported in Nature Medicine.

With an implanted stimulator turned on, the man was able to step with a front-wheeled walker while trainers provided occasional assistance. He made 113 rehabilitation visits to Mayo Clinic over a year, and achieved milestones during individual sessions:

  • Total distance: 111 yards (102 meters) -- about the length of a football field

  • Total number of steps: 331

  • Total minutes walking with assistance:16 minutes

  • Step speed: 13 yards per minute (0.20 meters per second)

"What this is teaching us is that those networks of neurons below a spinal cord injury still can function after paralysis," says Kendall Lee, M.D., Ph.D., co-principal investigator, neurosurgeon and director of Mayo Clinic's Neural Engineering Laboratories.

In the study, the man's spinal cord was stimulated by an implanted electrode, enabling neurons to receive the signal that he wanted to stand or step.

"Now I think the real challenge starts, and that's understanding how this happened, why it happened, and which patients will respond, says Kristin Zhao, Ph.D., co-principal investigator and director of Mayo Clinic's Assistive and Restorative Technology Laboratory.

Currently, as a safety precaution, the patient takes steps only under the supervision of the research team.

Early findings

The man, now 29, injured his spinal cord at the thoracic vertebrae in the middle of his back in a snowmobile accident in 2013. He was diagnosed with a complete loss of function below the spinal cord injury, meaning he could not move or feel anything below the middle of his torso.

In the study, which began in 2016, the man participated in 22 weeks of physical therapy and then had an electrode surgically implanted by Dr. Lee and his Mayo Clinic neurosurgery team.

The implant sits in the epidural space -- the outermost part of the spinal canal -- at a specific location below the injured area. The electrode connects to a pulse generator device under the skin of the man's abdomen and communicates wirelessly with an external controller. Mayo Clinic received permission from the U.S. Food and Drug Administration to use the device for a condition not covered by its FDA-approved label.

Continued progress

The research team then tried to determine if the man could stand and walk with assistance. During 113 rehabilitation sessions, the researchers adjusted stimulation settings, trainer assistance, harness support and speed of the treadmill to allow the man maximum independence.

The research demonstrated that the man was able to walk over ground using a front-wheeled walker and step on a treadmill placing his arms on support bars to help with balance. However, when stimulation was off, the man remained paralyzed.

In the first week, the participant used a harness to lower his risk of falling and to provide upper body balance. Trainers were positioned at his knees and hips to help him stand, swing his legs and shift his weight. Because the man did not regain sensation, he initially used mirrors to view his legs, and trainers described leg position, movement and balance. By week 25, he did not need a harness, and trainers offered only occasional help. By the end of the study period, the man learned to use his entire body to transfer weight, maintain balance and propel forward, requiring minimal verbal cues and periodic glances at his legs.


Physical Therapy Treatment for Vertigo

Vertigo is a common ailment that affects a large number of people every year. And although it isn’t a life-threatening condition, it can affect their quality of life substantially. Vertigo attacks leave a person feeling a sense of rocking, rotation, and spinning; and moving the head and body just makes the symptoms worse. Despite how common vertigo is, a large number of sufferers are unaware that physical therapy is one of the best and most effective ways to manage and treat vertigo. A useful technique is using physical therapy for Vertigo. This is want we're going to discuss in this article.

The technique and course of treatment for vertigo depends a lot on the cause of the problem. Vertigo can occur for a number of reasons, including vascular/circulatory impairment, infections in the inner ear, imbalances in the ear, issues with the cervical spine, problems with the central nervous system, and, most commonly, due to loose crystals in the ear that cause BPPV (Benign Paroxysmal Positional Vertigo).

What exactly is BBPV?

Typically BBPV is the most common cause of Vertigo and like me mentioned before it is typically caused by a mechanical change in the inner ear which causes loose crystals. When crystals become loose or disloged, it can cause disruption of your ear fluid which essentially creates a false sense of movement. This is why when you move your head or change from prone to supine position (laying down or facing down) will cause a sensation of vertigo. In studies conducted by physical therapists, it has been shown that 2-4% of the world's population is a risk for BBPV or in other words loose crystals in their ear.

Does all Vertigo come from BPPV?

No, typically BPPV is a very common cause of Vertigo but not all forms of vertigo come from BPPV or loose crystals. However determining if vertigo is caused by BPPV is a relatively easy process involving the Dix-Hallpike Test which essentially is a non-invase test that takes just a short of amount (usually minutes) to test if your vertigo is coming from the crystals in your ear.

Depending on the cause for your vertigo, you may need a different approach: as always, be sure to consult with a medical professional about what physical therapy might be right for you.

Different PT techniques for vertigo

In physical therapy, there are four commonly used techniques for managing and treating vertigo. The most commonly used technique is the Epley maneuver, which is extremely effective for treating mechanical ear imbalances, such as the loose crystals that cause BPPV. Although a common belief is that this maneuver can easily be performed on yourself, it is advisable to visit a physical therapist to avoid complications. Other physical therapy techniques for vertigo include the Semont maneuver, the Foster maneuver, and the Brandt-Daroff exercise – ask your physical therapist if these might be right for you.

Here's how a physical therapist can help vertigo patients

A professional physical therapist can help you to deal with your vertigo in many ways. Here are a few of the advantages that physical therapy has for vertigo patients:

  • A physical therapist can assess your problem and see how mild or severe your case of vertigo is. This is the most basic step, and it determines the rest of your treatment plan. Simply adopting one of the maneuver techniques yourself can do you more harm than good, and so a visit to the physical therapist can help you get your treatment running the right way, and keep it on course.

  • Once your symptoms have been evaluated, your physical therapist will suggest therapeutic exercises that can reduce the intensity of your symptoms, or in some cases, eliminate them entirely. They will also advise you on the frequency of the exercise, and the general routine to follow, based on your individual requirements.

  • Your physical therapist will also periodically re-evaluate you to check if there is any reduction in your symptoms. Regular evaluation helps to track your progress, and can also help to determine the effectiveness of the exercises that your therapist has given you. Depending on the results, you may be advised to continue, change, or stop your exercise routine.

A physical therapist can also help you with any queries that you may have, and dispel any common myths and misconceptions. Opting for physical therapy can be one of the best courses of action for patients suffering from vertigo, and it’s well worth discussing with your doctor and physical therapist.

What kind of physical therapist do I need?

There are many different kinds of physical therapists that can treat vertigo. Most physical therapists are prepared through their medical education to treat people with vertigo or dizziness. Options you may want to consider are the following:

A physical therapists who has had experience in this area of a physical therapist that has education on vestibular rehabilitation would be a great fit.

A physical therapist that has been board certified or a specalist in neurological physical therapy would be more than adaquelty equipped to help you.

Does exercise help with vertigo?

The short answer is yes but it depends on what caused your vertigo and how depilating it is for you in your current state. The specific types of exercises will depend on your unique situation which your physical therapist will be able to diagnose and prescribe for you. Often times however the exercises your physical therapy will recommend can help improve your balance, help you brain to focus and help to focus your vision and correct the differences between your inner ears which are causing vertigo in the first place.

Does physical therapy help vertigo?

Every case of vertigo is slightly different. The specific physical therapy treatments will highly depend on the diagnosis of your physical therapist. For example, there are different causes of Vertigo which require different forms of treatment. However, physical therapy does indeed help vertigo. A physical therapist can do a test to determine what the cause of your vertigo. If it is determined that the cause of your vertigo is BPPV then typically can be completely resolved in one or two visits with your physical therapist through the the application of the Epley Maneuver, which is a the best form of treatment with very success ratio.

If after the treatment, you are still feeling dizziness or imblance, we have balance training that will help regain your balance. If you are struggling with vertigo and you want experienced professionals to help you heal the issue.

What is the best treatment for vertigo?

There are short-term solutions such as antihistamines such as AntiVert. These types of over the counter medicines only solve the symptoms. They do not solve the issue permanently, which is why we recommend professional care by a physical therapist.

What causes dizziness?

Most commonly, patients who are over the age of 65 report feeling dizziness and feelings of imbalance. It is reported that more than 9 million people visit the doctor or a physical therapist due to feeling dizziness. More often then not, dizziness by itself is not a very serious debilitating condition but rather a symptom of a larger issue. This is why getting a professional diagnosis by a physical therapist will greatly benefit you. They can tell you exactly what is causing your dizziness and the best form of treatment. When you make an appointment the physical therapist will evaluate your condition by assessing:

  • balance

  • how you walk

  • mobility

  • neck and arm mobility

  • inner ear testing

Physical therapy for vertigo: Does it work?

The answer is yes, more often than not, physical therapy for vertigo or as it is often called, vestibular rehabilitation therapy is the only form of treatment needed to resolve your issue. If a few rare cases, there many been a need for a post-treatment plan. Your physical therapist will be able to tell you if you need a post-treatment plan to continue working on your problems until they completely disappear.

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Physical Therapy Plays an Essential Role in Total Joint Rehabilitation

One of the most important aspects of a total knee replacement is rehabilitation. A proper course of rehabilitation is essential in order to gain full benefit of the surgery. Patients will usually spend three to five days in the hospital after undergoing surgery. Most patients will usually start rehabilitation while in the hospital. After leaving the hospital, patients will either undergo outpatient therapy while living at home or in-patient therapy at a rehabilitation center.

Regaining strength and motion

After a knee replacement, exercising to regain strength and range of motion is crucial. Most patients begin to stand and walk using a walker within hours after surgery. Your physical therapy program will start with gentle exercises to help you bear weight on your new joint. Performing range of motion exercises after surgery is especially important to prevent scar tissue from limiting the flexibility of the new joint. You will also be taught how to manage pain after surgery. Some pain after a knee replacement should be expected.

Most rehabilitation programs for knee replacements usually include range of motion exercises, quadriceps strengthening, gait training and daily life training exercises. It’s important to avoid straining or overworking the knee during your recovery period. Healing takes time and you shouldn’t try to rush your rehabilitation.

Making progress

As you advance in your rehabilitation, you will be able to begin resuming normal activities. This will start as you progress from using a walker (or crutches) to a cane. Eventually you will not even need a cane and will be walking on your own. At this time you will be able to begin climbing stairs. Most patients start with smaller-height steps at first and then progress to standard-height stairs. You will be able to return home when you are able to safely get out of bed, walk up to 75 feet with crutches or a walker, use the bathroom, and go up and down a flight of stairs. Your physical therapy sessions will continue when you are back at home. Your therapist will visit you at least once at home to ensure that you can safely get around. After your home visits have ended you will begin outpatient physical therapy.

During outpatient physical therapy, your therapist may recommend using heat or ice treatments or electrical stimulation to help reduce any persistent swelling or pain. You will continue to use your walker or crutches while you are at home. Your therapist will help you increase the amount of weight you put on your new knee joint as it heals. In addition, your therapist will guide your through an exercise program that includes range of motion, strengthening, balance, and endurance exercises as well as functional activities. As your therapy progresses, you will also learn exercises that will help you with your day-to-day activities, such as going up and down steps, bending over, and squatting. Your therapist can also teach you specific exercises that will help you perform your job safely.

Returning to normal activities

Approximately six weeks after surgery, your doctor may give you permission to drive. You will need to move your legs easily to do this, which is why your daily exercises are so important. After you are able to drive the next step is returning to work. Your doctor and physical therapist will help you determine when you should return to work. This will be dependent on the type of work you do and the demands of your job. If your job requires heavy lifting or other manual labor you should discuss this with your doctor and physical therapist.

Remember that certain leisure and sport activities could damage your artificial knee over time. The more vigorous and strenuous the activity, the higher the risk of either damaging the new artificial joint or loosening it. Certain activities can also cause excessive wear of your new artificial knee. This is why if you wish to engage in skiing, martial arts, high impact aerobics, racquet sports, soccer, basketball and other similar sports, you should discuss your intentions with your doctor. Lower stress activities such as hiking, golfing, swimming and biking are usually okay.

Remember that your rehabilitative therapy is a vital party of your recovery. Your hard work during this stage will keep your recovery on track and allow you to enjoy all the benefits your knee replacement surgery provides.

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Advances in Physical Therapy Aid in TMJ Patient Recovery

Creating a custom TMD treatment plan is the first step to finding relief after diagnosis. Each patient is unique, and treatment options can range from using heat packs to having surgery. One option that can benefit most TMD patients is physical therapy.

Like other joints in the body, the temporomandibular joint is often responsive to certain physical therapy exercises, particularly if TMJ pain is the result of an injury. Keep reading to learn more about how physical therapists and dentists are working together to help patients, and how the latest advances in PT offer relief.

Bringing Dentistry and Physical Therapy Together

If your dentist finds that stretching and strengthening the temporomandibular joint will improve symptoms, this is when physical therapy comes into play. More and more dentists are beginning to work with specialized physical therapists in order for patients to get effective treatment. Physical therapist Jeff Humphrey says this team effort leads to TMD symptom improvements in up to 85% of cases.

Working with a physical therapist who understands TMJ treatment is crucial. While most physical therapy education programs will cover the TMJ, the extent to which it is covered varies. Good physical therapists now know that there is a relationship between the teeth and neck areas. This is something that many TMJ dentists understand, but they don’t have the training to provide patients with the necessary physical therapy treatments.

When dentists and physical therapists work as a team, the dentist can explain the underlying conditions and problems associated with the TMJ so that the therapist can create custom exercises. For the best results, dentists and TMD patients should prefer to work with PTs that are knowledgeable in Cranial Facial disorders.

What a Physical Therapist Can Do for TMJ Disorders

The therapy provided by a CFS goes well beyond stretching the jaw and relaxing the muscles around the temporomandibular joint. Specialized physical therapists will work on:

  • Muscles

  • Joint Movement

  • Soft Tissue

  • Upper Cervical Spine

  • Posture

The goal is to improve alignment as well as mobility through manual therapy and exercises that reduce the load on the TMJ, increase flexibility and strengthen the muscles. If the patient has suffered from an injury or has had surgery, physical therapy can be used to release scar tissue. Ultrasound and electrical stimulation tools are also being used to help reduce pain for some patients.

Transcutaneous Electrical Nerve Stimulations (TENS) utilizes mild electrical currents that are passed through the skin over the jaw muscles. It can help to block pain signals, increase circulation and relax the muscles.

Ultrasound Therapy directs high frequency sound waves at the temporomandibular joint. The sound waves can help to reduce swelling, improve circulation and decrease pain.

It is now well documented that physical therapy can have a profoundly positive impact on TMJ disorders when the physical therapist is properly trained. Organizations like The Physical Therapy Board of Craniofacial & Cervical Therapeutics are working to improve treatments and expand education for therapists across the country.

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Beyond Kegels, PT for Pelvic Floor Muscle Dysfunction

Nurse practitioners commonly see patients with disorders or symptoms related to pelvic floor muscle (PFM) dysfunction who may be candidates for pelvic floor physical therapy. In this article, the authors discuss their approach to the evaluation and treatment of these patients. The aim of this collaboration between NP and pelvic floor physical therapist is to improve health outcomes and quality of life for women with PFM dysfunction.  Nurse practitioners (NPs) who provide care for women see many patients who have symptoms that are related, at least in part, to dysfunction of the pelvic floor muscles (PFMs). Understanding of the pelvic floor structure, and how dysfunction of the muscles in this area contributes to gynecologic, urinary, and gastrointestinal problems, is important in both making diagnoses and formulating treatment plans. In these cases, a physical therapist who specializes in pelvic floor dysfunction can be a valuable partner in both confirming the diagnosis and providing therapy. Collaboration between NP and physical therapist can improve health outcomes and quality of life (QOL) for women who have discomfort, pain, and interruption of activities of daily living because of PFM dysfunction.

Pelvic floor physical therapy

The pelvic floor consists of a group of muscles that work to provide support to visceral organs, resistance to intra-abdominal pressure, maintenance of continence, and performance of sexual functions.1,2 The levator ani and coccygeus make up the deep pelvic floor which acts like a hammock, attaching from the pubic bone and slinging back to the coccyx and sacrum. The rectum, urethra, and vagina all pass through the pelvic floor; dysfunction in the PFMs can affect any or all of these structure.  Females of any age and in any life stage, including pregnant women,3postpartum women, 4 elderly women, 5 and even girls, 6 can experience PFM dysfunction. Many females with PFM dysfunction can benefit from pelvic floor physical therapy.

Pelvic floor PT addresses the muscles, ligaments, connective tissues, lymphatic system, and joints inside and surrounding the pelvic girdle, often in intimate regions that few people associate with muscles. Pelvic floor PT is similar to other types of PT in that the focus is on movement disorders such as hypermobility and hypomobility. The main goal of pelvic floor PT is to promote maximal function and QOL, specifically pertaining to muscles that can influence basic activities of daily life such as urination, defecation, and sexual activity.

Common diagnoses warranting referral to pelvic floor physical therapists

Pelvic floor physical therapists assess and treat a variety of conditions, including urinary/fecal urgency, frequency, and incontinence; constipation; pelvic organ prolapse; and prenatal and postpartum conditions such as low back pain, sacroiliac pain, and dia­stasis recti. In addition, they can treat pain in the abdomen, low back, or pelvis that arises during urination, defecation, sexual activity, or even just sitting. These physical therapists have advanced training in the pelvic floor to evaluate and treat joint dysfunction, muscle imbalances, and nerve entrapment, which can contribute to the aforementioned complaints. Some of the most common referrals to pelvic floor physical therapists are for management of the symptoms of urinary incontinence (UI), chron­ic pelvic pain (CPP), constipation, and pelvic organ prolapse.

Urinary incontinence

Urinary incontinence affects approximately 19% of women aged 19-44 years, 25% of those aged 45-64 years, and 30% of those aged 65 years or older.  Pelvic floor physical therapists can instruct patients in pelvic floor strengthening exercises to address muscle weakness and/or over-activity that contributes to UI. Research supports the recommendation that PFM training be included in first-line conservative management programs for women with stress, urge, or mixed UI.  Pelvic floor PT results in significant reductions in both symptom-related distress and symptom impact.

Chronic pelvic pain

Chronic pelvic pain is defined as pelvic pain lasting more than 6 months. The list of specific diagnoses that fall under the CPP umbrella is quite extensive and includes dyspareunia, vulvodynia, vaginismus, endometriosis, pudendal neuralgia, and interstitial cystitis. CPP affects 14%-24% of women during the reproductive years.  This pain can manifest as urinary frequency/urgency, a sensation of incomplete emptying of the bladder, decreased urine flow, constipation, burning and pain in the pelvic area, pain during and/or following intercourse, and pain in the low back and hips. Physical therapists who specialize in pelvic floor PT can address the muscular and skeletal dysfunctions that are contributing to CPP. The musculoskeletal (M-S) system has been found to be involved in the genesis and perpetuation of CPP; in fact, strong evidence indicates that 80% of women with CPP pre­sent with dysfunction of the M-S system.


Constipation is one of the most common gastrointestinal problems in the United States, affecting up to 28% of the population. Persons of any age, race, or sex can experience constipation, but it is most prevalent in women and greatly increases in persons older than 70. Constipation can result from impaired muscle coordination or overactivity around the rectum and anus, which can delay stool evacuation.  Pelvic floor physical therapists can assist with muscle re-training through biofeedback and rectal neuro­muscular training to address these deficits and improve ease of defecation.

Pelvic organ prolapse

This disorder, which results from relaxation of the PFMs and supportive tissues of the vaginal walls, may affect up to 60%-65% of premenopausal primiparous women.  Pelvic organ prolapse occurs when one or more organs such as the bladder, uterus, or rectum descend from their normal position within the pelvis. This phenomenon may occur as a result of injuries sustained during childbirth, aging, a woman’s tissue composition, chronic coughing, straining due to chronic constipation, and repetitive heavy lifting. Patients may experience a sensation of pelvic pressure, low back pain, a protrusion from the vaginal opening, and/or discomfort during intercourse. Pelvic floor physical therapists can provide education and lifestyle modifications to prevent the prolapse from worsening, as well as address muscle weakness that may be present to increase support to the organs.

Pelvic floor physical therapy evaluation and treatment

Nurse practitioners who refer a patient to a pelvic floor PT clinic can lessen the patient’s anxiety by explaining what to expect from PT. The patient may feel relieved to be able to freely discuss a pelvic floor problem with someone who is well versed in bladder, bowel, and sexual dysfunction related to M-S dysfunction. At the first visit, the physical therapist will take a thorough history and perform an examination. The examination will likely entail an assessment of the PFMs, which may be performed vaginally, rectally, or simply by external palpation or visual assessment. An internal examination of the PFMs will allow the physical therapist to assess PFM strength, endurance, coordination, and tissue quality.
An external examination may include assessment of the spine, hip joints, sacroiliac joints, and connective tissue around the abdomen, hips, inner thighs, buttocks, hamstrings, external genitalia, and/or anus. The therapist will take note of any hypermobility or hypomobility in the joints and in the soft tissue, which can create problems in the PFMs. Based on the history and examination findings, the physical therapist will tailor a treatment plan to help the patient work toward her goals. PT diagnoses can generally be divided into two categories, those that involve weakness and those that involve increased tension.  Although these two categories may seem to be discrete entities, some patients present with both muscle weakness and muscle tension.
Diagnoses that involve weakness of the pelvic floor can include UI or fecal incontinence, pelvic pressure or pain, and difficulty with bladder and bowel elimination. Treatment for these conditions generally focuses on attaining control of the pelvic floor and the surrounding musculature to develop strength, endurance, and coordination and to stabilize and control the pelvis and trunk as a system.
Pelvic floor exercises are typically initiated in gravity-assisted or minimized positions and progress to sitting, then to standing, and eventually to functional movements such as bending, squatting, and lifting, depending on the patient’s diagnosis and functional limitations. In addition, addressing muscle groups such as the transverse abdominis, multifidi, adductors, and respiratory diaphragm can help provide pelvic stability and enhance a pelvic floor contraction.  If a patient cannot voluntarily perform a pelvic floor contraction, neuromuscular electrical stimulation can be used, either via external electrodes at the perianal tissues or with an internal vaginal or rectal probe, to elicit a contraction or enhance a very weak contraction.
Many patients seen by pelvic floor physical therapists have pain related to muscle tension in the pelvic floor. Patients may experience pain with sitting, sexual intercourse, tampon insertion, and/or gynecologic examination and/or they may have difficulty with evacuating urine or stool. Many patients subconsciously clench muscles in their abdomen and pelvic floor, which can lead to joint dysfunction, tightness or imbalance in muscle groups, and nerve entrapment.  Teaching patients breathing patterns to achieve a drop of the diaphragm and pelvic floor can encourage relaxation and decrease pain during bladder and bowel evacuation or vaginal penetration.
Manual therapy, including techniques such as myofascial release and connective tissue manipulation, is also used to address pain related to PFM tension.  Manual therapy techniques involve forceful passive movement of the fascial elements through restrictive directions, allowing for muscular relaxation or decreasing painful scar tissue attachment, increasing general circulation, freeing tissue material, and releasing nerve entrapment by surrounding structures.
Surface electromyography or biofeedback is utilized to enable patients to receive auditory and/or visual feedback on the contraction and relaxation of the PFMs while performing exercise and movements.  Use of biofeedback can help patients develop an internal awareness of the state of the muscles to be used with daily activities and aid them in achieving higher or lower muscle tone, depending on their diagnosis.
Throughout treatment for muscle weakness or tension, attention is given to educating patients about practical methods they can use to ease their symptoms. These methods include simple changes in the diet (e.g., eliminating carbonated beverages, acidic foods, artificial sweeteners, and alcohol), biomechanical changes with day-to-day tasks (e.g., correctly transitioning from sitting to standing, correctly retrieving items off the ground to avoid an increase in pressure on the pelvic floor), and assuming positions to maximize efficiency of bladder and bowel elimination.  To reinforce the benefits of techniques used in the clinic, patients receive instructions in a home exercise program, which will enable them to eventually progress to independent management.

Physical therapy frequency and duration

With any type of PT, the length of time before any positive results can be appreciated varies from person to person, depending on the diagnosis and the severity of symptoms. However, a general rule is that patients with pain conditions may need up to 8 treatments to notice any improvement and up to 12 treatments to see functional or QOL-altering changes. For patients with incontinence diagnoses, a favorable change can be expected at about 6 weeks, if not sooner. These time frames are generally related to the length of time needed to make physiologic adaptations in muscle tissue.
The typical frequency of visits to PT is once or twice a week, again depending on symptom severity. As a patient improves, the frequency of visits is tapered to weekly, then every other week, and then monthly until she is ready for discharge from PT care. Some patients complete PT and achieve symptom resolution in 3 months. For others, PT helps manage symptoms of an incurable disease so that they can continue performing their activities of daily living, recreational tasks, and work-related activities with less severe or less frequent symptoms.


Many women with problems related to PFM dysfunction see their NP as the initial healthcare provider. Because many of these patients can benefit from pelvic floor PT, it is to their advantage if their NP has a close working relationship with a physical therapist who specializes in pelvic floor PT. The best patient outcomes are promoted through ongoing NP–physical therapist collaboration, because management will likely include a combination of PT, pharmacotherapy, patient education, and counseling.
It is appropriate to refer a patient for pelvic floor PT for most M-S diagnoses related to the bladder or bowel, pelvic pain, or prenatal or postpartum conditions. The NP may consult with the physical therapist prior to a referral if there is a question as to whether a particular patient is a good candidate for PT.

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Physical Therapy May Increase Fertility

Infertility can be one of the most heartbreaking medical issues for a woman to deal with. It's hard physically, with so many possible causes and relatively few solutions, but it's also devastating emotionally, as you usually don't discover it until you have set your hopes on having a baby. And with 11 percent of American women suffering from infertility and 7.4 million women shelling out for crazy expensive fertility treatments like in-vitro fertilization, it's one of the biggest healthcare costs in the country. The medical community has made great strides, but even advanced technologies like IVF only have a 20 to 30 percent success rate despite the hefty price tag.

But a new study shows promise in helping to treat infertility using a special physical therapy technique that's not only cheaper, but also less invasive and easier than most traditional practices. (Fertility Myths: Separating Fact from Fiction.)

The research, published in the journal Alternative Therapies, looked at over 1,300 women who suffer from the three primary causes of infertility: pain during sex, hormonal imbalances, and adhesions. They found that after they went through physical therapy, the women experienced a 40 to 60 percent success rate in getting pregnant (depending on the underlying cause of their infertility). The therapy specifically benefited women with blocked fallopian tubes (60 percent became pregnant), polycystic ovarian syndrome (53 percent), high levels of follicle stimulating hormone, an indicator of ovarian failure, (40 percent), and endometriosis (43 percent). This specialized physical therapy has even helped patients undergoing IVF raise their success rates to 56 percent and even 83 percent in some cases, as shown in a separate study. (Find out Everything You Need to Know About Egg Freezing.)

This isn't your regular ol' PT though. The specialized method of physical therapy decreases adhesions, or internal scars that occur wherever the body heals from infection, inflammation, surgery, trauma or endometriosis (a condition where the uterine lining grows outside the uterus), says Larry Wurn, lead author and a massage therapist who developed the technique used in the study. These adhesions act like an internal glue and can block fallopian tubes, cover the ovaries so eggs cannot escape, or form on the walls of the uterus, decreasing the chance for implantation. "Reproductive structures need mobility in order to function correctly. This therapy removes the glue-like adhesions that bind structures," he adds.

A similar method widely used by niche physical therapists is called the Mercier technique, says Dana Sackar, member of the American Academy of Fertility Care Professionals and owner of Flourish Physical Therapy, a Chicago-based clinic that specializes in physical therapy for fertility. During treatment, the therapist manually manipulates the pelvic visceral organs from the outside—a process that Sackar says isn't terribly painful, but isn't exactly a spa treatment either.

So how does pushing on a woman's abdomen help boost her baby-making chances? Primarily by increasing blood flow and mobility. "A malpositioned uterus, restricted ovaries, scar tissue, or endometriosis, can all reduce blood flow to the reproductive organs, limiting fertility," Sackar explains. By repositioning the organs and breaking up scar tissue, blood flow is increased, which, she says, not only makes your reproductive system healthier, but also helps your body to balance out its hormones naturally. "It prepares your pelvis and organs for optimal function, sort of like how you do training runs to prepare your body to run a marathon," she adds.

These techniques also help fertility by addressing the emotional roadblocks, as therapists work closely with patients to address mental needs as well as physical. "Suffering from infertility is extremely stressful, so anything we can do to help reduce that stress is good too. The mind-body connection is very real and very important," Sackar says. (In fact, Stress May Double Risk of Infertility.)

Because it's non-invasive and cost-effective, Sackar recommends trying physical therapy before other fertility treatments. She says she also works closely with patients' OBGYNs and other fertility specialists, using the therapy to enhance their medical options. Alternative therapies can sometimes get a bad rap, which is why Sackar thinks scientific studies like this are so important. "It doesn't have to be an either/or situation—the two types of medicine can work together," she says.

At the end of the day, everyone wants the same thing—a successful pregnancy and a happy, healthy (and preferably not bankrupt) mama. So it's worth trying a variety of options to achieve that. "Some women can snap their fingers and get pregnant like that," Sackar says. "But many women need an ideal situation to conceive and that can take work. So that's what we do with this physical therapy, we help them get to that point."

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Treating Traumatic Brain Injury With Physical Therapy

Physical therapy can be a life-changing treatment for people who have suffered a traumatic brain injury (TBI). A TBI is diagnosed when an injury to the brain damages or changes the way it functions. Blows to the head, car crashes and falls are the most common causes of TBI and many of those injuries are initially diagnosed as a concussion.

It’s typically only when changes in behavior or physical function appear that a traumatic brain injury is recognized. It’s not just football players and military personnel that can sustain a TBI. Children under age four are prone to falls and head injuries during play or as the result of some type of abuse. Even a “mild” concussion is a form of traumatic brain injury.

Vehicle accidents and sports injuries are the primary cause of TBI in 15-19 year olds, while falls are the most common cause of TBIs in older people. Symptoms vary widely depending upon the location of the injury and the part of the brain that’s affected. Patients may need to relearn how to perform tasks others take for granted.

Mental, physical, emotional and behavioral changes occur, but there’s no way to predict what those alterations will be or the severity. People may have problems with memory, vision, hearing and balance. Problem solving abilities may be impaired, along with the ability to pay attention. The person with the TBI often doesn’t know the changes have taken place or that they’re acting any different than usual.

PT Benefits for TBI

Those with a TBI may have difficulties turning over in bed or maintaining balance while sitting, standing or walking. Patients may experience weakness in the neck or limbs and even have problems lying down in bed. Physical therapy can help traumatic brain injury patients with:

Improving balance, coordination and stability

  • Increased alertness and attention
  • Muscle strength, flexibility and mobility
  • Improved injury levels and less fatigue
  • Better movement patterns
  • A return to fitness, sports and recreational participation

Traumatic brain injuries can cause a wide range of symptoms. Individuals may become more sensitive to touch, light and sound. Changes in behavior and emotional responses are common. Individuals may have difficulty controlling their emotions and experience emotional agitation. The changes may be so dramatic that the patient may not even seem like the same person to loved ones.

A traumatic brain injury can result in a coma from the moment of impact. Depending upon the severity of the damage to the brain, patients can require significant rehabilitation but still be unable to return to their normal work or full functionality. Traumatic brain injury is more widespread than many people think and is classified as a serious public health problem.

Prevention and Treatment of TBI

Your physical therapist can help with information and recommendations for safety equipment and gear to reduce the potential for a traumatic brain injury and provide treatment and rehabilitation for your symptoms if a TBI occurs. Specialized exercise and stretching programs will be developed to help maintain physical function, flexibility, range of motion and coordination.

Manual manipulation is beneficial for those who are unable to participate in an exercise program. The therapy is advantageous even for patients who are in a coma. If assistive aids are required for mobility, such as a cane or wheelchair, your physical therapist will help you learn how to use them effectively.

A variety of complementary treatments may be used in combination for the best outcome, depending upon your specific needs. Hydrotherapy, acupuncture, dry needling and therapeutic massage may be employed for overall fitness, to manage weight, and stimulate muscles. Aligning the neck and spine relieves pressure on the neurological system for better transmission of impulses between the brain and the body.

The range of symptoms and level of disability can vary widely with a traumatic brain injury and your physical therapist has preventative and restorative measures that can help you stabilize and restore your level of physical function. Your therapist will also work with your family and loved ones to help them understand what you’re going through and provide the support you need at every stage of treatment.

Physical Therapy For Cognitive Decline

Cognitive decline can be predicted long before the first lapses in memory or behavioral changes. Neurological studies suggest that motor changes, such as a slower gait and other gait abnormalities, represent some of the earliest signs of impending cognitive impairment.

While relatively unknown a decade ago, a growing body of evidence indicates that medical providers may be able to help delay or minimize patients’ symptoms of dementia through prescribed physical therapy and exercise.

Jen Nash, PT, DPT, NCS, a board-certified clinical specialist in neurologic physical therapy, has been working with at-risk older adults at Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas since 2011.

“Our neurologists regularly refer patients with cognitive impairment for physical therapy,” she says. “The goal is to increase patients’ strength and balance, ideally improving gait and helping prevent falls — but also to educate patients on the importance of physical activity as a neuroprotector of further cognitive decline.”

The brain-body link

Gabriel Léger, MD, a neurologist at the Lou Ruvo Center for Brain Health refers most of his patients with memory deficits for physical therapy. He immediately refers patients who have any type of movement issue as well as those who don’t perform regular exercise on their own. Patients with dementia are at much higher risk for falls, partly due to compromised gait patterns, imbalance and other cognitive deficits, including difficulties with attention.

But gait disruptions or not, every patient with cognitive decline can benefit from physical therapy — for the physical and cognitive strengthening, says Dr. Léger. While the connection between brain health and exercise may be unclear, he says it makes sense.

“Your brain weighs only about 3 pounds — a small fraction of your total body weight — yet it gets 15 percent of your blood flow. Getting your blood pumping, especially if it’s circulating exercise-induced trophic factors, is healthy for your brain,” says Dr. Léger. “Not only that, but moving muscles requires brain power. It makes sense that exercising your body is also exercising your brain.”

A large, randomized controlled trial in Finland, called the FINGER study, also has suggested a connection. In 2015, it reported that healthy lifestyle factors, including exercise, in individuals age 60 to 77 helped prevent cognitive decline later in life.

“The same factors that protect overall health, protect the brain,” says Dr. Léger. “Instead of merely prescribing medication for a patient, I also encourage exercise, healthy diet, brain-stimulating activities, social engagement and other tools to empower them to improve their own future.”

“People with dementia can learn” and improve function

In the neurorehabilitation clinic, Nash and other therapists work with cognitively impaired patients that have slow or unsteady gait patterns — as well as those who don’t.

Tools and techniques range from simple colored floor squares to virtual reality treadmills that can present real-world navigation scenarios and incorporate cognitive challenges. Therapy is tailored to the patient’s goals and current capacity. Episodes of care can last up to eight weeks, with one to two hour-long therapy sessions per week. Episodes recur as determined by patient follow-up.

Mary S. Morrison, PT, DScPT, MHS, GCS, a clinical specialist in Cleveland Clinic’s neurorehabilitation clinic in Avon Lake, Ohio, tells of an 89-year-old patient with cognitive decline who improved her Timed Up & Go (TUG) from 44 seconds to 18 seconds in less than four weeks. TUG is a standard mobility assessment based on a patient’s speed at rising from a chair, walking 10 feet, then returning to the chair and sitting down.

“We’ve been working on ‘stepping big,’ instead of taking little, shuffling steps,” says Morrison. “She’ll walk out of the center with longer strides than she walked in, but we want to help her retain this ability at home to reduce her risk of falling. People with dementia can learn these things.”

Physical therapy helps patients with cognitive disease maintain function longer and at a higher level, she says, which ultimately improves their quality of life.

Uncovering evidence of exercise’s brain benefits

The link between physical activity and physical benefits is obvious. It’s the link between physical activity and brain benefits that remains hazy.

In an effort to make a clearer connection between exercise and cognitive health, Cleveland Clinic investigator Stephen M. Rao, PhD, is spearheading the IMMUNE-AD (Immunological Mechanisms Underlying Neuroprotection from Exercise in Alzheimer’s Disease) project. Funded by the National Institute on Aging, the project will examine how physical activity counteracts the negative inflammatory effects of the APOE ε4 allele (APOE4), a genetic risk factor for late-onset Alzheimer’s disease.

Physical therapists at the Lou Ruvo Center for Brain Health anticipate producing evidence of their own.

“We’re in the middle of analyzing research data that we collected in 2016 and 2017 to quantify effects of a six-week physical therapy intervention on cognition, walking endurance, physical activity and quality of life in impaired patients,” says Nash.

In the meantime, Dr. Léger witnesses physical therapy’s brain benefits almost daily.

“About 75 to 80 percent of my patients come back and thank me for insisting they go to physical therapy,” he says. “They claim it makes a difference in their physical and cognitive well-being, and their families concur. Having a sense of purpose — to get up each day and complete an exercise regimen — improves their mood as well. Physical therapy has benefits for almost any patient at any stage of neurodegenerative disease.”

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The Benefits Of Postpartum Physical Therapy

There's so much we don't know about postpartum recovery—and so few people willing to discuss it candidly. “It’s easy to miss the bigger picture if you’re just looking at a woman’s private parts,” says Susie Gronski, DPT, PRPC, a board-certified pelvic rehabilitation practitioner who specializes in physical therapy. "The pelvic floor is just a piece of the puzzle," Gronski says, and it needs to be assessed in conjunction with the rest of the body. (Here are 8 bizarre things that happen to your body during pregnancy.)

Not all women have post-pregnancy complications, notes Gronski. “The body does a pretty good job at recovery for most women," says Gronski. Some will experience issues, however. Incontinence is one example—while common, it's not normal. “There are so many reasons why a woman could experience pain postpartum," says Gronski. On her list: nutrition, poor sleep, altered body mechanics, psychological and physical stress, and pre-baby health.

Pelvic physical therapy (PPT) techniques vary from therapist to therapist—biofeedback, hands-on assessment and manipulation, and exercises are all common. Common signs that you can benefit from postpartum therapy are pain—in the pelvis, back, neck, jaw, or abs, or during intercourse—along with incontinence, constipation, diastasis recti, or prolapsed organs. "PPT can help re-train pelvic floor and abdominal function and coordination to optimize recovery and strength postpartum," says Gronski. Here are 4 reasons to consider pelvic physical therapy after giving birth.

It might help your sex life

Sex is a concern for many women after giving birth. “Some women have no issues, but others might experience pain or lack of libido,” says Gronski. This could be due to many factors: stress, lack of sleep, family adjustments, relationship adjustments, and hormonal or physical changes. “Some of the clients I see come in complaining of painful intercourse due to an episiotomy scar. Teaching new moms how to work their own scar, relax their pelvic floor muscles, and relax their mind around pain associated with intercourse really helps,” says Gronski.

It benefits your health—both physical and mental

Postpartum therapy can serve as a valuable support system. “PPT takes the fear out of concerns like ‘Am I doing this right?’ or ‘’Maybe I’m hurting myself.’ and opens up the conversation to talk about sexual health and satisfaction,” says Gronski. She sees postpartum therapy as deeply empowering, and capable of strengthening both psychological and physical resilience. “We’re teaching women that they weren’t broken to begin with,” says Gronski. “ Studies have shown the more support a new mom has the less risk for postpartum depression and better outcomes to bounce right back.

It could assist with your back pain

“Anatomically, the lower back and pelvic floor are intimately involved,” says Gronski. That means if you have low back pain, it’s worth exploring the pelvic floor. “If you think about your body like a canister, the pelvic floor is the bottom, the abs make up the front, and the spine and back muscles are the back of the container. All these structures work together to create stability, as well as control, strength, and normalize pressure systems. If one is not playing along nicely, chances are the rest are working harder to compensate,” Gronski explains.

It won't hurt

“Pelvic floor therapy shouldn’t hurt,” Gronski says, adding that she rejects a “no pain, no gain” mentality. “I don’t believe in creating fear or pain during a session. It’s all about creating a safe, supportive environment to help enrich the lives of those you come in contact with," says Gronski. Along with exercises that can train the muscles in the pelvic floor and surrounding muscle groups, Gronski utilizes two physical therapy techniques: visceral manipulation (a gentle hands-on therapy that work on tissues around organ systems) or connective tissue mobilization (which releases restrictions of fascia and connective tissue).

Gronski emphasizes that there's no time limit for postpartum physical therapy. “Nothing is ever stagnant in this world, and neither is your health. Postpartum therapy helps women across their lifespan,” she says.

Addiction Treatment And Physical Therapy

Addiction affects more people than most of us truly know. In 2011, there were around 20.6 million people in the US, over the age of 12, with an addiction.

Let’s put it this way, roughly ONE IN TEN Americans are addicted to alcohol and drugs.

Only 11% of those ever receive any addiction treatment.

Keep in mind, that doesn’t even cover the biggest killer of them all, tobacco/nicotine use. An estimated 22% of US citizens are current cigarette smokers.

Shocking, isn’t it?

With those kinds of statistics, it’s easy to see the importance of addiction treatment.

Drug & Alcohol Addiction Treatment Options

There is no simple solution to an addiction problem, and it’s rarely as easy as just detoxing and discontinuing use.

Rehab centers are typically what come to mind when considering addiction treatment options.

What do these facilities typically use when treating drug and alcohol abuse?

Likely aspects to programs might include support groups, behavioral therapy, individual psychotherapy, and of course medicine.

While all of these are important features in addiction treatment, successful recovery isn’t just about changing behavior and medicating away the symptoms.

In recent years, addiction treatment professionals have been turning to a more holistic approach.

Holistic Intervention in Addiction Treatment

Most people have heard the term “holistic,” but it is often misunderstood. Particularly when it comes to addiction treatment.

“That’s hippie stuff!”

That sentiment is a common misconception when people hear the word “holistic.” So, what exactly does a holistic approach to addiction treatment entail?

As a general rule, holistic rehab treatments look at a complete physical, mental and spiritual model for treating alcohol and drug abuse.

Some types of holistic options include:

  • Massage
  • Chiropractic care
  • Yoga and meditation
  • Herbal medicines
  • Acupuncture and acupressure
  • Biofeedback and neurofeedback
  • Nutritional therapy

This is just a small sampling of holistic treatments. What binds them together is the intention to treat the wHOLe individual instead of focusing only on a single element such as behavioral therapy or medicine.

A truly effective program must address all aspects of a person, including the underlying issues which led to the addiction originally.

Physical Therapy: An important part of holistic recovery

Not mentioned above, and something that many do not consider when thinking of addiction prevention, treatment, and recovery is physical therapy.

It can be an extremely effective addition to any addiction treatment program.

The Benefits of Physical Therapy

Our bodies have extremely negative reactions to alcohol and drug abuse. It leaves people weak and often lethargic. It can also lead to various forms of disease.

Combined with initial detoxification and a program, like a 12 step, behavioral therapy, etc, physical therapy provides an important layer to successful recovery and prevention of relapse.

Without a strong body, addiction has a much easier chance of taking hold on a recovering patient.

Think of a time when you were very sick.

Did you feel sluggish? Did you have a lack of energy?

If it lasted any length of time, you may have found yourself in poor physical condition.

Were you happy? Were you productive? Were you motivated?

This is the same problem for drug and alcohol addicts. Physical therapy give the addict a healthy, positive method to recover physically and begin to lead a healthy lifestyle.

This is an important factor in creating lasting sobriety and avoiding “falling off the wagon.”

Opioid Abuse and Physical Therapy

Sadly, one of the fastest growing issues in America is prescription opioid abuse.

As reported by the US. Center for behavioral Health Statistics and Quality Data Review the number of accidental overdose deaths from prescription opioids has more than quadrupling since 1999.

Over 2 million people are estimated to be addicted to painkillers. It has developed into an epidemic.

The path from pain to pills is a dangerous one, leading to non-medical abuse and increasingly to heroin addiction.

Managing Pain to Prevent Addiction and Relapse

This spike in opioid abuse has led to an important related discussion dealing with non-drug related pain treatments.

For those who have had injuries, or surgery, or other forms of physical trauma, it may be necessary to use painkillers to aid in recovery. Unfortunately, this is the most common way people become addicted.

Physical therapy can be an effective way to manage pain without, or at least minimal, use of prescription drugs.

Even the CDC (Centers for Disease Control and Prevention) has been urging health care providers to reduce the use of drugs for pain, in favor of safer alternatives including physical therapy. And the White House Office of National Drug Control Policy has recognized PT as a possible wall against abuse.

Physical therapy pain management is an excellent method to help prevent opioid abuse before it even happens!

The High: Physical Therapy Feels Good

Physical therapy, exercise, and other holistic methods provide addicts with many benefits.

Besides just pain relief, physical therapy releases endorphins in the body which simulate the types of feelings produced by actual drug use.

These positive biochemicals help produce a sense of calm and wellness that is vital to both physical and mental health.

Addicts who receive physical therapy and exercise as a part of their recovery program are much more likely to complete their programs, as well as avoid relapse.

A Healthy Life After Addiction Treatment

Years of drug abuse can lead to a tremendous regression in a body and mind.

Addicts in recovery using physical therapy not only feel stronger, they ARE stronger.

This helps a person develop the state of mind needed to have a successful recovery, giving them a strong body and healthy mind. It provides a true sense of confidence and independence.

These benefits will hopefully lead to a new way of life for the addict, looking to themselves and not to drugs for their personal wellness.

Physical therapy and exercise can fill that gap that the addicts feels once they are free of their substance abuse, and help give them a bright and healthy future.


Physical Therapy For Sleep Apnea

Obstructive sleep apnea (OSA) is a condition in which you stop breathing, temporarily, in your sleep, often multiple times an hour. As the name suggests, something blocking an airway causes the problem. The implications of untreated OSA can include excessive daytime fatigue, high blood pressure and a greater risk of stroke or heart attack.

In some cases, the primary cause of OSA is that your tongue is longer or larger than normal and collapses in the rear of your throat during sleep. Many cases of OSA have other roots, however, includingobesityphysical obstructions (enlarged tonsils, deviated septum, etc.) and genetics (OSA tends to run in families).

Certainly, we cannot change your family history, nor can we perform surgery to correct a problem like enlarged tonsils (although such surgery may indeed be warranted). However, to deal with a collapsed tongue, we can prescribe tongue and throat exercises that may strengthen the muscles and provide enough “training” so this will happen much less often.

When obesity is a primary cause, excess tissue is present in the airways, blocking them and preventing normal respiration. Because losing weight improves OSA, we will begin by customizing a diet and exercise plan expressly for you, your age and your fitness level.

Not only will exercise help you lose weight but the physical exertion itself may help improve your sleep. Studies have shown a correlation between a better night’s sleep and a period of exercise, 10 minutes or more, during the previous day. Walking is a great place to start, but consult your physician if you have not been exercising for a while.

By the way, experts no longer believe that, for most people, exercising too close to bedtime detracts from sleep. Fitting in exercise whenever you can is fine and can break the vicious cycle of not sleeping well, then feeling too tired to exercise, then having the lack of exercise detract from sleep and so on.

Because a satisfactory night’s sleep is getting more and more recognition as essential to good health, we strongly recommend a comprehensive physical therapy treatment for OSA. Let us put you on the way to a restful sleep and a wide-awake, productive day!


Treating Hypertension With Physical Therapy

Hypertension is the medical term used to describe high blood pressure. It is a common but very serious condition; one-third of American adults and two-thirds of American seniors (those over the age of 65) are affected by hypertension.

The human body requires a certain level of blood pressure in order to pump blood throughout the arteries. When the arteries become narrowed, the heart must pump faster in order to carry out the necessary functions of the body.

Hypertension is typically asymptomatic and always dangerous. It increases the risk of some of the leading causes of mortality in this country, including stroke and heart disease. Because hypertension can be treated with lifestyle changes and holistic practices, it is inadvisable to rely on anti-hypertensive medications. In fact, studies show that there is no correlation between anti-hypertensive medications and longer lifespan.

Some common anti-hypertensive medications include diuretics, beta blockers, and calcium channel blockers. Diuretics deprive the body of potassium and can increase blood glucose levels. Beta blockers decrease the body’s response to impulses from the nervous system, which can lead to insomnia, depression, and cold extremities. Beta blockers may also affect blood glucose levels. Calcium channel blockers can cause heart palpitations, swollen ankles, and headaches.

For patients with hypertension, treating the underlying cause of hypertension (rather than masking the problem with drugs) is often the best option. This can be accomplished with changes in diet and lifestyle (quitting smoking, for example), as well as with healthy, drug free techniques such as chiropractic care and physical therapy.

Physical Therapy for Hypertension

There are a number of physical therapy techniques that can help to lower blood pressure in conjunction with healthy, positive lifestyle changes. Many hypertension patients struggle with weight-related issues or injuries such as neck pain or back pain. Physical therapy can help patients with a wide range of medical conditions to begin an exercise regimen that is safe and effective.

Stress relief is another major factor in reducing hypertension. For hypertensive patients who are suffering from anxiety, massage can be a powerful weapon in lowering blood pressure readings. One reason massage is so helpful is that is works to reduce steroid hormones, a good indicator of stress levels.

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Treating Depression With Physical Therapy

Contrary to some beliefs, depression is not a purely psychological condition. Many systemic factors—from chemical imbalances to chronic pain—can trigger depression. When medication and therapy fail, however, physical therapy can often help people who suffer from depression.

 Because chronic pain is a leading cause of depression, we can help a person alter his or her behaviors to reduce pain in daily life. Workers injured on the job often fall into depression brought on by chronic pain that can be alleviated through exercise and lifestyle alteration. Women suffering from postpartum depression have been found to show significant improvement when they engage in an exercise program.

 Individualized courses of exercise therapy show strong results in combating depression. Endorphins released by the brain during exercise have been shown to reduce pain and improve mood. Exercise also helps people whose depression is linked to issues with poor self-esteem or body image.

 Physical therapists can also fight depression through the simple act of diagnosing the illness. Often, during a course of physical therapy for another condition, we can recognize when a patient shows signs of depression. We work with specialists who can point the patient to treatments that can help alleviate symptoms that cannot be treated physically. Very often, depressed patients suffer from psychosomatic conditions that do not result from any physical injuries or diseases. The ability to recognize that the source of pain is not physical in origin can be crucial to help a person in need.

 Ultimately, we can be vital allies for people who suffer from depression. Our training and skills give us powerful insights into its causes, effects and treatments, along with the ability to help our patients to feel better. If you are feeling “blue” because of pain or poor self-esteem that threatens to overwhelm you, give us a call. We can start a physical therapy program to help alleviate your pain and lighten your mood so you can enjoy life and experience pleasure once again.

Physical Therapy's Role In Cancer Treatment

When someone is undergoing cancer treatment, physical therapy may not be the first healthcare field that comes to mind. Early cancer treatment is met with oncologists, radiologists, nurses and surgeons. Rightly so, as these healthcare practicioners are essential to the treatment and management of cancer. However, you should also consider the role of physical therapy in your cancer recovery.

Cancer rehabilitation is a growing area in medicine due to the increase in cancer survivorship. More and more individuals are beating cancer because of advances in medical technology, treatment and early detection. According to recent research from the American Cancer Society, the five-year survival rate of all cancers that were diagnosed between 2003 and 2009 is 68 percent. This is a 20 percent increase from 1975 to 1977. It is also estimated that over 13 million Americans have a history of cancer, and in 2014 there were an expected 1.6 million new cases. This means that the number of cancer survivors will continue to increase in the U.S. With more cancer survivors, there will need to be more recovery strategies.

Cancer treatment is a grueling course, leaving many people exhausted, weak and with a compromised immune system. Just getting out of bed can be a huge and daunting task, let alone exercising in a gymnasium or playing at the park with grandchildren. This is where a physical therapist comes in. Despite advances in medical treatments, individuals that receive cancer treatments typically experience extensive physical limitations during and after treatments. These limitations include and are not limited to cancer-related fatigue (CRF), pain, nerve damage, lymphedema, deconditioning, as well as incontinence.

There is strong evidence to support conservative management of these impairments through physical therapy. As each individual experiences different impairments during and after cancer treatment, it is important to have an individualized evaluation to focus your rehabilitation. Physical therapy can address common cancer related impairments including:

Lymphedema: Effective lymphedema management is accomplished through manual lymph drainage, range of motion exercises, aerobic exercise, and lymphatic bandaging.

CRF: Individualized aerobic training, strength training and functional management training is known to reduce effects of cancer related fatigue both during and after medical cancer treatments.

Pain: There are many pain relief strategies that can reduce the intensity and frequency of pain after cancer treatment. Specifically, treatment strategies including soft tissue mobilization, therapeutic massage, modalities, therapeutic stretching and strengthening.

Peripheral neuropathy: Often times, cancer survivors experience peripheral neuropathy, which is abnormal nerve function that can be experienced as pain, numbness and tingling. Physical therapy can help to improve nerve function or compensate for nerve dysfunction.

Deconditioning: Rebuilding endurance for activities and cardiovascular function can be difficult during and after cancer treatment. A skilled physical therapist is able to educate and monitor cardiovascular endurance training.

Genitourinary complications: For men undergoing treatment for prostate cancer and women undergoing treatment for bladder or ovarian cancer, incontinence and sexual dysfunction are common. A skilled physical therapist can help to rebuild the strength of the pelvic floor in order to improve urinary continence and reduce pain related to sexual function.

In a recent study published April 2015 in Physical Therapy Journal, researchers found that physical therapy services are more commonly sought out for individuals surviving breast and genitourinary cancers. Researchers sought to find the characteristics of patients with cancer that were referred for outpatient physical therapy and common clinical findings. Over the course of two years, data from 418 patients were analyzed. Genitourinary and breast cancers were the most common types of cancer in their sample. The most common impairments were strength loss and soft tissue dysfunction. Lymphedema was the most common issue for people with breast cancer and incontinence was the most common complaint for people that had genitourinary cancers. They also noted that pain and high fatigue levels were prevalent in individuals that had undergone radiation therapy. This study shows that therapy services are being utilized for individuals that have survived cancer, particularly breast and genitourinary cancer. However, this study also suggests that a large portion of cancer survivors are not seeking out rehabilitation services, even though they would likely find it highly beneficial.

The good news is that it is never too late to utilize rehabilitation services for cancer recovery. If you find that you are having trouble accomplishing daily tasks or functioning at your prior level of independence, seek out a rehabilitation expert and regain your vitality.

1. Alappattu Meryl et al. Clinical Characteristics of Patients with Cancer Referred for Outpatient Physical Therapy. Physical Therapy. April 2015 95 (4) 526-538.

Best Foods For Healing After Surgery

Have you recently gone through surgery? In addition to a physical therapy regime, eating these healthy foods will help you heal faster and get you back to your normal self! 

1. Lean Protein
Collagen, the most abundant protein in the body, plays an important role in knitting tissue back together. Typical protein intake is around 0.8 grams of protein per kilogram of body weight. But, after surgery, the demands for protein are much higher, especially if you have incisions to repair. Aim to get 1.5 to 2.0 grams of protein per kilogram. For example, if you weigh 150 pounds, target 102 to 136 grams of protein per day. That’s 25-30 grams per 3 meals and 14-23 grams per 2 snacks.

Getting extra protein doesn’t mean eating more red meat. Excellent lean protein sources include eggs, fish, turkey, beans and legumes. Whey protein is a tasty and convenient way to boost your protein intake. Whey protein is easily mixed with water (or soy, almond, rice or cashew milk) or incorporated into a smoothie. Check out our Green Smoothie recipe.

2. Fermented Dairy
Antibiotics are routinely prescribed after surgery to prevent infection. While antibiotics kill bad bugs, they also decimate the beneficial bacteria that line your digestive tract. Beneficial bacteria help digest your food and manufacture vitamins plus play a key role in immune system function. Repopulate your digestive tract with fermented dairy products like kefir and yogurt. Kefir is ideal because a small serving provides upwards of 8 to 12 species with over 10 billion live and active cultures. Yogurt provides fewer species and a lower bacterial count. When choosing, read labels as the sugar content and calories are higher with flavored products.

Supplementing with a broad-spectrum probiotic like Probiotic-8 also helps boost beneficial species. Just be sure to take your antibiotics separately from a probiotic. 

3. Fiber
Pain medications, anesthetic agents, alterations to diet, dehydration, stress and reduced physical activity after surgery can work against your body’s normal route of elimination. Aside from drinking plenty of water, popping a few prunes each day will help get things moving along. Prunes are a rich source of both soluble and insoluble fiber which softens and adds bulk to stool.

Other foods that are high in fiber include beans & legumes, apples, pears, bran flakes, oatmeal and flaxseed meal. Check out our list of top fiber sources

You can also help “move things along” by taking SurgiLax, a natural supplement that helps restore balance and regularity to your digestive system and bowel.

4. Deeply Colored Fruits
The stress of surgery along with the drugs that are used during the procedure generate an increased oxidative load on the body or free-radical production. While your body uses antioxidants to reduce or eliminate these harmful molecules, the requirements are significantly higher after surgery. Boost your antioxidant intake after surgery by eating deeply colored fruits like blueberries, strawberries, raspberries, blackberries, cherries, and pomegranates. These fruits contain anthocyanidins, compounds that not only enhance the effects of vitamin C, but improve capillary integrity and stabilize collagen matrix.

5. Orange Fruits & Veggies
Sweet potatoes are a superb source of beta carotene or pro-vitamin A which the body converts into vitamin A as needed. Vitamin A is needed for the repair and maintenance of soft tissue, mucus membranes, and skin so significantly boosting your intake (up to 10,000 IUs of vitamin A and another 15,000 IUs of beta-carotene) around the time of surgery makes sense.

Unlike its distant cousin the potatosweet potatoes aren’t as starchy and provide almost 4 grams of fiber per serving. Just clean and slice a sweet potato into 1” half moons. Toss with a bit of olive oil, season with pepper and salt and bake in the oven at 350 degrees for about 30 minutes.

Other excellent sources of beta carotene include carrots, dark leafy greens like kale, cantaloupe, mango and dried apricots.

6. Bell Peppers & Citrus Fruit
Bell peppers are an excellent source of vitamin C, providing 340 mg per medium pepper. Vitamin C is a water-soluble vitamin that helps cross-link collagen. Collagen is the most abundant protein in the body and if you’ve had an incision, this protein is crucial to proper wound healing. Stress depletes vitamin C stores so getting extra after surgery is recommended (upwards of 900 mg a day in divided doses).

Other excellent sources of vitamin C include guava, kale, citrus fruit, kiwi fruit, and broccoli.

7. Cruciferous Vegetables
Having a robust immune system ensures that your body wards off infection after surgery. Vegetables that contain indoles, phytonutrients that boost immune health, include Brussels sprouts, cabbage and cauliflower.

Have bad childhood memories of these veggies? For great flavor and quick preparation, try roasting Brussels sprouts or cauliflower. Opt for Mashed Cauliflower instead of mashed potatoes for a perfect post-surgery food that is low carb and nutritious.

8. Fungi – Mushrooms
Mushrooms also support a healthy immune system. A recent study showed better-functioning gamma delta T-cells and reductions in inflammatory proteins in participants that ate a 4 oz serving of Shiitake mushrooms daily.  Other immune boosting mushrooms include Maitakes and Reishi.

Mushrooms are great stir fried or grilled. Or try making our easy and flavorful Mushroom Soup.  Prepare ahead of time so that after surgery, all you have to do is reheat a bowl.

9. Nuts & Seeds
Pumpkin, squash and sesame seeds are an excellent source of zinc. Zinc is necessary for proper immune system function. The body requires zinc to develop and activate cells that are involved in immunity. Zinc is also important to wound healing as this mineral is necessary for protein synthesis and cell growth.

Oysters have the highest concentration of zinc and red meats especially beef, lamb and liver have some of the highest concentrations of zinc in food.

10. Pineapple & Papaya
Pineapple and papaya contain protease enzymes that the body uses to breakdown and digest proteins. As it turns out, these enzymes (bromelain and papain) also help reduce swelling and inflammation. The downside is that bromelain is concentrated in the stem of the pineapple (that chewy part you don’t eat!). So, taking a supplement like Bromelain with Quercetin may be an easier option.

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