Pelvic Floor by Nicole Prieto, PT

The pelvic floor - it’s a strange thing to be excited about... yet here I am.

Prior to my pelvic floor certification, when I would hear  “pelvic floor”, I immediately tended to perform a fleeting mini-Kegel. There was that acute awareness of my lady parts, resulting in a seemingly reflexive contraction of my own pelvic floor. I wasn’t sure if the awkward feeling was simply brought about by the fact that I was not used to hearing it, even in my work as an orthopedic physio. But as I studied more into it, and started acknowledging the [often overlooked] immensity of its relevance in human fitness and health, the paradigm shift transpired with a breeze.

Before I proceed, however, it is very much worth mentioning that pelvic floor physiotherapy addresses problems in areas that make people feel a plethora of emotions. I’m certain a lot of people still tend to respond to it in the same way that I used to - a reflex tension, perhaps to protect an area that has suddenly made you feel vulnerable, exposed, embarrassed, or insecure. These are quite negative emotions that come together in that overall feeling of awkwardness and nervousness when breaching the idea of pelvic floor physiotherapy. It’s a very personal process, and the associated social pre-/misconceptions do not help either. But trust us when we say, you’ll be fine, there’s nothing to be ashamed of. Getting comfortable with the pelvic floor idea will be the hardest part - the rest is just physiotherapy.

So let’s get real here first. There will be no further mention of the terms lady parts or private areas within this post and the next ones. Everybody has their own pelvic floor and genitalia, and euphemisms bring us very little benefit in making everyone comfortable in discussing pelvic floor issues. Because ultimately, it seems, a huge part of the problem is that it is the discussion part that is missing in identifying pelvic floor problems. As well, these issues have somehow become normalized in general knowledge, with people assuming that a little bit of incontinence or pelvic pain is to be expected as you age, or while you’re pregnant or after giving birth.

The warm and happy thought here is that, there’s no need to fret - we can help! There’s no need to keep it a secret, or discuss it in hushed tones with a very close friend or that one trusted health professional. Pelvic health concerns, much like all other aches and pains that you’d normally see a physio for, should not be a constant source of stress, anxiety and social discomfort.

So let us take the weight off your chest, by working with you to develop that key part of your core - your pelvic floor.

Talk to us if you have any questions or concerns. And if you have a lot of them - don’t hesitate to request a 15-minute phone call appointment with me (Nicole), to see if our pelvic floor services here at Park Lawn Physiotherapy would be the best fit for you.


Do I need Pelvic Floor Physiotherapy?


You’re probably hoping that you don’t, but there’s a chance that you do.


Pelvic floor problems can manifest in many different ways, but incontinence is the most commonly known and prevalent issue.

According to the Canadian continence foundation:


“As many as 3.3 million Canadians - nearly 10% of the population - experience some form of urinary incontinence… [and] according to the Canadian Urinary Bladder Survey, 16% of men and 33% of women over the age of 40 have symptoms of urinary incontinence but only 26% have discussed with their doctor.” 1


Let’s face it - talking about incontinence is far from lighthearted conversation. Oftentimes, people tend to keep it to themselves - so much so that most would probably choose to believe that it’s just normal to pee a little when they cough, sneeze, laugh out loud, or even when lifting heavy things during exercise or with regular tasks.


The truth is that that is what we consider as stress incontinence, and it’s a sign of pelvic floor dysfunction. As much as I dislike using that word in practice, dysfunction means that there is something off with the muscles and possibly the structures around it, which makes it less able to perform its functions.


The good thing here is that, just like the other muscles around your other joints, the muscles of the pelvic floor can be trained as well!


So think about it, if you find yourself experiencing the following things:

  • Very strong and/or uncontrollable urges to go to the bathroom

  • Urine and/or fecal leakage

  • Urinating more than 8 times a day

  • Difficulty with urinating / initiating a urine stream / burning with urination

  • Pelvic pain during or after bowel movement

  • Struggle with having regular bowel movement

  • Painful sex

  • Pelvic pain or pressure or feeling that something is bulging out/down

  • Vaginal or penile pain

  • Significant pain with menstruation (requiring medications or other intervention)

It’s likely worth your time to consult with a pelvic floor physiotherapist.

Adapted from Pelvic Health Solutions:

Screening for Pelvic Floor Dysfunction: A Validation Study


Pelvic floor physiotherapists receive additional specialized training on the internal examination of the vagina and rectum, and are able to diagnose and treat physical imbalances within the pelvic structures.


Talk to us if you have any questions or concerns. And if you have a lot of them - don’t hesitate to request a 15-minute phone call appointment with Nicole, our pelvic floor physiotherapist, to see if our pelvic floor services here at Park Lawn Physiotherapy would be the best fit for you.


___

References:

1 Learn about Bladder Health and the Causes of Incontinence. (2018). Retrieved from http://www.canadiancontinence.ca/EN/


Functional movement

Functional movement refers to movements commonly performed in everyday situations. 

The idea of functional exercise focuses less on using extensive machinery such as bench press or leg extension commonly available in most fitness facilities but more on their functional counterparts such as pushups and squats. 

The idea of functional exercise has become more prevalent in sports training as well. You now would rarely see high performing athletes doing excessive weight training, the shift has been made to focus more on the exact movements and types of movements performed during the sporting activity. Training specificity has been one of the more prevalent ideas in the world of physiotherapy and athletic therapy for a while. 

Sports requiring speed and agility should focus on movements that emphasize speed and agility. If you are a basketball player you will have little benefit from squatting 300lbs, However doing explosive sprinting and jumping might be a better training option. 

Physiotherapy focuses on regaining functional everyday movement such as squatting. Many people are hesitant to perform squats if they have hip or knee pain. However squatting is one of the most frequently performed movements we do on a daily basis. Without the ability to squat we would not be able to sit in a chair or a sofa, get in or out of bed, or sit down on the toilet.

Spring Injuries.

Some of the most common injuries we see around this time of the year are overuse injuries. 

People become more active. We may do more of the activities we haven't done much of over the winter such as running, walking or biking. Or we may decide to take up a new sport such as roller blading. 

Whatever the reason for the increase in activity it is essential to start slowly and increase the load progressively. After limited exposure to an activity for most of the winter it is generally not a good idea to jog for 30-40 minutes. Progressive and gradual loading is a cornerstone of any good exercise routine. 

Please contact us if you would like a progressively designed program for an activity of your choice or if you would like us to address any pains or aches that you've started experiencing with an increased exposure to an activity. 

The Right Type of Activity

The question of the right physical activity is a highly subjective one. Many aspects should be considered. 

Current research recommends 150 minutes of moderate to high intensity aerobic activity per week in bouts of 10 min or more. Adding 2 days of muscle and bone strengthening of major muscle groups in addition is advised. 

It is essential to find an activity that fits your lifestyle. Something that you can see yourself doing consistently and something that does not feel too hard. Most people are unsuccessful because their routine becomes too hard to follow. 

It's great to find an activity that does not feel overwhelming such as: sports, yoga, hiking, dance.

One more way to stay consistent with physical activity is to have other people hold you accountable. Personal trainers, group classes, or activity groups are good examples.

Another aspect to consider is finding the appropriate activity for your fitness level, medical condition, previous levels of activity. If you've been an athlete in the past, an athletic activity might be better suited for you.

When starting a physical activity program it is essential to progress gradually starting with lighter activities and progressing slowly through intensity and duration. 

Please ask us for more specific advice.

How is Physio Different?

One frequently asked question clinically is how is physiotherapy different from some of the other professions such as Chiropractic or Osteopathy?

Having worked with chiropractors and having been trained in numerous osteopathic techniques in the USA, I can say that there can be a good amount of overlap between the 3. I would even say that there may be little difference between a highly skilled osteopath, chiropractor or physiotherapist. All 3 professions use a hands-on approach to treating conditions. All 3 professions use manual skills to move joints, soft tissue, connective tissue and nerve tissue. 

However, one way physiotherapists differ from others is that they are a part of the current mainstream medical model. Physiotherapist are found in hospitals, skilled nursing facilities, assisted living facilities, inpatient and outpatient clinics, closely working with medical doctors. They follow scientifically proven methods when treating patients which is one of the main reasons Medical Doctors commonly refer patients for rehabilitation.

One of the main areas of focus in physiotherapy is exercise. Manual therapy and other modalities can help accelerate improvement, however the research strongly supports exercise and movement as the "magic bullet". Physiotherapists are trained to determine the most appropriate type of exercise for your specific condition and activity level. 

 

The Posture Myth?

There is a popular consensus that "bad posture" causes back pain.  You can find claims all over the internet, clinical offices and infomercials that you should work on your posture to reduce pain. Many professional schools teach this notion. It is common practice in physiotherapy and other practices to stretch and strengthen various muscles to address postural pain, yet there is little current clinical evidence to support this notion. 

"Bad posture" may have aesthetic disadvantages, impacts to our self-confidence and changes in how others perceive us, yet very few studies show that it leads to more pain. 

Like many things in our pop culture certain ideas become so ingrained that even when evidence suggests otherwise, we find it hard to change our beliefs. 

Most current clinical research has difficulty correlating "bad posture" with pain. Numerous studies have examined if subjects with certain postures are more likely to have back pain as a result of their posture. 

Spinal alignment such as increased or decreased spinal curvature, pelvic rotation and leg length discrepancy do not seem to make you more likely to experience pain compared to someone with "normal posture".

People who work in occupations which require frequent awkward posture do not seem to develop more pain than their counterparts who do not.

It is often more likely the reverse -- that pain leads to bad posture. Most people who are experiencing pain, shift or move away from the painful side. The theory is that as a result of pain you may be experiencing is causing you to modify your posture.  This can lead to pain not only in the joint affected but also other body joints. 

Research does point to an important postural fact: When loading your body with weight or when performing difficult and complex movements it is important for the movement to be executed with good form. Alignment tends to matter with heavy squats, lifting, repeated movements. The take away point is not so much to worry about posture, but rather think about how you move. Improve your quality and quantity of movement. Ensure that you are mastering a movement before adding resistance to the movement (lifting heavy weight or doing prolonged gardening). 

You should frequently change postures while working. Do not stay in the same position for too long. Take a call while walking, read while lying on your stomach, stand while writing, sit while doing computer work, stand while doing computer work, perform simple movements or stretches as a break from desk work. 

Bellow is the list of references supporting the discussion above. 

References

1. Grundy, Roberts (1984) Does unequal leg length cause back pain? A case-control study. Lancet. 1984 Aug 4;2(8397):256-8. http://www.ncbi.nlm.nih.gov/pubmed/6146810

2. Pope, Bevins (1985) The relationship between anthropometric, postural, muscular, and mobility characteristics of males ages 18-55. Spine (Phila Pa 1976). 1985 Sep;10(7):644-8. http://www.ncbi.nlm.nih.gov/pubmed/4071274

3. Grob, Frauenfelder et al. (2007), The association between cervical spine curvature and neck pain. Eur Spine J. 2007 May; 16(5): 669–678. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213543/

4. Nourbakhsh, et al. (2002) Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002 Sep;32(9):447-60. http://www.ncbi.nlm.nih.gov/pubmed/12322811

5. Dieck, et al. (1985) An epidemiologic study of the relationship between postural asymmetry in the teen years and subsequent back and neck pain. Spine (Phila Pa 1976). 1985 Dec;10(10):872-7. http://www.ncbi.nlm.nih.gov/pubmed/2938272

6. Franklin, et al. (1988) An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. 1998 Sep;28(3):133-8. http://www.ncbi.nlm.nih.gov/pubmed/9742469

7. Lederman (2010) The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain. CPDO Online Journal (2010), March, p1-14. http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf

8. Chaleat-Valleyed, et al. (2011) Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J. 2011 Sep;20 Suppl 5:634-40. http://www.ncbi.nlm.nih.gov/pubmed/21870097;

9. Smith, O-Sullivan, et al. (2008) Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine (Phila Pa 1976). 2008 Sep 1;33(19):2101-7. http://www.ncbi.nlm.nih.gov/pubmed/18758367.

10. Christensen, et al. (2008) Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):690-714. http://www.ncbi.nlm.nih.gov/pubmed/19028253

11. Papageorgeoui, et al. (1997) Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study. Spine (Phila Pa 1976). 1997 May 15;22(10):1137-42. http://www.ncbi.nlm.nih.gov/pubmed/9160473

12. Hodges, Moseley (2003) Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res (2003) 151:262–271 http://cdns.bodyinmind.org/wp-content/uploads/Hodges-et-al-2003-Exp-Brain-Res-experimental-lbp.pdf