Month: October 2023

Endometriosis is a chronic medical condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. Normally, the endometrium thickens, breaks down, and is shed during each menstrual cycle. However, in individuals with endometriosis, this tissue can grow on the ovaries, fallopian tubes, outer surface of the uterus, and other pelvic organs. In rare cases, it can even spread beyond the pelvic region.

During the menstrual cycle, the tissue growth outside the uterus responds to hormonal changes, causing it to thicken, break down, and bleed just like the endometrium inside the uterus. However, because this tissue is outside the uterus, it has no way to exit the body, which can lead to inflammation, pain, and the formation of scar tissue (adhesions). Over time, these adhesions can cause organs to stick together, leading to further pain and complications.

Endometriosis is often associated with symptoms such as:

• Pelvic pain: This can range from mild to severe and may occur before or during menstruation, during sexual intercourse, or during bowel movements.
• Painful periods: Women with endometriosis often experience more intense and longer-lasting menstrual cramps than usual.
• Painful intercourse: Pain during or after sexual activity is a common symptom of endometriosis.
• Infertility: Endometriosis can affect fertility by causing dysfunction of the reproductive organs or blocking the fallopian tubes.
• Heavy menstrual bleeding: Some individuals with endometriosis may experience heavier periods than usual.
• Gastrointestinal symptoms: Endometrial tissue outside the uterus can cause gastrointestinal symptoms such as bloating, diarrhea, constipation, and nausea, especially during menstruation.

 

Diagnosing endometriosis typically involves a combination of medical history, physical examination, and often a laparoscopic procedure (a minimally invasive surgery) to visualize and potentially remove the abnormal tissue for further examination.

Pelvic floor physical therapy can be beneficial for individuals with endometriosis, especially if they are experiencing pelvic pain, discomfort, or other related symptoms. Here’s how pelvic floor physical therapy can be helpful for those with endometriosis:

• Pain Management: Endometriosis can cause pelvic pain and discomfort. Often the pelvic floor muscles tense in response to the pain from the abnormal tissue and adhesions. Pelvic floor physical therapy aims to alleviate pain by addressing muscle tension, trigger points, and dysfunctional movement patterns in the pelvic floor muscles. Therapists use techniques such as manual therapy, stretching, and exercises to release tension and improve muscle function.
• Muscle Dysfunction: Endometriosis-related pain and inflammation can lead to pelvic floor muscle dysfunction, including tightness and weakness. Pelvic floor physical therapy helps identify these issues and develops a personalized exercise plan to restore proper muscle balance and function.
• Improved Pelvic Floor Function: The pelvic floor muscles play a crucial role in supporting the pelvic organs, controlling bowel and bladder function, and contributing to sexual function. Endometriosis can sometimes affect bladder and bowel function, leading to issues like urinary urgency, frequency, or pain during bowel movements. Pelvic floor physical therapy can help address these issues by improving muscle coordination and relieving muscle tension that might contribute to bladder and bowel dysfunction.
• Surgical Recovery: If an individual with endometriosis has undergone surgery, such as laparoscopy to remove endometrial tissue, pelvic floor physical therapy can aid in the recovery process. It helps to decrease and prevent scar tissue formation, maintain proper muscle function, and promote overall healing.
• Fertility: Adhesions caused by the abnormal tissue growth can contribute to abnormal movement (motility) and therefore function of the reproductive organs. Certain manual therapy interventions performed externally on the abdomen can aid in breaking up these adhesions and improving organ function, improving fertility. Such techniques are Visceral Mobilization and Lymphatic Drainage. Mercier Therapy is an external deep pelvic visceral manipulation technique focused on restoring blood flow and proper positioning of the uterus and ovaries within the pelvis.
• Individualized Treatment: Pelvic floor physical therapy is tailored to each individual’s needs. Therapists assess the specific symptoms, challenges, and goals of the patient and create a personalized treatment plan that may include exercises, stretches, relaxation techniques, and lifestyle modifications.

 

Magic City Physical Therapy has trained and licensed physical therapists with expertise in pelvic health including Visceral Mobilization, Lymphatic Drainage, and Mercier Therapy. If you’re considering pelvic floor physical therapy for managing endometriosis symptoms, call us today!

 

Hip hinging, also known as a hip hinge movement, is a fundamental biomechanical motion pattern that involves flexing and extending at the hips while maintaining a relatively straight spine. This movement is commonly used in exercises and activities that require proper lifting technique, such as deadlifts, kettlebell swings, and even picking up objects from the ground.

The hip hinge movement primarily involves the hip joint, where the hip flexors and extensors are the main muscles responsible for the motion. When you perform a hip hinge, you push your hips backward while maintaining a neutral spine, allowing the hips to bend and the torso to angle forward. This movement pattern helps to stretch and then engage the glute muscles. Proper hip hinge technique is crucial to avoid putting excessive stress on your lower back and to effectively engage the muscles that should be working during the movement.

Some key points for performing a hip hinge correctly include:

• Maintain a neutral spine: Keep your spine in a neutral position throughout the movement, avoiding excessive rounding or arching of the back.
• Push hips back: Initiate the movement by pushing your hips backward while keeping your knees slightly bent. Imagine you’re closing a door with your butt.
• Bend only at the hips: As your hips move back, your torso will naturally angle forward, creating a hinge-like motion at your hips
• Use the glutes and hamstrings: The primary force for returning to an upright position comes from your glutes and hamstrings. Focus on using these muscles to extend your hips. You should feel your glutes and proximal hamstrings when doing the motion correctly.
• Maintain a slight knee bend: While your knees will naturally bend a bit, the primary movement should be at the hips, not the knees.
• Keep most of your weight in your heels. Keep toes pointing straight forward.

Hip hinging is an essential movement pattern for maintaining proper body mechanics during various physical activities, especially when lifting heavy objects. Learning and practicing proper hip hinge technique can help prevent injuries and improve your overall functional strength. If you’re new to hip hinging or lifting exercises, it’s a good idea to seek guidance from a fitness professional to ensure you’re performing the movement correctly.

Hip hinging and the pelvic floor are related in the context of movement mechanics and body awareness, particularly during exercises that involve hip hinging motions. The pelvic floor is a group of muscles located at the base of the pelvis, and it plays a crucial role in supporting the pelvic organs, controlling bowel and bladder function, and stabilizing the spine.

Hip hinging movements are vital to preventing pelvic floor dysfunction, and avoiding excessive intra-abdominal pressure. Here’s how the two are related:

• Getting good glute lengthening and activation can assist in taking pressure off the pelvic floor. We find a lot of our clients tend to clench their glutes, inherently weakening this muscle group. If the glutes aren’t working like they should, something else (like the pelvic floor) will compensate. Lengthening and strengthening the glutes can help take this unwanted pressure off the pelvic floor.
• Breathing Patterns: Coordinating your breathing with the hip hinge is important. Inhaling as you hinge down and exhaling as you return to upright stance can help maintain proper pressure distribution. This can help protect your pelvic floor while lifting and help to lessen increased intra-abdominal pressure (which can negatively impact the pelvic floor).
• Mindful Movement: Being aware of your body’s alignment, pelvic position, and how your pelvic floor feels during the movement can help you better perform the exercise. Ultimately we want this hinge action to become automatic for our clients when they are loading and unloading the dishwasher, picking up their toddler, laying their baby in the crib, and various other activities of daily living.

 

Incorporating proper hip hinge mechanics, core engagement, and mindful pelvic floor relaxation can contribute to better movement patterns and pelvic floor health. If you’re unsure about how to properly engage your pelvic floor during movements like hinging, squatting, or other daily activities, come see us at Magic City Physical Therapy and work with one of our trained pelvic floor physical therapists.

 

Numerous women are not being adequately educated by their doctors about adhesions. A minimal proportion of women are even aware of the presence of adhesions. These adhesions, often referred to as “scar tissue,” are essentially formations of scar tissue within the body. Once these adhesions form, the body lacks mechanisms to manage them, resulting in their persistence and potential spread to surrounding structures.

Adhesions comprise tiny collagen strands that develop around injured tissue as the initial step in the body’s healing process. Common areas where adhesions form include regions previously affected by infection, inflammation, or endometriosis. Pelvic adhesions can give rise to a range of female health issues, spanning from infertility to persistent pain, including discomfort during intercourse. If you have undergone surgery, experienced an injury, infection, or endometriosis, there’s a considerable likelihood that you have developed adhesions. We have prepared a concise guide to help you determine whether you have adhesions following surgery.

What triggers the occurrence of pelvic adhesions?

• Surgery – Research indicates that 44% to 93% of individuals who undergo pelvic surgery can experience the development of pelvic adhesions. Cutting into the delicate tissues surrounding reproductive structures can lead to scar tissue growth around the healing site. A large number of women we treat for secondary infertility or chronic pelvic pain have undergone prior procedures such as C-sections, hysterectomies, cholecystectomies, or appendectomies.
• Inflammation – Recurrent inflammation is a prevalent factor contributing to the formation of adhesions. Pelvic inflammatory disease (PID) substantially contributes to infertility and pain cases we encounter. Persistent inflammation prompts the growth of scar tissue in the pelvic region, often around the fallopian tubes or ovaries.
• Infection/STIs – Sexually Transmitted Diseases (STDs) can result in chronic infection and inflammation, fostering the growth of scar tissue within the pelvis. Prolonged untreated infections or STDs lead to escalated adhesion formation, as the body endeavors to enclose and control the infection. One of the chief causes of blocked fallopian tubes stems from untreated infections like chlamydia or gonorrhea.
• Trauma – Activities like contact sports, car accidents, falls, or work-related injuries can prompt the development of pelvic adhesions. Since the initial response of the body to healing is to generate adhesions to enclose and isolate the injury, almost everyone harbors adhesions somewhere in their body.
• Chronic conditions – Conditions that lack definitive cures and recur periodically are categorized as chronic conditions. Two conditions contributing significantly to pelvic adhesions are polycystic ovarian syndrome (PCOS) and endometriosis. Both conditions share attributes leading to adhesion formation, including chronic inflammation and abnormal growths within the reproductive tract. PCOS derives its name from the cysts forming on the ovaries, which, along with the surgeries required to remove them, induce adhesions. Endometriosis refers to the presence of endometrial tissue outside the uterus. Inflamed endometriomal tissue fosters the development of scar tissue around the site, culminating in issues such as endometriosis-related infertility, pain during menstruation, bowel and bladder dysfunction, and painful intercourse.
• Radiation Therapy – Numerous former cancer patients have sought treatment for chronic pelvic pain due to radiation therapy. This treatment can lead to substantial scarring and mechanical dysfunction within a woman’s abdomen and pelvis. These patients often describe their pain as a persistent “stuck” or “tight” sensation.

Conditions Arising from Pelvic Adhesions

• Blocked fallopian tubes – One of the most prevalent forms of infertility stemming from adhesions is the obstruction of fallopian tubes. Adhesions wrap around delicate structures within the reproductive tract, obstructing the normal functioning of the reproductive system. Adhesions can impede the passage of sperm through the fallopian tubes, hindering egg fertilization. Fluid can also accumulate within the fallopian tube, also reducing chances of conception.
• Unexplained infertility – Adhesions are not discernible through most diagnostic tests. Confirming the presence of adhesions necessitates exploratory surgery to directly visualize them. Unfortunately, as most patients are unaware of adhesions, they don’t consider the possibility that their infertility could be attributed to adhesions. This leads to numerous women enduring unexplained infertility.
• Chronic pain – The patients affected by adhesions frequently describe sensations of being trapped, taut, immobile, and persistently uncomfortable. Given that adhesions bind to structures, causing perpetual tension, the prevalence of chronic pain among individuals with adhesions is vast.
• Sexual dysfunction – Pelvic adhesions can cause pain with intercourse and sexual dysfunction, including lack of desire and arousal, inability to orgasm (anorgasmia), decreased natural lubrication, and pain during and after penetration.

Holistic Approach to Treating Pelvic Adhesions

Manual Physical Therapy, specifically Visceral Mobilization, is a non-surgical and wholly natural treatment strategy for the treatment of pelvic adhesions. Magic City Physical Therapy provides hands-on therapy aimed at detaching and weakening adhesions within the body. Our foremost goal is to aid patients in achieving natural pregnancies, leading pain-free lives, and evade future surgeries. Our clinic has therapists highly trained in techniques such as Mercier Therapy, the Vodder method of Manual Lymphatic Drainage, and general Visceral Mobilization to assist in reducing these adhesions within the abdominal and pelvic cavity.

 

Weibel M-A, Majno G. Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg. 1973;126:345–353.

Bove, G.M., Chapelle, S.L., Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model, Journal of Bodywork & Movement Therapies (2011), doi:10.1016/j.jbmt.2011.02.004

Statistics show that fertility struggles can affect 17.5% of the reproductive-age population (World Health Organization). Infertility arises from various causes, encompassing issues related to sperm, endometriosis, ovulation or tube difficulties, among others. However, when focusing on female infertility, mechanical factors such as adhesions and endometriosis are believed to contribute to 30-50% of infertility instances. These adhesions and limitations can emerge following pelvic surgery, but are also frequently associated with conditions like endometriosis, PCOS, pelvic inflammatory disease (PID), tubal obstruction, polyps, pelvic floor muscle dysfunction, bowel obstruction, and chronic abdominopelvic pain. Additionally, secondary infertility has been identified post-Cesarean birth, potentially linked to mechanical factors. These adhesions can constrain the movement and functioning of organs, ligaments, fascia, and nerves within the pelvis, thereby influencing movement and mechanics across the entire abdominopelvic region.

How Can Manual Therapy Interventions Make A Difference?

Specific manual therapy interventions (termed visceral mobilization) at specific sites in the pelvis can help to improve tissue mobility and the response of the nervous system to that part of the body. This was first studied in the 70’s and 80’s in the Czech Republic; however, the first published paper I was able to find on this was published in 2004 by Wurn and colleagues. They evaluated the effect of manual physical therapy intervention on 53 individuals dealing with infertility, 36 of which were planning to undergo IVF within 15 months. Their results showed that 71% of the patients who were trying to get pregnant naturally achieved pregnancy within 1 year. Of those undergoing IVF, 67% achieved a successful embryo transfer.

An additional study by Kramp et al., 2012 looked at manual therapy interventions for 10 women with diagnosed infertility. Following treatment including improving pelvic symmetry and sacral mobility, treating myofascial dysfunction around the pelvis, manual lymphatic drainage, and visceral mobilization, 6 out of the 10 women were able to achieve pregnancy.

Rice et al. (2015) published a retrospective review of 1392 patients treated with visceral mobilization. They found that those who were post-surgical had 35% success and non-surgical patients had 69% success in achieving pregnancy. So, the thought here is that post-surgical adhesions may lead to more difficulty in improving tissue mobility.

What Is Involved In Physical Therapy To Improve Fertility?

During the initial evaluation, the physical therapist will talk with the patient about their history and the current challenges. This can include an evaluation from head to toe including:

• Posture/body mechanics screen
• Breathing and ribcage assessment
• Abdominal wall assessment
• Hips, Spine and Pelvis range of motion testing
• Pelvic Floor Muscle, hip, and abdominal muscle testing: Pelvic floor muscle testing is performed internally if the patient feels comfortable with this. This allows us to assess overall muscle tone, strength, and coordination.

Following the initial evaluation, the Physical Therapist and client will establish a treatment plan. This will be customized to the individual, but often will include education on strategies to increase reproductive success, specific exercises to optimize pelvic and spinal mobility, and specific visceral manual therapy techniques.

Did you know that certain pelvic health therapists can help with fertility? Our clinic has therapists highly trained in techniques such as Mercier Therapy, the Vodder method of Manual Lymphatic Drainage, and general Visceral Mobilization to assist in improving fertility.

 

Rice AD, Patterson K, Wakefield LB, Reed ED, Breder KP, Wurn BF, King Iii R, Wurn LJ. Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Altern Ther Health Med. 2015 May-Jun;21(3):36-44. PMID: 26026143.

Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Scharf ES, Shuster JJ. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. MedGenMed. 2004 Jun 18;6(2):51. PMID: 15266276; PMCID: PMC1395760.

Kramp ME. Combined manual therapy techniques for the treatment of women with infertility: a case series. J Am Osteopath Assoc. 2012 Oct;112(10):680-4. PMID: 23055467.

 

Chronic pelvic pain in men is often referred to as Chronic Prostatitis, Chronic Non-Bacterial Prostatitis, or Chronic Pelvic Pain Syndrome. Men in this category have no known prostate infection, but have pelvic pain lasting more than 3 months. Chronic pelvic pain is a challenging and debilitating, but treatable, condition affecting up to 8% of men in the United States (Krieger).

If you’ve been put on multiple antibiotics for chronic prostatitis, you are in the company of many men who have never had any infection in the prostate. The most common type of chronic prostatitis is chronic non-bacterial Prostatitis. Most men have multiple sites of pain, which can be confusing for the patient and medical providers. What most doctors and patients fail to recognize is that structures inside and outside of the urinary tract, particularly the pelvic floor muscles, its associated connective tissues, and/or the nervous system, can play a big role in non-bacterial prostatitis.

Not all pain in the male pelvic region can be attributed to the prostate. This is where a qualified Pelvic Floor Physical Therapist can evaluate for pelvic floor muscle dysfunction and help the patient get to the root cause of the symptoms.

Cyclist’s Syndrome denotes symptoms associated with pudendal nerve irritation or pudendal neuralgia. These symptoms encompass discomfort in the “sit bones,” perineum, genital area, and/or anus, along with pain experienced during sitting or cycling, as well as potential urinary, bowel, and sexual dysfunction. Additionally, there might be sensations akin to a foreign object in the rectum or perineum. Pudendal nerve irritation during cycling can result from a combination of compression (caused by the bike seat horn) and tension (due to repetitive hip flexion).

Numerous studies grounded in evidence demonstrate that pelvic floor physical therapy constitutes a beneficial approach to addressing pelvic pain stemming from tense muscles and constricted tissues, applicable to both men and women. The pelvic floor comprises muscles such as the levator ani, coccygeus, and obturator internus, which can develop adhesions, tension, or trigger points, leading to motion restrictions and pain. These trigger points manifest as palpable spasms or knots within muscle tissue, even affecting pelvic floor muscles, potentially causing adhesions in the fascia and connective tissues of the abdomen, groin, pelvic floor, and subsequently constricting pelvic organs like the colon, uterus, bladder, and prostate gland within the pelvic cavity.

The pudendal nerves and their branches originate from the sacrum (at the back of the pelvis) and traverse the pelvic floor region to innervate the vaginal, penile, and rectal areas. However, these nerves can encounter compression as they navigate through taut muscles and fascia, resulting in compromised pelvic floor functionality and heightened discomfort.

Playing a pivotal role as a core stabilizer, the pelvic floor collaborates with other core muscles—the Transversus Abdominus (the innermost abdominal muscle) and Multifidus (deep lower back muscle. Certain hip muscles also serve as pelvic floor muscles. These muscles work in concert to maintain core strength, flexibility, and prevent lower back pain.. When one of these core stabilizers weakens or sustains an injury, the remaining muscles must compensate, eventually straining the entire core and contributing to back pain, stiffness, and weakness over time.

The pelvic floor muscles directly influence three vital bodily functions: urinary, bowel, and sexual.

In terms of urination, the pelvic floor muscles encompass the urethral opening, relaxing during voiding and exerting closure or tension when not voiding. Muscle spasms can lead to urinary symptoms like leakage, strong urges to void, frequent bathroom visits (urinary frequency), and nocturnal awakenings for urination (nocturia). Women are advised against “hovering” over public restroom toilets, as this sustained partial squat increases pelvic tension and hinders full relaxation of the sphincters around the urethra, impeding complete urination. It’s recommended to use protective toilet seat covers and sit comfortably.

In the context of normal bowel movements, the pelvic floor muscles should be able to expand to facilitate the passage of stool. When not defecating, the pelvic floor maintains tension at the rectal opening to prevent leakage. Weakness in the pelvic floor can lead to leakage, while tightness can result in constipation, prolonged toilet sitting, and straining during defecation. Timely toileting, within five minutes of the urge to void, is advised. Although the feeling of complete emptying may not always be present, standing and leaving the bathroom is better than persistently straining. Prolonged straining can cause hemorrhoids or even lead to the development of a rectocele, further impairing proper function.

Regarding optimal sexual function, a strong, flexible, and coordinated pelvic floor contributes to more intense orgasms in both genders. A fully relaxed pelvic floor assists women in experiencing painless intercourse with their male partners. Those grappling with sexual pain may encounter challenges in their relationships or even avoid them due to feelings of shame or inadequacy.

Typically, individuals experience noticeable improvement within two months of consistent bi-weekly pelvic floor physical therapy including treatments such as trigger point release, myofascial release, dry needling, visceral mobilization, downtraining of the central nervous system, postural education, stretching and functional mobility, lifestyle and pain science education. Some achieve their goals sooner, while others might require up to three months. By diligently attending regular pelvic floor physical therapy sessions and routinely performing home exercises, faulty patterns can be reversed, and many individuals find relief from pain within two to three months (Fitzgerald).

Are you experiencing symptoms of MALE PELVIC PAIN? We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life.

 

Kulovac B, Aganović D, Prcić A, Hadziosmanović O. Management of chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Bosn J Basic Med Sci. 2007 Aug;7(3):245-9. doi: 10.17305/bjbms.2007.3053. PMID: 17848151; PMCID: PMC5736117.

Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008 Feb;31 Suppl 1(Suppl 1):S85-90. doi: 10.1016/j.ijantimicag.2007.08.028. Epub 2007 Dec 31. PMID: 18164907; PMCID: PMC2292121.

Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. 2006 Oct;176(4 Pt 1):1534-8; discussion 1538-9. doi: 10.1016/j.juro.2006.06.010. PMID: 16952676.

M. S Ajimsha, Laith Ahmad Ismail, Noora Al-Mudahka & Ahmad Majzoub (2021) Effectiveness of external myofascial mobilisation in the management of male chronic pelvic pain of muscle spastic type: A retrospective study, Arab Journal of Urology, 19:3, 394-400, DOI: 10.1080/2090598X.2021.1954414

FitzGerald MP. Can chronic pelvic pain in men be treated with myofascial trigger point release and paradoxical relaxation training? Nat Clin Pract Urol. 2005 Nov;2(11):534-5. doi: 10.1038/ncpuro0305. PMID: 16474595.