HELP I CAN'T PEE!!!

Here's a testimony from one of our Pelvic Floor patients that was too good to keep to ourselves. 

MY ROAD BACK TO A LIFE

I didn't have a life. That is, not much of one.  Sadly, I'd lost the ability to do many of the things that I enjoyed and that helped make life fun and meaningful. And THAT was because I'd lost the ability to do one of life's most basic tasks...I couldn't pee.

I assume, if you are still reading this, then something similar has happened or is happening, to you.I was in my office when I first realized I couldn't pee. Quite a shock. Quite uncomfortable. Quite a trip to go to the ER and have a catheter installed. That lead to medication to deal with my enlarged prostate that was, apparently, blocking the flow of urine down my urethra. It worked well for many months...until it stopped working well and I was back in the ER. This time my urologist recommended TURP surgery, a laser procedure to reduce the size of the prostate and open things up. Till it could be scheduled I had to wear the catheter. That meant no running, no sports, no working out, difficulty sleeping, occasional discomfort, and walking slowly.

Then I had the surgery and all was well...for about 2 months. And then the same problem returned. My urologist kept saying he didn't understand, the prostate was no longer squeezing on my urethra, it must be that I was doing something wrong, I must be getting too anxious and tightening my sphincter and preventing the urine flow.

So, apparently, it was all my fault for being too anxious. So we tried a few different anti-anxiety medications. I took them and he took the catheter off. And a few days later I couldn't pee and it was back to the ER. After some tests they could find nothing amiss, my urologist recommended redoing the TURP. We did. Nothing got better. By now I was getting recognized on my return visits to the ER.

Life had become nightmarish. I decided to try something different.

I went to another urologist who specialized in difficult cases. He recommended that I learn to self cath when needed. That way I could avoid ER trips and not have to wear a catheter. It was the scariest thing I ever heard of. No way I'd EVER do something like that! But what was the alternative? So I learned it and it was painless and no big deal.

And I told him I wanted to try physical therapy. He agreed and gave me a few names. I called around and that's how I ended up at Duffy and Bracken. Lucky for me!

I began seeing Ann Duffy twice a week. In the evaluation she used a biofeedback mechanism to measure the strength of my Pelvic Floor Muscles. I didn't know I had a Pelvic Floor nor did I know that there were muscles there. Turned out they were extremely weak. She could also measure their ability to relax. Turned out they were not very good at that either. My pelvic floor muscles were under strength and over tense. "You have pelvic floor dysfunction," Ann told me, and traced it back to surgeries I'd had in the area some years ago. She explained that, because the muscles are weak, they had to work extra hard to keep me from being incontinent. As a result they were in a constant state of tension. And that is what lead the muscles to over tighten at the wrong times and prevent me from being able to pee.

We had a theory on what was wrong that went beyond telling me to relax or giving me anti anxiety medications! And that lead to a theory of what would help: Strengthen the pelvic floor muscles and supplement that with relaxation techniques.

So that's what we did. I learned Kegle exercises (though probably not how to spell them correctly) that I did both with Ann and on my own as well as other exercises I could do at home. Using biofeedback we could measure the muscles' strengthening and also see what relaxation techniques worked best for me. We found deep belly breathing did the trick.

Things did not immediately get better. I had to self cath a number of times. Sometimes I felt pretty discouraged and anxious. Ann was encouraging but also action oriented. "What good does getting anxious serve?" she asked once. We got back to the Kegels.

Then things improved significantly! I had a long stretch of feeling fine. When I had a rough few days, Ann quickly figured out the problem...I'd hurt my lower back lifting some boxes I shouldn't have. The muscles there tightened and that caused surrounding muscles to also tighten...including those pelvic floor muscles. So Ann gave me stretches to do and then strengthening exercises for the area. Things have gotten better again.

I think the best thing I can say about my work with Ann at Duffy and Bracken is that it is individually oriented and self empowering. That is, what she did is figure out what was going on with ME and then devise exercises, stretches and relaxation techniques that enable me to vastly improve and, hopefully, remedy the problem. NOT oriented at all (at least in my case) to medications and that is something I think is a very good thing. They almost always have side effects.

Duffy and Bracken is a business and I'm sure Ann is a good business woman. But everyone knows that physical therapy can take a while and that can be expensive and cause people to shy away. But what I found with Ann is that she'll do her best to work with you, to use your insurance, to come up with something fair should the insurance stop helping or be unavailable for whatever reason.

I'm very happy with what I've accomplished with Ann's help. I'm back to my active life. I'm pretty confident that you will improve things, probably greatly, if you work hard and consistently with the folks there.

I'd be happy to talk to you about all this if you think it could be helpful.

Regards, 

Michael Leiman

TAKE YOUR "BACK" TO SCHOOL!

With the school year beginning next week...after a restful summer…..we will be back to a more structured routine!! The trains will be busy with school kids being part of the rush hour commute.

Every year for the past decade, I have observed school kids carrying heavy loads...totally unaware of their posture. As a Spine Specialist, I naturally notice poor posture in others and I must say adults are just as unaware of their posture.

Our sitting world places undue stress on the spine if we are not aware of “ WHERE OUR BODIES ARE IN SPACE”.  Leading unsurprisingly to all sorts of aches, pains, and complaints of back stiffness.

I have coined 3 words to describe the spinal positions:

•   Hammock Spine: this is when we slouch curving our spine to its limit ---that it resembles the shape of a hammock. All structures are being pulled and stretched up to their end point resulting in weakness and loss of stability. E.g. slouched on the couch sound familiar!!!

•  Swagger Spine: this is when the spine sways laterally and does all the work while the rest of the body comes along for the ride. E.g. Walking with packages and doodling sideways

•   Pencil Spine: this is when the spine is so straight and rigid that any movement seems impossible.  E.g. Turning and twisting to look behind is a total body effort

 I’m sure you can identify where you fall in this spectrum. 

If we are all busy doing yoga, pilates, cross fit and gym workouts --- why then does our super strong core still cause low back pain?  The answer is in our individual lack of postural awareness; and this is where the expertise of a skilled PT with a keen sense of observation is invaluable.

Static and dynamic posture determine spinal health…so why not put your “ BACK TO SCHOOL”. Let us teach you how to enhance spinal mobility, spinal strength and spinal wellness.

Duffy and Bracken has partnered with Intelliskin (a performance apparel company) to help build the bridge for patients who struggle with back pain due to years of poor posture. Our postural assessments consist of a total spine evaluation and assessment, corrective exercises and clothing advice to help maintain good spinal posture. 

Contact us today for more information. Isn’t it time that we adults took our BACK to School ---to improve our quality of life!

Renuka Pinto, MPT, PGDR, CSCS, CES

Renuka@duffyandbracken.com

D & B IS NOW IN-NETWORK WITH CIGNA!!

Duffy & Bracken Physical Therapy is pleased to announce that we are now a participating provider with Cigna Healthcare.

We participate in most major insurance plans, in-network as well as out-of-network. If needed, we offer payment plans to our patients and work with them to make treatment possible at a reasonable cost. With many of today's insurance plans, the out-of-network coinsurance can cost the patient the same (or even less) as the in-network co-payment.

We know that understanding your benefits and/or coverage can get tricky. Our experienced billing staff is committed to working with you and addressing all of your insurance concerns. 

Below is a list of the most popular HMO, PPO, POS insurance plans that we work with, both in- and out-of-network. If your insurance is not listed, do not hesitate to contact us. We will do everything possible to work with your plan.

United Health Care
Empire Blue Cross Blue Shield
Oxford Health Plan
Cigna
Empire Plan (MPN)
Medicare
Workers Compensation
No Fault
Federal Employee PPO
Mt. Sinai- NYU H.S.M.C.M.N.
Anthem
1199
Horizon NY & NJ

Sex & Your Pelvic Floor!

Did you know that physical therapy can help your sex life??

Duffy & Bracken, PT has a unique specialty called Pelvic Floor Physical Therapy that can benefit both men and women. There are very few physical therapy clinics that specialize in this and Duffy & Bracken was one of the first to do so. Not to mention, we now have 20 years experience in this area. 

Painful sex is NOT normal!! Many people experience ongoing pain during sex, and the longer they let this go on, the more chronic and stubborn it may become. We all know that a woman’s first sexual experience is often painful because the hymen, which is very sensitive may still be intact. Anything from tampons to GYN exams (with a speculum) or physical activity before intercourse may have widened the hymen. However, some women are unable to use tampons or have sex due to extreme sensitivity, pelvic muscle spasm or nerve pain-neuralgia. Fear-avoidance also adds to this problem since fear acts like cement to pain and makes it difficult to overcome. Understandably, everyone is afraid of pain but understanding where the pain is and why it’s there, in addition to learning techniques to decrease it; can slowly stretch the vaginal opening allowing you to have pain free intercourse. This process can be quite quick if you do your homework, and usually resolved in 6 to 12 visits or sometimes even less! Even chronic cases sometimes resolve quickly especially if you work at it with your therapist.  

Pelvic Floor conditions do not only affect women. Men who have pain with ejaculation may have painful or trigger points in their pelvic floor muscle (PFM) that can be treated with retraining and massaging of the muscle. Additionally, getting education that explains 'pain' can aid in reducing the fear and hopelessness that sometimes accompanies pelvic pain.

Pelvic pain and dysfunction may also cause urinary and bowel problems or vice versa since the pelvic floor controls voiding. Poor posture and muscular skeletal problems involving the back, pelvis, sacrum, coccyx (tailbone) and hips, can also be a cause or a result of pelvic dysfunction - or as we like to say the 'culprit or the victim.' 

Likewise, women may experience pelvic pain during or after menopause as we lose estrogen and the pelvic floor muscle thins and atrophies (muscle gets smaller). Men lose testosterone around age 60 and sexual dysfunction may accompany this. Strengthening the pelvic floor muscle can help keep and sustain erection plus improve orgasm for both men and women.

There are many reasons to keep the pelvic floor muscle healthy including: pain free sex, better orgasm, and improved sexual stamina. Not to mention, a healthy pelvic floor also prevents: prolapse (the bladder and cervix can fall out of the vagina), incontinence (leaking of urine or feces), and flatulence (gas). It also improves posture and results in a flatter stomach, as the pelvic floor muscle works together with the transverse abdominis (which holds the belly flat).   

Medical terms used to describe these problems include: pelvic floor dysfunction, dyspareunia, levator ani spasm, vulvodynia, vulvar vestibulitis, vaginismus, and erectile dysfunction. These conditions may accompany: coccydynia, low back, sacroiliac or hip diagnosis, urinary or bowel frequency, constipation or irritable bowel or bladder disorder, interstitial cystitis, and post-partum scars from tearing during childbirth.

Let us help you with these very personal problems today. So get a move on receiving help or recommending anyone you know to a specialized PT. We will make you feel comfortable in more ways than one!

Ann Duffy, M.A., P.T.

Owner & Pelvic Floor Expert

Ready, Set, Go The Distance Injury Free!

 

Are you preparing for a marathon, half marathon, 10k or 5k? Let the experts at Duffy & Bracken help you get ready for your race with our Marathon Training Program. We have put together a dynamic team of therapists to help our patients prepare for their race as well as prevent injuries.

Here at Duffy & Bracken our therapists want to see you perform at your best, so they have arranged an incredible package to get you ready for your chosen race. Since every individual has special needs and are at different fitness levels, we give you the option of choosing three out of the four available sessions. You have the power to decide what sessions you would benefit the most from based on your areas of strength and weakness.

Marathon Package Session 1:  “The Rub Down”
This 50-minute massage will utilize both deep tissue and medical massage techniques to restore your optimal performance. Physical Therapist Johann Howard helps to reduce pain, facilitate increased range of motion and improve tissue quality.

Marathon Package Session 2: “Body Fuel”
This 20-minute session will include tips on performance eating, proper hydration as well as suggestions on the finest supplements such as; gels, chews and recovery drinks. You will receive nutritional advice from physical therapist and avid runner, C. Shante Cofield. Since Shante is always training for her next race, she knows where you’re coming from. She’ll provide support, motivation and recommendations on informational reading about running.

Marathon Package Session 3: “It’s a Marathon Not a Sprint”
This 30-minute session will start by assessing your current training program. It will include a gait analysis, running stride and lower extremity mechanics evaluation. For optimal running the session will include core training and lower extremity strength training. Internationally trained therapist, Renuka Pinto, has been working with professional athletes for over a decade, so she won’t have a problem whipping you into shape. She’s our foot expert, so she will also make shoe and socks recommendations based on your individual foot type and running style.

Marathon Package Session 4: “The Finish Line”
This 20-minute post-marathon session will evaluate you after the race. It will include both corrective exercises for common running injuries as well as preventative exercises to avoid future injuries. Our therapists will be here to patch you back up and get you into a treatment plan if needed.

For just $250 we help prepare you for your most successful race yet. Whether it’s your very first race or you’re a veteran, we can help you cross the finish line injury free.

Call the office to reserve your sessions today!

Kieffer Pearce
Director of PR & Marketing
212-402-5430

Help Us End The Unfair Practice of "Specialty Copays"

A Bill (S.2319/A.1666) put forth by The New York Physical Therapy Association (NYPTA) is on the current NY State Assembly agenda and we need your help to get it passed. The unfair practice of so-called "specialty" copays is costing patients in dollars and forgone treatment, leaving New York State with a more costly and less effective health care system. 

Managed care companies continue to restrict access to physical therapy services by imposing "specialty" copayments of $40-$50. As the patient you maybe paying $50, while your insurance company is paying the physical therapist $5 or $10. Managed care health insurers have designated physical therapists as specialists for copayment purposes, allowing health plans to charge patients more per visit while maintaining reimbursement levels to physical therapists at 1980's levels, shifting more of the cost burden onto the backs of consumers and pushing PT's near bankruptcy.

These specialty copayments add up for New Yorkers, since physical therapy frequently requires multiple visits over an extended period of time as the practice of physical therapy works in conjunction with the healing process. In 10 visits the patient may pay ($50 X 10) $500 while the insurer pays ($5 X 10) $50. You have a COPAY and they have a Nopay.                                       
The bottom line is this: HIGH COPAYS HURT PATIENTS

The bill is currently in committee and we need your help to move it along. Please call your NYS Legislator and tell them to stop high copays for physical therapy care and to support S.2319/A.1666. This will help end the imposition of additional copays on New Yorkers for physical therapy services.
Sincerely,
Ann Duffy, MA., P.T.
Owner, Duffy and Bracken Physical Therapy


 Ways You Can Help!  

Talking Points for High Co-Pay Legislation - S.2319/A.166

Find your NYS Legislator

ELIMINATE WORKPLACE ACHES & PAINS!

Please allow me to introduce myself, my name is Julie and I recently joined Duffy and Bracken, PT. I practiced as a physical therapist for 7 years in Seattle Washington before moving to Downtown NYC. One of my specialties in Seattle was workplace modification and 5-hour return to work testing. These included activities such as touring a sawmill to adjust a workstation to accommodate an injured shoulder patient to modifying the internal organization of a police car to accommodate a low back patient. While the average New Yorker I currently treat is not in an industrial occupation, workspace modification is no less important. You spend 8-10+ hours a day at your desk and the more efficiently you set it up, the less stress you will experience on your neck, back and arms.

Here is a little test – can you sit with your back straight and feet flat on the floor for 5 minutes without fidgeting or adjusting and without an increase in pain? If you cannot then your core musculature does not possess the endurance for an 8 hour day in a chair.

Ergonomics strives to keep your joints in a neutral position to minimize the stresses on the muscles and ligaments. People come in different sizes so no two desks should look alike. Here are some suggestions for easy adjustments to your desk:

Adjustable Chair

When you are sitting your knees should be bent at a 90-degree angle with your feet resting on the floor. If you are petite and can lower your desk this is ideal but most desks do not have modifiable heights. If your feet do not touch the floor, bring the floor up to your feet with a footrest or even a small box.

The end of your seat should reach to four finger lengths to the back of your knee. Any farther forward can pinch nerves in your leg and make it uncomfortable to sit. Legroom under your desk should be at least 60 cm to allow for easy foot movement.

The backrest should be adjusted so that there is a convex surface supporting your low back. (If your chair does not have this I would suggest an adjustable lumbar support, which we stock here at Duffy and Bracken).

The arm rests should be positioned so that your elbows are slightly forward and bent at near a 90-degree angle.

With Foot Rest

 I am asked a lot about therapy balls as chairs. While I think this is good for watching TV, spending 8 hours a day on a therapy ball requires a lot of core endurance. If you would like to sit on a ball at work I recommend keeping a chair nearby for when your back becomes fatigued.

Keyboard

When you are typing your wrist should be supported and your elbows should be at a 90-degree angle. Because your arm rests should also support you at a 90-degree elbow angle it sometimes comes in direct conflict with your keyboard. I would suggest table length arm rests (they are shorter and allow you to push your chair up to the desk) on your chair or none at all if you are mostly on the computer or writing while at your desk.

Mouse

A traditional mouse used to control your cursor can add increased stress on your arm and shoulder because you have to elevate your arm for long periods of time. I recommend a trackball mouse. Your hand rests on the mouse and your thumb moves a roller ball that controls the cursor. They are inexpensive and your neck and shoulder will thank you.

Computer Screen

When you sit upright at your desk your eyes should be level with the top line of your screen. It is much easier for your eyes to track inferiorly without affecting your neck posture than it is for your eyes to track superiorly. If your computer screen is too high we tend to push our head forward and angle our head upwards, which tightens the back upper neck musculature. This is a good time to walk around your office and see your co-worker’s computer posture.

If you have a laptop it is harder to modify. I suggest putting it on a pedestal to raise the screen up and buying a wireless keyboard. 

 

Divide Your Desk Into Angles

Items that you use constantly should be within a radius of 50 cm – which means you do not have to reach far or rotate your body to grab them.  Items you use less can be a short reach away. 

Standing Desks

If you do a lot of reading you can make yourself a standing station at your desk. The optimal reading angle is with a 45-degree slanted desk and if you are writing the optimal angle for your elbows is with a 15-degree slanted desk. 

Unslanted Desk

 

Breaks

Most importantly you need to get up and walk around to give your body breaks from being in one position. Most people become so engrossed in what they are doing that they forget so I propose setting your cell phone to go off every 1-2 hours. A 5-minute walk around your office will help clear your head and give your muscles a chance to relax.

If you have any further questions about how to modify your workstation or you want a professional to assess your sitting ability, please do not hesitate to see me here at Duffy and Bracken, PT.

                                                                                                                                  

Julie Garner, DPT, COMT, CCI

julie@duffyandbracken.com