Ladies, Listen Up, Do Your Kegels!

I used to think kegels were for women with 5+ kids.  An up close and personal journey has taught me that, nope, they are for women just like me! I am a physical therapist recently moved from Orlando, FL to New York for my husband’s job transfer, and decided to venture into the “pelvic floor world” of therapy. I am a very active person, I go to the gym 4-5x a week with a variety of cardio and weights, and had an uncomplicated vaginal delivery two years ago.  

 As part of training for my new pelvic floor concentration, I used biofeedback equipment to test my kegel strength and coordination. While I wasn’t expecting high scores, I was shocked to see my poor attempt at a kegel looked more like a muscle twitch on the biofeedback graph.  And to top it off, I used every muscle in my lower body to get a whopping score of 9! Just to give you a frame of reference, that is about 25% of the normal value for women. I have since devoted 20 minutes a day to kegeling and am happy to say my scores are climbing quickly and are now around 25.

I should point out that I had absolutely no symptoms of incontinence, and therefore if not a PT would have never sought out pelvic floor therapy. I am very fortunate to have discovered my weakness prior to symptoms, because with my 2^nd pregnancy in progress and such poor pelvic floor strength, I would say incontinence was in my near future! I have since started telling all of my family and friends to do their kegels! And with talking about kegels I have found that a lot of women had the same ideas that I did. “Those are for my grandmother!” “That just comes with pregnancy” “Incontinence runs in my family.” And my favorite one from my mom: “You’re a physical therapist, so why are you teaching people to kegel? And how exactly are you doing this?”

I use my personal story as an example of why women should be proactive about their health. Let’s stop dismissing incontinence as just one of the effects of pregnancy or age, it doesn’t have to be! Your pelvic floor muscles are just like any other muscle; they need attention, time and consistency. And, yes, physical therapists treat pelvic floor muscles just like any other muscle in your body. If you’re a numbers person like me, call our office and schedule an appointment with one of our pelvic floor therapist and get your baseline scores and set goals for yourself. Or just start kegeling! You can start with quick contractions x 20 reps and endurance contractions up to 10sec x 10 reps and repeat this 5-10x a day. You can do it on your commute to work, while you watch TV, shower or at the gym.

 

 

 

 A quick summary:

 What is a Kegel?

·       A contraction of the pelvic floor muscles

 Purpose of the Pelvic Floor

1.    Support- acts as a sling or “hammock” to the bladder, uterus, intestines

2.    Sexual function

 Importance of a strong Pelvic Floor

1.    Supports healthy pregnancy, successful birth and minimizes postpartum complications

2.    Increased sexual pleasure

3.    Minimizing problems with urinary incontinence

4.    Decreasing risk for prolapse

                         

    

Candice Amat, PT, DPT
212-402-5430 

PREGNANCY: The Joy of Giving Birth!!

I started to write this blog the last week of work before going on maternity leave and then nature intervened --- so I finish this blog staring at the face of my second child quietly sleeping in her crib.

When I went through my first pregnancy I was determined NOT to be a victim to pregnancy related musculoskeletal problems, which we treat at our practice. There is nothing more moving than to see someone pregnant and suffering with sciatica, low back, pubic bone or neck pain or an inability to walk pain free… not because they are weak but mainly because they feel it is normal.

Pregnancy is a joyous moment and every pound that one gains (trust me I know I gained more weight with my second) is towards growth of a child they bear. So I put myself on an exercise regimen contrary to the popular ones like viz. yoga and Pilates. Instead I put myself on functional strength and balance exercises to help me cope with the changes happening to my body. After a successful pain free first pregnancy I devised P3: PLAN PREVENT PREPARE! And launched the program in 2012, the program is based on the science of movement, biomechanics and exercise.

So as I went about caring for my newborn and being a full time PT – I got back to my old weight and went about my business. Then in late spring last year --- I was pregnant again. This time I put myself on the P3 program like I had advised all my patients for the past two years. With pregnancy number two I was much bigger and gained 10 pounds mostly all in my belly. I am five feet tall and weigh 104 pounds –so walking around with a belly girth of 44 inches and working as a PT ---was no joke! Most colleagues and friends who compared me to my first pregnancy were shocked.

But let me be a testament to myself and all the other pregnant women out there who embraced the P3 method --- I had no back pain and no sciatica. Although I did have three groin spasms that I needed to stretch out -- all of my own doing trying to sprint walk across Broadway at 35 weeks to make a light (silly in retrospect).

So yes I did have a joyous birth experience --- where I could rely on my body – those strong core muscles that held the baby in place, those sling pelvic floor muscles that provided a hammock, those gluts and oblique’s that prevented me from waddling, those scapula stabilizers that allowed me to be a manual therapist. The list is endless....

So to all the women out there ---pregnancy does not have to hurt your muscles and joints. There are ways to turn in bed, walk, maintain good posture, sit on a toilet, dress and choose footwear --- so that you can have a joyous birth

Come visit us --- we can show you how!!!

Renuka Pinto, MPT, PGDR, CSCS, CES

Comments: contact our marketing person at info@duffyandbracken.com for a P3 Method Brochure

What Kind of Old Person Do You Want to Be?

My husband Paul and I have quite the long and active bucket list, which we have been busy checking off. Now, we are not dying but given the inevitable, we decided to make a list of things we wanted to do before that day. As a physical therapist, I have an understanding of the aging body that has made me realize we should set a time line. I have also seen a great variety in this aging process and it is not all genetics but also very active-dependent. 

So about 10 years ago, after noticing that my husband was ignoring my workout suggestions (as husbands do), I finally pushed the right button. I said, “Paul, with all your plans for the next 50 years, I was wondering what kind of old person do you want to be?” This got his attention! He wanted to know more. So I explained what sitting at a desk for 10-12 hours a day would do to him. I went on to describe how working out only certain areas of this body (pects, lats and rectus abdomens with push ups, pull downs and sit ups, plus 20 minutes on the stair mill 3-5x a week) although good in many ways was also causing imbalances in his body. These imbalances would probably end up in joint problems in his neck, shoulders, back, hips, knees and feet and eventually hip, knee, shoulder or back surgeries and maybe even joint replacements. These life-changing events might get in the way of his biking, skiing, water skiing, tennis, golfing, climbing and hiking.

I definitely had his attention and Paul, agreed to let me help him get properly evaluated and instructed in a balanced exercise regime which included a FMS (functional manual screening), sports performance improvement program, functional training, strengthening, balance and stretching. This has resulted in performance improvements and a couple of minimal injuries, which consisted of a minor calf strain and a few fractured ribs showing off how low he could get to the water while water skiing.

Without these improvements Paul may not have been able to fully experience Kilamanjaro, the Everest base camp, Fitzroy and Torres del Pain in Patagonia, the Milford pass in New Zealand or 54 holes of golf at St. Andrews in 12 hours this past August for his 54th b'day just to name a few. I am sure as he continues his program he will complete this ever-growing bucket list and be the kind of older person he envisioned. 

 How does this story affect you? 

Well, along our travels we met some people who were unable to accompany their partners up the mountain due to injuries or they were just not fit enough. Bad knees and backs now limit others we know who thought they were fit. Unfortunately, now that they have the time to travel they are no longer able to climb up to see the sites or are unable to play golf without a golf cart. 

How can you be the kind of older person you want to be and when should you start thinking about this? 

Now is the answer and Duffy & Bracken can help you design a customized program. 

• An FMS delivered by a highly skilled physical therapist will give you the knowledge to empower you to get on the right path. 

• A performance improvement program - if you play a sport - will give your body the right tools to begin performing the skill you have been having trouble with, no matter what sport or coaching you have tried. 

• GTS classes will give you a balanced exercise program and teach you how to exercise in a balanced way, push yourself and get results. 

• Happy Feet will evaluate and teach you how to take care of your feet by wearing the right shoes for you. 

• An Ergonomic review for your home or office desk will help you get the right set up to avoid straining your body 8-12 hours a day. 

Let us help you, help you!

Ann Duffy, P.T., M.A

If you would like to read another story of the importance of a FMS evaluation, balanced exercise programs, balance and stretching click on this link and see how these same principles are being used to reduce Standford’s football team injuries from 18 to one a year. …

Building a Successful Therapeutic Relationship!

The patient-therapist relationship is vital to the success of the patients' plan of care. Although that theory may seem obvious, the value of a functional relationship between a PT and their patient is sometimes neglected whether consciously or unconsciously. Good service is invaluable!

So how do we develop this relationship?

Open Dialogue: From the initial evaluation all the way to discharge, therapists and their respective patients should be continuously discussing the progression of their therapeutic program. Therapists should be assessing what's giving positive results, no results, or negative results.

Education: Therapists should be consistently keeping their patients aware and engaged by educating them on what may be causing any symptoms, the plan to treat it, why they're doing what they're doing, and what to expect from it all. Being that a therapeutic program has time limitations, it's also quite essential and beneficial for the patient to be given lasting information to take from their care in order to be responsible for their health in the forthcoming days after they have been discharged.

Accountability: On the other hand, therapists are not the only takers to responsibility. Patients MUST be willing to trust in the therapist's creative plan, follow the therapist's guidance, and take the initiative to perform their Home Exercise Program (HEP) regularly. Patients should be open enough to tell therapists how they feel about their current treatment program. I ask my patients how they feel about their treatment at almost every subsequent appointment.

When there's a good communicative relationship between the two parties, it creates a larger potential for a successful therapeutic experience even if physical therapy is determined to not be the cure to their specific disorder. As a Physical Therapist, I think I can speak for a grand number of other therapists when I say we find gratification in gratifying. Personally, it serves as a humbling reward for a patient to express gratitude for how they were treated throughout the patients' tailored program. It is the fuel that keeps my wheels turning (or my hands mobilizing to keep things in perspective).

 

Clifford Civil, PT, DPT, ACSM-HFS

clifford@duffyandbracken.com

Ski Season: A Guide to Preparing for the Slopes!!

I am so excited for ski season this year but before I hit the slopes I want to give some friendly advice to all of our patients on how to avoid an injury!

Here are some very scary statistics for you type 'A' personalities:

Half of all ski injuries involve the lower extremity (hip/knees/calf/ankle/foot) and about 1/3 are upper extremity (shoulder/elbow/hand/wrist) - the rest are back/trunk injuries and head injuries. Head injuries are almost twice as common as back injuries so wear your helmet!

With snowboarding, 2/3 of all injuries are upper extremity. Usually from falling on our stretched hands – wrist guards can significantly decreases the chance of a wrist fracture. Also if you plan on doing tricks, snowboarders are 3x more likely to be injured while jumping than skiers.

Now that everyone is properly scared here are some tips to prevent you from becoming one of the above statistics:

• Stay active! It takes a lot of endurance to ski down a hill and once you are at the top there are only two ways down – ski/snowboard or being sled down by ski patrol (yes I have had to do this – meniscus re-injury!) Start small – if you can keep a conversation while you perform your cardiovascular exercises then you are working at a good level.
• Stay flexible! While you do not need to be like Gumby, snow sports take a lot of movement.

1. Quadriceps – hold your ankle to your hip and push your pelvis forward
2. Hamstrings – sitting in a chair, put your leg straight out in front of you, heel on the ground, and lean toward your toes 
3. Iliotibial band – cross one leg in front of the other and push your hip out to one side
4. Hip rotators/low back – Lie on your back with your knees bent. Let your knees fall to one side. Hold for 30 seconds and repeat on the other side 

• Stay strong! I don’t want to hear any whining about being sore after skiing! 

1. Quadriceps – Squats 3 sets of 10. To add more strength, I add 5 seconds holds when my patients are ¼ their normal depth. This is to reproduce the stance posture you have when skiing or snowboarding. This can also be done on a BOSU ball (black platform side up) to make it harder and to insure that both legs are working equally 
2. Hamstrings and glutes – Lunges 3 sets of 10 to make things harder use a BOSU ball to lunge onto the blue dome side 
3. Core – Planks, hold 1 minute, repeat 3 times. On your toes and hands, push your body up. Do not let your back/hips dip down toward the floor.

• Improve your balance! It is always helpful to be upright while you ski! Stand on one leg (near something you can hold on to) for 30 seconds at a time - repeat 4x on each side. To make it harder you can stand on a pillow/BOSU ball or even close your eyes. 
• Be able to jump (a lot)! You will need to be able to jump and land at times on the slopes to turn or to impress your friends in the “trick park”. 45 degree stair jump – Start on the bottom of the stairs with your feet at a 45 degree angle from the stair then jump up one stair and land with your feet at the opposite 45 degree angle. 

Remember to warm up before you start on those black diamonds and no, this does not mean drinking cups of hot chocolate at the lodge. Now if you feel that you have been a couch potato since last season, may I suggest one of our Gravity Training System (GTS) classes. Each class has a three person maximum with a trained, experienced, wonderful instructor. A couple of classes before ski season will insure that you look fabulous on the slopes!

Let it Snow!!

Julie Garner, PT, DPT, COMT, CCI

julie@duffyandbracken.com

D & B NYC Marathon Champions

Congratulations to all the Duffy & Bracken patients who participated in the 2013 ING NYC Marathon. 

We are proud of all of your hard work and dedication. 

Thanks for allowing us to help you get ready for the race!

Finish time 3:39:00

Mile 18 and still smiling

Finish time 5:22:45

D & B therapist C. Shante Cofield, DPT finished in 3:55:51

 

 

 

Great Expectations: How To Pick A Physical Therapist

As a physical therapist, all too often I have new patients come in who tell me that they’ve tried physical therapy in the past for six, seven, eight plus months, with basically nothing to show for it. The two questions I always ask these patients are: “What did they do with you?” and “Did you think that what they were doing was helping?” While I don’t expect patients to remember every detail of their PT regimens, they should be able to say with confidence whether or not they felt that PT helped them. For those of you reading this who can align yourselves with the plights of those poorly-served PT patients, I’d like to offer you these few pointers to help ensure that your next PT encounter doesn’t leave you feeling like all you’ve managed to accomplish is throwing a few dollars at that high insurance copay or deductible.

Your physical therapist should be:

1. Present – Your physical therapist should BE PRESENT. If your therapist is spending 5 minutes with you then passing you on to an aide or trainer never to be seen again, it’s time to look for a new physical therapist.

2. Hands-on – While physical therapy does emphasize exercise and therapeutic activities, the manual techniques employed by your therapist can greatly help accelerate your healing process or correct dysfunction that could lead to injury down the road. If the physical therapy that you’re used to centers around ultrasound, heat packs, and stim, (electrical stimulation) with the therapist basically spending three minutes giving you a bad massage, it’s time to look for a new physical therapist.

3. Approachable and Informative – Too scared to ask your therapist why they have given you a specific exercise or why they are using a specific manual technique? You shouldn’t be. While the busy schedule of a physical therapist does not afford them the opportunity to spend hours upon hours with each patient, a therapist should be both willing and able to answer any relevant questions asked (and not asked) by the patient, within the allotted time.

4. Creative – Don’t expect a poetry reading when you go to physical therapy, however, your physical therapist should be able to provide you some variety with your exercises and treatments. If you’re doing the same exact thing at every session, for weeks on end, with no progression and no improvement in your symptoms, it’s time to look for a new physical therapist.

5. Competent – It goes without saying that your therapist should know what they’re doing, however, it is important that you feel confident in their competency. I’m not advocating that you base your physical therapist selection on their pedigree or how many letters they have after their name, but the manner in which they explain things to you, the exercises they prescribe, and the manual techniques they perform should all instill confidence in you that they can help you achieve your goals and improve your symptoms.

Here at Duffy & Bracken each of the physical therapists on staff bring with them all of these characteristics, and many more. However, my intent is not to tout how much better our practice is than others out there. Let this blog simply serve as an informative piece for anyone who has been to PT, is currently attending PT, or is looking for a physical therapist and wants to ensure the quality of services being offered. 

It’s your body. It’s your health. Choose wisely!

   

C. Shante Cofield, PT, DPT, CSCS

Duffy & Bracken Physical Therapy and Wellness

Carmen@duffyandbracken.com