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

Strengthening Your Weak Link!

Kinesiology is the study of movement. It is what physical therapists are experts at. In kinesiology, a leg or an arm is often referred to as a "chain." The reason being is that a leg or an arm is comprised of parts with links, those links being joints. Muscles originate on a bone, cross a joint and anchor on another bone so it can stabilize and move a joint. So when we hear the expression, "a chain is only as strong as its weakest link," we could easily apply that idea to a human chain. That's a very important concept especially if you are an athlete. 

Aside from being a Physical Therapist, I have been an avid martial artist for a good 20 years. In that time I have suffered a nice bouquet of injuries; everything from a broken bone, to torn muscles in my mid back. After a four year hiatus, I recently joined a new martial arts school. I wanted to see how well prepared I was physically to go back into this very demanding activity so I had myself evaluated by Renuka Pinto (the supervising PT here at D and B) using the Functional Movement System (FMS). The FMS system, is a movement screen that is often used to assess an athletes' quality of movement by studying each kinetic chain. It can also be used on a non-athlete to evaluate how well they are functioning in their body in terms of movement. The individual scores are added together to create an overall final score. The FMS helps to identify not only the athletes limitations or weakness but also the compensations that cover up those weaknesses. The test takes about 20-30 minutes. It is broken up into subsections that look at very specific movement patterns. What's great about the FMS, is that not only does it identify these weaknesses, with each section, it will also give specific exercises to help improve the areas the athlete is weak in making it a very clear systematic approach.

By the end of the test, I had a good idea of where my weak links were. Renuka and her student (Karen), gave me exercises to improve my weakness and  enlightened me on my compensations. So not only will the FMS help refine whatever game you compete in, but more importantly, will help identify what injuries you are predisposed to. Whether you are a golfer that wants to improve that vital finite control in your swing, or you are an Ironman competitor that is looking to improve your endurance, the FMS will help you improve your practice and prevent injury so you can keep doing the game you love to do... So for all of you athletes out there that are preparing for an event or want to maximize your chances of preventing injuries I would highly recommend the FMS here at Duffy and Bracken. It is one of the many programs we offer to try to maximize how we can help you. If you are interested, ask anyone of us and we'd be happy to answer any questions. 

 

Happy Training!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Johann Howard, DPT, LMT

DIARY OF A PREGNANT THERAPIST!

For my last blog before going on maternity leave for the first time, I felt inspired to share some reflections related to my experience during pregnancy which has enhanced my insight as a physical therapist. This may peak the curiosity of others interested in the topic of pregnancy or even on the topic of creating new physical experiences.

As I have undergone childbirth preparation classes and read material on natural childbirth in hope of promoting a birth experience as normal/natural and, believe it or not, enjoyable as possible, it has been repeatedly pointed out that the prevalent portrayal of childbirth as a painful and dangerous experience has created a fear of this experience and belief that this description is inherently true. Thankfully, there is a widespread body of resources that helps to transform these beliefs into confidence in a woman's innate ability to birth. This makes a very simple point that fear of the birth process creates resistance to and intolerance of the physical experience of labor, and that by both understanding the physiology of normal uncomplicated labor and trusting the natural ability of mother and baby to safely complete the process, this fear can be eliminated, allowing an entirely different birth experience to unfold.

So though one of the hottest topics during pregnancy is the birth itself, there is a lot of "story" about what "happens to" a woman's body during pregnancy as well. A conversation develops about the potential dangers of childbirth as well as the potential for injury due to pregnancy. This includes not only impact on the mother's body during birth but during pregnancy and in life after pregnancy. What I found novel is that while it is well established that these unfortunate perceptions of childbirth are prevalent in modern civilized societies, so might our perceptions of the experience of carrying a child before and after birth be influenced by cultural expectations. What became tangible for me was that much like I wanted to undo my learned cultural beliefs about childbirth, I could change my perception of what my body was experiencing as pregnancy progressed. Though I felt that I possessed helpful knowledge that would enable me to care for myself and "prevent injury", I still needed to believe in nature's design just a little more.

To build upon this conversation, I would like to also point out that so far the conversation is talking about the mother as a pregnant individual, not a mother and child living, moving, birthing, and continuing to live together with ease, harmony and comfort, and actually establishing a relationship (though perhaps not with a lack of new sensation and experience for both parties).

Let me illustrate what these changes in perception boil down to for me. There were times I was distressed because of pain while walking. However, as the baby grew it dawned on me that I was already the mother of this baby.Then a bigger picture emerged illustrating that just walking down the street pregnant was at this stage already an activity in our parent-child relationship. I began to realize that it made sense that I could move in a natural way (though perhaps slower) with her (yes, it's a girl!), and not only feel less pain but feel happy in my new relationship. Sensations that I felt as physical stresses (abdominal muscle strain, pubic bone pressure when I walked or sacroiliac pressure with changing positions) began to be perceived differently- as evidence that my baby was resting on certain body parts of mine or guides for me to move with more mindfulness. Feeling “out of breath” and extra work in my legs going up stairs changed into “taking in more air” for the two of us.

Now am I saying that pain is all in the mind? No. Have I enjoyed the benefits of physical therapy to prevent, prepare and manage? Absolutely! Though attention to physical wellness continues to play an important role, what has also contributed to me feeling better and better while walking and moving are perceiving things in the following ways:

1. RELAXING and trusting that my body can "carry" my baby without additional effort or injury if I let it. In the early stages I noticed that as I walked there were times I tensed muscles around my waistline and in my hips, exerting effort to “carry the baby”.  When I realized I could relax all those muscles and move in a way that was harmonious with her, I soon saw that my body did not feel added stress. 

2. Building on the point about relaxing, being sure to BREATHE PROPERLY. Though the growing uterus takes up space near the diaphragm and ribcage, the diaphragm can still do its job. A breathing pattern which primarily originates in the diaphragm and is not restricted by tension in the shoulders, ribcage, abdomen or pelvis is an essential component of efficient posture. Being able to maintain efficient breathing is a good sign that you are feeling good!

3. TAKING TIME to move, whether it’s getting up, moving in bed, walking or squatting, not just because of being heavier or that it’s “harder”, but because “moving for two” may take that extra bit of mindfulness to negotiate how to move in a way that is kind to my body. I’m not saying that you couldn’t still run in the Olympics if you wanted to, but as for me, no more running for the bus!

As a PT, I have learned important lessons from experiences as the caretaker of my own human body which enhance how I help others help themselves. Whether you are carrying a baby in your womb, a child in your arms or even bags of things in a city schlep, I invite you to create a new language for what it is you are doing. Is there some way you could create more ease for your body, create more harmony between you and the person or things you are carrying, or learn to trust your body more? Time and time again it is a relief to find out that breathing easier and relaxing more creates more efficiency, comfort and pleasure in the body. If you are unsure of how to create ease in your body - pregnant or not - schedule an appointment with a physical therapist...we can help!

Sara Chan, PT, CFMT

Sugar Uncovered: Don't Make These Mistakes!

In the last few weeks there has been a lot of buzz around sugar because of the law that Mayor Bloomberg is trying to pass limiting the sale of large sized sugary drinks. As a health coach, I have had many people ask me about sugar and its effect on the body. The short answer is frequent consumption of sugar leads to weight gain, lethargy, and mood swings. Prolonged overconsumption can lead to obesity, diabetes and heart disease! How could such delicious treats cause so much harm?

The challenging part is that sugar has become part of our cultural DNA, which makes it almost impossible to avoid completely. Every holiday has its special sweet. When we mark significant life milestones - birthdays, graduations, weddings - cake takes center stage. Children do well on a test; we reward them with ice cream. When I walk around the streets of NYC, there are frozen yogurt shops and cupcake cafes popping up on every corner. We are surrounded by it!

But aforementioned sweets are not the only sugar culprits. The obvious treats are easy to spot and we can try to avoid them. But what happens when we THINK we are making a healthy decision BUT we are actually ingesting large amounts of sugar and don't even know it!

Don't be duped by these seemingly healthy but sugary favorites:

• Sauces/Glazes - Many times to get that perfect complement to your savory dish, chefs will add a sauce or a glaze. But beware, many glazes have added sugars. So that soy glazed salmon dish you love may look like the healthier choice but could have over20g of sugar...more than 1 chocolate glazed doughnut!
• Yogurt - This delicious snack can be very healthy but beware of yogurt with added fruit. Yoplait strawberry yogurt has 26g of sugar...as much as a Snicker's bar! If you are going to eat yogurt, eat the plain and add your own fruit for the touch of sweetness.
• Granola - Eaten by hippies for years...it must be healthy right? As it turns out, Kellogg's Original Granola has 17g of sugar...as much as 3 chocolate chip cookies!! If you are going to have granola, either make your own or be sure to check the labels for lower sugar options.
• Coffee/Iced Tea -I was floored when looking into coffee drinks and iced teas. I never thought twice about these, as they were obviously the healthier choice to the dreaded soda. Wrong!  A Starbucks Grande Cafe Mocha has 33g of sugar, which doesn't include any flavor shots, or sugar people add after they get it. If you are going to drink coffee or iced tea it's best to have it black/unsweetened.

Knowing a few of these sugary pitfalls will hopefully help you to make healthier, informed decisions. At 1 Healthy Life we know that it's easy to get off the healthy track and sometimes difficult to find your way back. That is why we work with people to help them take small steps(like cutting out sugary drinks) now that lead to BIG changes in your health later.

Working with a health coach will:

• Help you to truly identify realistic, attainable health goals
• Develop a customized plan that will step you toward your goal over a series of sessions
• Hold you accountable (in a loving way) to those goals week after week
• Identify if there are certain steps that are not working for you and help you to modify the plan so it works specifically for you. Not everyone is the same...therefore, no plan is going to be exactly the same

1 Healthy Life has partnered with Duffy & Bracken Physical Therapy to develop a program that is the one...two health punch combining wellness & exercise. In only 3 months you will have a Total Health Transformation! We will dive deep into eating right, reducing stress and improving your energy while Duffy & Bracken trainers will kick your butt on their Gravity Training System to improve your muscle tone, flexibility and overall physique.

You only get 1 life; why not make it your best life possible? And you can...with small steps and support along the way.

Schedule your 1 on 1 complimentary health breakthrough session today. What do you have to lose?

Mina Penna, Holistic Health Coach

Mina Penna is a Holistic Coach who works with clients to help them reduce stress, improve their energy, find more balance and lose weight. Mina was certified at the Institute of Integrative Nutrition and is a member of the American Association of Drugless Practitioners. Additionally, Mina is the Corporate Nutritionist for Sabra Dipping Co., LLC.