What you should know about Prolapse

Prolapse is a common issue post partum that is not talked about enough. The definition of prolapse is “a protrustion of bladder, uterus and/or rectum into the vaginal wall”. This commonly occurs during pregnancy, labor or with chronic constipation. Common symptoms are a feeling of pressure or falling out in pelvic floor, sexual discomfort and/or incontinence. These symptoms typically get worse in the afternoon or evening time and feel better in the morning.

The first thing you should know about prolpase is that it happens at varying degrees and being aware of your degree of prolapse is /the first step! Yes, prolapse can get so bad that the protrusion into the vaginal wall extends outside of your vaginal opening, BUT just because this isn’t happening to you doesn’t mean you don’t have prolapse. There are things you can do NOW to prevent your prolapse from getting worse and to limit your symptoms.

I frequently have patients coming for incontinence, pain or weakness and during the initial assessment I find they have a prolapse and no one has told them. That’s great they are in my office to learn what to avoid and how to “treat” their prolapse, but what about all the others who aren’t getting to a pelvic PT? They are being told its okay to resume normal activity and even worse RUN, not knowing they could be making their prolapse worse!

Here is what I tell my patients:

-          Your pelvic floor is under the force of gravity when standing and sitting; you need to lie down (even better on an inversion wedge) to give your pelvic floor a break.

•  In the first 3 months post partum I recommend doing this every couple hours or as soon as you feel “pressure” symptoms returning.
•   Remember if you are baby wearing then this will increase the pressure on your pelvic floor which can worsen prolapse; this includes carrying an older sibling too!  So be even more mindful of “pressure” symptoms and lie down when needed. I found this much more difficult after my 2^nd was born because all of my “down time” from the baby I spent with my 2 year old. Bottom line- make sure you are listening to your body and taking care of yourself!
•  Kegels are great for strengthening your pelvic floor and vaginal wall which will give more support to your prolapse. Do 80-100 kegels a day and even better do them lying down or on an inversion wedge.  If you still have prolapse symptoms on a daily basis then do not run or do any impact sports; this will likely worsen your prolapse.  
  
•  Keep focusing on kegels and inversion! If you get to 6 months post partum and are still having symptoms see a specialist to discuss a pessary. A pessary can help your symptoms and allow you to return to exercise such as running.
• Do not strain on the toilet!

           

            Candice Amat, PT, DPT

               candice@duffyandbracken.com

  

Gravity: the constant

It’s been over two years since I have immersed myself into the Gravity Fit system. On reflection I feel I missed acknowledging the obvious and its worth for the first 15 years of my clinical practice.

The obvious being gravity is the ONLY constant in your life. It's dependable, it's unchanged, it's predictable and it's the same all over the world at any given time.

But what changes is its effect on you and your interaction with it during life. When you were a baby you had to overcome and learn to hold yourself up to gravity. You practiced and fell down a couple of times until you got proficient to be able to turn, walk, run and jump.

Your joints and gravity found a balance and harmony -- you moved and negotiated movement through gravity’s force.Then came sitting for hours at school, infront of the TV, the computer and smartphones. The age of technology caused us to lose our relationship with gravity as loss and lack of motion caused us to have loss of sensitivity to its force.

Yes, you lose the ability of your anti-gravity muscles to support you. So when you run or jump or walk or turn in gravity without being sensitive to its force --- you hurt yourself.

Not to mention while you age and become less supple in your ligaments your joints degenerate while gravity stays constant. To help combat this at Duffy and Bracken we have two gravity programs that we offer our patients- Gravity Fit and Gravity Training System (GTS). Your hands and corrective exercises provide the ability to align yourself with the force of Gravity, then these programs turn on the muscles needed to maintain this relationship and combat the adverse forces of a sedentary lifestyle.

So my motto " the sooner you get into a HAPPY relationship with gravity the less movement problems you have in your lifetime "

Renuka Pinto, PT, MA
Clinical Director
renuka@duffyandbracken.com

Health Insurance vs Health Assurance

It's a perspective on the Quantity to life vs the Quality of life.

We always prepare for the worst and roll with the punches! And we use the same approach for our health.

We have health insurance for all the possible things that can wrong and we get an annual physical, annual dental and get screened for cancers.Then we sit back and roll with the punches.

We accept the low back stiffness, neck pain, headaches, rickety knees and tight hips. 

What if you had health assurance? Then you would enjoy the QUALITY of life rather than the quantity.

So when health expenses is your number one expense--- don't you want to be in the driver seat?

Here's how you can do it:

1. Screen the system you use the most-- your muscles and joints

2. Find out how you place within your age group

3. Change the future by investing in the present

Here at Duffy and Bracken we offer wearable sensors technology to measure the movement of your spine and impact on your joints. Then we provide solutions to help keep them healthy.

Our approach is specific -- it's individual --  it's scientific --  it's quantitative -- it's innovative -- it's the future!

We believe you can have a pain-free life if you move efficiently.

Why not check your score and improve your game plan!

Renuka Pinto, PT
Clinical Director 
renuka@duffyandbracken.com

Protecting your package

Testicular Pain in Men after exercise

There is no denying the numerous benefits that exercise has to offer. It helps to increase your energy level, improve muscle strength and helps to maintain a healthy weight just to name a few. For some men a high impact or high intensity workout is your way of reaping those benefits. But as a physical therapist who specializes in Pelvic Floor dysfunctions, I remind my patients to protect your package.

What do I mean by that? Some of these high intensity or high impact exercises can lead to testicular and groin pain in men. It can be accompanied with symptoms of increased urinary urgency, frequency, difficulty to initiate urination, painful intercourse and constipation. Plus there can also be some abdominal pain or discomfort.

Although, it is important to rule out more serious causes like a hernia, testicular torsion, epididymis etc. often times the injury is from a musculoskeletal cause such as abductor muscle sprain, strain, pelvic floor muscle injury or spasm which can be aggravated by heavy exercise. There can also be altered body mechanics or posture which can put your muscles in compromising positions which make you prone to injury.

So What Do You?

• Visit your doctor to rule out serious pathology
• If there is a sprain, strain or pelvic floor spasm, visit a physical therapy clinic with a pelvic floor PT. 
• Wear cotton breathable supporting underwear to reduce irritation from sweat and help minimize excessive movement 

Here are some stretches that might help you if tight abductors or your pelvic floor is the cause:

Butterfly Stretch

Happy Baby

Frog Stretch

Piriformis Stretch 

What we do at Duffy and Bracken 

• We are a team of sports, orthopedics and pelvic floor physical therapists who follow a team approach to use our skills to your benefit
• Our Pelvic Floor physical therapists work with you for pelvic pain and urinary/constipation symptoms
• You are assessed for proper mechanics and posture using wearable sensor technology called dorsaVi
• We help to improve your movement patterns to eliminate the cause of pain and/or injury

Bhavti Soni, PT
Pelvic Floor Therapist
bhavti@duffyandbracken.com

Yoga with Anita

Yoga With Anita 

Fridays 4:15-5:45pm

Series 1 November 4,11,18
Series 2 December 2, 9,16

$105 for a 3-class series

Drop-in rate: $40 per class

Wednesdays 5:30-7:00pm

November 30
December 7,14,21

$135 for the series

Drop-in rate: $40 per class

Vinyasa - style class.

Emphasis on alignment, body awareness, saftey and you!

Class limited to 4 students 

To schedule a class contact Anita 

646-251-0730

www.anitahyoga.com

info@anitahyoga.com

 

The "Magic" of Physical Therapy

Physical therapy (PT) can deliver positive thoughts into motion when summoned. One popular aspect is when the beneficial outcome surrounding a successful PT encounter is mutually celebrated by all parties involved. However, sometimes there seems to be a general disconnect on the understanding of what makes a fruitful PT experience actually successful. After speaking with several patients and the general public, it seems that there's an abundance of confusion as to what physical therapy actually is and how it tends to work its “magic.”  

Throughout my frequent long days of working in an outpatient PT facility, I often hear patients erroneously utter the words "fix me” in various ways. Poor phrases tend to circulate the clinical atmosphere such as: "I need you to fix me." "Thanks for fixing me." "You fixed me, but I managed to screw it up again." I hate to be the bearer of bad news, but love to be the presenter of truth. The truth is that the aforementioned sayings are all misnomers and highlight an unfortunate epidemic plaguing the world of physical rehabilitation. This epidemic primarily relates to passiveness of patients in their rehab process. It is a passiveness created around erroneous expectations of physical therapists and misconceptions about therapist job requirements and abilities.

Contrary to popular belief, physical therapists don't really fix people. It's not a therapist's job to fix anyone, nor do therapists possess the superhuman qualities to fix anyone. What therapists actually do is coach. What we actually are, are coaches. We are health coaches, bio-mechanic coaches, musculo-skeletal coaches that develop a patient-specific plan of care consisting of various treatment techniques and therapeutic exercise to help restore functionality. The reason why it comes off as a “fix” is because when physical therapy is performed correctly to a treatable case, it allows for the augmentation of function and reduction/elimination of symptoms. We make people feel better, but we do not fix people. We provide the tools to help people fix themselves. These tools allow patients to be active participants in their rehab process and not passive mummies that view PT to that of a spa treatment. We provide the program, we provide encouragement, we provide help. Work is required for both parties involved. That is the fix, that is the magic. However, magic only happens when each party owns up to their role in the game.

Now, it is quite true that there are many useful techniques (manual, instrument-assisted, or modality treatment) employed by a PT that seem magical but are impossible to be duplicated by a patient. Although these therapist-applied treatments are beneficial, the true magic is formed when patients follow the therapist-scripted blueprint on how to keep those results attained from whatever the PT is solely capable of providing. What may feel like a fix will be disappointingly short-lived if active participation is neglected on the patient's part. The true magic of physical therapy is centered around the human experience and not from any form of spellbinding magical PT prowess in any case. Physical therapy uses the skill of the therapist combined with the wants and needs of the patient to bring the best attainable results possible. Active engagement is 100% required for all. Physical therapy may seem magical, but only due to all the unspoken intangibles involved around when humans interact together positively. Great communication and being on the same page highlight the true magic of physical therapy. Physical therapy is individualistic. It's altruistic. It's an art.

                                        

Clifford Civil, PT, DPT

clifford@duffyandbracken.com

Practicing Mindfulness: Get to Know Your Body Better!

Life is hectic. Between our jobs, taking care of our families, pets, plants, homes, etc., there is hardly a spare moment in the day to focus on ourselves. On top of that, we live in a bustling city that makes it even more difficult to tune in to our internal processes. Thus, it’s no wonder most of us experience stress of varying degrees, negatively impacting our emotional and physical states.

Mindfulness is one way to improve stress and help our bodies function better. Through self-observation without judgment, mindfulness can enhance one’s understanding of their present-moment experience. This practice of “tuning-in” has been supported by scientific research to have physical and cognitive benefits, including reducing blood pressure1, depression2, anxiety3, chronic pain4, and enhancing our learning and memory processes5. In addition, the American Heart Association supports the use of meditation and mindfulness as a means to reduce stress and risk of cardiovascular disease.6

Approaching your physical therapy with mindfulness can maximize the benefits of therapeutic exercises and help you to better understand your body. Here are some ways to use mindfulness to optimize your rehabilitation:

1. Take a moment to pause. Use this moment to gain an understanding of the state of your body. Whether you’re sitting on the subway, at your desk, or maybe lying on the treatment table about to do some exercises, take a moment to acknowledge any sensations or emotions you are feeling. Are you holding tension in any part of your body? Can you consciously let that area relax? After a stressful meeting or exercise, how has your body responded? Establishing a connection between stress, emotion, activity, and your pain can help you gain a sense of control of how your body feels.

2. Focus on your breath. Bringing attention to the breath is a great way to tune into the body and help you to relax. To start, place one hand on your chest and the other over your navel. Take note of how they rise and fall as you breathe. Is your breath slow and steady, or restricted and tense? Do you tend to hold your breath more when you’re stressed or exercising? It’s quite common for people to hold their breath when they’re exerting themselves. Therefore, try practicing focused breathing while doing your exercises!

3. Perform exercises with intention. When performing your exercises, you should have an understanding of the area being targeted and the purpose of the exercise. For example, is the exercise helping with strength or flexibility? When you’re performing the exercise, do you feel it working the targeted area? Are you performing the activity with the proper form? If you are unsure, just ask your physical therapist. They will be more than happy to review your exercises with you!

4. Quality over quantity. As you progress through your rehab, your exercise list starts to grow and it can take a while to get through everything. You may find yourself quickly powering through those leg raises or rows because you need to get back to work or start dinner, or they may be challenging and you just want to get them over with! Unfortunately, when performing exercises faster, the tendency is to lose that sense of intention discussed above and form starts to break down. Without the proper form, you might not be optimally working the targeted area, and therefore not reaping the full benefits of the exercise. Therefore, when it comes down to it, your physical therapist would rather you maintain the quality of the exercises, even if that means you may have to reduce the quantity.

In conclusion, get to know your body! We as physical therapists are here to get the ball rolling and provide guidance, but ultimately you play the most important role in your body’s journey toward healing. Practicing mindfulness in your everyday life and applying it during your therapy will help enhance your understanding of your body and make the most out of your rehabilitation.

Hillary Keating, PT, DPT

hillary@duffyandbracken.com

References

1. Hughes, Joel W., et al. "Randomized controlled trial of mindfulness-based stress reduction for prehypertension." Psychosomatic medicine 75.8 (2013): 721-728.
2. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology. 2000;68:615–623
3. Roemer L, Orsillo SM, Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial.Journal of Consulting and Clinical Psychology. 2008;76:1083–1089.
4. Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics. 2007;76:226–233.
5. Hölzel, Britta K., et al. "Mindfulness practice leads to increases in regional brain gray matter density." Psychiatry Research: Neuroimaging 191.1 (2011): 36-43.
6. "Meditation and Heart Health." Meditation and Heart Health. http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/TakeActiontoControlStress/Meditation-and-Heart-Health_UCM_452930_Article.jsp#.VrIReLIrJD8 . 07 Feb. 2016.