Human Performance and Rehabilitation Centers, Inc.

All About Parkinson’s

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in the area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.  The specific group of symptoms that an individual experiences varies from person to person.

Symptoms

Primary motor (movement) signs of Parkinson’s disease include the following:
Tremor of the hands, arms, legs, jaw and face
Bradykinesia or slowness of movement
Rigidity or stiffness of the limbs and trunk
Postural instability or impaired balance and coordination

Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not. By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

Progression

The progression of Parkinson’s disease varies among different individuals. Parkinson’s is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years, but is not considered a fatal disease. Movement symptoms vary from person to person, and so does the rate at which they progress. Some are more bothersome than others depending on what a person normally does during the day. Some people with Parkinson’s live with mild symptoms for many years, whereas others develop movement difficulties more quickly.

Non-motor symptoms also are very individualized, and they affect most people with Parkinson’s at all stages of disease. Some people with Parkinson’s find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Since Parkinson’s disease (PD) is a chronic condition, it is important to develop and maintain a solid PD management plan. Research has shown that those who take an active role in their care see an improvement in their Parkinson’s symptoms.

Management

Managing your care means not only finding the right doctor, but ensuring you are prepared for your visit and talking to your doctors about the right issues. It means, not just taking your medications, but keeping track of when you need to take them. People with Parkinson’s are best served by a multi-disciplinary approach that provides not only the expertise of a PD specialist, but also the help of a physical therapist, occupational therapist, speech therapist, nutritionist and social worker. Some people also require medical consultants in areas such as psychiatry and neurosurgery. It is important that these healthcare professionals are aware of each other and communicate regularly, and that they all know the full list of treatments and medications that each is prescribing.
Physical and Occupational therapy focus upon restoring the ability to move effectively and safely by instructing and facilitating normal movement patterns and providing safety education and adaptive equipment to facilitate a person’s ability to maximize independence with mobility, self-care and activities of daily living.

Speech therapy focuses upon restoring swallowing, speech and language production and understanding and cognitive (thinking/memory) functions.

National HelpLine:
Ask the experts at PDF your questions
Are you looking for a support group? Call us at (800) 457-6676 or email info@pdf.org to find a group in your area

The toll-free HelpLine/email service – staffed by a team of information specialists – can:
Answer your questions about Parkinson’s disease: symptoms, treatments, complementary and alternative therapies and the latest scientific studies reported by the media.

Identify financial, legal and other resources to help you live well with Parkinson’s.
Provide access to an interpreter for non-English speaking callers.

Good Posture Provides Tangible Benefits

We have probably all been told at some point in our lives, more often than not by mom or grandma, that we should fix our posture or stand up straight. Well grandma was on to something there! More often than not, while working with patients who are experiencing back, neck, or shoulder pain, I will identify one or more postural deviations which are likely contributing to their symptoms. Some of the most common postural deviations that I see on a regular basis include forward head, anterior pelvic tilt, and rounded shoulders.

Ideal posture gives our body a solid foundation from which to move. The spine is naturally made up of curves with the neck and the low back arching slightly and the mid back rounding slightly. Proper posture minimizes the strain on our muscles and joints and decreases the amount of work that our muscles need to do in order to fight gravity and keep us upright. In ideal standing posture from a side view our ears should line up with our shoulders, hips and knees and there should be a slight curve outward at the mid back and inward at the low back. In a sitting position, our bottoms should be near the back of the chair with our backs supported by the chair. The knees should be bent at approximately 90 degrees (meaning many of us need to adjust our chair height) and our shoulders and neck should be relaxed.

A postural deviation that is increasing in prevalence is forward head posture. This is what it’s called when our chins are sticking out and our ears line up in front of our shoulders. This commonly occurs with reading, computer work, television viewing, and texting. We have a tendency to bring the neck/chin forward in an attempt to get our eyes closer to whatever is holding our attention. Unfortunately, prolonged forward head posture can contribute to neck tension and soreness, headaches, and tingling in the arms. Cell phones tend to bring out the worst neck posture because we often bend our necks down at significant angles while also bringing the chin forward as we read, text or play games on the relatively small screen. The perceived weight of the head increases significantly the more we bend our heads forward. An exercise that you can do to correct forward head posture is cervical retraction with a chin tilt. To perform this exercise nod your chin down just a tiny bit then bring your neck straight back as you think about lifting the base of your skull as if it were being pulled by a string tied to the ceiling. Hold for a few seconds and then relax.

A second common postural deviation is excessive anterior pelvic tilt. This often occurs as a result of tight hip flexor muscles. As a culture, we spend more time sitting than what is ideal for our bodies. We often sit for extended periods for transportation, work, and recreation/relaxation. This can enable the muscles at the front of our hips to shorten and get tight, pulling our pelvis forward. When we stand with anterior tilt, we often increase the arch in our low back as a compensation to stay upright. This can put excessive strain on the low back over time. By pulling the hips forward and the pelvis into a neutral position the back can return to its natural position. An exercise to correct excessive anterior pelvic tilt is the posterior pelvic tilt. This can be performed in multiple positions. One way to do a posterior pelvic tilt is to start lying on your back with your knees bent and the bottoms of your feet flat on the floor. From this position gently press your low back down to the floor and use your abdominal muscles to gently rock your hips back or “tuck your tail”. Another exercise which may be necessary to correct excessive anterior pelvic tilt is to stretch the front of the hips or hip flexor muscles if they are tight.

The final postural deviation that I see very frequently is rounding of the shoulders. This often shows up as a combination of the shoulder blades being far apart and the arms being rotated in so that if a person is standing with their arms relaxed by their sides their palms would be facing behind them. It is also common for people with rounded shoulders to also have a greater than usual bend in the upper back. People with this posture commonly report neck or shoulder pain. This posture puts the body in a poor position for reaching or lifting overhead. Try rounding your shoulders and slumping your upper back, then try to raise your arms overhead from that position. Now try raising your arms while sitting up tall and gently pulling your shoulder blades back. Your arms should be much easier to raise from the second position. Not only is it harder to move your arms from the rounded position but this posture makes it easier for your rotator cuff tendons to be pinched. People with proper posture have the lowest incidence of rotator cuff tears. An exercise to correct this postural deviation is scapula or shoulder blade retractions. To do this exercise stand with your arms by your sides and gently pull your shoulder blades back and together with your thumbs facing out. Hold for a few seconds then relax. Be sure that your shoulders aren’t coming up toward your ears when you do this exercise.

In order to efficiently move our limbs, it is essential to have good posture. We can decrease the strain on our muscles and joints by making small adjustments in our static and dynamic positions. Proper alignment can be one step toward decreasing pain in the neck, back, or shoulder.

Hurt on the Job? You May Need a Functional Capacity Evaluation

Functional Capacity Evaluations (FCE) are full body assessments that are performed to determine an individual’s ability to safely return to work at pre-injury status or to determine if work modifications are necessary to allow the employee to safely resume their job. FCE’s are commonly used for:

  • Employees that have suffered musculoskeletal work related injuries and an evaluation is requested to determine their physical abilities in comparison to the demands of a target job
  • Establishing a disability claim
  • A generic test to assess an individual’s current physical ability when the job goal is unknown

The Process

Your therapist or trainer will request a job description for review to assure all job demands are evaluated. The results of the FCE are then compared to the job description. If the client does not meet all the job demands, the evaluator will determine if the employee is a candidate for a work reconditioning program and recommendations will be made to the physician ordering the exam.

The length of the test and the number of days required to complete testing will vary depending on the injured body part. Hand, elbow, and shoulder exams are performed on one day and take approximately 4 hours to complete. Spine, hip, knee, foot, and ankle exams are performed over two separate days, taking approximately a total of 6-8 hours to complete. Clients are asked to dress in clothing and shoes that permit them to safely perform the presented tasks, and that information is provided prior to the day of testing.

The test may be executed by a physical therapist, occupational therapist, athletic trainer, or a kinesiologist. The test items are designed to determine cardiovascular fitness, lifting capabilities, strength, balance, and hand coordination. In order to perform the test, the individual must be medically stable and have met maximum medical improvement as determined by their physician.

Feeling Faint? Everyday Activities Can Make You Dizzy.

Dizziness can be caused by many things: side effects of medication, low blood pressure, low blood sugar, and anxiety. Dizziness following bending over to tie shoes, lying down in bed, looking in the blind spot, and walking down a grocery aisle are all frequent causes of dizziness related to a vestibular disorder. Vestibular dizziness symptoms may include everything from the room spinning to a feeling of off balance or unsteadiness.

There are three major systems in the body that help you maintain your balance. Vision helps to locate the horizon and objects in a person’s path. Sensory mechanics in the feet and legs help identify the type of ground underneath a person’s feet. The last system is the vestibular system which is located in the inner ear behind the ear drum. The vestibular system is what causes motion sickness, makes the stomach turn on a roller coaster, and what jolts a person awake when dreaming of falling.

The vestibular system has three main functions: stabilization of visual images (keeping eyes on a target), maintaining postural stability (especially with head movement), and providing spatial orientation. These three functions are controlled by coordination of the central vestibular system (brain and brain stem) and the peripheral vestibular system (shown to the left). There are two main parts of the peripheral vestibular system. The three fluid filled semicircular canals that detect angular head movement such as shaking your head to say “yes” and “no”. The vestibule contains the otolith organs which detect vertical and horizontal acceleration, like riding in a car and an elevator. If either of these systems are disrupted in any way it can cause dizziness. Two of the most common vestibular issues are benign paroxysmal positional vertigo (BPPV) and unilateral vestibular hypofunction (UVH).

BPPV is caused when otoconia (calcium carbonate crystals) from the vestibule fall into the semicircular canals. This causes movement of the fluid in the canals, which in turn moves the hair or ampulla, which triggers the sensation of movement. When someone with BPPV lies flat, bends forward, or looks up, this movement causes the crystals in the canal to move, moving the fluid, and then the hair, which triggers the sensation of spinning in the brain. This can be fixed by moving the crystals out of the canal by performing specifically sequenced positions which can treated by a medical professional familiar with vestibular rehabilitation in as little as 1-2 visits.

Unilateral vestibular hypofunction usually occurs following a viral illness, head trauma, or a vascular incident, such as a stroke or blockage, that decreases or eliminates the receptor input of the vestibular system to the brain. This causes less intense sensation of dizziness, more commonly characterized as feeling off balance. Common complaints of UVH are off balance or slight dizziness when turning a corner, picking something up from the floor, walking in the grocery store, or driving. Rehabilitation for UVH can take between 6-8 weeks with therapy to improve gaze stabilization (maintaining vision on a target), postural stability (maintaining standing balance), and decrease motion sensitivity.

Balance Issues? Your Appointment Explained.

Many times, doctors will send a patient to physical therapy if he/she has experienced a fall, been ill, or just felt unsteady while walking. There are several different components to increasing and maintaining balance and mobility.

When you arrive for your appointment, there will be paperwork to complete, most importantly a past medical history form, including a list of your medications. This information is needed to see if you have any conditions or take any medication that could contribute to your symptoms.

During the evaluation, the therapist will test the muscle strength in your legs and assess your balance. These tests are done in an effort to determine which system of balance needs to be addressed. There are three primary systems of balance: vestibular, visual, and proprioceptive. The vestibular system is located in your inner ear and is sensitive to head movements and can create dizziness if there is a dysfunction. The visual system plays a role in your balance by interpreting what you see and making adjustments to obstacles that are ahead, such as a curb. Proprioception is the feedback that you receive from your feet being in contact with a surface. This is important if you are walking on an unstable surface, such as grass or gravel. These three systems help maintain your balance, and your legs have to be strong enough to help hold you up!

The PT will analyze how you walk and determine if you need an assistive device, such as a cane or walker, for safety. Your balance may be tested by performing tasks such as balancing on one leg and standing with your eyes closed and by performing tasks that involve putting your feet close together or in front of each other. Some of these tests may seem silly, but they give the therapist information about your ability to perform daily activities safely.

Often, your therapist will want to see you once or twice a week to work on increasing strength and balance. One thing to remember with balance is that repetition helps the body re-learn the correct way to perform daily activities. More than likely, the PT will send you home with exercises to perform on your own. Performing these exercises will help maintain your mobility and strength between PT visits. Working on balance is a time-consuming process; you will need to be patient with yourself as your symptoms improve. Most importantly, therapists want patients to remain safe with their mobility and prevent future falls. By improving strength and balance, you will be on the right track to stay injury free!

Knee Pain Explained

Knee pain is something nearly every person experiences at one point or another, usually related to a particular injury or provocative activity, such as lots of kneeling for spring planting in the yard or playing the occasional game of basketball. How do you know the difference between a serious injury versus simple overuse? The causes of knee pain typically fall into one of three categories: traumatic, overuse, and degenerative.

Traumatic is self-explanatory; a fall, collision, twist, or awkward landing can create enough force to damage the structures inside the joint. When this type of damage occurs, the person may experience severe and immediate swelling, severe pain, a loss of ability to move the joint, and an inability to bear weight through the limb; a safe bet is when two of the three exist, the person should seek medical attention from a physician and/or physical therapist immediately. Attempting to “walk it off” is not recommended.

An overuse injury can be a little tougher to recognize. Starting a fitness program or a dramatic change in a person’s activity level (more or less) can provoke this type of pain. So can rapid increases in body weight, such as pregnancy. Adolescents who are going through growth spurts will often have pain in the knees because of changes in the way the muscles and joint function together. The pain may show up immediately or gradually, appearing more and more frequently until it is constant. Swelling may appear but is typically not severe and disappears overnight. Depending on the structure inside the knee that is taking the abuse, surgery may be needed, but many times this is treated quickly and effectively with a short course of rest, stretching and strengthening.

“Degenerative” describes the normal changes our joints experience with aging, specifically thinning of the articular cartilage and the loss of quality in the soft tissue of the joint. Knee pain from degenerative changes generally does not produce swelling and is provoked by remaining in one position for a great deal of time.

Besides pain, a problem within the knee (or any joint) will also cause the muscles around the joint to stop working effectively. Over time this will produce a loss of muscle size as well as a loss of control of the joint. The longer the joint remains untreated, the more severe the muscle atrophy and loss in function will become. Other joints may become painful as a result, particularly the areas above and below the injured joint or the opposite side. Medical treatment should begin before the body learns bad movement patterns.

Unless severe structural damage is present, a course of physical therapy will often be successful in getting rid of pain and restoring a person’s usual activity level. Any physician can refer to physical therapy and in many states no referral is required; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem is severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.

Regular Headache or TMD?

It’s been a long day that started with a pounding headache and a rough day at work. A great movie is on TV and the start to a perfect night of relaxation is complete with a warm bag of popcorn. As I settle in and the movie begins, I take the highly anticipated first bite and…OUCH! What was that? The pain is from my mouth but it’s not a normal toothache. The pain in my face and jaw travels up to my temple and ear. My headache has not only returned, but has intensified! I’m experiencing signs and symptoms of temporomandibular disorder (TMD). Can you relate? The National Institute of Dental and Craniofacial Research estimates over 10 million Americans are affected by TMD. This disorder impacts many within our own community and HPRC is here to help inform, educate and treat to restore a healthy and desired lifestyle.

Background: Anatomy and Function

Temporomandibular disorder involves the temporomandibular joint (TMJ) and/or the surrounding musculature. The TMJ is a hinge joint that connects the jaw to the skull, just in front of the ear on both sides of the head. Movement at the TMJ allows for up and down and side to side motions of the jaw for talking, chewing and yawning. The cervical spine and surrounding musculature influence the position and control of the joint.

What Are the Signs and Symptoms of TMD?

Common signs and symptoms are, but not limited to:

  • Pain in the jaw, face, temple region, neck, shoulder and/or ear at rest or during movement
  • Limited jaw motion opening, closing and/or side-to-side
  • A “stuck” or “locking” feeling in the jaw, “clicking” or “popping” when opening and closing the mouth that may or may not be painful
  • Headaches
  • Fatigue in the jaw, head and/or neck region

These symptoms may be temporary, recurring or chronic.

What Causes TMD?

The exact cause of TMD is not clear, but clinicians do believe signs and symptoms arise from problems in the surrounding muscles, the joint itself, stiffness in the cervical spine and poor ergonomics/posture. A rapid onset may occur after an injury, such as a blunt force to the face or whiplash. Other contributing factors include:

  • Grinding/clinching teeth at night
  • Osteoarthritis or rheumatoid arthritis in the TMJ
  • Dislocation of the disc in the TMJ
  • Work, home or emotional stress
  • Recent prolonged and/or high-level dental work
  • Recent cervical injury or surgery
  • Diet (i.e., nuts, ice, tough meats)
  • Overuse/habits (i.e., bubble gum, biting nails, chewing the end of a pen/pencil)

Treatment Options

The most effective treatment for TMD typically involves a collaborative team effort between the patient, a physician or dentist and a physical therapist. As the patient, the following steps may be help in easing symptoms:

  • A soft diet
  • Ice applied outside (ice packs, frozen vegetables) and inside (popsicles, pieces of ice) the jaw
  • Avoid extreme jaw motions that hurt and/or create popping
  • Reduce stress and learn relaxation techniques
  • Keep your teeth slightly apart and jaw relaxed during daily activities

A physician or dentist will evaluate you for TMD, as well as for other possible issues in the teeth, jaw, head and neck. X-rays or an MRI may be performed if found necessary to further examine hard and soft tissues. Medication may be prescribed to help with inflammation. Dentist and oral surgeons can prescribe a helpful tool to reduce the effects of grinding at night called a night guard or splint. These custom made appliances prevent the upper and lower teeth from coming together while sleeping, thus reducing the grinding forces that contribute to TMD.

Physical therapists play a key role in the collaborative effort to get you back to a healthy, desired lifestyle. A licensed PT at HPRC will evaluate and treat all factors contributing to your TMD to reduce symptoms today and to prevent recurrences in the future. Treatments include:

  • Manual techniques (i.e., stretching, mobilizations and manipulation of the TMJ and cervical spine)
  • Exercise instruction (stretching and strengthening of the musculature surrounding the TMJ and cervical spine)
  • Patient education (detailed activity modifications, postural instruction and relaxation techniques)
  • Modalities that help reduce pain and improve tissue health.

Carpal Tunnel Syndrome Explained

Do you wake up at night finding yourself having to shake out your hand because it falls asleep? Do your fingers go numb while you are typing at work? If you answer yes to either or both of these questions, you may have Carpal Tunnel Syndrome.

What is it?

Carpal Tunnel Syndrome is a condition in which the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. It is formed by the carpal bones on the bottom of the wrist and a ligament structure on top (transverse carpal ligament) that runs across the wrist. The Median nerve, is just below this ligament, and provides sensory and motor functions to the thumb, index finger, middle finger and ½ of the ring finger.

Carpal Tunnel Syndrome is a repetitive use injury/Cumulative Trauma Disorder and can begin with numbness and tingling that comes and goes in above specific fingers; however, it can become constant, causing an increase in discomfort in the hand and even forearm. This can be caused from poor positioning while sleeping allowing wrist(s) to stay bent for long periods, using tools that vibrate for long periods of time, poor ergonomics while sitting and typing or even while standing at a work bench with repetitive use of hand(s). Other symptoms include weakness with gripping objects, dropping items with affected hand, swollen feeling in fingers, and/or awakening at night due to discomfort in thumb, index and middle fingers.

If you have these symptoms, It’s important for you to seek medical attention quickly as compression on the nerve will continue and can eventually lead to nerve damage.

How to treat it

Treatment will be based on your age, past medical history and the extent of the syndrome. To begin relieving compression on the nerve at the wrist and prevent wrist motion, wrist splints are beneficial to wear during the time the symptoms are more prevalent. Other treatments can include anti-inflammatory medication, phonophoresis/iontophoresis, median nerve glides, ASTYM (Augmented soft tissue mobilization), changing positions of work station (ergonomics), or surgery to relieve the compression of the nerve in the carpal tunnel.

If your symptoms are not improving with conservative treatment above, a nerve study (EMG) can be ordered to determine the location of the compression and its severity. As a result, this will allow the surgeon to determine if surgical intervention is warranted or to continue with conservative treatment to alleviate the symptoms.

If you have surgery, what to expect:

Surgery is a scary thought and there are risks involved; however, this surgery is performed using a scope and a small incision and recovery is time is minimized as long as you follow instructions via the doctor and your therapist. If you are non-compliant, the recovery can be long and make you question why you had surgery.

In general, the surgery for CTS is performed under local or regional anesthesia and is an outpatient procedure allowing you to go home the same day after surgery. For endoscopic approach, there is a small incision made at your wrist area, and the tissue that is pressing on the nerve will be cut to decrease the pressure.   After the surgery, a bulky dressing will be used to immobilize your wrist, but your fingers are free allowing you to move them immediately after surgery.

You will follow up in therapy 3-5 days after surgery. The bulky dressing will be removed, incision cleaned and your home exercise program will be initiated. A smaller dressing will be reapplied after therapy for ease of daily dressing changes at home. Approximately 10-12 days from surgery, stitches will be removed either by doctor or therapist and will continue to progress your movement and activities, as tolerated. The length of recovery can vary with each person especially if the nerve has been compressed for a long time, return of your sensation may take longer. Typically, four weeks from surgery, strengthening activities will begin under the supervision of a therapist to ensure you are progressing well without pain or discomfort. Weekly progression of resistance’s/weight limits are issued via your therapist and this methodical succession will return you to your prior level of function pre-Carpal Tunnel symptoms. Full recovery of the nerve is said to be approximately 18 months, but most people’s sensation returns well before that time frame.

Managing Lymphedema

Lymphedema is a condition that has received a lot of attention in recent years. It can result when the lymph nodes are removed or damaged due to cancer treatment. Cancer patients aren’t the only ones who can have lymphedema, which causes swelling in the arms or legs. Individuals suffering from obesity or vascular issues can also experience it. While lymphedema has no cure, it can be managed effectively with physical therapy.

The lymphatic system is a network of organs, nodes and vessels that make and produce fluids necessary to the body’s function. When the lymph nodes are compromised, they fail to remove proteins from the lymphatic fluid, causing an accumulation of fluid and swelling in the limbs. It’s most often an asymmetrical condition, meaning it will only affect one arm or one leg. If the arms or the legs are both affected, one is usually worse than the other.

Many cancer patients will come to us immediately when their lymph nodes have been removed or radiated. But many other patients have suffered from lymphedema for years before they discover exactly what it is and that physical therapy can help.

We use three main techniques for addressing lymphedema: manual lymphatic drainage, multi-layer bandaging and circulation exercises. The duration of therapy will depend on the severity of the case.

  • Manual lymphatic drainage is an incredibly effective technique for pushing fluid out of the areas where it has built up toward the lymph nodes and the center of the body. A therapist should follow specific pathways, or “watersheds,” natural highways that help the fluid reach the lymph nodes and organs where it will be processed and ultimately flushed out of the body as urine.
  • Once manual lymphatic drainage has been performed, multi-layer bandaging helps keep the fluid from returning. Wrapping a leg or arm with bandaging has a compressive effect that helps restrict fluid build-up.
  • Circulation exercises are also an important part of lymphedema management. These are simple movements performed in a sequence that help pump fluid through the lymphatic pathways.

A good therapy program also teaches patients and caregivers to conduct these techniques at home. Once progress is made and independence is gained in therapy, a patient will continue to manage his or her condition, returning to therapy for extra support when the need arises.

Painful Sex… Physical Therapy?

You might find yourself asking why you would see a physical therapist for dyspareunia (pronounced dis-puh-roo-ne-uh) or in layman’s terms, painful sex.  The short answer is because musculoskeletal pain is a significant component of pelvic pain and dyspareunia.  Pelvic Physical Therapy is a specialization in the field of Physical Therapy that treats pelvic pain.

Were you aware that you have muscles in the base of your pelvis that are under your control?  These muscles are aptly called the pelvic floor muscles.  The muscles are attached to the front of the pelvis, connect to the tail bone and sacrum at the back of the pelvis and extend outward to reach the side walls of the bony pelvis.  They are the only load bearing horizontal oriented muscles in your body.  Think of a muscular bowl or hammock in the bottom of your pelvis.  Diane Lee PT, prefers to call these muscles a condominium rather than a floor as this gives a more accurate picture of their complex interactive placement with all the connective tissue, organs and nerves of the pelvis.  These muscles serve three main functions:

  1.  Supporting the organs within the pelvis, hence their load bearing function. They support your bladder, rectum, the female  vagina, uterus  and ovaries, and the male prostate.  So they are” always working “at a postural level
  2.  The muscles are sphincteric, in other words they control the opening and closing of the urethra, vagina, and rectum.
  3.  The muscles assist in the sexual response, by providing tone to the vaginal walls, maintaining erection in the female and male  and production of reflexive contractions of the deep muscle during orgasm.   Poor sexual response has been associated with  weak muscles  and poor awareness of muscle.  These same muscles provide stability to the pelvic joints, assisting the increased  demands on the low  back during strenuous tasks.

So what role does the muscle play in pain?  Superficial dyspareunia involves the first layer musculature, those that assist with vaginal tone and erection.  Deep dyspareunia involves the deeper muscles of the pelvis which support the organs and help the low back w stability.  The organs of the pelvis, the muscles and even the skin communicate messages through spinal cord and to each other through nerve tissue.

Muscular tension can be generated through organic cause and by direct injury.  Connective tissue can become restricted secondary to muscular tension and nerve irritation.  Tense/ tight muscles can compress and or stretch nerve tissue.  A pain cycle ensues moving from pain to muscular tension to nerve compression and connective tissue restriction and back to pain.

Muscular pain can be the source of dyspareunia, sometimes seen in postpartum women after injury to the muscle system during birth, or it can be in response to infection or dermatological changes within the tissue to name a few.   Hip pain, because of the proximity of the hip muscles to the pelvic wall can be a contributing factor in dyspareunia.  Low back pain can affect the pelvic floor musculature.

Dyspareunia can be related to hormonal changes in the postpartum breast feeding female or menopausal female, secondarily affecting muscle tissue.  The pain of endometriosis and interstitial cystitis can include musculoskeletal pain. In dyspareunia muscles are generally over working and need to learn to regain their normal length, their ability to relax and return to normal postural levels.  Assessment of dyspareunia includes an evaluation of the low back and pelvic joints, ability of the muscles to contract and especially relax and lengthen and evaluation of the nerve and connective tissue about the pelvis.

Physical therapists treat muscular pain with pressure, gentle stretching techniques and specific relaxation exercises. Mobilization of the spine, pelvic joints and connective tissue are generally a component of the treatment process.  The goal of treatment is to gain awareness and specifically motor control of the muscle to reduce or eliminate the cycle of pain.  Pelvic physical therapy restores the length-tension relationship of the muscles.

Painful sex can be embarrassing to discuss.  A pelvic floor physical therapist will put you at ease.   A pelvic health PT understands the complexities of the pelvic floor, and will help your muscles to regain their normal function.