Human Performance and Rehabilitation Centers, Inc.

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.

Signs of a Receptive, Expressive and/or Social Pragmatic Language Disorder

Receptive, expressive and social/pragmatic language are considered critical milestones in a child’s life, but sometimes they are delayed. It’s important that parents and caregivers pay attention to the signs that a child is slowly progressing, not progressing or even regressing in language skills so he or she can receive the proper therapy. Early intervention is essential.

In the early years of life, children should begin to make basic connections between language and their surroundings. For example, a child should observe his/her parents’ mouths when they speak and begin to perform gestural language (e.g., waving). Children should also begin to understand what their parents’ words mean (following commands), form sounds that will eventually become words and pair their own words to become utterances about objects or events. When children have language disorders, they will lack one or more of these basic skills.

When one of our speech-language pathologists begins to work with a patient, a comprehensive evaluation is conducted, which includes assessing language (understanding and use), speech/resonance, voice, fluency, oral motor and swallowing abilities. A thorough plan of care with long-term goals and short-term objectives is developed and therapy is initiated. A big part of success in therapy is working closely with parents and caregivers because the home is an environment rich in opportunities to reinforce language. Home programs can empower the parents and caregivers to be involved in moving the child’s language skills along through play, interaction and socialization.

At HPRC Pediatric Therapy and Pediatric Rehabilitation, our setting is unique in that it offers comprehensive services, including therapy for gross and fine motor skills. If a child exhibits problems in these areas, we have physical and occupational therapists on site to work and collaborate with speech-language pathologists. Together, as a comprehensive team, we can see a child’s development as a complete picture.

Are young female athletes at greater risk for ACL injuries?

Young female athletes are five times more likely to sustain an ACL tear than their male counterparts. This is especially common in explosive multidirectional sports like soccer or basketball. It’s important for girls to learn how to jump and land properly in order to prevent an ACL injury from occurring.

Female athletes from about 14-18 years of age are at greater risk than boys of injuring the anterior cruciate ligament (ACL). This is largely due hormonal changes. An increase in estrogen during puberty causes relaxation of the ligaments and the natural widening of the hips causes changes in biomechanics. A female athlete is likely not conscious of these new structural changes as she continues to snag rebounds or bolt across the soccer field. She may inadvertently land or stop stiff-kneed or in a locked position, and she might have a greater tendency to internally rotate the knee due to weakness of the developing outer hip.

In addition, a female athlete may be accustomed to using only the quadriceps instead of her developing hamstrings to control movements. All of these factors can put the ACL at risk.

It’s important to teach young women early on how to adjust the way they run and jump in competition in order to prevent an ACL tear. A physical therapist can screen an athlete to evaluate body mechanics, potential weakness and faulty movement patterns. Prevention is key. And it’s time well spent since a young athlete who has suffered an ACL tear is 70% more likely to suffer a re-injury.

Here are some strategies:

  • Young athletes should be in shape for the demands of their chosen sport. This includes both cardiovascular capacity and muscular strength. During fatigue or exhaustion, even a small weakness or poor body mechanics can become a bigger problem.
  • A good strengthening program will encourage better hamstring-to-quad strength ratio, which will help reduce reliance on quads only.
  • Good lateral hip strength and hip abduction control will help maintain proper knee position so that a girl doesn’t experience what we call a valgus collapse, or the extra internal rotation of the femur and the knee falling inward.
  • Proper proprioception is key. When the foot hits the ground, the knee should be properly positioned over it. This allows for strong core-hip stability during lunges, running and multidirectional activities.

Physical therapists don’t just treat patients after an injury. They also work with patients to prevent one from occurring.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.

Achilles Tendon Injury

The Achilles tendon is an essential part of daily life. Spanning from your heel bone to your calf muscle, this band of tissue allows you to participate in everything from competitive sports to recreational activities, or just simply getting around. While the Achilles is the strongest and thickest tendon in the body, it can also be vulnerable to injury.

How Achilles tendon injuries happen

Athletes certainly experience their fair share of Achilles tendon injuries, but so can the average person. A variety of issues can cause the tendon to partially tear or even rupture. These include an abrupt and incorrect stepping down movement, wearing high-heeled shoes over the long-term, contact injuries or overuse. A tear can occur anywhere along the tendon from the heel to the calf. Injuries are more common in middle-aged individuals, and generally effect men more often than women.

How to recognize a tear

Partial tears, which are vertically or horizontally oriented along the tendon, are much more common than ruptures, or complete tears. You can usually feel a tear when it happens. It will cause the area around the Achilles to feel sore, tender and it may cause swelling. When a patient experiences a complete tear, normal walking is instantly compromised since the tendon is severed and essentially rolls up like a Roman shade. A rupture will require surgery and follow-up physical therapy.

Treating a partial tear or a post-op rupture

A full recovery from an Achilles injury demands patience. Rest is key. If surgery is not indicated, some patients benefit from wearing a boot to keep the tendon in a neutral position. If surgery is indicated, the patient will be referred to physical therapy typically around the 6th post-operative week, but will remain in a boot until 12 weeks post-op, on average.

During therapy sessions, a PT will manually stretch the tendon to bolster blood flow and to improve the relationship between the tendon and the heel bone and/or the calf muscle. The PT will also issue home exercises to encourage healing while minimizing inflammation. When the patient is ready, the PT will introduce gentle exercises like seated calf raises and exercises using therapy bands to increase blood flow. Next, the therapist will guide the patient through a progression of walking activities and dynamic stretching like lunges and standing calf raises with the goal of an eventual return to the individual’s desired level of activity. Another important part of therapy is restoring – or improving – a patient’s sense of balance, so a therapist may also deploy exercises that improve biomechanics. As the patient builds strength and flexibility, it will be possible to once again run and jump.

Continued maintenance

A home exercise program is a key part of helping a torn Achilles tendon heal throughout therapy. Wearing proper footwear is also important. While active adults are always eager to jump back into their former routines, it’s crucial that they practice patience and allow the Achilles tendon to heal fully to prevent re-injury.

Cupping and Taping: Not Just for Elite Athletes

The 2016 Summer Olympics in Rio made folks aware of a couple of different physical therapy techniques popular among elite athletes. Remember the round bruises around the shoulders of five-time Olympian Michael Phelps? Those were from a process called “cupping.” And beach volleyball guru Kerri Walsh Jennings routinely competed with a pattern of tape on her shoulder. Not just for elite athletes, cupping and kinesio-taping are effective strategies for everyday PT patients experiencing a range of issues. Here’s what you need to know.

Cupping

This is an aggressive manual therapy technique meant to enhance range of motion and optimize muscle function. A physical therapist places a special plastic suction cup on the surface of the skin to effectively pull skin and fascial tissue away from the muscle. This releases adhesions that may have formed from a collagen fiber build-up. Over years of use and stress, a patient can develop scar tissue and adhesions within the muscle that limit range of motion, making the muscle feel tight and sometimes causing pain.

Cups come in different sizes for use on different areas of the body. A therapist will identify the proper placement of the cup by examining the skin for tautness and testing the muscle’s range of motion. While the process leaves a circular bruise, it actually invites more blood flow to the area and helps trigger healing. Avoid any kind of cupping that also includes skin laceration techniques because this can introduce infection. Cupping should not be used on patients with blood clots or those taking blood thinners.

Taping

The kind of tape you’ve seen on elite athletes is different from the common tape or bandage that holds a sprained ankle in place. Instead, this is a special type of stretchy tape meant to promote muscle function and guide the muscle into proper movement. A physical therapist places the tape in a deliberate pattern. As it guides the joint through motion, it sparks kinesthetic and proprioceptive feedback. In other words, it’s coaxing better function out of a muscle or joint because it’s showing it how to move correctly. This provides stability and helps prevent injury or re-injury. It also helps teach the muscles to contract properly.

Because they both show good results, cupping and taping are becoming popular therapy techniques for treating everyday patients.

My aching back: Using physical therapy to address low back pain

If you’ve experienced low back pain, you’re not alone. According to the National Institute of Neurological Disorders and Strokes, about 80% of American adults – both men and women – will experience low back pain at some point in their lives. For many patients, physical therapy is an effective tool in improving low back pain and restoring strength and function.

The low back, or lumbar region, is an incredibly important part of the body. Comprised of five vertebrae, the low back supports the weight of the upper body as we go about our daily lives. Multiple components have to work together for the low back to function properly. Soft cushions or discs between the vertebrae act like shock absorbers as we walk, lift, run and jump. Ligaments hold the vertebrae in place. Tendons attach the muscles to the spinal column. Finally, dozens of pairs of nerves are embedded in the spinal cord. Each of these parts works in tandem, so when something is compromised, we feel pain.

No two patients experiencing lower back pain are built exactly the same, which is why a physical therapy setting can be so effective in addressing a patient’s issues and body mechanics. Our goal is to restore normal physiological motion in the low back through tested hands-on therapy techniques that zero in on each joint. In many cases, this mechanical approach is a much more effective – and certainly less invasive – than surgery.

Some of the patients we see experience pain due to spinal stenosis, or the narrowing of spaces in the spine. This is usually caused by age, normal wear-and-tear or arthritis. As joints grow harder and more narrow over time, they can encroach on the nerves that are rooted there. When that happens, the nerves become compressed. We use techniques including traction modalities, manual therapy, joint manipulations and extension exercises both in the clinic and at home.  These therapies help give the nerves more room to function and can help reduce pain in our patients.