Everybody has one, nobody wants to talk about it: What is my pelvic floor and how do I know if it’s not working right?

Pelvic health is all the rage right now. From medical journals to Self Magazine to TikTok, the pelvic floor is a hot topic. There’s plenty of evidence that shows that a healthy pelvic floor can be key in overall physical health and quality of life1. But what exactly IS the pelvic floor, and why is it so important?

In short, your pelvic floor refers to the muscles that sling between your pubic bone in the front of your pelvis and your tailbone. Of course, these muscles help you do the things you’d expect, like supporting bowel and bladder control and helping with sexual function. But these muscles do much more than that - they also play an important role in keeping your core stable. They’re the muscles that help you control your posture and keep you from overexerting your back muscles2 during daily activities like moving from sitting to standing, to maintaining balance and strength during more demanding activities like lifting and running. We use these muscles all day, every day, for much more than just controlling our bladders.

So how do we know if there’s something wrong with these muscles? When you mention “pelvic floor”, it brings to mind the image of the new mom who’s struggling to keep bladder control during sneezing or coughing. But pelvic floor problems are much more common than you think – and the symptoms can vary. Symptoms of pelvic floor dysfunction include:

·       Urinary leaking

·       Uncontrollable gas or difficulty with bowel control

·       Feelings of heaviness or increased pressure in the pelvis, like your insides are slipping down

·       Constipation – do you ever feel like you need to strain or push too much with BMs? Have painful BMs?

·       Difficulty fully emptying your bladder – do you ever have to go to the bathroom 5 minutes after you’ve just gone?

·       Pain or burning with urinating

·       Sexual dysfunction, including pain with sex or difficulty with erections

·       Low back, hip, groin, or tailbone pain that hasn’t been helped with other treatments

·       Having to get up to urinate 2+ times / night  on a regular basis

If you’re experiencing any of these symptoms, the first thing to realize is that YOU ARE NOT ALONE. More than 1 in 4 women will at one time or another experience one or more of these issues3. The likelihood of having trouble controlling your bladder or experiencing pelvic pain increases with age and with giving birth. Men are also likely to experience pelvic floor problems, but because of the lack of knowledge, the stigma, and the discomfort associated with experiencing pelvic floor issues, pelvic floor problems in men are underreported4. You may find that it’s embarrassing or difficult to discuss issues like pain with sex or urinary leakage with your doctor, but these problems are both very common and very treatable.

The next thing to realize is that, while popular, doing kegels may not be the best answer to some of the problems listed above – in some instances, it could actually worsen your symptoms! What’s more, research has shown that as many as half of us are doing kegels incorrectly5.

In many cases, it’s best to see an expert to get your pelvic floor evaluated. Pelvic floor physical therapists have specialized training in pelvic floor issues and can teach you exercises, healthy habits, and even breathing techniques that can often get you feeling better quickly. So, if these symptoms are sounding all too familiar to you, come see us so that we can help you gain the knowledge, coordination, and confidence you need in your pelvic floor to move about your world!

Author: Dr. Katheryn Weed, PT | November 16th 2021

1. Bedretdinova A, Fritel X, Zins M and Ringa V. 2016. The effect of urinary incontinence on health-related quality of life: is it similar in men and women? Urology. vol. 91, pp. 83-89.

2. Pelvic Core First. 2016. The Pelvic Floor and Core [online] [viewed 29 March 2018]. Available from: https://www.pelvicfloorfirst.org.au/pages/the-pelvic-floor-and-core.html

3. Wu, Jennifer M et al. “Prevalence and trends of symptomatic pelvic floor disorders in U.S. women.” Obstetrics and gynecology vol. 123,1 (2014): 141-148. doi:10.1097/AOG.0000000000000057

4. Hirschhorn AD, Kolt GS and Brooks AJ. 2013. Barriers and enablers to the provision and receipt of preoperative pelvic floor muscle training for men having radical prostatectomy: a qualitative study. BMC Health Services Research. vol. 13, no. 1, pp. 305

5. Mason L, Glenn S, Walton I and Hughes C. 2001. The instruction in pelvic floor exercises provided to women during pregnancy or following delivery. Midwifery. 2001, vol. 17, no. 1, pp. 55-64.

Is R.I.C.E outdated for acute injuries?

We all know the acronym R.I.C.E - Rest, Ice, Compression, Elevation - often used after an acute soft tissue (muscle, tendon, ligament) injury such as an ankle sprain or pulled muscle. We know there is merit to each of these things individually with injury recovery, but as of recently, strict rest after a soft-tissue injury is being challenged in the sports medicine world. After an acute injury, brief periods of rest and unloading of the injured tissue are recommended for a limited duration to avoid further injury to the tissues and allow localized healing mechanisms to occur at the cellular level. However, studies are now showing that progressive loading of the injured tissues may be superior than R.I.C.E alone. Controlled, progressive loading of the acutely injured soft tissues can help restore tissue strength and has been shown to improve healing times when compared to strict immobilization and rest. Hence, this is where the updated acronym P.O.L.I.C.E comes into play! 

According to a recent editorial by the British Journal of Sports Medicine, P.O.L.I.C.E or Progressive Optimal Loading - Ice - Compression - Elevation, may be the best treatment guidelines to assist you in managing an acute soft tissue injury(1). Progressive optimal loading is a broad term referring to gentle, controlled forces applied to the tissues as tolerated. These forces can range from hands-on (manual) techniques applied to or near the injured tissue by your Physical Therapist to gentle range of motion or isometric muscle contractions. As the BJSM clinical commentary states, the word “optimal” will depend on multiple variables relating to the injury including nature, severity, and timing of the injury. These types of early interventions can promote recovery at the cellular levels of the injured tissues and allow them to remodel into stronger, healthier tissues. It is important to know what exercises are appropriate in the P.O.L.I.C.E model for the promotion of healing to the tissues, and that is where your Doctor of Physical Therapy at Colorado Sports Physical Therapy will guide you. Call today if you are healing from an injury and looking for ways to speed up your recovery to get back to the activities you love!

References:

1. Bleakley CM, Glasgow P, MacAuley DCPRICE needs updating, should we call the POLICE?British Journal of Sports Medicine 2012;46:220-221.

Ramping up to running season safely!

We know it’s still July, but fall races are already on the minds of many athletes, coaches, and parents. As such, we wanted to remind you that one of the best ways to prevent injuries during the fall is to be mindful of safely and effectively increasing the volume, frequency, and intensity of training after being off for the summer! 

As a clinic, we see a lot of injuries that are caused by a sharp increase in running frequency or the distance of runs (or both!) as athletes are preparing for their upcoming races. While every athlete’s tolerance is different, many athletes ramping up their training often experience injuries like plantar fasciitis, hip and knee pain, and overuse injuries such as shin splints or metatarsal irritation. 

With that in mind, you may be asking: what can you do to ward off some of these injuries and promote a successful return to running? The following are some general tips for ramping up your running in a safe manner:

1. Know that “one size fits all” does NOT apply when it comes to training programs! Each person is different and your body will respond differently than others to an increased workload. As the demands on your body are increased, your muscles, tendons, bones, and ligaments all have to adjust and adapt to the increased workload. When the load on these tissues exceeds their ability to adapt, this can increase the likelihood that you will suffer an injury.  It is important that, when running, you increase mileage and training frequency gradually to allow your body the time it needs to adapt. Structuring your training in this way can help reduce the risk of reinjury and prevent recurring injuries.

2. Cross-training! Runners love to run; however, cross-training in different forms of aerobic activities like cycling, swimming, elliptical, and rowing are all fantastic ways you can work on your aerobic capacity while decreasing stress on our body’s tissues as they adapt to increased workload on your run days. 

3. Strength training! There is a multitude of research available that points to increased resiliency of tissues when regularly exposed to strength training. One study, published by the British Journal of Sports Medicine in 2014, found that the incorporation of regular strength training for study participants reduced sports injuries to a frequency of less than one-third and decreased incidence of recurring overuse injuries to less than half.* 

4. Clean up your running mechanics! With the repetitive nature of running, small tweaks in your running form can potentially make a tremendous difference! How can you figure out if your running mechanics could use some work? Schedule an appointment with one of our Doctors of Physical Therapy for an evaluation where we will evaluate ways we can maximize your running abilities! 

References: *Lauersen JB, Bertelsen DM, Andersen LB

The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials

British Journal of Sports Medicine 2014;48:871-877.

What is in an Home Exercise Program?

While many patients would love to have a physical therapist that could be with them 24/7 like Russell Wilson, for most, it is not a realistic aspiration. How do we achieve success instead? By implementing a cohesive home exercise program (HEP) for each patient. That being said, not all HEPs are created equal and we would like to provide some tips on what to look for with your own programs including what to expect from those here at Colorado Sports Physical Therapy.

1.       Programs should be created to fit YOUR individual needs. Many injuries come from imbalances in strength and mobility so your plan should look to address those needs. For some of us, that means more strength exercises and for others, it may mean mobility, flexibility, and range of motion activities.

2.       HEPs should have variations in intensity and should grow with you through your treatments. I like to tell my patients that by the time they are done with me, they should have 20-30 exercises that they can choose from ranging from easy to very challenging and that fall into different categories such as pushes, pulls, lateral movements, or rotational movements, to name a few. That way, you AND your body do not get bored, and you can vary your workouts depending on how you are feeling.

3.       A good portion of your activities should be able to be performed in the comfort of your own home. Sure, getting on a lifting program can be helpful (and the PTs at CSPT can also help with this), but in order to increase your chances of sticking with the program, it’s best to have activities that require minimal equipment and space. This way, you have NO EXCUSES!

4.       Your program should be something that you feel comfortable with. This means you have spent ample time learning the techniques and how to modify them. Remember our blog about pain? Exercises should not be triggering your pain, so make sure that you know the proper modifications in order to continue your progress on a day-to-day basis.

5.       Lastly, remember that the definition of insanity is to do the same thing over and over and expect different results. That means, if things are not working, CHANGE IT! Your HEP is meant to supplement your physical therapy sessions to help you get better faster so if you don’t see a change or you feel worse, talk to your PT about it. Chances are they have a whole host of other exercises in their repertoire that may work better for you!

With all this being said, the MOST important thing about a good home exercise program is your willingness to perform. Keeping to your homework will only help you get better faster, which is everyone’s goal. Want to get your very own HEP in place today? Reach out and schedule your initial evaluation today with our experienced team!

Get Your Snow Prep Plan in Place!

Whether you are Team Ikon, Team Epic, or loyal to the backcountry, everyone’s goal for the ski and snowboard season is the same- to shred as many days as possible! Some of us are lucky enough to make it through every day without aches and pains, but for the vast majority, hitting the slopes is a constant physical battle. At Colorado Sports Physical Therapy, we believe in starting your training early and having a plan in place that will be able to get you back on the slopes day after day.

Our Snow Prep Program looks to create a custom program that identifies your current strengths and weaknesses, while taking into account any past and current injuries. We will utilize a combination of functional movement screens, muscle testing, flexibility, and range of motion  tests to determine potential problem areas during our initial evaluation and then set a program to incorporate rehabilitative activities with strength and conditioning to get you into peak condition for your first tracks of the season.

One of the most important components of the strength and conditioning portion of our Snow Prep Programs is the use of eccentric strength training. Basically, it is not how much you can lift, but how well you can control that weight in slow, controlled motions. Think about going off a jump. Your explosive, concentric strength will give you the ups, but your eccentric strength will give you that soft landing that will make everyone else jealous. 

Another major component of our Snow Prep Program is core strength activities. Imagine going through a field of bumps and making quick, tight turns instead of feeling like you are driving over a boulder field. Imagine trying to carve on your edges so hard that your body is almost parallel to the ground. Both of these scenarios are possible by strengthening your core.  Our Snow Prep Program will give you detailed exercises that you can utilize to build this strength

Our goal with those participating in our Snow Prep Program is to give you the best start AND finish to your season. Call us today at 720-216-5128 or Click here to set up your initial evaluation and get a customized plan designed just for you! For a limited time, Purchase your Initial Evaluation for $100 and receive your first follow up on us! Individual and package offers are also available.

Physical Therapy for the Active Pregnant and Postpartum Mom

               For those of us who have had the experience of pregnancy and postpartum life, you know that not only does your life turn upside down, but your body changes immensely. Most of the time, we chalk it up to the normal aches and pains of growing and birthing a human, but in reality, you don’t always have to just suck it up and deal with it.  As someone who has dealt with managing these pains with and without a physical therapist, I know that physical therapy can help you immensely, both during and after your pregnancy.   

              I went into my first pregnancy feeling great. I was lifting, spinning, and doing general workouts until I was about 34 weeks pregnant, but I still suffered from sacroiliac pain and sciatic nerve pain that had me laying on the floor in tears and scooting around my office relying on my peers to help me with treating my patients. I had an unplanned C-section for this pregnancy and the recovery was brutal, especially living in a walkup apartment and on a subway stop with 4 flights of stairs instead of an elevator. After 6 months, I finally worked out the kinks in my body and was almost pain-free, but I definitely did not get back into fighting shape.

              Fast forward two years and, when I became pregnant with my second daughter, I knew that I needed more help. Thankfully, I had phenomenal resources around me and I would be remiss if I did not give a shout out to Dr. Natalia Farnsworth, PT. Not only did she work through pain that would cause my leg to give out every time I turned right on my skis (obviously, not ideal), but after my pregnancy she got me going within a week after my second unplanned C-section.

              To be clear, I was not getting into my pre-pregnancy jeans within that first week, but compared to round one, I was able to walk better, feel stronger, and negotiate those subway stairs more confidently in a fraction of the time. I went from being barely able to engage my core to do a pelvic tilt to swinging a 25 lb kettlebell by week 8 post-pregnancy.  My 3 year old diastasis recti was gone, my hip pain was gone, and I was well on my way to becoming the strongest and fittest I have felt since I was competing in gymnastics at college.

              Personal experience aside, as a clinician, I have also seen the benefit of physical therapy for my pregnant and postpartum patients. In the medical field, we know that exercise during pregnancy can help to decrease the risk of gestational diabetes, so our ability to help you manage your orthopedic pain during that time can help keep you active. For those who are trying to return to an active lifestyle post-pregnancy, it is helpful to have someone who can give you tips to get your strength and flexibility back.

              You may be asking yourself, why doesn’t everyone get physical therapy for these aches and pains? Why doesn’t my doctor recommend PT? The simple answer is that we, as a profession, have come a long way from the days of just using hot packs, ultrasounds, and stim as the basis of our treatments. Now, we use combinations of exercises, manual techniques, and a lot of patient education as the foundation for our plans of care.  As practitioners, we are working to educate not only our patients, but other medical providers of the benefits of physical therapy during pregnancy and post-pregnancy.  As we continue to watch the physical therapy practice develop, we believe that this type of care is quickly becoming the norm.

It's Fantasy Football Time!

Yes, it is just about that time of year again and if you are like us, you are excited about the prospect of the return of FOOTBALL! With the return of the NFL, it brings the return of fantasy football. Every year, I have patients asking me about who to draft and stay away from when it comes to injuries, so I would like to share some tips.

1.       Not everyone is Adrian Peterson. In fact I am pretty sure he is an alien. The vast majority of human beings cannot fully recovery from ACL surgery in only 6 months. I remember telling a friend of mine that, in no way, should you draft him. No one could have predicted that he would return to such a level so quickly and not re-tear his ACL. Also, side note, if you are having ACL surgery, please do not ask your PT to recover as quick as AD. Most return to sport protocols are more like 9-12 months at a minimum. Just look at the case of Jake Butt, the Michigan-turned-Broncos tight end who is almost at 2 years post op, but looking great!

2.       Some injuries can truly tank fantasy points. I had a great conversation with Dr. Mark Drakos from Hospital for Special Surgery in New York, who was also a team doctor for the New York Giants, and he referred me to a very interesting 2010 study out of Duke University regarding NFL players and Achilles ruptures. Basically, it concluded that only two-thirds of players in the NFL with Achilles ruptures return to play and of those players who do, their performance was significantly affected not just in the first season back, but over the next three. How did they measure their performance? In games played and fantasy points of course! What about Michael Crabtree you ask? Well in the first years back after his 2013 injury, he was not effective at all. It took him another 3 years to be a top target for the Raiders.

3.       Concussions are not to be messed with. Are you looking at players that have a history of concussions? If you are, don’t be surprised if they end up on the sideline again this year in concussion protocols. Even with the new tackle rules, I think you are still going to see quite a few this year because tackle form can’t be corrected overnight.

4.       Beware of the MCL sprain. I like to refer to this one as the most painful minor injury you can have. Every time you see a player cut or pivot, you are seeing them put strain the Medial Collateral Ligament (MCL). While surgery is usually not needed in this recovery, it tends to be incredibly painful and lateral movements can take your breath away. If your job is to juke and cut in order to dodge tacklers, you can imagine how painful that could be. 

Obviously, every athlete recovers differently and when it is your full time job to rehab, recover, and prevent injuries, you will get better faster, but hopefully you can use one or two of these tips to avoid getting stuck on the waiver wire with no one to pick up when your star goes down. Happy drafting everyone!

When is “No Pain No Gain” Actually True?

              We all know that when you work hard for something, the results can be spectacular, however there can also be a downside to that. Who hasn’t heard the phrase “no pain, no gain”? As a young athlete, I know I must have heard it almost every day in the gym, and I continue to hear it to this day. While there is some truth to the statement, you must remember that all pain is not created equal. In fact, pain is something that has evolved with humans as a protective mechanism with our body basically telling us, “if it hurts, don’t do it”.  Here are some other helpful thoughts when dealing with pain.

1.       How much pain are you in?

This is one of the first questions your physical therapist may ask you. It seems like common sense that the more pain you are in, the worse, but there is something very important to keep in mind. Pain can be a muscle inhibitor. This means that when you are actively causing pain, your muscles most likely are going into protection mode and will not work optimally. Think about those lovely times that your sibling or friend gave you a dead leg and you immediately fell to the floor. That gives you a pretty good idea of muscle inhibition through pain.

2.       Where is your pain?

This is a big one. Pain in your joint is very different than muscle pain and really, there should never be a time that it should be happening. Do your knees hurt when you squat? Stop. Does your shoulder hurt when you throw? Stop! Most of the time, this is correctable with strength, flexibility, and education, but they should never happen! And furthermore, you should be able to do these activities relatively pain free.

3.       What kind of pain are you having?

Here is another question that most of you should have heard and it helps us make clinical decisions when it comes to your diagnosis and plan of care. Sharp, stabbing, shooting pain are all red flags for us. They can indicate acute, active injury with possible nerve involvement. If you feel this kind of pain- stop what you are doing and seek help! Pain that is more along the dull, achy side is usually more indicative of chronic conditions, but is still important to address. Don’t wait to address it, because it can be harder to get rid of the longer you wait.

4.       How long does your pain last?

Do you go for a run and your pain lasts for a week? That usually is not a great sign. Delayed onset muscle soreness, or DOMS, is the technical terminology for the soreness you have 24-72 hours following a hard workout or that first day back on the slopes. This is a normal muscle reaction that will subside with rest and gentle movements (remember that pain can actually make your muscles feel weak). Anything longer than that could indicate actual injury. A good general rule is pain that lasts for anything more than a few days should probably be checked out.

To be fair, the medicine of pain science is far more complicated than what is presented above. In fact, there are physicians that focus only on pain management. However, you can learn to be better aware of what your pain means and how to manage it when you can learn to describe it. No pain no gain should not be a definitive lifestyle, but an idea of how you can work hard to gain specific results.