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As with many issues, often we aren’t sure if what we are experiencing is normal and expected, if it will just go away, or if we need to have it looked at. For many women who are pregnant and postpartum, this is made even more difficult as we are often told that symptoms we are experiencing are normal because “you’ve had kids” and that “this is just how it is now” which can delay effective treatment of these issues! Here you can see a case study on Prolapse, which outlines some of the issues that someone may experience.

The presenting symptoms:

A 31 year old woman attends the clinic mentioning a history of intermittent pelvic floor heaviness “feeling like things are falling down” and discomfort. She has noticed that the heaviness has been worse since starting back with weight lifting at her gym 1 month ago. She has two children ages 2 years and 4 months old.  She had continued to go to the gym throughout her pregnancy (symptom free), but notes she had reduced her weights somewhat during her third trimester.

She hadn’t returned to the gym until now, as her life has been quite busy since the delivery of her second child! No pelvic floor pain, urinary or fecal incontinence is reported.  She had felt like now was a good time in her life to return to the gym and is quite devastated at this setback. Going to the gym and working out had been an

important part of her life-mentally, socially and physically and she is worried she won’t be able to do any activity at all anymore.

She went to see her family physician as was concerned about her symptoms and was referred to pelvic floor physiotherapy for prolapse. She reports no symptoms first thing in the morning, but these progressively worsen as the day goes on.  Some days are better than others with her symptoms.  Lifting weights at her gym and lifting her children aggravate her symptoms.  She notes she did just get over a bad cold and had been coughing/sneezing quite a lot during the past month. She also identifies that she has always had issues with constipation.  Both of her deliveries were vaginal with no instrumentation (forceps or vacuum) or complications. She is currently breastfeeding.

Assessment and Treatment

The client was assessed with an internal pelvic examination by a pelvic floor physical therapist. A Grade 1 cystocele was found. (A cystocele means the prolapse was from the bladder descending into the wall of the vagina and a Grade 1 prolapse means the organ descent was halfway to the vaginal opening). The pelvic floor muscles were weak with a Gr. 2 strength (a weak squeeze and no lift of the pelvic floor muscles) and tight.

The client and the therapist worked together to increase her pelvic floor strength and coordination, as well as to optimize her intraabdominal pressure management systems. Toileting positions and discussion around constipation management were discussed and the client was able to implement these at home. Optimizing postures during breastfeeding and throughout the day were discussed to reduce strain on the pelvic floor and discussed on how to successfully get them implemented at home.  Education on anatomy of the pelvic floor and the pelvic organs/their supports as well as POP was provided which will help the client to take control and understand the why behind the recommendations.

Activity modifications were implemented but keeping her active was part of the plan and exercises were progressed as appropriate.  The client returned to her gynecologist for a pessary fitting to use intermittently during heavier weight lifting at the gym. She was seen in follow up 2 weeks after the initial assessment and then 1x/month for 6 months. She was able to return to her weight lifting and was symptom free with all tasks and activities at the conclusion of therapy, although her Grade 1 prolapse remained.

Have you been struggling with prolapse symptoms? Not sure if your symptoms could be part of prolapse, please feel free to contact us and we will help chat you through what you are experiencing as best we can.

Don’t delay start your road to recovery today!

Maja Stroh is a physiotherapist that has a particular interest in pelvic health and perinatal care. She graduated from the U of S MPT program in 2009 and has been working with pelvic health populations since 2013. Maja’s interest in helping her clients and spending quality time with her family has brought her to Warman Physio where she will be providing services in the Saskatoon and Warman locations.

March was Endometriosis Awareness month, and we have provided some information related to endo for everyone on our social media (Facebook and Instagram). If you are wondering what endometriosis looks like for someone living with it, you can check out the story we posted earlier in the month. As promised here are some of the things that Pelvic Floor Physiotherapy can do for you…

Pain Science

Physiotherapists that work with pelvic pain conditions, such as endometriosis, have additional training specific to the actual science behind pain. Having this knowledge to give to our clients allows us to de-mystify pain, help us understand pain perception, and why the symptoms are occurring. Globally with pain science, one of the most important things to understand are there are no pain signals to the brain. The brain receives information from the body, and depending on what all those signals are saying, will determine if something is painful or not. Have you ever stubbed your toe when you are having a great day? It hurts SO MUCH. But, if you stub your toe while you are in the middle of an argument with someone, it doesn’t hurt the same; that’s pain science!

Everyone has heard a story of someone being in an accident of some kind and being able to get to a hospital (or civilization) before feeling pain.

How does this apply to endo? Endometriosis is the presence of uterine-like tissue outside of the uterus, within the pelvic bowl and abdomen (generally). Endometrial tissue contracts during menses to shed the lining of the uterine wall. If this tissue is outside of the uterus… it still contracts on the tissue it is adhered to.

Which brings us to….

Assist muscle tension

If you have a muscle that is contracting and creating more tension over time, and you aren’t stretching it, eventually it becomes tighter. Have you tried stretching tight muscles? How about making them contract more?

Here is where we talk about what happens in a painful body – when we have abdominal and pelvic pain, we try and protect the area. This protection leads us to adopt a fetal position. Tightness develops in the abdominals, hip flexors, pelvic floor, and diaphragm, which plays into the pain cycle. Pelvic floor physiotherapists will work with each woman to obtain appropriate length, strength, and coordination of the muscles in the abdomen and pelvic bowl.

Tight muscles are often painful muscles.

Provide self-assistance tools

We are here to help you, help yourself. Giving you tools to reduce pain for between episodes, things to try during painful episodes, and ultimately manage your pain.

Some things that could be helpful include: stretching your hip flexors, deep breathing, yoga, meditation, using a wheat bag, and releasing muscles using an acupressure ball (or tennis ball).

 

Endometriosis can’t be cured by physiotherapy, but the symptoms can be managed. Contact us today to see how we can help you, or use the Book Now section to schedule your assessment today, and take control.

*Note: Kendra Usunier is our Pelvic Floor Physiotherapist that is able to take new clients at this time. Only clients that have seen Haylie Lashta previously are to schedule in with her at this time. We appreciate each person and their unique journey to find us, contact us directly should you have any questions.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.

Case Study: A client HD came to the clinic after several weeks of shoulder, shoulder blade and arm pain. This pain started in the shoulder and moved down the arm. The client would describe the pain as ‘sharp’, ‘burning’, ‘shooting’, ‘deep achy’, and ‘pins and needles’ depending on what they did. Initially their pain would come and go, but over time the pain would stay for longer periods of time. This client found that sometimes anti-inflammatory medication and massage helped, but it always came back. Since their pain started in their shoulder it was believed that it was a shoulder injury (rotator cuff). After assessment by a physiotherapist it was identified that HD had issues from the neck resulting in shoulder and arm pain. With treatment including home exercises, stretches and programming, the client was able to return to full function and a pain-free state of being!

neck-pain

The story of HD is not uncommon. Often people are not sure where to go for a variety of issues and complaints. Your local Warman Physio is able to provide assessment and treatment of any ache or pain occurring within the body, whether it was caused by an injury or ‘just showed up’ one day.

Physiotherapists are trained to provide assessment and treatment of all the body systems including the muscles, tendons, ligaments, and nervous system to identify what is causing any pain or issue.

Following is a list of conditions that Physiotherapists can help with in the neck and arm:

  • Disc bulges in the neck
    • often causes pain as is outlined in the image above with the red highlighted areas depending on the level the bulge is present
  • Nerve compression or irritation of nerves of the neck
    • pain down the arm with moving the head a particular direction like in shoulder checking
  • Carpal Tunnel syndrome
    • pain and tingling in the hand often upon waking from a night’s sleep to start
  • Rotator cuff injuries
    • pain in the shoulder often with reaching over head or behind the body
  • Tennis/Golfer’s elbow
    • pain on the outside/inside of the elbow often with lifting/carrying

 

How does the neck cause pain in the shoulder and arm?

The body is a complicated group of systems that work together to allow us to complete our everyday tasks. Our neck has 7 vertebra (C1-C7) that go from the base of the head to the base of the neck. Within your neck there are 2 joints at the top and bottom of each vertebra, and most of them are separated by small discs. Our spinal cord is enclosed inside a tunnel within the vertebra. The nerves that go down into the shoulder and arm come out from between the vertebra, through the muscles and down the arm. These nerves then control the muscles (creating movement) as well as sensation (touch, temperature, etc). If something happens to the nerve throughout it’s path down into the arm it can create issues in the movement, sensation, or both!Sometimes it is hard to figure out where pain is coming from – the muscles, joints, nerves, tendons (attach muscle to bone) or ligaments (attach bone to bone). Leave the guess work out of your pain and have it assessed by your local Warman Physio! We currently have appointments within 0-2 business days and have accommodating hours for early morning (8 am) and after work (until 8).

Haylie Lashta BScKin, MPT Certified Pelvic Floor Therapist:

As a physiotherapist that works with women who are pregnant and women’s health (pelvic floor physiotherapy) and a mother myself, I find that often women have many questions while pregnant.  Shouldn’t I be sore? Isn’t it normal to have pain while pregnant? A little bit of pee when I sneeze/laugh/stand-up is ok though right?

My answer to this in short is NO!  Often newly pregnant women will be told a variety of things to appease them in reply to many complaints ‘well it’s what you signed up for’ or ‘you’re pregnant, what did you expect?’ and are otherwise brushed off when concerns of pain are raised. This is beginning to change! Women who are pregnant need not be in pain, discomfort or other physical distress; and are often not accepting these as answers to their concerns.  Often, physiotherapy can help!

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First let’s talk about pelvic girdle pain (think your gluts or bum, pubic bone and hips). This can often be addressed with Rost Therapy and manual skills of a physiotherapist.  We work with women who are pregnant to assess and determine their specific underlying causes of the pain and provide you with a home program that helps you help yourself. My motto is if I am able to do something in-clinic to help a client to feel better, then I should be able to provide a home exercise to help keep it that way.  Rost Therapy in particular takes a look at pelvic symmetry and utilizes the muscles that attach around the pelvis to promote symmetry, and provide you with some home exercises to help.  To me there is nothing worse than providing a treatment the client must continue to return and pay for over and over, ultimately not allowing them to continue their progress at home. In the image above you can see the Rost Symmetry position (feet together, knees apart), often when in this position individuals experiencing SIJ pain will have one knee sitting higher than the other.

What is something you can do NOW to help your pelvic girdle pain? Check how you are sitting or laying.  We often want to cross our knees or pull them together; this creates tight muscles and tension in the inner thigh which can be a cause pelvic girdle pain.  Instead of crossing your knees, cross your ankles and let your knees sit open (wider than your hips).  This is also why when laying on your side we suggest you place a pillow between your knees (think thick enough to lift knee to hip height).  This will encourage relaxation and decreased tension in those inner thigh muscles.

Now, the pelvic floor and pregnancy.  I get many women who are pregnant coming into the clinic that are anxious because they haven’t been ‘doing their kegels’.  Do no fret, I do not necessarily recommend kegels to my women who are pregnant.  Let’s think of the reason why for a minute.  Kegels are a strengthening exercise for your pelvic floor muscles.  These muscles are like a sling between your pubic bone and tail bone, and their main function is to close the anus, urethra and tighten the vagina.  Essentially kegels are intended to pull everything up and in.  Now, when we go into labour, we want the babies to come down and out.  See my predicament? I work with women to promote pelvic floor relaxation, pre-labour stretching and delivery prep of the pelvic floor.

What is something you can do NOW? Relax that pelvic floor! If you’re sitting in a chair imagine that you are trying to drop your vagina towards the chair (similar sensation to relaxing prior to a bowel movement) while breathing in, then rest as you exhale. This is an active relaxation and I often cue ‘Relax down and out’.

Many times when I see women for pelvic floor therapy I find the pelvic floor is very tight and high. Anyone only ever really talks about the kegel ‘strengthen the pelvic floor!’ and strengthen we try.  Without a balanced relaxation all we do is shorten.  Imagine you go to the gym and you want to do bicep curls (hand to shoulder) and someone tells you to just pull up and hold there for 10 seconds, rest for 1second then repeat.  your elbow wouldn’t straighten all the way down and it would begin to stay bent.  This decreased relaxation causes tight and short muscles which makes it very difficult for them to do their job, which at this time (pregnancy) the end goal is allowing a baby down and out.  This could be one (of many) reason(s) women are experiencing higher degree tearing of the pelvic floor during delivery.

No one individual is the same, and each assessment will lead to different treatment plans for my clients.  Which is why I recommend a comprehensive prenatal assessment when pain starts, or at approximately 32-36 weeks gestation prior to delivery for delivery prep. Keeping these things in mind could save you later.

In a nut shell: don’t ‘sit like a lady’ and relax that pelvic floor!

Just in time for spring running weather, Warman Physio will be offering a Running Clinic March 10, 2016! Presented by Physiotherapist Kevin Bergen, the education session will provide information on:

– common running pains/issues
– typical training mistakes
– stretches that are geared towards runners to try
– possible gait analysis (chosen ahead of time)
– how to tell when an appointment is required
– possible information on ‘prehab’ before changing running routine
– the importance of strength as well as endurance and it’s affect on running

We will be providing snacks and beverages for those who attend. The location of the event will be determined by the number of people that register for the event – to register please e-mail info@warmanphysio.com titled “Registration for Running Clinic”, or call the clinic at 306-373-9355 (306-373-WELL). There will be a limited number of spaces, make sure you don’t miss out!