On "Heal Pelvic Pain," by Amy Stein

Amy Stein, MPT, BCB-PMD is a long-time friend of Herman & Wallace.? As the founder of Beyond Basics Physical Therapy, in NY, has been working in pelvic rehabilitation for more than ten years.? Amy Stein?s work outside of the clinic has made her a pioneer in the field.? She co-founded Alliance for Pelvic Pain, an educational retreat for patients, as well as penned several books on pelvic pain and dysfunction.? Her most recent book, Heal Pelvic Pain, is a significant resource for patients and practitioners suffering from or interested in pelvic pain and dysfunction.


Heal Pelvic Pain

By: Amy Stein

Heal Pelvic Pain describes the many types of pelvic pain and pelvic floor dysfunction (PFD). ?It also encourages an array of treatments that blend exercise, massage, nutrition, and other self-care practices in lieu of surgery.? There is a need for a broader discussion of pelvic pain, its prevalence, and alternative treatment options.? Heal Pelvic Pain does just that.

For patients and practitioners, Stein?s book clearly articulates many different types of PFD as well as encourages natural healing.? Furthermore, its accessibility allows anyone to understand the consequences of untreated pain or dysfunction.

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New Product Ideas for Your Consideration!

This summer, Herman & Wallace began creating products with a new process that we call ?Pre-Funding?.? We want to produce products only if they are useful to therapists, and who better to tell us than you, the pelvic rehab therapist.? The idea behind Pre-Funding is simple: we create an idea for a product (called a Product-Concept offer it for a trial period at a discounted price, and if enough people pre-fund the concept, we proceed with building the product.? This gives us an opportunity to get critical feedback from therapists before the product is developed, thereby allowing us to generate a higher quality product before we send it out. So far, this program has been a big hit!

Every product from our last round of pre-funding was fully funded and built.? This would not have been possible without the participation of therapists who pre-funded.? The feedback was invaluable, enabling us to generate better, more useful products.? We hope to receive the same comments on our future product concepts!

This week we released a new group of product concepts.? The Male Kegel is a tool to help PTs educate male patients about the pelvic floor muscles and how to exercise them.? Self-Stretching the Pelvic Floor illustrates appropriate stretches for different types of pelvic floor dysfunction.? Pregnancy After 30 examines how pregnancy differs for women over thirty, as well as describing the special considerations for over-thirty moms-to-be.? Our Advanced Breathing Techniques product concept is another resource to help therapists teach patients about the respiratory system and different breathing techniques.

The trial period only lasts thirty days, at which time the pre-fund discount will expire.? Please check out our Products Page before time runs out!

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Promoting Your Practice and Social Media

For PTs growing or beginning their private practices, treating patients can be the easy part. Because we went to PT school to learn to help patients, not become business men and women, the business side of things is often much more difficult.  For therapists trying to promote their practices, using social media can be an effective and free tool for promoting oneself as a clinician.


Advance Healthcare  recently published an excellent article on physical therapy and social media, titled “PTs Going Social.”  The article touches on many of the benefits of utilizing social media as a method to generate referrals for one’s private practice.

The assumption is that social media can change how businesses advertise and remain relevant in today’s market.  Facebook, Twitter, LinkedIn, and even Pinterest offer users the chance to quickly and easily generate content and post it on the web.  However, effectively generating content to best promote one’s practice online is no mean feat.

With over a billion active users, Facebook has become the figure-head of the social media.   Websites like Facebook offer great marketing opportunities.  They’re easy to use.  In about a minute, one can go from clicking “Sign Up” to creating content to promote his/her practice for free.  Seems perfect right?

The truth is much more complicated than that.  Generating and tailoring content on the web often takes the back seat when there are demanding patients and bills to pay.  Simply put, with everything else going on at one’s practice, it’s easy to see why grappling with a new marketing tool takes a backseat.

However, for PTs who do take the time to become familiar with and utilize social media, it can reap huge rewards.  Posting videos of exercises to Facebook or re-tweeting a relevant comment made by a colleague on Twitter build’s one presence within the community.  With each share and post comes potential referrals.  Although a post might not land one a new client on its own, it can certainly help build those relationships. Or as Ian Manning puts it in the article, “it’s the first step towards making the call.”

Furthermore, participating in this community is a “two-way street…[F]ollowing other physical therapists on Facebook” is an easy, effective way to have news, clinical knowledge, and information come right to your Facebook page.

In order to help the therapist navigate the many avenues for marketing, Herman & Wallace recently developed a product for Marketing Your Women’s Health/Pelvic Floor practice. This presentation will equip you to build your referral business and appropriately harness new marketing tools.

Herman & Wallace also offers an online course, through Medbridge, titled, Physical Therapy Marketing with Passion!  This course is taught by H&W instructors, Brandi Kirk, PT, BCB-PMD and Teri Elliott-Burke, PT, MHS, BCB-PMD.  Try it today!

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Soccer Star Struggles with Ulcerative Colitis

Ulcerative Colitis (UC) dramatically effects a patient’s livelihood.  UC is often confused with Crohn’s Disease, another major inflammatory bowel disease.  While they do differ in origin, both diseases share similar symptoms, such as blood in a patient’s stool.  Furthermore, like Crohn’s Disease, UC tends to affect young people (those between the ages of fifteen and thirty).

Chronic and often severe, UC has no known cure and, in rare cases, can even be life-threatening to the patient.

The Daily Mail posted a news article about Manchester United’s Darren Fletcher, who recently underwent his third surgery for UC.  Over the last few years, Fletcher has frequently struggled to stay fit.  He has played just thirteen games since December 2011.

Multiple surgeries, as in Fletcher’s case, are not uncommon.  UC spreads and deeply infects the lining of a patient’s colon and rectum.  Although there is no known cure, correctly applied therapy has been known to markedly reduce symptoms and even lead to long-term remission.

Herman & Wallace offered their first on Bowel Pathology and Function in Stony Brook, NY last month and is in the midst of confirming dates for another course in 2014.  Keep a look out for updates!

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Urinary Incontinence Affects Just About Everyone

Urinary Incontinence (UI) is about as pervasive of a condition as any.  Allegro Medical posted a blog recently on “Managing Bedtime Adult Urinary Incontinence.”  As they note in their piece, over “one-third of adults wake up at least twice during the night” to urinate.

Nearly everything that involves the uncontrolled outflow of urine is a type of urinary incontinence.  Meaning, the underlying cause of Urinary Incontinence can be anything from diet to dehydration to weak pelvic floor muscles.

While UI is most pervasive in men over forty, women of all ages, especially pregnant and postpartum women, are affected.  For patients, this can be an exhausting and embarrassing affliction so much so that many do not seek out medical professionals for treatment.

Our Urinary Incontinence Manual is specifically designed to focus on adult UI and includes everything from educational tools for patients to resources for marketing an incontinence practice.  Purchasers receive the product electronically after they purchase, and all forms are customizable with your own clinic’s info and logo.  Check out this and other offerings on our Products page!

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Sacroiliac Joint Dysfunction and Lower Back Pain

Sacroiliac Joint (SIJ) Dysfunction is a common cause of lower-back and pelvic pain.  Although athletes suffer frequently from SIJ Dysfunction, this condition can also affect many others, including and especially pregnant women.  The SMART Clinic wrote a blog post about SIJ Dysfunction recently, explaining that, “Women during pregnancy can experience SI Joint pain due to the release of a hormone called “relaxin” that creates instability (unstableness) within the SI joint.”

Nearly 80% of Americans suffer from lower back pain at some point in their lives, and lower back pain “is the most common cause of job-related disability, and a leading contributor to missed work” in the United States.  For those who suffer from persistent back pain, SIJ is the confirmed point of origin in 13% of cases.

Frequently painful and sometimes debilitating, SI joint dysfunction is surprisingly easy to develop.  Like many other pelvic conditions, everything from bending-over to sitting-down can lead to SI joint dysfunction.  Traumas like sports-related injuries and traffic collisions are other frequent precursors.  SI joint dysfunction can rarely be addressed by surgery (and, even more rarely, should it.)

Herman & Wallace will be putting on a course about treating SIJ Dysfunction in Tampa, FL this October.  This course, focusing on treatment and evaluation of both the sacroiliac joint and the pelvic ring, will focus on what influences and upsets the SI joint.

Seats are limited – register today!

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Pelvic Organ Prolapse Patients Developing Pudendal Neuralgia

In 2011, the FDA issued a warning to patients and medical professionals that transvaginal mesh implant surgery for pelvic organ prolapse (POP) often created more problems than it solved.  The warning also noted that “there was no clear evidence transvaginal POP mesh repair was more effective than non-mesh repair” for treating POP.  Furthermore, the FDA report emphasized that the mesh itself, rather than surgical error, lead to pelvic pain in many patients.

However, transvaginal mesh implant surgery remains a commonly recommended treatment for POP.  A Justice News Flash post, titled “Don’t Wait In Vain For Pelvic Pain To Resolve After Removal of Mesh Implants”, recently discussed how this surgery often leads to the development of Pudendal Neuralgia in patients, “more often than not [requiring] complete removal of the mesh.”  In short, in lieu of sending these patients to trained physical therapists, and, in spite of FDA warnings, many medical professionals continue to recommend transvaginal mesh implant to treat POP.

Pudendal Neuralgia, already an underdiagnosed, undertreated, and underserviced illness, is noted for how few therapists and other medical professionals have the proper training to treat it.  Peripheral nerve regeneration can take up to six months for patients who developed Pudendal Neuralgia after surgery.

Ultimately, it is the patient who is left to suffer for extended periods of time and go through unnecessary procedures.  Patients with either POP or Pudendal Neuralgia would be much better served by a trained pelvic rehabilitation professional than a doctor who is unaware of, or ignores, alternatives to a surgery that FDA warnings against.

For pelvic rehab professionals, this means that asking about previous surgery, particularly transvaginal mesh surgery, is vital to treating patients who suffer from pelvic pain.

This August, Herman & Wallace is proud to offer a course on Treating and Assessing Pudendal Neuralgia in Altanta, GA.  We hope to see you there!

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Sticks and stones may break my bones...

While on a walk with my son recently, as he was collecting sticks, he casually repeated the phrase "sticks and stones may break my bones, but words can never hurt me..." and it allowed us to have a brief discussion about how words can, and do, hurt people. Parents today are armed with terrific tools to learn about emotional intelligence, and how the power of language can, for example, help preserve a child's self-esteem while the parent still sets up boundaries. How often are we trained as adults to pay attention to the phrases, gestures, or words that we use during adult interactions, or in patient care interactions? Think about a mentor, supervisor, or friend who you admire- who you aim to emulate. What is it about the person's interactions you find inspiring? Is it the command of the situation she has, the compassion she exudes, or the intelligent way she can say things to a patient? Regardless of the trait you are admiring, communication is likely a key factor in the interactions you find pleasing.

A recent MedScape article asks doctors to share words they let fly, only to wish they could take them back. We have all spoken in haste, in frustration, or in jest, only to realize that we have offended a patient, a family member, or a colleague. The most important thing in that situation may be the actions that follow the indiscretion. And as many martial arts traditions teach, the highest form of self-defense is to avoid conflict in the first place, so how can we best position ourselves to avoid using phrases, gestures, or other communications that offend and create barriers between ourselves and the patient? The most critical part of the solution is awareness. We all use phrases that are so commonly part of our everyday life we don't even know we are using them. It could be "cool" or "is that right?" Do you really mean that a patient's response to your intervention is "cool?" And do you really want the person to clarify if what they are saying is true? What if we took the world as literally as some of the children in our lives do? What would our day look like? Looking at some typical, and lazy ways that we talk, is is accurate to say the following?

  • I'm starving
  • I wanted to die
  • He is so worthless
  • You'll be fine
  • How many of us are truly starving in our communities? Is someone worthless simply because you did not get a return phone call? Will the patient be fine, or do you need to say so because you want to feel less worried?
    And how do you feel about the person who begins a discussion with these?
  • Let me be honest with you
  • Here's what you need to do
  • I hope this doesn't offend you
  • I realize this might seem like micromanagement of every single word out of the mouth. I encourage you to try sometime being truly, excruciatingly aware of what you say, even for an hour. If you invite the kind of honesty required to make habit changes, you could ask a colleague if there are any phrases you often say that are annoying, or not useful. You could ask a student to write down phrases you use in patient care and then compare those phrases to more inspiring language you could employ. The next time you give a presentation, ask a trusted colleague how your use of language was perceived. You may be unpleasantly surprised to find out that you used the word "like" as if it were going out of style (and it did...) When we are really comfortable with our patients, perhaps we have treated them off and on for a few years, or they simply are a person we get along well with, dropping into casual conversation, dropping an f-bomb, or confiding personal details can happen. If you find yourself in this situation, you might simply apologize with a smile, and state that you forgot your manners, and request the patient forgive your casual attitude. We are always in a power situation with our patients, and can never assume that a casual attitude is not misconstrued.
    Another habit that can cost you a patient, or a promotion for that matter, is using phrases that come across as callous, or using gestures that indicate a lack of sensitivity. Are you someone who holds the imaginary gun to your head and pulls the trigger when you want to express how maddening a situation was? What do you know about the person to whom you are talking? Did a loved one commit suicide? Again, intention does not really matter once you have completed an act that hurts or offends, and only by improving our awareness of every word, every hand gesture, can we work towards always saying what we mean, and being careful with other people's trust. Hand gestures outside of our own cultural awareness is another topic fraught with the potential to make a wrong move. When in doubt, check in with what your hands are doing: hold on tight to your pen, clipboard, or theraband, and avoiding pointing, thumbs up sign, and other common gestures that may not mean what you think it means.
    While sensitivity of language and gestures takes effort, awareness, and being able to take feedback with openness, everyone wins in the end.

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Biomechanics and Pelvic “Dumping”

Total Physical Therapy recently posted two excellent videos on the pelvic “dump”: the Pelvic “Dump” and Muscle Length and the Cure for the Pelvic “Dump”.  The first video describes how the hamstrings, abductors, and the gluteal (“glutes”) muscles affect pelvic “dump”, also known as the pelvic tilt.  The second examines stretching techniques that can ease the tightness and, thus, treat pelvic tilt.

Pelvic tilting occurs when the pelvis is not orientated correctly, and is becoming more and more common as sedentary lifestyles bceome the norm in America.  Daily activities, such as sitting at a computer for example, can often lead to a pelvic tilt.  Resting against the back of one’s chair or leaning forward to read small print can feel more supportive than utilizing the correct muscles required maintain proper posture.  To put it another way, when doing activities many Americans do daily, it is often easier to rest one’s body on another surface for extended period of time than it is to exercise proper biomechanics.

However, this behavior often leaves patients with pain and stiffness in the back, knees, and hips.  Furthermore, if left untreated, these symptoms have a tendency to become more severe over-time.

This August, Herman & Wallace will be presenting a course on the Biomechanics of the Hip & Pelvis. In the course, instructor Steve Dishavi will show a number of videos on proper posture and body mechanics, and instruct on how to analyze a patient’s movement and make corrective recommendations.

Seats are limited.  Register today!

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The Complicated Relationship between Kegels and Pelvic Rehab

For more than sixty years, Kegel exercises have been a common, albeit rudimentary, form of treatment to strengthen the pelvic floor.  These exercises have become so omnipresent that the pelvic floor is commonly known colloquially as the “Kegel muscle.”  Perhaps best known by the public for their ties to increased sexual function, Kegel exercises are often inappropriately considered the hallmark of pelvic floor wellness.

In a recent Chronogram article, titled “Could Your Pelvic Floor Use a Renovation?”  Wendy Kagan describes the significance of Kegel exercises: “Today they’re a first-line defense against genital prolapse and urinary stress incontinence (i.e., leakage that occurs with jarring movements like coughing, jumping, or lifting). Dreaded by some, championed by others, Kegels are the pelvic equivalent of flossing—something most women know they should do, yet often guiltily do not do.”

The biggest problem with this article is that Kegels are not the “first line of defense”.  Nor are they, necessarily, the best practice for everyone’s daily regimen.  Prescribing pelvic floor strengthening without properly assessing the pelvic floor can be harmful for patients.

Kegels have become more popular in the public sphere.  Popular exercise programs such as Yoga and Pilates often include Kegel exercises as part of their routines.  Some have over-expressed the sexual benefits of Kegels.  One hardly can open a Cosmo without finding an article on Kegel exercises for enhanced performance and pleasure during sexual activity.  Furthermore, for men, Kegels have been prescribed as solutions for everything from erectile dysfunction to premature ejaculation.  As popularity and awareness has grown, many have taken to performing Kegel exercises without speaking to a professional, which is never a good plan for benefiting one’s health.

However, the popularity of Kegels brings with it a public recognition that pelvic floor health is imperative and deserves to be cared for actively.  Though not quite the silver bullet that Kagan’s article suggests, when properly recommended by a PT, Kegels, can be an important tool in treating patients. .  As we examined in a past Pelvic Rehab Report: “Pelvic Floor Muslces: To Strengthen or Not to Strengthen?”, doing Kegels correctly is more than just tightening the muscles: “If a patient presents with pelvic muscle tension, shortening of the muscle, and poor ability to generate a contraction, a relaxation phase, or a bearing down of the pelvic muscles, how in the world will trying to tighten those overactive muscles bring progress?”

Herman & Wallace recently began developing a product to help therapists educate and treat patients on how to properly execute Kegel exercises.  Check out “All About Kegels” to learn breathing techniques and exercises to help patients effectively build pelvic floor strength.

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