​I created a handout on pubic symphysis pain in pregnancy while waiting for a patient to arrive for their appointment. Pregnancies can be very different between people and not all pregnant people have pubic pain. For those who do, I hope this information is helpful!








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What is the pubic symphysis?

• The name of the joint in the front of the pelvis, where the pubic bones come together, connected by thick, supportive fibrocartilage
• Thought to be painful in 1/3 of pregnancies, with increasing awareness of symptoms by providers
• A strong, load-bearing joint

What are symptoms of pubic symphysis pain in pregnancy?

• Shooting pain in the front of the pelvis
• Radiating pain into the lower abdomen, back, groin, perineum, thighs
• Pain with walking, placing more weight on one leg, lifting a leg out to the side in a standing or side lying position
• Pain with activities like bending forward, getting up from a chair, going up or down stairs, turning in bed
• Pain relieved by rest

Why can this joint be painful during pregnancy?
​
​We don’t entirely know, but some of the leading hypotheses include:

• Biomechanical strain (loading of the joint)
• Metabolic and hormonal change in pregnancy leading to ligament laxity
• Muscle weakness
• Weight gain during pregnancy
• Other predisposing factors (having > 1 birth, genetics, family or personal history, hypermobility disorders, lack of regular exercise, history or back or pelvic injury, history of low back pain, psychosocial factors)

What can I do to manage a painful pubic symphysis during pregnancy?​

#Pubicsymphysis #pregnancyjointpain #pubicpain #paininpregnancy #exerciseinpregnancy #crotchpaininpregnancy #pregnancywellness #exerciseduringpregnancy # pregnancy groin pain

New Year’s Resolutions:   goals that we set to better ourselves, our relationships, and the world around us. Depending on whether you’ve had success with this year’s resolutions and those in the past, making New Year’s resolutions (and sticking to them) can seem like a daunting task. Counselors and psychologists tell us that successful resolutions need to have an attainable goal, plan of action, some sort of accountability, and small, manageable steps toward your goal. Many of us have been working on our goals, and quite a few of us have given up on our goals. The type of behavior change required to successfully conquer our New Year’s Resolutions is a tall order indeed.

Pelvic floor physical therapists can help you with your New Year’s resolutions (I bet you knew I’d say something like that)! Have you been avoiding exercise for fear of peeing your pants? Do you avoid yoga or leave early because of the dreaded fart during Savasana pose? Are you unable to walk or run as long as you’d like or at all because of leakage, heaviness in the pelvis, or pelvic pain during or afterward? Are you trying to focus on physical intimacy with your partner but pelvic pain is stopping you? Are you tired of having to change your clothing because you leak when you’re rushing to the bathroom? Want to play with your kids more often but leakage stops you?

As a physical therapist specializing in pelvic floor therapy, I treat all these symptoms. Pelvic floor muscle problems such as weakness or trouble with coordination may be at the root of such symptoms. Sometimes the pelvic floor muscles have difficulty relaxing or are tightening when you think you are relaxing them which can lead to pelvic floor pain issues. And often I can provide you with behavioral, dietary, and fluid intake recommendations that significantly reduce or eliminate symptoms of an overactive bladder.

Your first appointment involves a detailed look at the history of when and how your symptoms started, what’s worked for you in the past and what hasn’t, and what your goals are for pelvic floor therapy. Keeping your goals in mind, an examination involves assessing the function of your pelvic floor muscles, and often abdominal and hip muscle strength and spine and hip flexibility. We’ll create a treatment plan based on your goals and the exam findings and you’ll get exercises and activity modifications for homework from your first session, so you can take concrete steps toward your goals.

Accountability is built into physical therapy treatment as your follow up sessions focus on what parts of your home exercise program have been working for you and what parts haven’t gone well. We can modify exercises based on equipment you have access to, or even to be able to exercises at home with your kids, and without equipment at all! You’ll never be shamed for not doing your exercises at Foundations Physical Therapy; if you don’t get to your exercises, we may need to be more creative in figuring out what a successful home program looks like for you. You may need to take a break from physical therapy and come back if life gets busy. I am here to help you be successful in creating the life you want, free of pelvic floor muscle problems.

If you have goals you’d like to meet in the New Year and you feel that you might benefit from pelvic floor physical therapy, please reach out to me. I offer a complimentary 15-minute phone consultation to all potential clients to discuss your symptoms and physical therapy treatment options. You can reach me for a phone consultation at (928) 350-8270, or you can fill out the contact form on the website.
 

Have you ever gone to a doctor’s office or physical therapy clinic when in pain or scared about a health issue, and the music was blaring loudly, or the receptionist was curt, or maybe it was hard to get comfortable in the waiting room? Or maybe you were called back to an exam room and had to sit for a long time waiting for your provider, while in pain, filled with worry and unanswered questions? Have you ever felt like your doctor or clinician was pressed for time, not letting you get your questions out, or asking questions that had nothing to do with why you were there? Or maybe you were simply told what was going to happen during your appointment, such as a physical exam, without feeling like you had a choice whether or not this was going to happen?
 
Unfortunately these experiences occur far too often in medical practices due to limited time providers can spend with patients and because providers aren’t often considering trauma-informed care when treating patients. These experiences at best might lead to a negative review on Google, and at worst can result in poor care or a traumatic experience in the doctors’ office.

So just what is trauma-informed care and why is it a central part of care at Foundations Physical Therapy? To understand the answer to this question you have to first understand that trauma is a very common human experience, and due to this, I expect that many of my patients have experienced some sort of trauma. This trauma can be either directly or indirectly related to the reason I’m seeing a patient for physical therapy.
 
Trauma can be any event or experience that is distressing or disturbing to an extent where our psychological and emotional response continues in a way that can impact  our behaviors and beliefs in the future. Trauma comes in all shapes and sizes. Trauma can be physical, such as an injury to the body, sexual assault or rape. It can occur from being in war, being involved in an accident, being stuck outside in a  thunderstorm, having an illness or injury, losing a loved one, or going through a divorce. Trauma can also be related to repeated daily insults such as when people are repeatedly mis-gendered or when a person is treated differently or discriminated against based on their sex, gender, age, beliefs, and ability.
 
So when you think of all the different ways people can experience and have trauma, it’s hard to believe that a patient walking into a doctor’s office doesn’t have some sort of history of trauma. Which brings me to the second part of the original question. When people experience trauma, it affects how well we can access health care, our ability to interact with healthcare providers and our ability to participate actively in our health care plan.
 
Knowing that most people I treat (and most people in general) have some sort of history of trauma, providing trauma-informed care is essential in my practice. I would argue that it is a duty of all health care providers to provide trauma-informed care. Providing trauma-informed care in healthcare settings means:

• Creating an environment and a relationship that allows people to feel safe, heard, welcomed, and respected.
• Providers and support staff showing compassion and kindness for patients as the important human beings they are.

 
Foundations Physical Therapy is a quiet, calm, and relaxing space where appointment times are long enough for you to really tell your story. The intake forms are inclusive and allow you to answer questions in your own words. My goal is to create a healing environment where you can have success with physical therapy, not despite any past traumas, but working alongside them. 

​The sign pictured here is hanging on my wall just opposite of the chair patients usually sit in during the beginning of our first appointment. I sincerely hope that each and every one of my patients feels safe and cared for in this office, just like that sign says.
 
For more information on how Foundations Physical Therapy strives to provide trauma-informed care, check out the Statements page on the website and scroll down to the Trauma-Informed Care Statement. If you have questions about trauma-informed care or suggestions on how to improve trauma-informed care at Foundations Physical Therapy, please comment below, call (928) 350-8270 or email me at [email protected].
 
#traumainformedcare #peoplematter #everyonehasapast #pelvicphysicaltherapy #physicaltherapy #compassionatecare #foundationsphysicaltherapy           #flagstaffpelvicpt
 
 
 
 
 

Two weekends ago I was able to get out for a hike to Fisher's Point via beautiful Sandy's Canyon in Flagstaff, AZ. Sandy’s Canyon is quite possibly my absolute favorite place to hike. It’s relatively quiet early in the day but gets busier as the day goes on. It has flat sections and some climbs depending on if you want to go all the way up to Fisher’s Point to the lookout or not. It has shade and also a sunny canyon bottom with many wildflowers. It even has a little cave. Kids and pups can hike it too, depending on their level of hiking experience (that's my 10 month old puppy, Kaia, in the video)!

As a pelvic floor physical therapist, of course I had to think about pelvic floor stuff on this gorgeous hike! Something I hear often from folks I treat for pelvic floor issues is that it’s hard to hike or hike for as long as they would like. I’ve successfully treated people who’ve been limited in hiking by many different pelvic symptoms such as:

• Pelvic pain (pain anywhere in the external genitals or internal pelvis, or even the pelvis itself)
• Urinary incontinence (leaking urine)
• Urinary urgency (“I can’t hold it,” leaking before you’re in a good place to pee)
• Bowel issues (urgency, leakage and more)
• Pelvic organ prolapse (feeling of heaviness or falling out)

These symptoms are often due to treatable pelvic floor muscle problems. Because of these issues, people often modify their hiking or avoid hiking altogether. My patients with these symptoms have reported to me that they’ve had to:

• Shorten their hikes
• Hike more slowly than they’d like
• Avoid carrying as much (which can be a big problem if you’re not carrying enough water in Arizona!)
• Avoid hiking on rougher terrain
• Avoid hiking on hills
• Hike less often or stop hiking

If you love to hike like many of us in Arizona do, and are finding yourself limited by pelvic floor issues, it might be time to come see a pelvic floor physical therapist. As a pelvic floor physical therapist, my goal is to get at the root of why you’re having your pelvic symptoms, help you change any modifiable factors, and get you back to doing what you love to do. That may mean:

• Strengthening or re-training your pelvic floor muscles
• Improving your trunk and hip strength
• Teaching you how to modify what and when you’re drinking
• Modifying your gait (how you walk or hike)
• Teaching you how to be in control of your bladder or bowels, instead of letting them control you

 
Do you wish you could hike more in our beautiful Northern Arizona? Fall is coming and I can’t wait to walk around in the beautiful aspens as the weather cools down. If you’d like to talk about your pelvic floor symptoms and get some relief, contact me using the contact form, or call Foundations Physical Therapy at (928) 350-8270. I look forward to helping you figure out how to hike and live the life you want to live, without pelvic floor muscle problems limiting you. 

A very dear friend of mine suggested to me earlier this year that I should use a “more artistic” version of the pelvis for the logo of Foundations Physical Therapy. “It kind of looks like a gremlin,” he said, referring to the image I had chosen. But I didn’t want to change the logo – partly because it had taken a long time to arrive at the current design, and partly because I’m stubborn. But the main reason I didn’t want to “soften” the pelvis image is because of the mission of Foundations Physical Therapy, which is: 

Foundations Physical Therapy helps return people to the life they want to live by providing equitable, accessible, and trauma-informed physical therapy for individuals with pelvic muscle dysfunction.

My well-meaning friend suggested I ought to use a line-drawing version of the pelvis, with smoothed edges, or an image of the pelvis shaped like a butterfly. Aside from the fact that I’ve helped people with their pelvic pain and incontinence issues for over a decade now, and view the pelvis very differently from most people, my main goal in using the actual anatomical image of the pelvis was to demystify the pelvis.

To me using an anatomically correct pelvis picture in the Foundations Physical Therapy logo says, “here’s a pelvis, and it’s ok to talk about the pelvis.” Because of a variety of factors involving cultural influences, people often have a difficult time talking about all things pelvic – we tend to avoid talking about sex, and sexual problems, especially pelvic pain. This is true of conversations in larger groups as well as between couples. Bladder leakage is something that is laughed about as normal, and “just a regular part” of having a baby. And fecal leakage or bladder leakage in people after a prostatectomy? It’s just not mentioned.

I believe we should and can improve our ability to discuss the mysterious pelvis. If your pelvis hurts somewhere, I want you to feel ok bringing that up with me or your medical provider. If you have bladder or bowel leakage, you don’t have to live with it forever. If you feel afraid of pressure in your pelvis or are scared to move for fear that you will put something out of alignment, we should be able to talk about that.

Here are a few interesting facts about the Foundations Physical Therapy logo and pelvis anatomy to get the conversation started:

• The pelvis in the Foundations Physical Therapy logo is a female-sex pelvis. You can tell because of the wider angle in the center-front of the pelvis (and yes, I’m a big fan of the television series “Bones”)
• A wide variation in pelvic shapes among the sexes exists despite many medical and midwifery programs still teaching Caldwell-Malloy classification (1), which was well established in the 1950s and has been criticized as being overtly racist (2)
• The shape of your pelvis doesn’t necessarily determine the outcome of your birth (1)
• The colors of the Foundations Physical Therapy logo were chosen to represent inclusivity (special thanks to Fiona Martin, science illustrator with Visualizing Science for the artwork)
• Fusion of some parts of the pelvis (3) is not fully complete until age 30
• The pubic symphysis (the joint in the front of the pelvis) and the sacroiliac joints (the joints where the sacrum fits inside the pelvis at the backside) are extremely strong joints that are well adapted to handle daily loads
• The roughness of the joint surfaces of the sacroiliac joints gives those joints the greatest ability to resist movement out of any joint in the human body (4)​

Do you wish you could talk more about the pelvis? Do you have unanswered questions or pelvic problems? If so, please comment below, contact me using the contact form, or call Foundations Physical Therapy at (928) 350-8270. I look forward to helping you figure out how to live the life you want to live, without being limited due to pelvic floor muscle problems.
 
References:

1. Kuliukas A, Kuliukas L, Franklin D, Flavel A. Female pelvic shape:  distinct types or nebulous cloud? British Journal of Midwifery. 2015;  23(7):  490-496.
2. Geller PL, Stockett MK. Feminist Anthropology:  Past, Present and Future. 1st ed. University of Pennsylvania Press; 2006.
3. Broome DR, Hayman LA, Herrick RC, Braverman RM, Glass RBJ, Fahr LM. Postnatal maturation of the sacrum and coccyx:  MR imaging, helical CT, and conventional radiography. AJR. 1998; 170:  1061-1066.
4. Vleeming A, Stoeckart R, Volkers AC, Snijders CJ. Relation between form and function in the sacroiliac joint. Part I:  Clinical anatomical aspects. Spine. 1990; 15(2):  130-132.

This is a continuation of the initial blog series I have written to answer some of the most common questions I get about being a pelvic physical therapist and what our treatment involves. I hope you enjoy reading these posts, and if you have any questions after reading them, please feel free to contact me by leaving a comment below the post, filling out the contact form on the website, or by calling the office at (928)350-8270.
 
A pelvic floor physical therapy session is really quite similar to any other physical therapy session, except we also talk about and treat problems with muscle function “below the belt.” As you may have read in last week's post, problems with pelvic muscle function can create a lot of barriers with engaging in the activities we enjoy doing. 

I think one of the big questions people really want to know the answer to is, “does pelvic floor physical therapy involve an internal examination, when does it happen, and what is it like?”
 
Here are some facts about that internal pelvic muscle assessment that we pelvic floor physical therapists are specifically trained to provide: 
 

• Only with your informed consent and when clinically appropriate, an internal pelvic muscle exam can be performed by a physical therapist with specialized training to assess your pelvic floor muscle function.
• The internal pelvic muscle exam involves a gloved and lubricated finger to assess for pain in the pelvic floor muscles and surrounding structures, as well as strength, endurance, and coordination of a muscle contraction. I can also assess pelvic organ prolapse during an internal pelvic floor muscle assessment.
• The pelvic floor muscle examination can help us understand if your pelvic floor muscles need strengthening exercise, relaxation training, or a combination of both interventions. 
• Not everyone coming to pelvic floor physical therapy needs an internal muscle examination.
• The pelvic floor muscle exam does not always occur during the first appointment (or the second, third or fourth). It occurs when it is clinically important, and you have provided your full, informed consent.
• This exam is not really like a pap smear for those who are used to that procedure.
• There is no speculum involved in the internal muscle exam.
• You have the right and are encouraged as needed, to have a support person with you during a pelvic floor muscle exam. 
• You do not have to agree to participate in the internal muscle exam, even when it is clinically indicated. People have many different reasons for not wanting to participate in an internal pelvic floor muscle assessment, and as a compassionate and trauma-informed care provider, I fully respect this. There are many other methods for assessing your pelvic floor muscle function. 

 
On your first visit you should expect that we will talk (a lot) and for me to ask (a lot) of questions, and hopefully you will feel comfortable asking (a lot) of questions too! We will figure out your physical therapy goals together and then do an examination (which may or may not involve that pelvic floor muscle assessment), and you will go home with some homework.
 
Follow up sessions will look similar, but with less examination or assessment time and more treatment time. We will check in with how your homework went, discuss progressing your exercises when appropriate, and changing some of your homework if you had difficulty with it. Honesty is important during physical therapy sessions, because if an exercise really increases your pain, I can very likely modify it. If you are not doing your home program because life is busy, we’ll talk about that and figure out some solutions together.
 
As always, I look forward to helping you achieve your goals with pelvic floor physical therapy, or perinatal physical therapy (for those during and after birth). Please contact me if you have any questions about this post, by sending me an email at [email protected], or calling the office at (928)350-8270.

Another question I often encounter is:  what made you want to become a pelvic floor physical therapist? Why did you get into this field? 

I am a pelvic floor physical therapist because no one shouldhave to limit their physical and social activities because of pelvic floor problems. And no one should have to feel the embarrassment or shame that often accompanies pelvic floor issues:

• No one should have to cover up their wet backside with a tied-on jacket or sweater due to leaking with sneezing, coughing or because they couldn’t get to the bathroom on time. 
• No child should have to experience the embarrassment or shame that comes with having to wear a different pair of pants from the school nurse’s office due to wetting themselves at recess or in class.
• No one should have to feel embarrassed or worried about smelling bad at work or with friends because of incontinence.
• No one should have to modify their daily routine or travel because they can’t make it more than 30 minutes without having to find a bathroom.
• No one should be afraid to go out with friends and family or afraid to exercise because of leakage. 
• No one should have to be careful when carrying and caring for their newborn due to fear that their muscles aren’t strong enough or due to pelvic discomfort or pain. 
• No one should have to be afraid of daily activities or sexual activities due to pelvic pain. 

These are just some of the many reasons that drive me to be the best pelvic floor physical therapist I can each day. These very real lifestyle limitations are often minimized by medical professionals and people in general as issues that “come with aging,” or “come with having a baby,” or “he/she/they’ll grow out of it.” But these are very real issues and limitations that significantly impact a person’s life and they are why I do what I do: help people with their pelvic pain, their incontinence, and their strength during and after pregnancy. 

To learn more about the why, what, and how of pelvic floor physical therapy, please contact me through the website or call Foundations Physical Therapy at (928)350-8270. I look forward to helping you figure out how to live your best life without limitations due to pelvic floor problems.
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#PelvicFloorPT #PelvicFloorPhysicalTherapy #mywhy #peeproblems #leakage #painwithsex #FoundationsPhysicalTherapy #pelvicpain #diastasisrecti #wetpants

In these first few blog posts, I will attempt to answer some of the most common questions I get about being a pelvic physical therapist and what this type of treatment involves. I hope you enjoy reading these posts, and if you have any questions after reading them, please feel free to contact me by either filling out the contact form on the website, sending me an email at [email protected], or calling the office at (928)350-8270.

What is Pelvic Physical Therapy?
Pelvic physical therapy is a specialization of the broader field of physical therapy. All physical therapists have earned their licensure by graduating from an accredited physical therapy program as well as passing a board-certifying exam.

Pelvic physical therapists have additional training in assessment of pelvic floor muscle function. The pelvic floor muscles are several layers of muscles that surround the anus, vagina, and urethra. These muscles help support of our organs, keep us continent, and play a role in sexual function as well. Pelvic physical therapists also have additional training in assessing and treating the musculoskeletal system for people during and after pregnancy. Our special training helps us treat the following issues that many physical therapists cannot:

• Urinary incontinence
• Urinary urgency
• Symptoms of pelvic organ prolapse (a feeling of falling out or pressure in the pelvis)
• Certain types of constipation
• Bedwetting in children
• Pelvic pain
• Diastasis recti (unusually large distance between the abdominal muscles, often associated with pregnancy, but also present in those who are overweight, of any gender)
• Early detection of lymphedema (swelling of a limb often associated with cancer treatment)​

The purpose of pelvic floor physical therapy is like all physical therapy: to get you back to doing what you love. This may include participating more fully in sports, social activities, work, and family life, and (specific to pelvic floor PT) improving your sexual wellness, which means being able to participate in the kind of sexual activity you enjoy without being limited due to pain or other musculoskeletal issues.

I look forward to helping you achieve your goals with pelvic floor physical therapy, or perinatal physical therapy (for those during and after birth). Providing physical therapy in this specialty area is really motivating for me, and it has been a longstanding passion of mine to help people with pelvic and perinatal conditions. Again, please contact me if you have any questions about this post by sending me an email at [email protected] or calling the office at (928)350-8270.