Women may experience breast pain and swelling due to injury or trauma, infections, breastfeeding complications, cancer, or surgery. Overuse or injury of the pectoralis muscle can result in a strain and cause breast pain and swelling. Many times there is pain along the sternum (breastbone) and anterior chest wall. Another source of breast pain may be costochondritis which is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the sternum. Trauma can include vigorous coughing or vomiting. The resulting strong, sustained contractions of the intercostal (rib) muscles can lead to chest wall tenderness that may be
perceived as breast pain. Some women experience mastitis, infection of the breast glands/ducts, which can lead to obstruction, pain, and result in inability to breastfeed your newborn. Blocked ducts, stress, fatigue, cracked nipples, and previous mastitis are risk factors. Women faced with breast cancer may develop musculoskeletal impairments following mastectomy and breast reconstruction. Lymphedema and weakness are complications that can affect the entire arm. Women who have undergone breast augmentation may experience swelling, scar tissue tightness and myofascial pain.

How can Pamela Morrison Physical Therapy help with breast issues?
These are all serious breast issues and Pamela Morrison Physical Therapy, PC can provide you with an expert evaluation and sensitive care of your specific complaint. Whether the breast issue is from trauma, disease, surgery, or breastfeeding complications, we evaluate the entire upper quadrant. This can include assessing the cause of pain and swelling, neck and arm range of motion, strength, scar tissue mobility, joint mobility, and flexibility. Treatment may consist of pain relieving modalities, manual therapy, prescriptive exercises, and stretching. Other more specific treatment can include manual lymphedema drainage to reduce accumulation of lymph fluid post-mastectomy. Our therapists are trained in a specific protocol to quickly resolve obstructed breast ducts and help resolve or prevent mastitis.

Coccygodynia is a term that refers to the pain in or around the coccyx,
also known as the tailbone. In most cases, patients feel the pain while in the sitting position yet it can also be apparent in various positions, even while walking. The pain can also be described as rectal and/or vulvar burning. Numbness of the buttock or posterior thighs can also be experienced. The coccyx pain can be aggravated by prolonged sitting, bowel movements, sexual intercourse, or during menstruation. Almost one third of all cases of coccygodynia are idiopathic in nature, which means that the real cause is unknown. Known causes include trauma from a fall backwards, fracture or injury from childbirth, repeated poor posture, straining upon bowel movements, spasms or trigger points of the surrounding pelvic floor muscles, referred pain from the sacrum or spine, inflammation or irritation of the surrounding
nerves, and misalignment of the sacrum or sacrococcygeal joint.

How can Pamela Morrison Physical Therapy help with Coccygodynia?
At Pamela Morrison Physical Therapy, PC our therapists are experts in the evaluation and treatment of coccyx dysfunction and pain. We provide successful treatments including modalities for pain relief, correction of misaligned joints, release of spasm and trigger points in the surrounding muscles; perform nerve mobilizations to relieve nerve compression, instruct in proper posture, and recommend sitting cushions that are appropriate for each individuals needs.

www.coccyx.org

There are different types of urinary incontinence. Stress incontinence is when you leak urine during activities that increase pressure on the bladder such as sneezing, coughing, laughing, jumping, jogging, or lifting.  There may be insufficient strength in the muscles supporting the bladder, urethra, and pelvis.  Urge incontinence is when you feel a terrible urge or pressure to urinate and leak on your way to the bathroom.  Some also may experience urge and leak when they put their keys in the front door, when hearing water running, or when outside in the cold weather.  Mixed incontinence is when someone has both stress and urge incontinence.  Fecal incontinence is when you are unable to hold or control stool in the rectum and leak feces.

How can Pamela Morrison Physical Therapy help with incontinence?
Physical therapy can help all types of incontinence.  After a comprehensive physical therapy evaluation, it may be determined that weak or incoordinated pelvic floor muscles or trunk (core) muscles are contributing to the problem.  Other musculoskeletal issues such as trigger points, myofascial tightness, malalignment of pelvic, sacroiliac, spine, and/or hip joints may be a causative or perpetuating factor. Diet and behavior can also affect incontinence.  Studies have shown that pelvic floor muscle exercises help with urinary incontinence.  Using real-time ultrasound and biofeedback enables the patient to understand the function of pelvic and low back muscles in bladder health. Your expert physical therapist at Pamela Morrison Physical Therapy would then implement an individualized treatment program to address any issues found during the evaluation. 

Myofascial restrictions or adhesions (abnormal connective tissue cross linking) can bind pelvic organs or structures together.  Adhesions involving the female reproductive organs (ovaries, uterus, Fallopian tubes) can and do cause infertility. Pelvic, sacrum, coccyx, and/or spinal joint malalignment may compromise normal physiological processes necessary to facilitate pregnancy. 

How can Pamela Morrison Physical Therapy help with infertility?
Your comprehensive evaluation at Pamela Morrison Physical Therapy can determine if there are any myofascial adhesions or joint dysfunctions.  A study has shown that myofascial assessment and release of pelvic and abdominal structures can improve fertility and successful IVF outcomes.  Deep abdominal massage, also called Mayan massage, performed by our expert physical therapists may help with achieving successful pregnancy. Specific visceral (organ) and urogenital manipulation techniques require advanced trained physical therapists to perform.  Our therapists have undergone extensive training to provide expert care. 

IC is a chronic pain problem involving the pelvis, bladder, and urethra that occurs in men and women. Chronic inflammation of the bladder can occur.  Symptoms may include urination frequency, urgency, pain, pressure, and burning.  These symptoms can occur in the suprapubic region of the pelvis and /or surrounding areas.  Patients may experience thigh, groin, low back, and hip pain.  Some experience pain or pressure before, during and/or after urination.  Upon urinating, symptoms are often alleviated. 

How can Pamela Morrison Physical Therapy help with IC?
A comprehensive physical therapy evaluation can determine if there is a musculoskeletal or neurological problem potentially causing or perpetuating the bladder and pelvic pain.  Your musculoskeletal evaluation at Pamela Morrison Physical Therapy would determine if there are related joint problems, muscular problems, or nerve involvement in the pelvis, around the bladder area, and in surrounding structures.  Your physical therapist may perform myofascial and trigger point release techniques, nerve tension release techniques, and realign pelvic, sacroiliac, spine, and hip joints which may improve your symptoms or resolve them.  There are also other modalities such as electrical stimulation that may help calm the bladder and/or relieve pain.  Using real-time ultrasound and biofeedback enables the patient to understand the function of pelvic and low back muscles in bladder health. Specific exercises such as stretching, core stabilization, and pelvic floor muscle exercises may be prescribed.  Helping you to gain control of bladder habits can also be addressed.

Childhood urinary incontinence can be caused by an underlying disease process (organic incontinence), or can have no associated abnormality (functional incontinence). Incontinence is uncontrollable leakage of urine or ”accidents” or “leaks”. Nighttime bedwetting or sleep wetting is called enuresis. Nighttime bedwetting is more common than day wetting. Children with nighttime incontinence issues should see their doctor to assess them for bladder capacity, an immature nervous system, anxiety disorders, genetic predisposition, sleep apnea, or structural problems. Daytime incontinence can be related to or caused by an overactive bladder, infrequent voiding, small bladder capacity, structural problems, pressure from hard stools from constipation, consumption of bladder irritants, and the inability to control their pelvic floor muscles or weak pelvic floor muscles. Overstrenuous toilet training can result in children being unable to relax their pelvic floor and sphincter muscles to properly empty their bladder. This may result in being unable to fully empty their bladder when they do have the proper urge and use the toilet. Voiding frequency in children is relevant from age 5 or attainment of bladder control. Physical therapy treatment for pediatric incontinence therefore begins at age 5 and up.

How can Pamela Morrison Physical Therapy, PC help children with incontinence?
Physical therapy for pediatric incontinence might include scheduled bladder retraining, behavioral modification, pelvic floor muscle re-education, surface electromyography biofeedback (external electrodes or “stickers”), and prescriptive therapeutic exercises. Medical research has shown that proper pelvic floor muscle training and biofeedback drastically improves voiding dysfunctions in children. Treatment at Pamela Morrison Physical Therapy, PC is geared towards being educational and fun. Parents’ participation is crucial to the success of treatment.

Pelvic pain may be acute, chronic, or recurring.  Chronic pelvic pain is pain that has been present for more than 3 months.  Both men and women can experience chronic pelvic pain.  Pelvic pain is pain in the groin, lower abdomen, sacrum, coccyx (tailbone), vaginal, testicles, or rectal regions that can spread to the thighs, lower back or buttocks.  Issues and diseases that contribute to or cause chronic pelvic pain include gynecological, urologic, gastrointestinal, musculoskeletal, neurological, trauma, sexual dysfunction, and depression. These issues can be related to myofascial trigger points in the abdomen, low back, and pelvic floor muscles.

How can Pamela Morrison Physical Therapy help men and women with pelvic pain?
Our comprehensive pelvic evaluation will help to identify the cause or perpetuating factors of your pelvic pain.  An extensive medical history and physical exam will help determine whether poor posture, tight painful muscles, trigger points, weakness, or nerve disorders are a contributing factor.  Other factors we evaluate include tight scar tissue or adhesions, misaligned joints, and faulty movement patterns.  Treatment techniques that we find extremely effective with patients with pelvic pain include advanced manual techniques such as myofascial release, joint mobilization, nerve tissue tension release, and stretching.  Correcting abnormal movement patterns and posture via neuromuscular re-education, therapeutic exercises and core strengthening is another goal for our patients.  Incorporating pain reducing strategies using modalities such as moist heat, cold packs, therapeutic ultrasound, electrical stimulation and TENS is another component of our care.

At Pamela Morrison Physical Therapy, our therapists understand the birthing process, common medical interventions, and aftercare.  After labor and delivery, women often have incontinence complaints, low back and pelvic pain, scar pain from c-section or episiotomy site, pain with intercourse, weak abdominals including diastasis recti, and pelvic floor dysfunction.  At times, the cause of the problem is from the birthing experience including positioning, length of time pushing, trauma, pre-existing conditions, and other medical interventions. Some women may sustain a pubic symphysis separation or coccyx injury during childbirth.  Obtaining clearance from your physician or midwife to begin exercise is advised.  Postpartum women often are dealing with changes in their bodies, fatigue, and post partum depression.

How can Pamela Morrison Physical Therapy help postpartum patients?
A comprehensive women's health evaluation is provided by one of our expert physical therapists.  Body mechanics instruction for bending, lifting, carrying, and other activities of daily living are crucial.  Diastasis recti and pelvic floor dysfunction are assessed and severity is determined.  Diastasis recti is when the linea alba (connective tissue) between the rectus abdominus muscles stretch during pregnancy and the recti muscles separate creating a gap. Weakness of these muscles results in decreased support of the spine and organs.  The use of abdominal binders and prescriptive strengthening exercises for the core and rectus is our effective approach. Prolapse of the uterus, bladder, and rectum are assessed and addressed immediately.  Strengthening pelvic floor and trunk muscles is very helpful.  Hemorrhoids are other concerns that can be evaluated and treated by our trained women's health practitioners.  Scar tissue mobilization, correcting pelvic and hip joint alignment and mechanics, and pelvic floor rehabilitation are also incorporated into your program.

At Pamela Morrison Physical Therapy our therapists are experts in working with pregnant patients.  We understand the demands placed on the body during the different phases of pregnancy.  There are tremendous increases in blood volume and hormonal changes that can impact soft tissue structures. Many pregnant women experience low back pain and "sciatica", which are usually caused by postural changes and sacroiliac dysfunction. Edema or swelling of the arms and legs, carpal tunnel symptoms, neck pain, headaches, incontinence, pelvic pain, and lower extremity pain are other common ailments.  Stretching of the round ligaments that support the uterus may cause groin discomfort.  Increased laxity in the ligaments may be a contributing factor to low back and pelvic pain during pregnancy.

How can Pamela Morrison Physical Therapy help pregnant patients?
Our special luxury treatment table has a removable belly piece for maximum comfort during treatment. This enables the expectant mother to assume a prone position (face down) more comfortably if necessary. Treating with expert manual therapy to ease painful muscles, decrease edema or swelling, and increase joint motion and flexibility is another key to our successful outcomes.  Spinal strengthening, core stabilization, upper back strengthening, pelvic floor exercises (kegels), posture and body mechanics education, stretching exercises, and positioning education are addressed.  Therapy balls and foam roller exercises are incorporated and quite useful in facilitating core stabilization.  To prepare you for labor, your physical therapist will be sure to correctly align your pelvis and enhance mobility of the pelvis and coccyx (tailbone) to optimize your birthing experience.  Prenatal exercises are prescribed to suit your individual needs.  Using biofeedback, we can also assess which birthing position may be optimal in relaxation of your pelvic floor muscles.  We also make recommendations for supportive garments such as sacroiliac belts to provide external support. Our facility also offers childbirth classes by childbirth educator/doula.

The pudendal nerve of the pelvis can become compressed as it passes through the inside portion of the ischium or "sits bones" portion of the pelvis.  The nerve path exits from the greater sciatic foramen, travels around the ischial spine, and passes through the lesser sciatic foramen.  Compression can occur at any of these sites.  Chronic pain can be felt in the perineum, abdomen, buttock, vulva, penis/testicles, and anus.  Many patients have increased pain upon sitting.  The pain is usually one-sided but there have also been cases where both sides are involved.  Symptoms can be pain, burning, numbness, and/or tingling in the pelvis and can radiate elsewhere.

How can Pamela Morrison Physical Therapy help with PNE?
After a thorough evaluation, your diagnosis can be confirmed.  Our physical therapists perform specific connective tissue techniques, such as skin rolling and myofascial release, around the nerve to release the compression.  Specific techniques called nerve tissue tension releases and neural mobilization may help decrease or alleviate symptoms.  Malalignment of the pelvis, sacroiliac joints, spine, or coccyx can be a causative or perpetuating factor and are readily addressed by manual corrective techniques.  Exercises are often prescribed with instruction.  We can also help determine if there are other potential causes of your pain besides pudendal nerve issues.

At Pamela Morrison Physical Therapy our therapists are experts in dealing with all orthopedic and sports injuries. Exercising improves health and is strongly promoted by health care professionals but sometimes injuries occur unexpectedly or overtime.  Accidents, insufficient training, or using improper equipment can cause these injuries.  Not warming up, poor hydration, fatigue, or lack of stretching can also lead to injuries.  Some of the most common sports injuries are sprains and strains, knee injuries, Achilles tendon injuries, plantar fasciitis, shin splints, fractures, dislocations, tennis/golfer’s elbow, iliotibial friction syndrome, patellofemoral syndrome, low back pain, and rotator cuff tears. One of the best treatments for an injury that has just occurred is to rest, ice, apply compression, and elevate the injured area.  This method helps to reduce swelling and pain and expedite healing.  Seeing a physician is highly recommended to make sure the injury is not more severe than initially expected. 


How can Pamela Morrison Physical Therapy help with sports orthopedic injuries?
A comprehensive musculoskeletal and biomechanical evaluation is performed to determine the cause of pain and a diagnosis is determined.  Strength, flexibility, balance, and stability are evaluated. Gait and shoe wear analysis occurs for all leg and low back injuries.  Pain is managed through use of modalities such as electrical stimulation, TENS, therapeutic heat ultrasound, ice, moist heat, and laser therapy.  Manual therapy such as soft tissue massage, myofascial release, cross friction massage, trigger point release, stretching, neuro-reeducation, and joint mobilization are some of the techniques utilized by our manual therapists to facilitate faster healing.  A prescriptive exercise program is designed for each patient.  Sports specific activities are incorporated into the exercise rehab program.  Principles of core strengthening are applied to athletes of all age groups.

For Runners
We have extensive experience working with marathon runners in helping prepare for a race or with any post race injuries.  Running shoes should meet certain criteria to be considered “high standard”.  Ask us how to better evaluate running shoes for a smarter purchase.

Vaginismus is described as an involuntary contraction or tightening of the pelvic floor or vaginal muscles in response to attempted penetration.  There are many possible causes such as anxiety, prior physical experiences that may have been traumatic, childbirth, hormonal changes, surgery, or a medical problem.  If penetration is painful or there is a history of pain with intercourse, a cycle of pelvic muscle spasm can occur. 

How can Pamela Morrison Physical Therapy help Vaginismus? 
Following a comprehensive musculoskeletal evaluation, treatment may include correction of any misaligned joints of the spine, pelvis, sacrum, and coccyx.  The pelvic floor muscle activity can be influenced by the supporting joints and/or the nerve pathways.  Relaxation training, biofeedback, manual therapy, stretching exercises, prescriptive therapeutic exercise, electrical stimulation, heat modalities, and vaginal dilators may be incorporated into your therapy program.  A physical therapy approach to vaginismus has been very effective for our patients.

Vulvodynia is defined as pain in the vulva lasting more than 3 months.  The pain can be described as burning, rawness, itching, achy, stinging, throbbing, irritation, or discomfort.  Vulvar pain can be generalized meaning that the general area of the vulva hurts or localized meaning that a specific area of the vulva hurts.  Vulvar pain can occur at rest and/or be provoked by touch/pressure. Localized vulvar pain can be local to the vestibule (vaginal opening) called vulvar vestibulitis or local to the clitoris called clitoridynia. Many patients complain of pain with intercourse, sitting, tight clothing, and/or sensitivity to topical agents such as creams and soaps.  Others report that their pain fluctuates with their menstrual cycle.  Vulvar pain can be related to an infection, inflammation, skin conditions, diseases, neurologic or musculoskeletal disorders.  

How can Pamela Morrison Physical Therapy help vulvodynia? 
Through a comprehensive evaluation of your musculoskeletal system it can be determined whether there is a muscle, joint, or nerve problem contributing to or causing the pain.  Those who have vulvodynia may have associated hip, sacroiliac, coccyx, or low back pain.  Pelvic floor muscle dysfunction is also a common finding.  Nerves that may be involved include the sciatic, posterior femoral cutaneous, sciatic, ilioinguinal, obturator, genitofemoral, and pudendal.  Treatment may include pain relieving modalities, biofeedback, manual therapy, pelvic floor muscle dysfunction rehab, therapeutic exercises, core stabilization training, use of vaginal dilators, and a home program.  There have been several studies and articles showing that physical therapy can help patients overcome vulvar pain.