Newsletter & Blog

Strengthening Core Muscles to Improve Bladder Function and Gait in a Patient with ADEM

In this photo we are using proprioceptive neuromuscular facilitation to encourage improved core muscle recruitment and strength. Having the patient use gross motor movements utilized in rolling on her weaker side will work her core muscles. It is ideal to give the bladder a lot of support by strengthening the diaphragm, multifidis, pelvic floor muscles, and lower abdominals (otherwise known as the canister muscles). ADEM is acute disseminated encephalomyelitis and is characterized by a brief widespread attack of inflammation in the brain and spinal cord that damages the myelin of nerves. Our p[...]

Preparing for Labor and Delivery with Hip Impingement

Here we are performing hip mobilizations in sidelying on a pregnant patient who has a prior history of hip dysfunction. Because of an old trauma she has a history of hip impingement. Femoroacetabular Impingement (FAI) is also known as Hip Impingement. This painful condition occurs when there is abnormal contact between the femoral head and acetabulum during motion. With hip impingement, patients usually present with groin pain and a reduction in hip range of motion. Even if the disorder is asymptomatic prior to pregnancy or during the 1st trimester, the patient can become symptomatic during th[...]

Scoliosis as a Cause of Chronic Pelvic Pain

Scoliosis is a spinal curvature that can be a cause of an symmetrical pelvis. One side of the pelvis sheers upwards as a compensation of the curvature. Besides causing a functional leg length discrepancy (side of sheered pelvis upwards “shortens” the leg), there are many changes in the soft tissue structures such as pelvic ligaments, pelvic muscles, and nerves. Structures on the sheered or upslip side are tractioned or pulled upwards. In this patient, she is experiencing left sided chronic pelvic pain. Her left pelvic floor muscles are being tractioned or pulled upwards. This can result in pel[...]

Ruling out Hip Impingement as a Cause of Chronic Pelvic Pain

Femoroacetabular Impingement (FAI), also known as Hip Impingement, occurs when there is abnormal contact between the femoral head and acetabulum during motion. FAI and the muscle imbalances around the joint can alter hip and pelvic biomechanics during gait. Performing range of motion testing of the hip and special orthopedic tests such as the FADIR may help diagnose the issue. With the patient supine with one leg extended, flex, adduct, and internally rotate the hip. The test is positive if this reproduces the patient’s anterior groin or anterolateral hip pain. In patients with FAI there is a [...]

Winter/Spring 2018 Newsletter

Featured articles include Osteitis Pubis, Retraining the Pelvic Floor in a Pilates Instructor, and Hip Impingement Can Cause Pelvic Floor Muscle Pain. To view the newsletter, please click here.[...]

Helping Reflux with Physical Therapy and Dietary Changes

‬There are 2 types of reflux that patients suffer from. Laryngopharyngeal reflux (or LPR) is when stomach acid comes up into the throat. A common treatment for this is a proton pump inhibitor oral medication. Gastroesophageal reflux or GERD involves a backup of stomach acid into the lower esophagus. We treat GERD and LPR via visceral manipulation, spinal joint mobilization, corrective breathing pattern techniques, and other advanced manual therapies. Here we are performing a manual release technique of the lesser curvature of the stomach. This patient has decreased mobility and motilit[...]

Retraining the Pelvic Floor Muscles in a Post-Partum Patient who is Training as a Pilates Instructor

Here we are using Rehabilitative Real-Time Ultrasound to help our patient downtrain the dominant use of her transversus abdominus muscle (a lower abdominal muscle). Many people who perform Pilates learn to overuse their lower abdominals instead of utilizing their pelvic floor muscles. The overuse of abdominal muscles during a pelvic floor contraction can create a downward force on the bladder. This is counterproductive because the pelvic floor contraction is to gain support of the bladder in an elevation pattern. The pelvic floor needs to contract in an “elevator fashion” upwards or cranially [...]

Pelvic Physical Therapy for the Transgender Patient

Our practice has been helping the transgender patient overcome pelvic pain and other symptoms they have due to transitioning surgeries. Dr. Morrison was the first physical therapist in the US to lecture nationally on the topic of physical therapy for the male to female transgender patient. She presented the surgeries they undergo, the overall costs, healing process, medications, post-operative pelvic pain issues, and how best to provide comprehensive care at the American Physical Therapy Association Meeting in 2012. Her audience included pelvic floor physical therapists predominantly. She also[...]

Sacrotuberous Ligament Release to Help Prepare for Labor and Delivery

The sacrotuberous ligament is a structure that is under-recognized as important to assess and treat during pregnancy. The ligament runs from the sacrum to the ischial tuberosity and has connections into the tailbone and hamstrings muscles via connective tissue. It crosses posterior to the sacrospinous ligament creating an "x" or "t" depending on orientation.When taut the sacrotuberous ligament can cause the pelvis to become posteriorly rotated, cause tension in the same side pelvic floor muscles, inhibit needed coccyx or tailbone mobility for birth, be a source low back pain, and delay or prev[...]

Patient with Pelvic Pain and Constipation Presents with Possible Fracture

Our elderly patient, who is an avid bike rider in NYC, reported having a bike crash and got up to continue riding a few days ago. Instead of starting treatment to help her with her chronic constipation via pelvic rehab as planned, we put on our athletic training hats and proceeded to evaluate this contusion. We held off on sEMG biofeedback, visceral mobilization, intestinal massage, and pelvic floor muscle rehab to assess her limb. Ruling out a possible fracture began: Fractures present with deformity, swelling, black and blue (ecchymosis), and pain. She was fully weight bearing and not antalg[...]