Women’s Health Physical Therapy – What to Expect

By: Shona S. Craig, DPT, CLT-Vodder

Have you had any of these problems: leaking urine, poop in your pants, pain with intercourse, pressure sensations “down there,” painful periods, digestive issues, pain during pregnancy, fear of pregnancy and delivery, adverse reactions to birth, menstruation or menopause?  If so, you may benefit from having a pelvic floor physical therapist on your team.

Physical treatment for the pelvic floor has existed for thousands of years.  In recent decades, physical therapists recognized the need and have become experts in pelvic floor rehabilitation. Specializing in this area requires additional training.  Pelvic health physical therapy, as it is becoming known, also looks at how the physical structures are impacted by gender, social roles, emotion, spiritual, and psychological life.

Many people do not realize that there is any professional help for the symptoms mentioned above. Physical Therapy has an answer!  Here is a list of what to expect from a PT visit:

  1. Thorough assessment: Women’s Health physical therapists ask A LOT of questions, some of which may seem very personal!  Topics include bladder, bowel, sexual, and menstrual/menopausal symptoms, pregnancy and delivery history, history of injuries and abuse, and pain symptoms.  A physical assessment of your bones and muscles focused on the spine and hips is performed that includes posture, alignment, range of motion, strength and flexibility.
  2. Physical evaluation (surprise!): Most women expect a pelvic exam from their gynecologist but not their physical therapist.  Pelvic health physical therapists are trained in evaluating the muscles of the pelvic floor.  The physical therapist can assess strength and flexibility of your pelvic floor muscles, pelvic alignment, areas of pain/discomfort and pelvic organ prolapse.  You can always choose to opt out of the direct assessment of your pelvic floor.  External assessments can be made and exercises can still be determined.
  3. Educate! Educate! Educate!:  Understanding your body and how it works is the first step to taking charge of your symptoms.  Having this knowledge helps you to know what you can change and empowers you to take the necessary steps towards your goal. Education can range from anatomy/physiology, how to use the toilet (you thought you knew!), how to have pain free sexual intercourse, how to treat your own symptoms, how to how exercise, and more!!!
  4. Guided specific movement training: Physical therapy exercise training for people with pelvic muscle problems is very extensive.  An exercise program may include pelvic floor and hip stretching and relaxation, pelvic floor muscle strengthening, urgency control exercises, exercises working with internal air pressures, pelvic organ decompression, core strengthening, spine mobility, and functional stabilization.   Pelvic floor biofeedback is a tool using electrodes placed externally on the perineal area or intra-vaginally that read muscle activity.  This technology helps you visualize and connect with your pelvic floor muscles.
  5. Manual therapy: This term refers to hands on methods of addressing pain, muscle tension, scar tissue, fascial restrictions, and general movement dysfunction.  Techniques can be performed externally and internally. Focus is on the pelvic floor muscles, pelvis, spine and abdominopelvic organs.  This author is partial to fascial release therapies to address adhesions (myofascial release, visceral manipulation, craniosacral therapy, and scar tissue mobilization), manual lymphatic drainage (particularly the original Dr. Vodder method) and trigger point release.

It is normal to have some apprehension about pelvic floor rehabilitation as it is a vulnerable and intimate part of our bodies.  Your privacy is respected during all sessions and the therapists go at your pace, explaining everything along the way.  You are welcome to invite someone to accompany you to your appointments if this will make you more comfortable.  Every woman deserves a physical therapist on their team when addressing the pelvis.



Satya: The relativity of truthfulness

By Sara A Nelson, PT, DPT, WCS, CYT

Yoga’s ethical guidelines include satya, truthfulness.  Arguably, practicing the ethical guidelines in movement is what makes a movement yoga.  Exercise sessions (yoga asana or postures) become a place to realize where our bodies are in relation to a value we want to bring to life. There are many different aspects of truthfulness in action that can be examined.  This article examines the relativity of truthfulness.

Relativity in this context implies our perception of a phenomena is based on our position in space.  An example that is often used is the sound an engine of a car makes as it approaches and then as it moves away.  The pitch will change.  As it comes near it starts at a higher pitch and comes down as it approaches. Then as it moves away it becomes a lower pitch.  At different times in this relationship it is true that this same object appears to be making a high pitched sound and at others a low pitched sound and they are both true.  That truth is based on our relationship to the object.  So you could say there is ‘your truth’.  There are three ways we can use this idea during movement practice.

#1. Our bodies go through a cycle of birth, growth, blossoming and fading.  They do this over the course of a lifetime and over the course of a day.  There can be other cycles of birth, growth, blossoming and fading within our lives.  Our movement practice is a place to recognize where your body is in it’s cycles.  The observer mind notices the position of the body in relationship to these cycles and to time.

#2. Over time we may accumulate the effects of developed beliefs, thoughts and emotions.  They harden in the body and create holding patterns.  Observing our body through movement with honesty is an opportunity to see these holding patterns.  Letting them go through various means of breath and movement gives a chance at new birth.

#3. A vitally important point about the relativity of truth created by living in a body is that the object making the sound is the same object no matter the perspective of the observer.   In movement, we develop the observer self to discover what the one constant is.  Some have named this the Divine, the Tao, the Universal Truth, Cosmic Consciousness….

The practice of truthfulness in movement can be done as one goes through the day as well. Observe yourself, appreciate the variety of perspectives of those around you as well as your own, and seek the One Truth.

“these mountains

that you are

carrying, you were

only supposed to


Najwa Zebian


Compression Wear: What does it offer you?

The use of compression has been around since the time of Hippocrates (5th century BCE).  In modern times research has proven their effectiveness in certain conditions such as venous insufficiency and leg ulcers.  In general, there is a rising use of compression stockings for other reasons.

How compression works.  Veins, which return blood to the heart, have valves.  If the walls of the vein become weakened, those valves can fail to close, causing pooling of blood in the veins.  Over time, this leads to a back of fluid in the tissue space.  The lymph system which normally transport this fluid away becomes overwhelmed and the legs can become chronically swollen, discolored and hard.  Compression can support the veins and skin so that they can function better.  The effect can be dramatic, but also slow and accumulative over time.  Like watering a plant, consistency can result in a bigger healthier plant.  So regular use of compression can result in healthier tissues over the course of years.  This is shown in research for conditions such as lymphedema or chronic venous insufficiency.  Some speculate that it is good for prevention and other uses as well, such as travel and sport.

Research supports the use of compression when on air flights longer than four hours.  The research is mixed on the use of compression for sport.  One study Saint Mary’s College in Moraga, California, with positive results, showed that using compression socks reduced heart rates during exercise as well as lactate values and increased oxygen saturation. The study received product support from Zoot Sports, an athletic gear supplier.  Although compression most likely won’t improve performance, it could help prevent some soreness.

Is compression something you should consider?

Many people have jobs that require a lot of prolonged sitting or standingIf your legs feel tired and achy at the end of the day, compression can help your legs feel better, and prevent a worse problem.

How to easily make compression a part of your wardrobe

Apply these steps to making compression a natural part of your daily routine:

#1 Finding something you enjoy wearing.  There are an increasing number of compression products for all parts of the body, and for different activities.  There is more choice in colors and patterns.  If you find something that appeals to you, you are more likely to wear it.

#2 Ease your way into it.  Compression varies in strength and the amount of the body that is covered.  Different conditions require different amounts of compression.  If you are not used to wearing compression, starting with lighter compression over a smaller area and for a shorter amount of time.  Then work into more vigorous compression.  That process can help you be consistent.  You may choose to wear compression only with work or exercise, and give your self time off at other times.

#3 Work with someone who can help you find the right product for you.  Due to the increasing complexity of the compression market, there are people who dedicate their work to helping people find the right compression and fit.  Isaac Nelson, at Therapy Solutions, is a certified lymphedema therapist and massage therapist who offers the service of garment consultations for better health, and sport performance!



The fifth modifiable health behavior

Recently, the Arizona state government was considering whether to refuse to hire smokers.  Smokers are easy to pick on.  The evidence against smoking is so obvious, it is just a bad idea.  But if we are going to penalize people for participating in modifiable health risk behaviors we have to consider that the Centers for Disease Control identified four such key behaviors: smoking, poor diet, physical inactivity, and excessive alcohol consumption. (1,2)  Arguably it is just as bad to be inactive and over weight as it is to smoke.

We need to get as worked up about healthy eating and exercise as we do about smoking.  I am regularly amazed by the number of people who are willing to put up with pain, immobility and incredibly inconvenient medical treatment but are resistant to changing a health habit.   Marketing wins. (3)

I propose three steps to improving health in America, and it starts with you.  Rather than pick on the other guy, let’s take care of our own struggles with those four behaviors.

Commit to daily practice of at least one healthful habit.  This is not easy and you may need help with it.  There are groups that use the science of addiction to sell you more cigarettes and more food. (3,4) So if it feels like too much, take advantage of the services we offer to help you develop nurturing habits.

Practice the fifth modifiable health factor: good mental health.  So, I am made up this name, but there is numerous research articles supporting the idea that happiness and a positive attitude has a measurable and positive effect on health.  The fact is, if people took care of their mental health, they would need less medical intervention. (5).  Visit with our counselor, at the clinic, who will teach you some simple ways to feel good, including managing pain.  You can also visit http://www.happify.com for some ideas, or http://www.richardmoss.com for a free online course.

The third step: form a CenesGroup.  Okay, I made that up, too.  Get three our four friends together, and sign up for a free consultation with our personal trainer who will help your group form goals to support you make healthy choices together through the year.  By joining forces, you will save money and increase your chances of lasting success.


  1. http://www.cdc.gov/chronicdisease/overview/#sec2
  2. Eva Martin-Diener, et al. The combined effect on survival of four main behavioural risk factors for non-communicable diseases. Preventive Medicine. Volume 65, August 2014, Pages 148–152 (http://www.sciencedirect.com/science/article/pii/S0091743514001893)
  3. Salt Sugar Fat, by Michael Moss, Random House. Feb 2014.
  4. http://archive.sph.harvard.edu/press-releases/2007-releases/press01182007.html)
  5. http://www.ripsych.org/importance-of-mental-health)

Acupuncture and Fibromyalgia

Jonathon Faix, LAc, has joined the staff of Therapy Solutions.  We are very happy to have him here, and the treatment options he brings.  He is a wealth of knowledge and does an awesome job of putting the practice of acupuncture into understandable terms for the western mind.  He is this weeks guest blogger and provides some insight into the role acupuncture can play for those with fibromyalgia.

The body’s defensive systems are often thought to only include the white blood cells, and the body’s detoxification systems are only limited to certain organs. However, this is not a complete picture. Individual cells have mechanisms to eliminate or neutralize heavy metals and toxic chemicals, and the ability to mount their own defense to invading pathogens.

These defensive and detoxification pathways require mineral and vitamin cofactors to both activate and deactivate. In the case of fibromyalgia these systems are lacking the necessary nutritional components to properly deactivate. What happens is excessive amounts of what’s known as superoxide and nitric oxide is produced, and these two compounds combine forming peroxynitrite. The peroxynitrite irritates and damages the local tissues causing another release of nitric oxide and superoxide to fight off an apparent pathogen or toxin. A lack of antioxidants, chiefly glutathione and superoxide dismutase, means the body is unable to mitigate or turn off the inflammatory pathway. The result is a viscous cycle of inflammation and pain.

As a result of this chronic pain the nervous system treats the painful area as if significant trauma had occurred or a serious infection has taken hold. The result is that the nervous system stimulates the fascia to tighten around capillary beds, reducing blood flow to the area to prevent excessive blood loss or to prevent a perceived infection from spreading. This further compounds the situation resulting in loss of nutrient and oxygen delivery to the tissues.

How Acupuncture Can Help
The definition of health to an acupuncturist is nutrient rich, highly oxygenated blood circulating freely to all tissues of the body. Acupuncture works by stimulating nodes that are composed of dense beds of venule, capillary, arteriol, lymphatic, and related nerve tissue (the acupuncture points). These beds rise off deeper blood vessels (the meridians) and are interrelated through the nervous system. Through physical stimulation of the nodes in one area the nervous system promotes blood flow to areas of the body distal to the stimulation site. This restores or promotes proper blood flow to an area, and with that fascia relaxes, nutrients (called Ying) and Qi (in this context Qi is properly translated as “vital air,” ie. oxygen) are delivered through the blood (called Xue) to the tissue. With this restoration of proper blood circulation any pain is quickly alleviated.

Significant pain relief after the first acupuncture treatment is typical. Successive treatments along with a nutrient supplementation program will keep the pain from coming back. Most experience long-term resolution after six treatments once a week. Those with chronic fatigue, either alone or in conjunction with fibromyalgia, typically need to come in twice a week for at least six treatments followed by six treatments once a week in order for there to be long-term resolution.


The Uniqueness of Every Pregnancy

Every woman who is pregnant becomes a remembrance of our experience with pregnancy and child birth. It may be common experience, but it is a unique experience for each woman. And the memory of our pregnancies and deliveries last a life time, no matter how they turn out. They are amazing and profound experiences and when we see others in that situation we want to share what we learned. In the end only no one can really prepare us for what Life has to teach us.


Kara shares her experience:

Spending nine months pregnant while providing massage and physical therapy services, I ended up receiving much advice during this time period. I heard all of what I did and possibly did not want to know regarding pregnancy, labor, and delivery.  My first trimester brought on many days of morning sickness symptoms and while working through my symptoms, I was offered much advice from saltine crackers first thing in the morning, sea sickness bands, to peppermint and ginger remedies, and down to my all-time favorite quote, “this too shall pass.” And although this period did pass, I’m not sure it was the encouragement I was looking for.

As pregnancy progressed I had a few patients tell me that I looked “so tiny” (for how far along I was). Being that that could have quite possibly been the first time me and tiny were put together, they just may have gained some extra special treatment that session. I shared this with my husband that night and he tried that line too hoping for me to add some additional working hours as a massage therapist, but I caught onto his scheme.

From my stand point I was able to gain a new perspective and understanding in treatment for my patients especially the pregnant women I treat. I took my experiences of sciatic pain, ligament instability, and other physical limitations with pregnancy and feel now that I can better understand and treat from a whole new perspective. I will tell you that core stabilization is truly the key and even though there is a baby there, you can still contract those abdominals throughout pregnancy.

Towards the end of pregnancy, I had the privilege of hearing numerous women’s own labor and delivery stories that while some provided me with some useful advice, others made me wonder what I was getting myself into.  All in all, I enjoyed my nine months working and allowing others to join me on my journey. There were many patients during this time that gave me strength and inspiration through their advice that I only hope I was able to provide them through therapy.

October 28, Kara joined the ranks of those with an amazing story to tell.


Things that would put me out of business

1.  Start new activities in a small amount and build up gradually

2.  Keep a regular schedule of sleeping, moderate exercise and healthy anti-inflammatory eating

3.  Poop regularly

4.  Practice mindful breathing and mindful movement

5.  Use your abdominal muscles effectively.

This might actually reduce the health care crisis as well.  Don’t tell anyone, it might hurt the economy……