Women and Heart Health

Carrie Fisher’s death in 2016, highlighted a problem facing women: 90% of women have one or more risk factors for heart disease or stroke, but many do not even know they have a problem prior to a fatal heart attack. In fact, symptoms of heart disease are often different for women compared to men and are often misinterpreted as acid reflux, the flu, or normal aging. In addition, women have a higher lifetime risk of stroke than men. According to the American Heart Association, 1 in 31 American women die from breast cancer every year, but one in three dies of heart disease (stroke and heart attack), making heart disease the No.1 killer of women in the U.S. Younger women are not excluded from silent heart attacks either. Learning the risks of heart disease and making lifestyle changes as preventative measures can not only save you from a heart attack, but also can be less expensive and more pleasant.


What is cardiovascular disease?

Cardiovascular disease is a broad term that includes a variety of heart and blood vessel conditions. It can be referred to as coronary artery disease, peripheral arterial disease, heart attack, stroke, high blood pressure, heart valve disease, and congenital heart disease, to name a few. The most common cause of cardiovascular disease is atherosclerosis which is a build-up of cholesterol and plaque on the inner walls of the arteries, thus restricting blood flow to the heart. Chronic low-grade inflammation is prevalent in all stages of atherosclerosis. Without adequate blood, the heart becomes starved of oxygen and vital nutrients it needs to work properly, causing chest pain called angina. When one or more of the coronary arteries becomes blocked, a heart attack can occur.

Heart attack symptoms in women (American Heart Association)

  • Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. However, women can experience a heart attack without chest pressure.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach
  • Shortness of breath with or without chest discomfort
  • Breaking out in a cold sweat, nausea or lightheadedness
  • Chest pain is the most common heart attack symptoms in men and women. However, women are somewhat more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain


So what can you do to prevent heart disease? Get going on these 8 ways to get on track!

  1. Quit smoking. Your risk for heart attack and stroke decreases by 50% after just one year of quitting
  2. Improve cholesterol levels by lowering your LDL levels, the “bad cholesterol”
  3. Control high blood pressure. Regularly check your blood pressure
  4. Get active! Start an exercise program involving walking 30 minutes/day
  5. Follow a heart-healthy diet. Choose healthier fats such as leaner cuts of meat, fish, nuts and olive oil
  6. Get to a healthy weight
  7. Control diabetes. The World Health Organization suggests 6 tsps (25g) of sugar/day
  8. Manage stress and anger. Practice relaxation techniques such as deep breathing, yoga, enjoyable hobbies





Thyroid Dysfunction: a hidden cause of joint pain.

By Sara A Nelson, DPT

Over years of providing physical therapy in the outpatient setting, patterns become more apparent.  One pattern I became aware of was women with joint pain and underactive thyroid glands.  When I went searching, I found the connection.

The thyroid gland is a small butterfly shaped organ at the front of the throat.  Although small, it has far reaching effects in the body.  Thyroid hormone regulates metabolism and growth.  It has an effect on many functions including breathing, heart rate, body weight, muscle strength, menstrual cycles, body temperature, cholesterol levels and more!

When the thyroid produces too much hormone, symptoms include anxiety, nervousness, trembling, and hair loss.  When there aren’t enough thyroid hormones, symptoms include fatigue, dry skin and hair, depression, sensitivity to cold, and joint and muscle pain!

There are several possible causes for thyroid dysfunction.  If you suspect you have problems you need a thorough evaluation by a medical doctor.  Genetic predisposition can play a role.

Autoimmune thyroiditis, also called Hashimoto’s disease, is seven times more common in females compared to males. Did you now that 4-10% of women will develop postpartum thyroid inflammation during the first year after giving birth?  About 20% of these women develop Hashimoto’s disease in later years.

Treating the inflammation can assist with reducing joint pain and help you have a healthier thyroid gland.  Good thyroid function is supported with a healthy diet, exercise, rest and stress management.  Yes, one more reason to develop your health habits!  Learning how to exercise when inflammation is present may take the help of a professional (like a physical therapist!)  to find how to move without aggravating joints and worsening inflammation.  There are some special diet recommendations that come from natural medicine.  You can consult a naturopath for more information on that approach for healthy thyroid.

Don’t wait for problems to develop.  It is much more cost effective to prevent than cure!

The Economics of Fitness (Do healthful practices save you money?)

By Sara Nelson, PT, DPT

There are four modifiable lifestyle factors that are known to increase risk of illness.  These are inactivity, obesity, excessive alcohol/drug use and smoking.   It only takes a calculator to see that stopping a $10 a day smoking or junk food habit would save nearly $3650 per year.  But what about the cost of the vegetables you should be eating? According to the US Department of Agriculture, the cost of 9 servings of fruit and vegetables per day is $2.60.  Maybe you need some help learning how to prepare those vegetables to appeal to your palate.  So, it may be worth the cost of using a nutrition coach.

Pain management is another example of cost vs. benefit of medical intervention compared to health habits.  In recent years it has been popular to manage pain with injections, procedures and medications.   An injection can cost as much as $600 (plus the office visit).  A year’s supply of pain medication can be as much as $6000.  In the end, the person has not learned how to change their pain.  Pain may return and they are as helpless as they were on the first encounter with pain.  Compare that to the cost of rehabilitation. At $150 average physical therapy visit, that same $6000 would pay for 40 visits, and at the end of that the patient would have better fitness and skills to change their pain the next time.

Massage has also been shown, scientifically, to help pain.  You could get as many as 80 visits with that $6000!  Research is also mounting as to other health benefits provided by getting regular massage.  For instance, massage has shown to reduce blood pressure, thus helping heart health.

Let’s look further at the medical costs incurred with heart disease.  Stent placement (a mesh tube inserted into an artery in the heart) costs $30,000-$50,000.  Medications to control ischemic heart disease can be $25 to over $400/month, depending on the medications prescribed.  This doesn’t take into account the side effects of those medications.  Compare that to the cost of a gym membership or home stationary bike.  Research has shown thirty minutes of stationary biking three days per week is nearly as effective as a stent placement.  The side effect may be weight loss, improved mood, improved energy and greater mobility.

But say you have been inactive and you jump on that bike and hurt your knee.  Now, it has cost you more.  Well, there is the value of using someone to guide you in exercise who can help you to ease back into it without injury.   Other forms of guided exercise have good scientific evidence supporting their use for all kinds of health issues.  These include yoga, Qi Gong, and good old weight training.

Maybe your doctor has recommended compression stockings but you don’t want to pay the extra cost of these medical grade garments.  A procedure to correct varicose veins costs as much as $3000, and you still have to wear compression stockings afterward.

Being fit and healthy helps if you do become ill.  Those who are fit and healthy withstand the rigors of illness and treatment better than those that are unfit.  It is in your financial interest to be fit, in healthy or ill states.  The old adage is true: an ounce of prevention is worth a pound of cure.  Spend some money now to save money (and suffering!) later!!


Breast Pain and What to Do About It.

One common breast symptom that is often NOT cancer related is pain (only 7-10% of breast cancers have breast pain as a presenting symptom).  But breast pain is a problem for many women.  In a study published in 2014, over 50% of the 1659 subjects had breast pain and some for over half their life.

The causes of breast pain include hormone fluctuations due to menstruation, some birth control pills and infertility treatments, some medications, low thyroid function, poor fitting bra, breast cysts, large breasts, lack of fitness, inactivity and excessive stress.  Breast swelling and pain can be seen with some shoulder and neck problems.  This has to do with muscle tension that compresses vessels and subtly limits fluid return leading to the secondary problem of breast pain and swelling.  It is important to have a doctor help you sort out the cause of the symptoms.
How to address breast pain

Once you have had your symptoms medically evaluated and you have been cleared of pathological conditions like cancer, then ask for a referral to a women’s health physical therapist (PT).   You may find surprising, is that a PT can help you to ease breast pain, but many of the causes of breast pain are best addressed by physical therapy.  Physical therapy that helps breast pain includes the following:

Myofascial release (MFR) – This is a generic term for a form of manual therapy.  The type of MFR I am referring to here works with your body by providing a gentle stretch to the connective tissue that surrounds and supports all the structures in your body including the breasts, neck rib cage and shoulders.  By providing a low load, long duration stretch the tissues gain better mobility and can relieve pain.

Manual lymphatic drainage (MLD)—This method is another form of manual therapy.  MLD is a light technique that takes many hours to learn.  If a therapist is well trained they can be very effective in reducing swelling that contributes to pain.

Instruction in self care – A PT can help you learn how to change your symptom using self treatment methods, behavior modifications and education on the role of posture, bra fitting, diet, inflammation and stress management.  They will teach you how to modify these components to reduce pain.

Exercise – Many women who are experiencing breast pain are also unfit and/or generally inactive.  There are usually reasons why lack of fitness develops and a physical therapist can help you work through the barriers to find a consistent and enjoyable program that can help relieve pain.

So don’t put up with breast pain.  Check with your doctor and then come see a women’s health physical therapist!  Physical therapy will help you sort through the various contributing factors and come up with a plan of action to put you on a path of feeling better!


Asteya: Non-stealing

Surprising insights arose this week as I put my intention toward the concept of Asteya and how it might express it self in an asana practice.

First for what Asteya is: non-stealing.  As I contemplated this, a dream came to me:

I dreamt of someone I love and respect.  I think she was representing my feisty self that is eager to achieve social justice and help the down trodden, and can slip into anger and rage in trying to fight those battles.  Even seeing them as battles!  Well, she had an American flag tattooed on her middle finger!  And another tattoo on her wrist with patriotic colors and a cloth draped across the name of the current president.  Although all the letters weren’t visible, enough was there to know who it was.  I thought, why would you want that name on you if didn’t like what it represented?  The dream comes during the week the president decided it would be okay to make a “twitter” comment about the potential of releasing a nuclear bomb, descending to the level of a crazy dictator making similar claims.  It was an outrageous comment in a string of outrageous comments.  This week has felt surreal.  Well enough of politics, what is the Asteya here?

I turn to Gandhi, who freed a nation practicing non-violence and truthfulness.  He remained peaceful in the face of outrageousness. He didn’t allow himself to become permanently stained from his own rage.  He practiced Asteya.

“Be content with what you have; rejoice in the way things are.  When you realize there is nothing lacking, the whole world belongs to you.” Lao Tzu

A way to practice acceptance of “the way things are” in asana comes in the balance poses.  Iyengar in Light on Yoga, starts from tadasana with all or nearly all, the standing poses.  Find your grounding, your center. The central channel in front of the spine, the sushumna, can be imagined as a tube of liquid light, peacefully flowing up and down.  Connect with this peaceful center.  Let this be the anchor you hold as you execute any pose.  While learning, use what you need to sustain that grounding as you branch out in a posture.  That may mean using props or the wall.  Learn to face difficulty with inner peace.

Another perspective on Asteya in asana, is noticing how one area of the body may “steal” from another area of the body.  Another way to say that is how one area of the body compensates for another area.  When one area is stiff and doesn’t move, another area moves too much.  When one muscle group is weak another muscle group over works.  Yoga class is a place where someone can help you see and address these compensations.   Yoga asana helps with rebalancing these compensations.

Another way we steal from ourselves is to believe we are less than we are, we steal our joy.  So, it follows that in yoga we practice accepting ourselves and where we are at.  I love this quote from Word Porn:

“Tired of trying to cram her sparkly star-shaped self into society’s beige square holes, she chose to embrace her ridiculous awesomeness and shine like the freaking supernova she was meant to be.”

Be that!!

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