Common Conditions Treated

Common Conditions Treated

The focus of my practice is musculoskeletal evaluation and treatment for orthopedic, lumbopelvic, obstetric, gynecologic, urologic and colorectal conditions. I utilize manual therapy, therapeutic exercise, movement re-education/motor planning drills, connective tissue massage and myofascial release treatments. Observation of function and movement as it relates to your condition is an essential component of my treatment. I have access to biofeedback and other treatment modalties. I schedule an uninterrupted 50- 55 minutes of treatment for each visit.

Childbearing Year- Pregnancy and Post Partum
Urinary Incontinence- Stress, Urge, or Overactive Bladder
- Voiding Difficulties
Bowel Dysfunctions
- Fecal or Gas Incontinence
- Constipation
Pelvic Pain Conditions
- Pelvic Floor Tension Myalgia
- Levator Ani Syndrome
- Vaginismus
- Vulvodynia, Vulvar Vestibulitis
- Interstitial Cystitis / Painful Bladder Syndrome
- Male Chronic Pelvic Pain or Prostatitis
- Pudendal Neuropathy and Neuralgia
Musculoskeletal
- SI Joint Dysfunction
- Coccyx or Tailbone Pain
- Pubic Pain
- Lumbosacral Strain
- Fibromyalgia
- Osteoporosis
- Improvement of Musculoskeletal Function/Abdominal Wall Tone
- Special Low Back, Hip, Pelvis problems that haven't responded to previous P.T.

The Childbearing Year: Pregnancy and Recovery

The childbearing year brings dramatic changes to the body. Physical therapy can assist you in managing these musculoskeletal changes. We work with back, pubic, pelvic, thoracic, tailbone, and sacroiliac pains as well as changes in the primary muscles of delivery, the pelvic floor.

Pregnancy: The body changes can stress the musculoskeletal system. Bed rest will also cause significant change in the musculoskeletal system.

Preparing for Delivery: We utilize biofeedback to help you understand contraction and relaxation of the muscles of delivery (the pelvic floor and abdominals) as well as discover the best birthing and breast feeding position for your musculoskeletal condition.

Post partum: Recovery can include strategies to regain muscle tone in the abdominal wall and pelvic floor - muscles that create your internal girdle of support and are responsible for bowel, bladder and sexual dysfunction. Some women have pelvic pain from scars (c-section, episiotomy), as well as fallen organs called prolapse, cystocele (bladder dropping) or rectocele (rectum dropping).

Also, the weakened muscle of the abdominal "core" may cause you to change the mechanics of daily tasks, causing low back pain, posture changes, and difficulty performing daily tasks.

Recovering from C section -Evaluation and treatment of abdominal scar, myofascial pain and specific evaluation of the entire trunk muscles will help eliminate weakness and support your recovery. New approaches to abdominal stabilization, control and strengthening exercises will help you create an internal girdle of muscle support required for complete recovery.

Painful intercourse: Scars from episitomy or tears of the pelvic floor muscles can contribute to painful intimacy and pelvic pain conditions. Special training is provided on muscle control, stretching and relaxation. Biofeedback can be used to assess and treat muscle tension and train relaxation.

Sacroiliac, lowback, pubic, tailbone/ coccyx pain can occur with childbirth trauma and improve with physical treatment.

Dropped organs and pelvic pressure- Common after childbirth are changes to the pelvic organ support system. The symptoms are a feeling of organs dropping or falling out. Physical therapy has been utilized to help you treat the symptoms of this condition commonly known as cystocele (dropped bladder) or rectocele (dropped rectum).

Incontinence of Bladder or Bowel - Education and training in proper habits and techniques to control urgency and/or leakage. You are instructed in an individualized pelvic floor exercise (Kegel) instruction based on assessment of your muscles. Treatment can retrain the muscles for essential control and support the internal organs. Analysis of pelvic alignment an movements/activities that cause your symptoms completes the treatment approach. See incontinence for complete description.

Book Links

Ever Since I had My Baby
By Roger P. Goldberg, M.D.,M.P.H. (Crown Publishing Group 2003)
ISBN# 0-60980-8729
This book covers topics such as reproductive health, anatomical changes that most commonly causes stress incontinence during and after childbirth, pelvic prolapse. Important tips for sex after childbirth, as well as education on pelvic reconstructive surgery are discussed.

Pelvic Health & Childbirth
By Magnus Murphy, M.D., and Carol L. Wasson (Prometheus Books, 2003)
ISBN# 1-59102-0786
Covers topics related to the risks of pelvic floor injury involved with vaginal delivery. Urinary and fecal incontinence, sexual dysfunction, chronic pelvic pain and sagging, protruding pelvic organs, nerve and tissue damage, follow-up surgery and a discussion on vaginal birth versus elective cesarean are all discussed at length by the authors.

How to Raise Children Without Breaking Your Back
Alex Pirie and Hollis Herman MS., PT, OCS ISBN #
A body manual for new mothers and the parents of small children. It is easy to understand and immediately put to use. contains information on the postpartum body changes head to toe, stretching and strengthening exercises for life long fitness and health, along with practical tips on lifting, carrying, and nursing.

Preparing and Recovering from Childbirth with Physical Therapy

Posture and muscle evaluation. Strengthen or stretch muscles to correct your body alignment, function and prevent or decrease pain.
Pelvic Floor Issues - Learn strengthening and relaxation as well as delivery positions prior to labor. If after delivery you have weakness or pain this can be evaluated and treated. See Pelvic Floor Evaluation for more information.
Movement and Body Mechanics
Abdominal Muscle Recovery
Unique approach to SI, lumbopelvic dysfunction which can include manual therapy, joint mobilization, myofascial treatment and progressive abdominal and trunk movement re-education and strengthening. An evaluation of the pelvic floor muscles may help identify myofascial or strength problems that contribute to lumbopelvic problems.

Urinary Incontinence

Bladder Control Problems - Conditions that cause leakage and loss of control are called incontinence. Medical treatment models suggest that pelvic floor exercise and habit changes can improve this condition in up to 80% of these conditions in women and men. Most people are not familiar with these techniques which are commonly referred to as behavioral techniques for incontinence. If these techniques don't work for you, medication or surgery can be an option. Bladder Incontinence has several definitions.

Urge incontinence is urine leakage with a strong desire to empty usually at an inappropriate time.
Stress incontinence is to urine leakage with physical exertion, sexual activity or while coughing, sneezing or laughing.
Overactive Bladder is urgency and frequency of urination with greater than 8-9 visits to the toilet in 24 hours with or without leakage of urine.

For more information on incontinence go to http://www.nafc.org/ or http://www.womenswaterworks.com/

We will assess your needs for an exercise program or more extensive rehabilitation using equipment to enhance and train better muscles. We use a variety of equipment including biofeedback, vaginal weights, pelvic floor electrical stimulation or pelvic floor educators. It usually takes between 4-10 visits over several months to see changes.

Exercise and Bladder Incontinence - Many women don't stop running because of aging joints or injury. Instead they stop because the muscles of their pelvic floor are so weak that they leak urine every time they take a step. Exercise incontinence is a very common problem that women discover usually as teens in high impact sports like gymnastics, after childbirth or later as they approach menopause. Frequently leaking occurs when beginning an exercise program or starting to train for an exercise event like a triathlon or chasing your children.

The impact of exercise on the pelvic floor muscles varies from woman to woman. Some have a weaker pelvic floor than others due to childbirth, surgical trauma or simply lack of use.

Nygaard, I. et. al (1990). "Exercise and Incontinence."Obstetrics and Gynecology 75:848-851
Bo, K. (2004). "Urinary incontinence, pelvic floor dysfunction, exercise and sport." Sports Med 34(7): 451-464.

Incontinence Treatment

Physical Therapy involves an evaluation of your pelvic floor muscle strength and bladder/ bowel habits. We will establish a treatment program based on the evaluation findings. You will learn proper habits and techniques to control urgency and/or leakage and gain an understanding of normal bladder and bowel functions.

Bowel Dysfunctions

Bowel Control Problems- The inability to control gas or a bowel movement is called anal or fecal incontinence. More than 5.5 million Americans have fecal incontinence. It affects people of all ages--children as well as adults. Incontinence occurs either when you feel the urge to have a bowel movement and areunable to hold it until you can get to a toilet or when stool may leaks from the rectum unexpectedly. For more information on fecal incontinence go to www.digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/ or www.emedicine.com/med/topic3326.htm

Incontinence Treatment

Constipation refers to the inability to evacuate the bowel on a normal schedule without excessive straining. Medical evaluation can help determine the primary cause of constipation. In some cases the problem is associated with tight or incoordinated pelvic floor muscles. Physical therapy with biofeedback can train the muscles to relax appropriately and work more efficiently.