Susan, DPT

11/25/2020

Pelvic Floor Physical Therapy for Women

Are you experiencing incontinence, painful menstruation, pelvic pain, pain with s*x, diastasis recti, low back pain, or organ prolapse? You’re not alone. Around 40% of women experience pelvic floor disorders. While it’s common, that doesn’t mean that it’s normal or something that you have to live with. Pelvic floor physical therapy can provide a comprehensive plan to address and mitigate these symptoms.

The pelvic floor muscles are essential for supporting the pelvic organs, healthy voiding, and s*xual function. They contribute to the overall health and quality of life. They function as part of the deep abdominal muscle system and can be retrained and improved even after damage or dysfunction caused by pregnancy and childbirth, abdominal or pelvic surgery, changing hormone levels with menopause, or painful periods. Pelvic floor dysfunction can also be associated with conditions including interstitial cystitis, endometriosis, ulcerative colitis, chronic constipation, vulvar pain, pudendal neuralgia, painful bladder syndrome, and polycystic ovarian syndrome to name a few. If you are experiencing any of these symptoms or have any of these underlying conditions, you might benefit from physical therapy.

Diagnostic and treatment procedures may include:

• Manual therapy
• Transverse abdominus stabilization and strengthening exercises
• Bladder diary
• Ultrasound
• Electrical stimulation
• Breathing and relaxation techniques
• Pilates for abdominal and back stabilizer strengthening
• Diet education
• Pelvic floor exercises

What to Expect

Your first visit consists of an evaluation of your current condition and symptoms. This includes a comprehensive medical history, questions about your eating, drinking, voiding, and s*xual habits related to your symptoms. An assessment will be done on your posture, movement patterns, hip, abdominal, and pelvic floor muscles as necessary to determine contributing factors such as weakness, tightness, or strain. This can include both an external and an internal exam.

Incontinence and Pelvic Pain

Often weak or damaged pelvic floor muscles from childbirth, aging, or illness can contribute to incontinence and pelvic pain. Physical therapy can help you to regain awareness, strengthen, and retrain the pelvic floor muscles. This can include bladder retraining, strengthening, and education to improve the control of pelvic floor muscles.

Physical therapy can help if you’re experiencing:

• Leakage of urine when coughing, sneezing, or laughing
• The need for frequent urination or an uncontrollable urge to urinate
• Pain in the pelvic region
• Painful pe*******on or s*x
• Organ prolapse
• Pre- and post-partum related issues including diastasis recti, low back pain, episiotomy, difficulty recovering or getting back to your normal self and pre-pregnant fitness level
• Coccyx disorders

07/09/2020

06/28/2020

Your key to spinal health and longevity.

5 Daily Essential Exercises for Spinal Health and Mobility

Movement is essential to maintain one’s health. In this blog, I’m going to focus on spinal joint health. A joint is a place in the body where two different bones are connected. It’s essential to maintain mobility at the different joints in the body and at the same time, it’s important to strengthen the muscles that surround the joints especially for example at the ankle joint if you’ve had multiple ankle sprains. After a sprain, the ligaments, the tissue that attaches the bones together, become overstretched and they cannot return to their previous length. It’s important to maintain a healthy balance between flexibility and injury prevention. This is best done by maintaining mobility at the joints and making sure that the muscles are recruited properly when the body moves. For example, it’s important to do cross-training and to both strengthen and stretch your muscles. Many injuries can be prevented by making sure that the joints move properly and that the muscles are properly balanced. Here are 5 ways to maintain the overall health of your spine.

1. Spinal mobility – Pelvic Tilts (Cat/Cow):

The spine is a unique structure. Without going too deep into its anatomy, it consists of multiple bones stacked on top of the other. Within the round-shaped bone or vertebra there is a round body in the center where the disc lives. The disc has annulus fibers on the outside and a soft nucleus pulpous in the center. It is a unique structure because of the way it is built. Unlike the other joints of the body, the spine requires movement for the joint to get its lubrication or nutrients. When you sit still for a long time, your back can feel stiff, and also with time, the spine becomes less lubricated or moist leading to the discs drying out, which increases one’s chance of having a collapsed disc or a disc injury. Movement is a simple way to maintain spinal health.

There are several beneficial movements for general spinal health and mobility. My favorite is a cat/cow, which is a basic pelvic tilt. You can perform this in the classic yoga position where you’re on all fours in a quadruped position with your wrists directly under your shoulders and knees directly under your hips, or you can perform the exercise in a seated position. For the cow, you bring your stomach down while you look up and bring your tail bone up. Don’t forget to engage your abdominal muscles. For the cat, you do the opposite and bring your stomach up rounding your torso, shoulders while looking down. See the attached pictures. You can perform this exercise throughout the day. Even if you only get in 1 set with 10 reps, you’ll feel and notice a difference.

2. Abdominal Strength: Pilates 5’s

Until my gym closed during COVID-19, I taught Pilates weekly for 8 years. I’m a strong believer in the benefits of Pilates. Pilates is a series of exercises that focus on abdominal and back strengthening along with joint mobility and improved overall posture. I’m a big fan of the Pilates 5’s or the Vacation Series, because this is a collection of 5 different exercises that can easily be performed at home and provides excellent abdominal strengthening. There are 4 different abdominal muscles and for these exercises, I want to focus on the deepest layer, the transverse abdominus. This is one of my favorite muscles in the body and is significantly important for maintaining overall spinal health. The muscle fibers run horizontally and it is like a built-in corset. The muscle runs from the bottom of your rib cage to the pelvis and is a deep muscle that provides postural stability.

There are 5 exercises in the Pilates 5 series:

1. Single-Leg Stretch
2. Double Leg Stretch
3. Single Straight Leg Stretch “Scissors”
4. Leg Lowers
5. Criss Cross or Bicycles

1. For Single Leg Stretch, you lay on your back with your legs positioned so that your knees are lifted up directly above your hips. If you don’t have a mirror, you can check your position by reaching your arms straight and your palms will make contact with the top part of your knee. You have the option of lifting your head, neck, and chest like you’re doing a crunch or leaving your head down. Make sure to keep breathing throughout the exercise and not strain or constrict your airway. Your hands will hold onto one of your thighs as you straighten out the other leg. You exhale as you straighten your leg and inhale as you switch, but don’t stress out about the breathing. Focus on your form first while making sure you’re breathing. You’ll then switch sides and repeat. You can perform 1 or 2 sets of 10. Use a mirror to observe your tabletop position if you can.



2. Double Leg Stretch is similar to a single leg stretch with both legs. The leg motion is almost identical as your legs start in the 90/90 tabletop position with both hands holding the back of your thighs and they are both are extended or straightened. The lower your legs come, the more challenging the exercise, but strive to maintain your low back maintaining contact with your mat because this means that your abs are doing the work. Once the back starts to arch up, then the hip flexors or the muscles in the front of the thigh are the ones doing most of the work. The arms start holding onto the back of your thighs and then as you straighten out your legs, you bring them up by your ears. As you’re bending your knees in, your arms circle down by your side to resume the initial position.



3. Single Straight Leg Stretch “Scissors”

For this exercise, you start on your back and lift one leg up. Your hands reach behind your thigh while the other leg kicks twice in the air hovering over the ground. As with the other ones you can perform it with your head, neck, and chest lifted or your head can rest down on your mat.

4. Leg Lowers is an exercise that focuses on your lower abs. This is the part of the muscle from your belly button until your pelvis. It’s usually the weaker part so this is a great exercise to use to target some extra belly flap. It’s especially useful for postpartum. There are several different options and modifications. You’ll start laying on your back with your legs up in the 90/90 tabletop position that I described above. It’s essential that you’re aware of your lower back and make sure to press it towards the mat while contracting your abdominal muscles. Then you’ll lower one or both legs like you’re trying to tap the floor. The key here is that the motion is not coming from your knees. Your knees remain bent in the 90-degree angle. You’re lowering from your hip joint. Sometimes I like to have my patients use a ball or yoga block under their knees to ensure that their movement is coming from the correct place. It can also be performed in the advanced version where the legs are straight and start reached up towards the ceiling. As with the other exercises in this series, you can lift up and hold an isometric contraction or keep your head rested down on your mat. The most important part of this exercise is that your low back maintains contact with your mat. Once your lower back starts to lift up, that’s as low as you go. Most likely if you’re performing this exercise correctly you won’t be able to lower your leg all the way to the floor.



Criss Cross or Bicycles is an exercise that targets your oblique muscles. Those are the side abdominal muscles. For criss-cross, your hands rest on the back part of your neck with your elbows bent and reaching wide rather than tucked in by your ears. You start lifted up in tabletop 90/90 position as was shown for Single Leg Stretch. You straighten one leg as you turn towards the knee that remains bent. It’s important that the motion is coming from your abs. I like to think about reaching my opposite shoulder and towards the opposite knee to maintain the correct positioning. You then come back through the center and move to the other side. If you really want to get the most out of this exercise see if you can move slowly and keep your chest and shoulders lifted up off of the ground the whole time. As with the other exercises start by performing 1 set of 10 reps and increase up to 2 or 3 as long as your not sacrificing your form.



3. Multifidus strength

The multifidus is a crucial and often overlooked deep spinal muscle. It is similar in function to the transverse abdominus and provides deep postural stability. It is essential to strengthen this muscle because its atrophy is commonly seen with low back pain. To target the multifidus, it’s not necessary to use weights and do exercises that we see bodybuilders doing. Some simple Pilates exercises are all that you need to protect your spine and this crucial muscle.

1. Quadruped Leg Lifts
2. Bird Dog
3. Swimming

For Quadruped Leg Lifts, you start in a quadruped position where you are on all fours with your hands positioned directly under your shoulders with your elbows straight and your knees directly under your hips and your legs hip-distance apart. You place a towel or the mat under one knee. While contracting your abdominals and keeping your back completely still, you lift up the opposite knee maintaining your abdominal contraction. Perform up to 10 on one side and then switch to the other.



Bird Dog starts in the same position, but without the folded towel or mat under your knee. For Bird Dog, you maintain a straight neutral spinal position while you extend or reach out your opposite arm and leg. It’s important to keep your hips squared towards the floor and to do this it helps to lift your leg up lower than hip level. Your opposite arm can reach so it is located beside your ear with the elbow straight. Focus on the transitions and keeping your back and abdominal muscles engaged so that your spine doesn’t move. Perform 1 or 2 sets of 10 reps.



Swimming is performed in a prone position or on your stomach. Your arms and legs are stretched out. You alternate lifting your right arm and left leg with your left arm and right leg. Make sure to keep your elbow and knee straight and think about lengthening your arm and leg from your shoulder and hip joints rather than lifting high. Perform 1 set of 10 and work your way up to 2 or 3 sets of 10. Keep your hips level and your gaze down to maintain a neutral spine.



4. Hamstring Stretching

The Hamstring muscles are commonly tight especially with patients who have low back pain. There are several different variations of stretches that can be performed. To get the most out of your stretching, it’s essential that it’s done regularly and that the positions are held for at least 30 seconds. I typically prefer holding my stretches for a few minutes to make sure that the tissue has a chance to release and stretch. One of my favorite ones to give to patients is the Hamstring Doorway Stretch. This is a great one because it doesn’t require any straining to hold your leg up. Instead, it can be performed in a restful position.

For the Hamstring Doorway stretch, you need to lay on the floor with one leg up on the wall and the other one straight on the ground in the doorway. Place the leg on the wall, the one that’s being stretched up and position your hips so that they are level and that you are able to have your knee straight. If you want to make the stretch even more intense flex your foot.



5. Piriformis Stretching

The piriformis is a muscle that goes from your sacrum to your lateral thigh. It is important to maintain its flexibility to prevent sciatica and for overall spinal health. You can test the length of yours by laying on the floor. Start with both of your legs stretched out. Next, bend one knee and cross your leg so that your ankle is right above your knee. Now check where your knee is positioned while making sure that your hips remain level. If your knee is way up like most Americans, you have a tight piriformis. If your leg is relatively level of straight across from your ankle to knee, then your piriformis is not tight, but you will still benefit from this stretch. Hold this position for at least 30 seconds. If that’s not possible for you, you can work up to 30 seconds. Another easy and convenient way to stretch your piriformis is the Seated Piriformis Stretch where you are sitting upright in a chair with your leg crossed over so that your ankle is over your knee. With your other hand, you can gently push down your knee while keeping both sit bones down. Another option if you have solid abdominal strength is for you to lean forward slightly while maintaining a straight spine. For this, you’re hinging from your hips until you feel a stretch.



I hope that this helps and am excited for you to start implementing these essential movements and exercises. As a reminder, this isn’t a substitute for medical advice. This is a solid maintenance program that will help you keep your spine healthy. As always please message or write in the comments of if you have any questions and/or feedback when you start trying these exercises.

05/31/2020

Check out my latest blog on Urinary Incontinence. I'm now certified to treat pelvic floor this includes women with pelvic pain, incontinence, or postpartum.

05/23/2020

Check out my latest blog Key Lessons from ESPN's The Last Dance

5 Key Lessons on Leadership from The Last Dance

I typically don’t watch much TV, but I’ve made an exception for The Last Dance. It’s a documentary charting the 1990s Chicago Bulls focused on Michael Jordan. It consists of 10 episodes that are 50 minutes long with no or minimal commercials. The episodes are gripping and have an ideal mix of the 1997-1998 season with flash backs to Michael Jordan’s childhood along with Scottie Pippen, Dennis Rodman, and Phil Jackson. It includes footage from several games along with behind the scenes previously unseen footage at practice and in the locker room. The episodes are gripping and filled with valuable information about successful coaching, franchising, the NBA, players mindsets, work ethics, and everything in between. The series currently has a 9.4/10 rating on IMDb and 95% rating on Rotten Tomatoes. It’s welcome and timely for sports fans who missed the 2020 NCAA tournament, NBA finals, and the 2020 Summer Olympic Games. The series is directed by Jason Hehir and aired on ESPN on April 19 to May 17, 2020. It is now available on Netflix, ESPN, and on ABC.

This is a must-watch series for sports fans and anyone hoping to get a closer look inside the NBA. One of my favorite topics to study is mastery. I’m an avid listener of Tim Ferriss’ podcast and am fascinated by success stories in any discipline. I believe that these patterns are vital to study, analyze, and model for a successful life. We all define success differently. For me success is having a healthy and holistic lifestyle surrounded by the people that I love, and pursuing my passions and interests while giving back to others. Michael Jordan defined success based on his performance on the basketball court. He was obsessed with winning. Each time he stepped out on the court, he gave his 100% performance. He was interested in showing the fans a good game, but most of all he wanted to prove his dominance. His motivation was both intrinsic and extrinsic and much of his drive came from anger and wanting to prove himself. There are valuable leadership lessons that can be learned from Jordan and The Last Dance. Here are the 5 most impactful.

1. Even if you’re the GOAT (Greatest Of All Time), you can’t win a championship without your team
2. The loyalty and role-modeling that exists between a coach and his players/mentor and mentee is a powerful motivator and vital to success
3. It’s essential to value each member of the team for who they are and allow them necessary allowances to be themselves to achieve optimal performance
4. Even the best can only handle so much and it’s important to recognize greatness, but avoid putting others on a pedestal
5. At the end of the day, one’s career, or life, while accolades and championships are important, it’s one’s legacy and impact that lives on and matters the most

Even if you’re the GOAT (greatest of all time), you can’t win a championship without your team

Michael Jordan was an exceptional athlete. But he was not the best at first, in fact in his sophomore year of high-school, he didn’t make his varsity team. He was motivated and hungry. He surrounded himself with experts and followed their advice. After failing to make the team, he continued practicing with his brother and spent an entire summer working on honing his skills. As he improved, he listened to his coaches and was determined to work harder than the other players while in college at North Carolina under Dean Smith and Roy Williams. He became one of the top NCAA players, but didn’t get an ego. He continued working hard and stayed in college through his junior year. He decided to enter the NBA draft after Smith advised him to and was the third overall draft pick. In Chicago, he kept his focus and work effort despite being surrounded by temptations of drugs and money. He became the overall best player in the NBA. In his second season after missing 64 games due to an injury, the Chicago Bulls qualified for the NBA playoffs. Jordan was the best player overall and even scored a record 63 points in Game 2 of the series, but the Boston Celtics swept the Bulls. Again, in the following year from 1986-1987, despite a stellar performance from Jordan, the Bulls were swept by the Celtics. Jordan was the best player, but his team was unable to advance playing a style that was focused solely on him. This strategy was also unsuccessful in the 1987-88 and 1988-89 seasons where the Pistons were able to stop the Bulls utilizing a “Jordan Rules” coaching method that focused on double and triple-teaming Jordan every time he touched the ball. It wasn’t until Phil Jackson was promoted to head coach and additional skilled players were acquired that Jordan was able to be a part of a championship team. He had to be coachable and be willing to change how he played. This involved trusting his teammates and helping coach and motivate them. After the Bulls adapted their playing style from a Jordan centered to a cohesive team approach, they were able to dominate the league and win 3 straight NBA championships from 1991-1993 and then again from 1996-1998.

There are many key lessons here. As the famous Thomas Merton quote goes, “No man is an island.” No matter how successful, skillful, or masterful one is, it’s impossible to truly be successful and win the championship of life without a team and an approach of cooperation and mutual support. This is why so many single-person entrepreneurs struggle to be successful and why so many businesses are unsuccessful. The culture of a company is an integral key to its success. In terms of health and fitness, an indispensable component of success is having the support of a community. There is only so much that one can accomplish on his or her own and true success comes as a result of hard work, determination, lots of hours of practice, and being a part of a supportive culture or team.

The loyalty and role-modeling that exists between a coach and his players/mentor and mentee is a powerful motivator and vital to success.

Michael Jordan had several close relationships that were key to his overall success. He wouldn’t have become the best basketball player of all time without the strong connections that existed between him and his mentors. First, his family was supportive and played a large role in his success. After not making his high school varsity team, his mother was the one who encourage and motivated him to work hard over the summer. He respected her advice and listened. He was highly competitive and his brother used this competitive nature to his benefit. They spent countless hours playing basketball. He also had a close relationship with his father who was always honest with him when he was drifting off-track. Jordan respected his father’s advice and support, which was an integral part of his success in both childhood and adulthood. While in college he was mentored by Smith and Williams and continued to listen and follow their expert advice. He put in extra hours of practice on his own before and after his official team practice. This allowed him to gain the confidence he needed to take and make the NCAA tournament game-winning shot as a freshman. Even when he was by far the best player in the NBA, he allowed Phil Jackson to coach him and changed his playing style to one that was team-centered, which allowed him to win championships. Much of Jordan’s success is a direct result of him choosing excellent mentors, listening, and following their advice. If he had had a closed mindset, he most likely wouldn’t have won 6 NBA championships with the Bulls. Additionally, Jordan went on to mentor younger players in the NBA including Kobe Bryant, and giving back and sharing/teaching others is another common trait found in the most successful.

The application for this key point is to make sure that when you want to learn or develop in a particular area, you find excellent mentors and that you’re able to heed their advice. Even if you’re the best, there’s still much to learn, and the most successful players in life are the ones who have what Carol Dweck calls a growth mindset. They are constantly open to learning and growing. This is key to becoming the best. In terms of health and fitness, it’s important to take yourself and your health and fitness goals seriously. If you need to hire a personal trainer, go to a physical therapist or chiropractor, surround yourself with a fitness community. The people we surround ourselves with matter and it’s vital to set yourself up to win.

It’s essential to value each member of the team for who they are and allow them necessary allowances to be themselves to achieve the optimal performance

I was struck while watching The Last Dance by how accepting and understanding Phil Jackson was with the different players on the Bulls. In particular, I loved learning more about his relationship with Dennis Rodman. I’ve always had mixed thoughts about Rodman with his wild hair, piercings, and clothing. Phil Jackson and Michael Jordan instead of criticizing him or trying to make him conform to their team accepted him as he was and allowed his authenticity to shine. There was one part in the series, I think in the third episode, where Rodman was allowed to go to Vegas because Jackson and Jordan knew that he needed to party in order to then regroup and have the necessary focus that he needed back with his team. Although he did not return on his own after the agreed-upon 48 hours, once he was back he wasn’t chastised or punished. Jackson had the entire team training and performing drills to “get Rodman back in shape.” It turned out he was the fastest runner even after a week of partying. Jordan trusted Rodman and knew how to motivate him by allowing him to be authentic. He valued Rodman for the skills that he brought to the team and his mastery of rebounding and defense instead of focusing on their differences. Jackson did an amazing job of building comradery between the different players and this was vital because it led to a winning team culture that was strong and durable enough to win championships.

It’s important to keep this in mind for any business or team. Success is the result of building others up and allowing different players the freedom to shine. We all have different and unique gifts and are most successful when we are encouraged to develop our gifts and are put in an environment where we are loved and appreciated for who we are. Also, the best relationships, partnerships, and teams are often diverse. It’s vital that we keep an open mind and allow different values and perspectives. This is one of the keys to business success and is another example of why the Bull’s basketball team was so dominant in the 1990s.

Even the best can only handle so much and it’s important to recognize greatness, but avoid putting others on a pedestal

At times while watching The Last Dance, it was hard for me to watch the parts where Jordan was surrounded by the media. Of course, it’s natural that he had a celebrity status, but, he was held to impossible standards. While it didn’t appear to affect his basketball game, it took a toll on him and contributed to him deciding to retire after the 1993 and 1998 seasons. Jordan’s main focus was on basketball and on winning at all costs. This contributed to off-court gambling and other activities that were inconsistent with his, “Be Like Mike,” image. He was constantly expected to perform, which was physically and mentally exhausting. He had to remain composed with the media and every time he went out in public he had to be “on.” It got to the point where he was not able to leave his hotel room. At one point he states that, “winning has a cost.” In his opinion, it was more important for him and his team to be able to win, than for him to be a nice guy in practice.

Jordan’s method was highly successful and it shows that even the greatest are imperfect. To get the best out of someone, it’s important to not hold them to impossible standards. This includes ourselves. Striving for perfection often contributes to stagnation and burnout both of which hurt overall performance. In Jordan’s case, we’ll never know if he would have been able to accomplish more or would have continued playing.

At the end of the day, one’s career, or life, while accolades and championships are important, it’s one’s legacy and impact that lives on and matters the most

While Jordan continues to be remembered as one of if not the greatest basketball player of all time, his legacy lives on. He won an impressive number of championships and has amassed billions of dollars through his endorsements and businesses. He played a vital role in increasing the visibility of the NBA in Europe on the Dream Team and the Chicago Bulls will forever be remembered as the most dominant NBA team of the 90s. Despite his popularity, he’s also remembered as a mean and borderline abusive teammate and avid gambler. He was uncompromising, dedicated, and worked harder than everyone else. Even while attempting to get into the major leagues for baseball, his coach noted his commitment to his batting practice and hard work ethic. He truly is a living example of someone who walked his talk.

Jordan is a true legend and leaves a strong legacy. One of my favorite parts of The Last Dance was in the final episode where it was stated that Jordan’s biggest competitive edge was his ability to be present in the moment and his superior mental toughness. He never focused on whether or not a shot would be made before he took it. After his body was exhausted from a long game 6 against Utah where Pippen was struggling with a back injury, Jordan used his mind and mental toughness to win the championship game. This mental toughness can be cultivated and improved. It involves being aware of self-talk and choosing to practice quieting the mind through breathing exercises or meditation. This is what truly separates the top performers and can be successful in any field. Thank you for reading. Please feel free to share your thoughts and reactions from The Last Dance. Also, more blogs to come on mental toughness and the practice of meditation.