Tag Archives: Pelvic Pain

Scoliosis and Pelvic Pain: Treating the Whole Body to Improve Outcomes

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Many people when they think of scoliosis think of the standard forward bend test as a kid at annual scoliosis screenings. They think if they passed these screenings earlier in life, scoliosis is something they do not have to worry about. However, there are many individuals with scoliosis who do not display severe spinal curvatures and may never know they have it despite being screened as children. Many people exhibit mild curvatures that do not cause obvious pain or any pain at all. However, if you have pelvic pain and scoliosis, there could be a link with directing parts of physical therapy treatment towards your scoliosis to help optimize outcomes.¹

Scoliosis is a musculoskeletal deformity of the spine that causes it to curve to one side and creates a problem with movement. The curve can appear as a “C” shape or an “S” shape. Scoliosis can be classified as structural or functional. Structural scoliosis is a curvature of the spine that does not go away with position changes. Adolescent idiopathic scoliosis (AIS), a type of structural scoliosis, occurs in patients from 10 years old until they reach skeletal maturity.  In adulthood, AIS can continue to progress or adult degenerative scoliosis may occur.² If you are over 40, increased age has been associated with an increased prevalence of scoliosis.³ ⁴ Functional scoliosis is a curvature of the spine due to elements not involving the spine such as muscle imbalances, leg length discrepancy, or poor postural habits.² ⁵  

Symptoms of scoliosis include:²

  • One hip or shoulder higher than the other
  • Uneven shoulder blades
  • A “rib hump” and feeling like one side of your ribs is sticking out more
  • One arm hanging longer than the other
  • Legs appear uneven
  • The above listed are accompanied by back pain or breathing difficulty/asymmetry

elvis

The prevalence of scoliosis in patients referred to a clinic with pelvic pain has been found to be high. Scoliosis may contribute to pelvic pain by influencing the pelvis, muscles, and surrounding joints. Pelvic pain can be highly associated with pain in the hip flexors, quadratus lumborum, abdominals, piriformis, and levator ani. Scoliosis may impact all these muscles negatively secondary to causing pelvic obliquity, leg length discrepancy, muscle imbalances, and postural faults.¹ Additionally, scoliosis may impact the respiratory system secondary to decreased chest mobility and asymmetrical inspiration. Impaired breathing patterns and lack of diaphragm usage can impact the pelvic floor negatively secondary to the pelvic floor and diaphragm’s close relationship.⁶ ⁷ Many studies have found a higher rate of occurrence of back pain and inguinal pain in patients with scoliosis then those without.¹ ⁸

Treating the muscles surrounding the scoliosis and postural retraining exercises may help decrease pelvic pain and back pain, especially in the case of a functional scoliosis. If breathing is asymmetrical or impaired, physical therapists can provide proper resisted breathing and strengthening exercises to improve respiratory function and postural control.⁷ In cases of structural scoliosis, collaboration with physical therapy and a medical team may lead to better outcomes on pelvic pain.

There is a reason why your physical therapist may be focusing treatment at your mid back or lumbar spine in order to help decrease your pelvic pain. Good posture is one of the keystones to optimal musculoskeletal health. The team at New Dimensions Physical Therapy can provide you with a thorough postural assessment when considering causes of your pelvic pain and prescribe the appropriate postural strengthening and breathing corrective exercises. Manual therapy to help decrease symptoms and pain can also be provided as needed. Addressing the body as a whole system is key to helping heal chronic pelvic pain cases.

Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

  1. Tate, L. Prevalence of scoliosis in a pelvic pain cohort. J Womens Health Phys Therap. 2015; 39(1): 3-9.
  1. Seattle Children’s. (2015). What Is Scoliosis? Retreived from http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/
  1. Kebaish KM, Neubauer PR, Voros GD, et al. Scoliosis in adults aged forty years and older: prevalence and relation-ship to age, race, and gender. Spine. 2011;36(9):731–736.
  1. Urrutia J, Diaz-Ledezma C, Espinosa J, Berven SH. Lumbar scoliosis in postmenopausal women: prevalence and relationship with bone density, age, and body mass index. Spine. 2011;36(9):737–740
  1. Raczkowski J, Daniszewska B, Zolynski K. Functional scoliosis caused by leg length discrepancy. Arch Med Sci. 2010;6(3):393-398.
  1. Mohammadi P, Akbari M, Sarrafzadeh J, et al. Comparison of respiratory muscles activity and exercise capacity in patients with idiopathic scoliosis and healthy individuals. Physiother Theory Pract. 2014;30(8):552-556.
  1. Kim JJ, Song GB, Park EC. Effects of swiss ball exercise and resistance exercise on respiratory function and trunk control ability in patients with scoliosis. J Phys Ther Sci. 2015l 27(6):1775-1778.
  1. Sato T, Hirano T, Ito T, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Eur Spine J. 2010;20(2):274–279

Overcoming Painful Intercourse: Women’s Health Physical Therapists Should be Part of Your Medical Team

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If you have pain with intercourse you likely do not talk about it or you may think it is normal. If occurring, you may endure it or avoid the activity all together. These responses can lead to significant emotional and psychological repercussions. You may not even know where to start or may be too embarrassed to bring it up to your physician. You also probably have no idea a physical therapist specialized in women’s health can play a significant role in reducing your pain.

The medical term for painful intercourse is dyspareunia. Dyspareunia is recurring or persisting pain with sexual activity that can cause significant distress or conflict. It occurs in approximately 10-20% of women in the US. There can be two types of dyspareunia, one occurring with initial penetration and the other occurring with deep penetration.¹

 Common causes of dyspareunia include:¹

  • Pregnancy (especially during the second half) ²
  • Postpartum trauma
  • Vaginal atrophy post menopause (affects 50% of postmenopausal women due to decrease in estrogen)
  • Vaginismus (involuntary contraction of the pelvic floor muscles that limits vaginal entry)
  • Vulvodynia (pain localized to the vagina and supporting structures)
  • Orthopedic issues
  • Dermatologic disease (examples include lichen sclerosis and psoriasis)
  • Endometriosis
  • Interstitial Cystitis
  • Perivaginal infections¹

All of the above listed conditions are unique issues that come with varied treatments. However, a common problem that can occur in all of the above issues are pelvic floor muscles functioning inappropriately.¹ Treating and retraining the pelvic floor muscles are where women’s health physical therapists play a role as part of the medical team.  In a sample of 132 women that examined the effects of a multidisciplinary program consisting of pelvic floor physical therapy, medical management, and psychological intervention for vulvodynia, strong significant effects were reported in reduction of dyspareunia, sex related distress, sexual arousal, and overall sexual functioning. Thus, a multidisciplinary approach to painful intercourse including pelvic floor physical therapy can have positive outcomes. ³

If you are considering surgery for painful intercourse issues you also may want to discuss trying pelvic floor physical therapy with your physician before surgery to see if it is a viable option. In a sample of 90 patients with a history of sexual dysfunction researchers compared patients who underwent a surgical procedure versus pelvic floor physical therapy alone. Orgasm and dyspareunia improved significantly in the physical therapy group and dyspareunia was more painful in the surgical group. Therefore, pelvic floor physical therapy may be a good option to try before considering surgical procedures if your doctor thinks you are an appropriate candidate. ⁴

Physical therapy treatment for dyspareunia can include soft tissue mobilization to internal and external muscles, pelvic floor muscle retraining exercises, dilator programs, biofeedback, and orthopedic exercises. ⁵ Women’s health physical therapists also can provide options for positions during intercourse based off orthopedic considerations or pain locations. Partner and patient education about dyspareunia is also important secondary to partner responses to pain and women’s maladaptive beliefs regarding vaginal penetration being found as strong predictors to sexual pain behaviors. ⁶ It is important to address all the factors contributing to dyspareunia with your medical team for success. If you feel you are suffering from dyspareunia, you don’t have to. The team at New Dimension’s Physical Therapy can help improve your symptoms and direct you on the right track for treatment. Painful intercourse is not normal and there are many viable conservative treatment options to help.

Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

  1. Seehusen D, Baird D, Bode, D. Dyspareunia in women.Am Fam Physician. 2014; 90(7): 465-470.
  2. Galazka I, Drosdzol-Cop A, Naworska B, et al. Changes in the sexual function during pregnancy. J Sex Med. 2015; 12(2): 445-454.
  3. Brotto LA, Yong P, Smith KB, et al. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015; 12(1) 238-247.
  4. Eftekhar T, Sohrabi M, Haghollahi F et al. Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: a randomized clinical trial. Iran J Reprod Med. 2014; 12(1): 7-14
  5. Ensor W, Newton Roberta. The role of biofeedback and soft tissue mobilization in the treatment of dyspareunia: a systematic review. J Womens Health Phys Therap. 2014; 38(2): 74-80
  6. Brauer M, Lakeman M, Van Lunsen R, et al. Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. J Sex Med. 2014; 11(12): 3051-3063.

 

 

Low Back Pain During Pregnancy: Women’s Health Physical Therapists to the Rescue

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Physical Therapists, particularly those specialized in women’s health conditions can play a vital role in helping women progress through pregnancy with less pain and improved function, while also preventing post-partum musculoskeletal issues. Weight gain and the position of the growing baby, while considered normal, can lead to a variety of symptoms that can be implicated in low back pain:

Suffering from Low Back Pain During Pregnancy (dragged)

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     In addition to excessive anterior weight gain, the hormone relaxin increases ligamentous laxity during pregnancy leading to excessive joint motion and possible micro-injury to ligaments:

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Pregnancy-related low back pain often begins in the first trimester of pregnancy and tends to increase with advancing pregnancy and subsequent pregnancies.1 Women’s Health physical therapists are musculoskeletal experts in providing core-focused training while preventing overstretching of muscles, tendons, and ligaments, which may be contraindicated in pregnancy. The types of exercise programs that have been shown to be the most effective are stability ball exercises and progressive functional core stabilization programs. Yoga by a trained physical therapist or prenatal yoga expert has also been shown to improve low back pain in pregnant patients.1 Dysfunction of the diaphragm, an essential muscle of breathing, has also been shown to be implicated in low back pain. Pregnancy may inhibit excursion and function of the diaphragm that a physical therapist can retrain through breathing exercises and coordinating appropriate breath with exercise.23 Women’s health physical therapists are also trained in providing appropriate external bracing for pregnant women if needed, especially in the third trimester. Research has shown the use of pelvic belts have a strong positive effect for the treatment of pregnancy related low back pain.4

Diastasis recti, a separation of rectus abominus muscle down the middle can also occur during pregnancy. The presence of a diastasis recti has been found to be significantly related to a support related pelvic floor dysfunction diagnosis and may be implicated in low back pain.5 The occurrence and size of a diastasis recti has been shown to be greater in non exercising pregnant women than in exercising pregnant women.6 Exercises putting too high of an increase in intra-abdominal pressure such as crunches or involving excessive twisting may worsen separation. The transverse abdominus plays an important role in lumbopelvic stability, by activating prior to sudden movements and providing compression to the sacroiliac joints. Women’s health physical therapists are trained in providing appropriate abdominal strengthening and retraining of the transverse abdominus.7 They also can provide temporary taping methods of the diastasis recti to decrease pain during exercise.

The common daily activity of prolonged sitting can lead to a variety of issues. Ergonomic advice on proper workstation set up involving a desk attachment board to support the forearms has been shown to reduce low back pain in a sample of pregnant women.8 Easy to do postural exercises throughout the day with or without a band can also help with shoulder, neck and upper back pain from prolonged time spent at the computer. Coccyx or tailbone pain may develop during pregnancy due to hormonal changes, stretch to the pelvic floor muscles, and postpartum due to difficult delivery. Altered sitting postures due to tailbone pain can lead to increased low back pain. Women’s health physical therapists can provide instruction on proper sitting supports and treatment to the appropriate muscles when indicated to improve coccyx pain. 910

Women should not have to suffer with chronic neck and back pain during pregnancy, and should be advised to see a specialized women’s health physical therapist as soon as possible. The sooner a patient can begin appropriate exercises for pregnancy, the easier it is to retrain muscles and prevent faulty biomechanics during daily activities. New Dimensions Physical Therapy has a team of specially trained women’s health physical therapists to help patients progress through pregnancy comfortably. An evaluation will consist of a musculoskeletal and postural evaluation from head to toe, along with questions about what activities bring on symptoms. Sessions may include pelvic supports, taping, manual therapy as needed, and advice on proper seating and sleeping positions. Methods to activate core muscles appropriately, particularly the transverse abdominus during functional activities and modifications of activities may be taught. Additionally, an exercise program and possible referral to either Pilates or yoga programs should be provided for the patient to independently work towards reducing and keeping symptoms tolerable as pregnancy progresses and to restore your body from the childbirthing process. 9

 Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

  1. Belogolovsky I, Katzman W, Christopherson N, et al. The effectiveness of exercise in treatment of pregnancy- related lumbar and pelvic girdle pain: a meta-analysis and evidence based review. J WomensHealth Phys Therap. 2015; 39(2):53-64.
  1. Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012; 42(4):352-362.
  1. Jassens L, McConnell A, Pijnenburg M et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47(1):12-19.
  1. Stephenson R, Steiner S, Puniello M. The effect of lumbopelvic support in the third trimester of pregnancy. J Womens Health Phys Therap. 2007; 31(1):25.
  2. Spitznagle T, Leong F. The relationship between diastasis recti abdominus and pelvic floor dysfunction diagnosis. J Womens Health Phys Therap. 2007; 31(1):26
  1. Chiarello C, Falzone L, McCaslin K, et al. The effects of an exercise program on diastasis recti abdominus in pregnant women. J Womens Health Phys Therap. 2005; 29 (1):11-16.
  2. Lee S, Kim T, Lee B, et al. The effect of abdominal bracing in combination with low extremity movement on changes in thickness of abdominal muscles and lumbar strength for low back pain. J Phys Ther Sci. 2014; 26(1):157-160.
  1. Dumas G, Upjohn T, Dellisle A. Posture and muscle activity of pregnant women during computer work and effect of an ergonomic desk board attachment. Int J Ind Ergonom. 2009; 39(2):313-325.
  1. Tanner H. (2015). Introduction to caring for the pregnant patient [Powerpoint slides]. Retrieved from https://www.medbridgeeducation.com/courses/details/ introduction-to-caring-for-the-pregnant-patient
  1. Maigne JY, Rusakiewic F, Diouf M. Postpartum coccydynia: a case series of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387-392.