Services

              Low Back Pain
              Chronic Pelvic Pain
                     Pelvic Floor Dysfunction
                     Orthopedic
              Spine/Core Stability
              Orthopedics
              Incontinence
              Pregnancy/Postpartum

    Lymphedema (leg, trunk, genitals)
    Post Breast Therapy Pain Syndrome
           Lymphedema (arm, trunk, breast)

Low Back Pain It is estimated that 8 out of 10 Americans will develop low back pain at some time in their life. Low back pain can be localized to the back or it can spread down into the buttocks, legs, groin or abdomen. Patients frequently obtain x-rays or MRI's from their treating physicians to find a cause for the pain. Many of our patients have been diagnosed with degenerative disc disease, herniated discs or "pinched" nerves. Some of our patients have negative findings with special tests. Regardless of the diagnosis, our treatment approach will significantly decrease your pain and increase the quality of your life. It is our experience that sacroiliac dysfunction (SIJ) is a common diagnosis that is frequently missed. The signs and symptoms of an SIJ can mimic other conditions. Please see the common patterns of distribution that has been documented by the following authors. We have also noted that many of our chronic pelvic and back pain patients have been participating in strength training that actually makes their condition worse. Ironically, many patients do not even realize that the exercise's are making their condition worse. The pain does not always occur during the exercise itself. We promote a healthy lifestyle that includes a routine exercise program. We have found that our patients are participating in exercises that do not correctly isolate important muscle groups. Once a muscle imbalance has been created, the stronger muscles get stronger and the weaker muscles get weaker. We help our patients identify these weaknesses and give them tools to create balance and stability in their muscles and joints. Please read more details in our Spine/Core Stability Program. Back to Top

Chronic Pelvic Pain Chronic Pelvic Pain (CPP) can encompass a variety of medical conditions and physical therapy diagnoses. To assist you in understanding the services we provide, we have divided them up into symptoms that can be orthopedic related (see Low Back Pain) and those that can be caused by Pelvic Floor Dysfunction. Please note that symptoms can be a combination of orthopedic and pelvic floor causes. Abdominal pain can also come from a variety of sources. Possible sources of pain include: referred from the sacroiliac joint (SIJ), ilioinguinal neuropathies, pubis symphysis dysfunction, scar tissue from surgeries, trigger points from the pelvic floor, connective tissue restrictions or referred pain from abdominal viscera. The diagnosis of chronic pelvic pain is often given to patients when the physician is unable to find a medical diagnosis to explain the severity of the symptoms. Under these circumstances, it is not unusual to find a musculoskeletal component. Many medical diagnoses have been documented to have a musculoskeletal component. It is very important to be thoroughly screened by your physician for any medical diagnosis that requires medical intervention. If you continue to have symptoms after the medical intervention, we feel that an evaluation by a physical therapist trained in treating chronic pelvic pain may be indicated. Common medical diagnosis that may have a musculoskeletal component include, but not limited to:      •   Vulvodynia      •   vaginismus      •   dyspareunia      •   interstitial cystitis      •   prostatitis      •   orchidynia      •   vulvar vestibulitis Back to Top

Pelvic Floor Dysfunction What are the symptoms of pelvic floor dysfunction? They can be numerous in nature but have been described as follows:      •   pain with, during or after sexual relations      •   genital pain      •   urinary urgency and frequency      •   deep pain in the lower back radiating to the legs, thighs, groin and hips      •   lower abdominal pain      •   vaginal or rectal pain      •   pain with urination or defecation      •   pelvic pressure of falling-out feeling      •   involuntary loss of urine or stool      •   pain with daily activities; sitting, walking, standing      •   burning, itching, stinging of the vulva and outer vagina      •   difficulty initiating a urinary stream What causes pelvic floor dysfunction? The cause of pelvic floor dysfunction is unknown but is likely a combination of events. A wise colleague of mine once described it as a glass being filled with water that eventually overflows. There are numerous traumatic events that contribute to the filling of water in the glass. The event that causes the water to overflow can be as simple as a cough or a urinary tract infection. This overflow is recognized as the breaking point in the system that leads to the development of pain or dysfunction. Events that have been correlated with the development of pelvic floor dysfunction include:      •   direct physical trauma; surgical procedures, sports injuries, fractures, sudden severe muscle strain, car accident, pregnancy or complicated delivery      •   repetitive minor trauma, chronic cough, constipation, straining to void      •   chronic tense holding patterns that develop in childhood as a result of sexual abuse, traumatic toilet training, abnormal bowel patterns, stress or sports training.      •   chronic hip and back pain and causing compensation patterns of the pelvic floor      •   inflammation of the pelvic organs such as urethritis, cystitis, vaginitis, prostatitis and endometriosis.      •   Chronic faulty posture and weak core musculature Where are the pelvic floor muscles and what do they do? The pelvic floor is a hammock-like web of muscle and connective tissue that covers the pelvic bones and supports the rectum, bladder and vagina. A functioning pelvic floor is integral to increases in intra-abdominal pressure, provides rectal support during defecation, has in inhibitory effect of bladder activity, helps support pelvic organs, and assists in lumbopelvic stability. Coordinated release of the sphincters within a supporting extensible levator ani allows complete and effortless emptying. The pelvic floor muscles also contribute to one's sexual appreciation. Who develops chronic pelvic pain? Chronic pelvic pain (CPP) is one of the most common medical problems affecting women today. It is estimated that 14.7% of women in their reproductive ages reported chronic pelvic pain. Extrapolating to the total female population gave an estimate of 9.2 million women suffering from CPP in the United States alone. The diagnosis and treatment of CPP accounts for 10% of all outpatient gynecological visit and 40% of all laproscopic surgeries. Chronic pelvic pain is listed as the indication for 12-16% of hysterectomies performed in the United States, accounting for 80,000 procedures annually. Chronic prostatitis is the most common urological diagnosis in men older than 50 years and is the third most common diagnosis in men younger than 50 years. This diagnosis results in at least 2 million office visits per year. The average urologist sees approximately 10 prostatitis patients per month, 30% of whom are new patients. Specific urinary pathogens are detected infrequently after culture. The vast majority of these patients are categorized as having chronic nonbacterial prostatitis or prostatodynia, otherwise known as Chronic Pelvic Pain Syndrome (CPPS) in the male. How is chronic pelvic pain related to pelvic floor dysfunction? Dysfunctional muscles of the pelvic floor are frequently overlooked as a contributor to chronic pelvic pain. Unfortunately, not all doctors are aware of pelvic floor dysfunction, and others simply don't believe that it exists. Thanks to the experts in our field, it has been well documented in the literature that many urogynecologic symptoms arise from the presence of a short, painful hypertonic pelvic floor. Back to Top

Orthopedic Component to Chronic Pelvic Pain The orthopedic component to chronic pelvic pain usually comes from sacroiliac dysfunction, low back pain, leg length discrepancies or rotated segments of the cervical-thoracic-lumbar spine. Back to Top

Spine/Core Stability "Core" is a common phrase used with fitness and rehabilitation professionals. The concept of core stability is to be able to optimize forces through the spine to decrease stresses to the joint and optimize functional strength. The body has many different layers of muscles. The "core" is the deepest layer of muscles. It is ideal to be able to effectively isolate these deepest layers and then progressively learn to recruit additional layers in a particular pattern for optimal function. Core strength training has very many levels and applications. It is our experience that patients are taught too advanced level of core exercises for their current abilities. When an exercise is too advanced, patients lose their neutral spine, hold their breath or mass contract by using compensatory muscles as a strategy to perform the desired movements. These strategies would be inappropriate and the goal for "core stability" is lost. Inappropriate activation of these muscles can actually make your condition worse. Advanced level exercises often involve the use of pilates machines, balls, foam rollers, and weights. Our beginning level exercises start with correct isolation of muscles and then progress to the use of the arms and legs as a lever arm of force to the inner core muscles. We then progress the level of difficulty using different positions, resistance, and changing the stability of the surface. Our core stability program is personalized to your abilities and conditions. Modifications may be required based on your diagnosis, age, level of activity and personal goals. A thorough evaluation of your personal needs will be determined on your first visit. This program is intended to be done at home with minimal use of equipment and when appropriate we can transition back to the gym. Back to Top

Orthopedics Orthopedics is the study of the musculoskeletal system. The musculoskeletal system includes: bones, joints, ligaments, tendons, muscles, and nerves. Orthopedic injuries can be caused by a variety of mechanisms; the most common ones are listed below. Overuse injuries, otherwise known as cumulative trauma disorders, are described as tissue damage that results from repetitive demand over the course of time. The term refers to a vast array of diagnoses, including occupational, recreational, and habitual activities. Examples include: tendonitis, bursitis, tennis elbow, shin splints, etc. You can also develop overuse injuries or prolong effective healing from injuries by:      •   Using poor techniques. Some techniques are better suited for abilities or biomechanics      •   Doing only one type of exercise. Joint pain and muscle pain can be caused by not effectively strengthening muscles around an entire joint. Sports injuries tend to be categorized as either:      •   Traumatic (Acute) Injuries - Acute pain and injury is usually the result of a specific impact or traumatic event. Examples include: fractures, bruises, sprained ankles, joint dislocations/subluxations, etc.      •   Overuse (Chronic)Injuries - Chronic pain from overuse injuries, on the other hand, tends to have subtle or vague symptoms that develop slowly. What begins as a small, nagging ache or pain can grow into a debilitating injury if it isn't recognized and treated early. Examples include: sprains, strains, tendonitis, bursitis, etc. Post-operative rehabilitation plays an important role in regaining function and strength after undergoing an operation. Examples include: joint replacements, arthroscopy surgeries, tendon/ligament repairs, spine surgeries, etc. Acute traumatic injuries usually result from accidents. Examples include: falls at work, lifting too heavy of an item and feeling your "back go out", motor vehicle accident - whiplash, recreational accident - wreck an all terrain vehicle, falling down while hiking, etc. Chronic pain conditions - old injuries that never seem to heal or recover Custom orthotics - Orthotics are orthopedic devices that are used to alter or modify foot function and are designed to treat, adjust, and support various biomechanical foot disorders. Some orthotics are simple, commercially-made devices, such as cushioned heel cups or insoles for shoes that are sold over the counter in drug stores or other retail establishments. The most effective orthotics, however, are custom-made devices that are crafted to meet the specific needs of a particular individual. Custom orthotics are created using an impression of the foot called a cast, which duplicates any misalignments in foot structure. The finished orthotic is placed in the patient's shoe to support the foot and eliminate abnormal foot biomechanics by keeping the foot properly aligned. We like to try a conservative treatment option for painful conditions. If there is an underlying biomechanical insufficiency (example - pronation or flat feet) that is impeding progress then we recommend the option to try an orthotic. Back to Top

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