Blog Posts

Symptoms in the Sky (part III)

11/26/2017

For those patients with increased frequency or urge urinary incontinence, the idea of long plane rides in the window seat can be scary. The Voluntary Urinary Inhibition Reflex (VUIR) and double voiding may be effective methods of management for the above conditions when traveling. The purpose of the VIUR is to neurologically inhibit the smooth muscle that contracts for bladder emptying. From the patient's airplane seat, to activate this reflex, have him or her perform a light pelvic floor contraction (kegel) 10 times with a 10 second hold.

The purpose of double voiding is to empty the bladder as much as possible in a single trip to the bathroom. To perform the double void, have a patient urinate as usual in the airplane bathroom. When the first void is complete, females can stand back up for ~30 seconds; males continue to stand. The patient can then resume the preferred peeing position until he or she urinates a second time.

Symptoms in the Sky (part II)

11/19/2017

Many of us have suggested the use of lumbar supports for carseats when patients with low back pain have long drives, but what about long flights? If the lumbar support will fit in a patient's carryon, that is great. However, in some cases, the support will not fit and a flimsy plane pillow will not cut it. In said situation, the patient and I will identify an article of clothing that can be donned for boarding the plane then doffed for rolling into lumbar support that fits his or her needs.

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Symptoms in the Sky

11/12/2017

Lets say you have been working with a patient who suffered from some form of chronic pelvic or back pain and he or she has been making great, measurable, progress. The aforementioned patient has a long flight coming up and is concerned of symptom management during transportation. In such case, the patient and I will identify exercises that offer the most immediate symptomatic relief that can be discretely performed in close quarters; chin tucks, shoulder retractions, pelvic tilts, light kegels, etc.. Typically, picking two exercises and alternating them every half hour offers sufficient management of symptoms and gives autonomy back to the patient for the duration of his or her travels.

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Take a Minute

11/5/2017

Occasionally, as a physical therapist, you may find yourself working with a patient for an extended period of time for a particular diagnosis, which initially seems, unrelated to pelvic health. You work every external orthopedic and neurologic angle in your arsenal of physical therapy tools and, despite a valiant attempt to preserve your patient's modesty, the realization occurs that an internal examination may shed light regarding limited progress. You discuss with your patient that an internal vaginal or rectal exam is the next best course of action. Despite your own slue of professional experience, a pelvic exam from someone other than a urologist or gynecologist is a novel experience through the eyes of most patients. Typically, I educate the pelvic exam candidate one session prior to the execution of our aforementioned exam. The patient should be given time to decide if he or she is physically, emotionally and spiritually willing to participate in an exam of such a personal part of the human anatomy.

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Breaking the Wall

10/29/2017

As evidence based practitioners, most of us physical therapists build a wall of evidence around ourselves consisting of the most current research. Now, I would like to direct your attention to the accidental birth of "Mckenzie Technique." Mckenzie, a physical therapist in New Zealand, instructed a patient with low back pain to wait, on his back, in a private room. The patient misunderstood and lied on his stomach; the pain mysteriously vanished. Without the use of Meta Analysis, Systematic reviews or Randomized Control Trials, a new and currently accepted technique was birthed from a simple misunderstanding. The picture that I am trying to paint is not to be afraid of trying something different. Without putting patients in danger, attempt to break the wall of evidence you have built by trying something new.

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Parting Words

10/22/2017

On discharge day for patients suffering from pain driven by favoring certain postures, I find it is important to have “the talk.” Looking back at a patient I met with chronic low back pain, I recall that she favored being "Beyonce" but would not give "Michael Jackson," the late king of pop, time of day… Allow me to explain. The aforementioned patient would hold an anterior pelvic tilt, Beyonce, during most activities, static or transitional. Once we discovered her affinity for emulating Beyonce, we slowly began impersonating Michael Jackson, posterior pelvic tilt. At discharge, before telling the patient to “just beat it,” it may be helpful to assure that it is okay to be either pop star as long they change it up every once and a while.

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Flare Up Days

10/15/2017

On a day that is otherwise out of a patient's control due to an acute low back or pelvic flare up, let them take back the reins. Instead of going through the typical exercise routine, let them pick 2 exercise that otherwise do not exacerbate symptoms. Also, have them relax supine with hips/knees resting at 90 degrees and hips abducted and externally rotated into a position of their choice that is comfortable but somewhat resembles an open pack position for the levator ani. Hot or cold compress? Be ready with your advice if that is what he or she is looking for but otherwise the choice is their own.

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Sunday Supplemental

Men & Women's Health

NEWSLETTER

Symptoms in the Sky (part III)

Symptoms in the Sky (part II)

Symptoms in the Sky

Take a Minute

Breaking the Wall

Parting Words

Flare Up Days

​Sunday Supplemental

Men & Women's Health

NEWSLETTER

Symptoms in the Sky (part III)

Symptoms in the Sky (part II)

Symptoms in the Sky

Take a Minute

Breaking the Wall

Parting Words

Flare Up Days

Sunday Supplemental