In 2011, the FDA issued a warning to patients and medical professionals that transvaginal mesh implant surgery for pelvic organ prolapse (POP) often created more problems than it solved.  The warning also noted that “there was no clear evidence transvaginal POP mesh repair was more effective than non-mesh repair” for treating POP.  Furthermore, the FDA report emphasized that the mesh itself, rather than surgical error, lead to pelvic pain in many patients.

However, transvaginal mesh implant surgery remains a commonly recommended treatment for POP.  A Justice News Flash post, titled “Don’t Wait In Vain For Pelvic Pain To Resolve After Removal of Mesh Implants”, recently discussed how this surgery often leads to the development of Pudendal Neuralgia in patients, “more often than not [requiring] complete removal of the mesh.”  In short, in lieu of sending these patients to trained physical therapists, and, in spite of FDA warnings, many medical professionals continue to recommend transvaginal mesh implant to treat POP.

Pudendal Neuralgia, already an underdiagnosed, undertreated, and underserviced illness, is noted for how few therapists and other medical professionals have the proper training to treat it.  Peripheral nerve regeneration can take up to six months for patients who developed Pudendal Neuralgia after surgery.

Total Physical Therapy recently posted two excellent videos on the pelvic “dump”: the Pelvic “Dump” and Muscle Length and the Cure for the Pelvic “Dump”.  The first video describes how the hamstrings, abductors, and the gluteal (“glutes”) muscles affect pelvic “dump”, also known as the pelvic tilt.  The second examines stretching techniques that can ease the tightness and, thus, treat pelvic tilt.

Pelvic tilting occurs when the pelvis is not orientated correctly, and is becoming more and more common as sedentary lifestyles bceome the norm in America.  Daily activities, such as sitting at a computer for example, can often lead to a pelvic tilt.  Resting against the back of one’s chair or leaning forward to read small print can feel more supportive than utilizing the correct muscles required maintain proper posture.  To put it another way, when doing activities many Americans do daily, it is often easier to rest one’s body on another surface for extended period of time than it is to exercise proper biomechanics.

However, this behavior often leaves patients with pain and stiffness in the back, knees, and hips.  Furthermore, if left untreated, these symptoms have a tendency to become more severe over-time.

For more than sixty years, Kegel exercises have been a common, albeit rudimentary, form of treatment to strengthen the pelvic floor.  These exercises have become so omnipresent that the pelvic floor is commonly known colloquially as the “Kegel muscle.”  Perhaps best known by the public for their ties to increased sexual function, Kegel exercises are often inappropriately considered the hallmark of pelvic floor wellness.

In a recent Chronogram article, titled “Could Your Pelvic Floor Use a Renovation?”  Wendy Kagan describes the significance of Kegel exercises: “Today they’re a first-line defense against genital prolapse and urinary stress incontinence (i.e., leakage that occurs with jarring movements like coughing, jumping, or lifting). Dreaded by some, championed by others, Kegels are the pelvic equivalent of flossing—something most women know they should do, yet often guiltily do not do.”

The biggest problem with this article is that Kegels are not the “first line of defense”.  Nor are they, necessarily, the best practice for everyone’s daily regimen.  Prescribing pelvic floor strengthening without properly assessing the pelvic floor can be harmful for patients.

While many prenatal women practice yoga to stay healthy and fit during pregnancy, prenatal yoga is becoming a more and more popular tool to prepare women for labor.  The topic of prenatal pregnancy was recently covered in the Welland Tribune.  The article, titled “Prenatal Yoga Gets Women Ready for Birth,” follows Angela Sacco, a registered nurse and pre- and post-natal fitness specialist. Sacco has attended more than 100 births.  Her eight-week program is specially-tailored to aid pregnant women as they prepare for giving birth.

According to Sacco, “Yoga in the delivery room, be it home or hospital, is meant to relieve pain, build confidence and make it all go quicker.”

This November, Herman & Wallace is proud to bring our Differential Diagnostics of Chronic Pelvic Pain and Dysfunction to Orlando, FL!  This three-day course is taught by Peter Philip, PT, ScD, COMT.

Although exercise is critical for pregnant women (just as it is for everyone), few receive the appropriate amount of exercise.  This may seem intuitive, but physical symptoms of pregnancy often are a barrier to physical activity for women.

A recent Research Report article published in The Journal of Women's Health - Physical Therapy, titled “The Impact of Symptom Type and Frequency on Activity Level During Pregnancy,” studying the daily records of physical activity for “sedentary women with a history of preeclampsia,” discusses how maternal weight and gestational age affect activity levels.  For example, women who are already over-weight have lower activity levels during pregnancy.  Similarly, the further along the baby is, the less likely the mother is to be physically active.  Women, after week 28, have the greatest reduction in physical activity.

This is problematic because a healthy mom is crucial for both the health of the mother and the health of the baby.  Furthermore, symptoms like fatigue and backache decrease among more active moms.  Gestational diabetes and cardiovascular disease are less likely among active moms as well.  Over-exercise can be detrimental as well; however, the numbers of women over-exercising during pregnancy is negligible compared to the majority, who are under-active during pregnancy.  Often, these physiological problems persist after pregnancy.

Despite the fact that millions of men and women experience pelvic floor dysfunction, it is often and incorrectly considered a “women’s health issue” and pelvic rehabilitation is often thought to be the province of Women’s Health physical therapists.  Information about pelvic rehabilitation is often couched in language that revolves around perinatal and elderly female patients, while ignoring men, athletes, and teens.

For example, both male and female athletes can be frequent sufferers of pelvic floor dysfunction, as a by-product of the extreme stress high level performance takes on their bodies, often linked to sports hernia and femoroacetabular impingement.

This year, Herman & Wallace is introducing a new course which applies a sports medicine approach to treating the pelvic floor and core. Biomechanics of the Hip and Pelvis illustrates how understanding pelvic balance and manual movement therapy are integral to treating and preventing injury.  This course is instructed by Steve Dischiavi, MPT, DPT, ATC, COMT, CSCS, who is the PT for the Florida Panthers hockey team and is applicable to treating all patients: from men to new moms, athletes to the elderly.

Pudendal Neuralgia (PN) is a neuropathic condition that causes patients to suffer chronic pain or numbness.  Furthermore, PN is often accompanied by fecal incontinence, urinary incontinence, and numbness of the genitalia.  Patients experiencing PN struggle with one of the most difficult nerve conditions and one that affects men and women alike.

Physical therapy has shown itself to be one of the few methods to successfully treat PN.  However, few physical therapists have the knowledge, experience, and skills required.  Recently, Greg Vigna, M.D., J.D. wrote an article for New York Injury News about pudendal neuralgia.  In it, he describes the obstacles facing patients with PN:

"Historically the management of pudendal neuralgia was only available at a select few centers throughout the country. The reasons for this is that pudendal neuralgia was quite rare, often overlooked, and under diagnosed by the medical community. There are only a few doctors in this country who have received the advanced training in the management of this disorder. Even fewer have the advanced surgical training. A great number of physicians do not have a base understanding of the pudendal nerve and are unaware of pudendal neuralgia."

We are excited to announce Herman & Wallace instructor Ginger Garner, PT, MPT, ATC, PYT will speak at the National Athletic Trainers’ Association’s (NATA) 64th Annual Meeting and Clinical Symposia this June. Her advanced presentation, titled Yoga Pulls Double Duty: Establishing Controlled Flexibility in Athletes, has already sold out!

With PF1 Durham just around the corner, and PF1 Seattle in January sold-out with a 20-person wait list, our next PF1 is filling up quickly.

PF1 in Maywood, IL from March 1-3 is over half-full, and additional registrations are rolling in each day. If you are interested in joining us for PF1 in Maywood, do not hesitate to register. We expect this course to fill up before the holidays are upon us, so act quickly.

Once PF1 in Maywood is full, the next available PF1 is in Houston, TX in early May 2013. If you'd like to take this popular course before May of 2013, we suggest registering for the Maywood course today!