Fibromyalgia is a clinical condition of unknown etiology characterized by chronic generalized body pain associated with fatigue and psychological distress. It typically presents in young to middle aged women and can result in sleep disturbance and significant impairment in activities of daily living.
While medical therapy for fibromyalgia exists and may to a limited extent be beneficial in managing pain, physical therapy plays a major role in treatment and rehabilitation. The aim of physical therapy is aimed at deconditioning and muscle weakness. There are different modalities of physical therapy aimed at treating different aspects of fibromyalgia.
1. Cadiovascular Fitness Training
Patients suffering from fibromyalgia are generally inactive and often become physically inactive over time. Exercise has shown benefits in long term management of fibromyalgia, with studies even showing an improvement in pain. In recent years, exercise remains one of the most commonly recommended treatments.
Exercises are ideally low impact and could include Tai Chi, water exercise, and Qi Gong. Water based exercises seem to offer a small degree of advantage over exercises performed on land, but sometimes are not as convenient to perform. Based on patient function prior to initiating therapy, exercise programs can be tailored to the patient specifically.
2. Physical Therapy
Treatment is aimed at increasing overall muscle strength, and is aimed at reducing muscle weakness. Common advice and treatment may include:
- Avoid muscle overloading- ie lifting heavy weights
- Correcting body alignment
- Muscle conditioning and stretching
- Encouraging general activity
3. Muscle Massage
While this provides both psychological and physical relief to some extent, there is no strong evidence that it is useful as an individual treatment modality; rather it is better used in combination with other therapies.
Randomized controlled trials have shown that acupuncture can provide significant improvement in pain reduction and a reduced perception of pain. However its long term benefits have not been adequately studied, and there is no clear guidance on how often treatment should be administered. It may be more beneficial as an adjunct therapy.
5. Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is an electrical based pain reliever. It is more useful for localized pain, and hence its use for fibromyalgia may be limited. However it is an easy therapy that the patient can self administer at home.
Exercise and physical therapy are mainstay treatment options for fibromyalgia. Treatment options need to be tailored to the individual. With optimal therapy, patients can experience a significant improvement in symptoms.
BONE HEALTH FOR ALL AGES:
Why does bone health matter?
Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For bones to be healthy, it is important to maintain physical activity with a healthy, balanced diet full of calcium, vitamin D, and other supplements as needed.
So what is a physical therapist’s role in bone health?
Physical Therapists are experts in the movement system. They can help patients achieve peak mobility and strength, all while keeping your individualized care in mind. The advanced knowledge of PTs is especially important for patients who already have compromised bone health or risk for fracture like: osteoporosis, female athlete triad, fad dieters, obesity, post-menopause age, long-term steroid therapy, cigarette smoking, high alcohol intake. This is not a complete list! Based on information HERE: Fracture Risk Factors!
What is osteoporosis and what does it have to do with physical therapy?
Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and increased fragility of bones, making them more susceptible to breakage. This is typically diagnosed by a physician with a bone mineral density scan, taking into account blood levels of vitamin D, calcium, and history of prior fracture. For more information about osteoporosis in general look at: National Osteoporosis Foundation!
Physical therapists are the ideal providers to create an exercise program for those individuals who have osteoporosis, osteopenia (low bone density, but not quite osteoporosis), or those who have risk factors for fracture or falling. PTs are trained, as part of their 3 year doctoral program, to understand postural alignment, movement, gait analysis, balance, and the importance of weight bearing exercise to increase bone density and prevent injury.
So what are weight-bearing exercises and how can I do them?
First off, noone who is at risk for falls, fracture, or who has a known medical condition should start an exercise program without the consultation of a physical therapist or physician first!
Second, weight-bearing exercise includes anything the stresses the bones through their long axis. This includes:
- Walking (best results for strengthening the femoral neck, thereby decreasing risk for hip fracture)
- Yoga (Controversial: may provide whole body weight-bearing, however, can increase risk of lumbar bending which can increase compression fractures; Additionally, fall risk should be assessed before performing higher level balance exercises.) Read more here: Yoga, vertebral fractures, etc.
- Dancing (Those dancing with the stars celebrities are protecting their bone density!)
- Tai Chi (TONS of benefits, see effects on bone density HERE)
So, isn’t this just for “older” people?
NO! Starting healthy habits sooner ensures more compliance later. It is much more difficult to start an exercise program after diseases or injuries have already occurred, so better sooner than later! Additionally, your peak bone mass is about 18 in women and 20 in men…. so START NOW!
For fun activities for your loved ones who are younger check out: Best Bones FOREVER!
What does posture have to do with it?
Obviously, as a physical therapist, I am biased about good posture. However, I know how hard it is to make this a habit. The reason it is so important is that proper posture can prevent injury, pain, falls, and FRACTURE. This is critical for those high risk people! Here are some tips:
- Remember the plumb line: Keep ears in line with shoulders in line with hips in line with ankles. See PLUMB LINE!
- Use pillows when sitting or lying to support yourself in a good position.
- Bend your knees and keep your back relatively straight while you lift things. Always keep loads close to your body.
- Maintain regular fitness as staying active can prevent injuries.
Remember: By 2020, over 50% of Americans are expected to have osteoporosis. Let’s try to keep that number lower and reduce fracture risk in the future!
If you feel you are at risk or you already have osteoporosis, call us today at Legacy Physical Therapy to set up an appointment to see how physical therapy can help. 636-225-3649
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Clinical Resident in Women’s Health Physical Therapy at Washington University in St. Louis
Did you know that there are physical therapists who focus especially on female issues? In fact, there are physical therapists here in St. Louis who are Board Certified in Women’s Health Physical Therapy (WCS).
There are multiple times in a woman’s life in which physical therapy may be appropriate. We will talk about 2 important time periods in this article: 1) during pregnancy, and 2) postpartum
Physical therapy can be a wonderful adjunct care provider during pregnancy to help with common pain complaints such as:
- Low back pain
- Sacroiliac joint dysfunction
- Carpal tunnel syndrome
- Pelvic and pubic pain
- Foot pain
- Incontinence (bladder leakage)
- Round ligament pain
Physical therapy treatment during pregnancy may include:
- Posture education to avoid injury and decrease pain
- Manual therapy to restore alignment and improve soft tissue guarding
- Therapeutic exercises for improving muscle performance and posture
- Abdominal and pelvic floor training
- Fitting for various support belts to help with stability and pain
If you are like many pregnant women, you may have concern about what exercises are appropriate during pregnancy. A physical therapist is a great resource for instruction on the do’s and don’ts of exercise during pregnancy.
The stresses of pregnancy, vaginal deliveries, and C-sections may lead to myofascial complications following the birth of the baby. Many women suffer in silence because they feel their symptoms are “Normal” after they have a baby. Fortunately, many of these symptoms can be easily treated by a physical therapist specializing in postpartum care.
Common Postpartum Complaints include:
- Low back and lower extremity pain
- Upper back and neck pain associated with breastfeeding
- Upper extremity pain or numbness associated with child care
- Diastasis recti: Separation of the abdominal muscles which commonly occurs during healthy pregnancies.
- Pain with intercourse or orgasm
- Clitoral, vaginal, rectal, pubic, or tailbone pain
- Pain and decreased mobility at scar of C-Section, episiotomy, or perineal tear
- Pelvic floor weakness
- Urinary or fecal incontinence
- Urgency and frequency
- Pelvic pain
How Physical Therapy Can Help:
- Soft tissue mobilization, myofascial release, deep tissue massage
- Therapeutic exercise for improving abdominal and pelvic floor muscle performance
- Posture, lifting techniques and biomechanics
- Home exercise program
- Abdominal binder/brace fitting
- Scar massage
- Therapeutic ultrasound to breakup clogged milk ducts
- Modalities for pain control
- Instruction in return to exercise safely
- Instruction in proper lifting/carrying of baby, stroller walking, and other activities of daily living to avoid injury
Pregnancy, childbirth and childcare are all events that result in significant physical changes and new stresses on a woman’s body. Women’s Health Physical Therapists are specifically trained to meet the special needs of women during this time of their lives and beyond.
Call us today at 636-225-3649 to set up your FREE SCREENING to see if physical therapy is right for you.
Awhile back we asked you to support a bill to take on the insurance company’s crazy high co-pays. SB 159 passed the Senate 34-0 and the House of Representatives 136-22, but it still needs the Governor’s signature.
That is why WE NEED YOUR HELP AGAIN!
Governor Nixon must sign or veto S.B. 159 by July 14th and your call/email could be the one that makes it happen!
Contact the Governor today! It is as simple as clicking on the link below to email the governor directly and emailing the statement below (copy and paste). It took me all of 30 seconds to do, soPLEASE take 30 seconds out of your day to email him today.
The e-mail link to contact the Governor is http://governor.mo.gov/contact/
Let Governor Nixon KNOW:
“I support the fair co-pay bill, Senate Bill 159 (S.B. 159) to ensure Physical Therapy copays are fair– the same as my doctor visit copays. Please sign this Bill.”
The address to mail a letter is:
The Honorable Jeremiah Nixon
Governor of the State of Missouri
216 Missouri State Capitol Building
Jefferson City, MO 65101
Let’s make sure Governor Nixon knows Missouri cares about being able to afford and access physical therapy care!
Call, write or email and help make this fair copay bill a reality.
Brooke Kalisiak PT, DPT, WCS
So this past Sunday, I along with 3 other teammates participated in the Go! St. Louis Marathon Relay. Each one of us runs roughly 6-7 miles of the 26.2 mile course and then passes the timing chip along to the next teammate. For those of you who know me, you know that I do not and have not ever considered myself a runner. Because of this, I found my mind wondering quite often while I was struggling through my 6 miles. I recorded these musing after the race and thought others might find them interesting. Hope you enjoy.
At 5:40 in the morning: Why did I sign up to run the first leg of this race?
At the start of the race: It’s really beautiful day for a race. Six miles won’t be too bad. Surely I can run as fast as most of these people.
First mile: This isn’t too bad. I can probably run my whole 6 miles and be okay.
Second mile: Why did I think running 6 miles today was a good idea? I have never really enjoyed running, what made me think I would start now.
If you have to stop and stretch it 2 miles it’s probably not going be a good race for you.
Just had the people who are going to win this race pass me as I’m still in my second mile.
I can’t believe the majority of these people are going to be running 13 or 26 miles today!
Look how much that lady rotates her torso. I bet her back hurts. I should give her my card.
Miles 3: Seriously I’m only halfway to my destination!
I didn’t think holy Hill was until mile six, but this sure feels like a holy hill!
I appreciate running through Anheuser-Busch but not sure I like the smell of hops to motivate me while running.
She really pronates her foot. I bet that she’s going to get plantar fasciitis.
He really wiggles his hip side to side I wonder he has IT band issues.
I walk faster than some of these people run, maybe I should just try walking this thing.
Mile 4: I get to see the person who most likely going to finish last and it reinvigorate me to keep running because I’m sure as hell going to beat him.
Really wish the first leg wasn’t so much of an out and back run. It is no fun seeing how far I have to go back.
Mile 5: Look how much that lady adducts and medially rotates her femur. I bet that her knee really hurts.
I wonder where we can go get breakfast after the race because that sounds like a really good idea right now.
Mile 6: I am very happy for the shade and the crosswind provided by the buildings in downtown St. Louis it’s going to be hot today.
I am very happy that I am just about finished running especially when I hear them start announcing to get to the left for relay station!!
Yes, I see Megan, I am almost done running!!!
Living on a Prayer makes a great motivational song when you’re almost finished running!!
So there it is. The mad ramblings of a physical therapist while running! Hope you enjoyed! By the way, big thanks to my teammates: Megan, Sara, and Angela for putting up with me!!
Vaginal pain is a condition that millions of women will deal with at some point in their lives. Unfortunately many women will never seek treatment or if they do they will be told that there is nothing wrong or nothing can be done. An article in The New York Times urges women to be persistent in seeking treatment, because there are things that can be done.
One of the treatment options recommended is pelvic physical therapy. Check out our website for more information on how physical therapy can help.
National Women’s Health Week is a weeklong health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health. It brings together communities, businesses, government, health organizations, and other groups in an effort to promote women’s health. The theme for 2012 is “It’s Your Time.” National Women’s Health Week empowers women to make their health a top priority. It also encourages women to take the following steps to improve their physical and mental health and lower their risks of certain diseases:
- Visit a health care professional to receive regular checkups and preventive screenings.
- Get active.
- Eat healthy.
- Pay attention to mental health, including getting enough sleep and managing stress.
- Avoid unhealthy behaviors, such as smoking and not wearing a seatbelt or bicycle helmet.
In observation of National Women’s Health Week, the American Physical Therapy Association in combination with the Section on Women’s Health has created a wonderful resource: Women’s Health Across the Lifespan. This eBook is intended to provide insight into some of the many conditions common to women and the many ways in which a Women’s Health Physical Therapist can help to treat them. There are some conditions that women may be hesitant to discuss with their healthcare providers. The good news is that conditions such as incontinence, pelvic pain, lymphedema, those that occur during pregnancy and following birth, and others, can all be treated by a physical therapist, often with solutions that do not involve surgery or long-term use of prescription medications.
Here at Legacy Physical Therapy, we hope that you take this call to action to heart and take charge of your health. If you are dealing with any of the conditions discussed in Women’s Health Across the Lifespan, we hope that you contact us at 636-225-3649 to set up your FREE screening to see how physical therapy can help.
HAPPY NATIONAL WOMEN’S HEALTH WEEK!
IT’S YOUR TIME!
Do you go to the bathroom when you don’t need to “ just in case,” hoping you won’t have to when it is inconvenient? Just in Case peeing or JIC’ing can cause havoc for your bladder. By JIC’ing you are actually training your bladder to empty more frequently and often prematurely. This can lead to bladder issues such as urgency, frequency, and leakage.
To break yourself of this habit, before you JIC trying asking yourself “Do I really have the urge to go to the bathroom now or am I going because it is convenient?” If the answer is the latter then do not go to the bathroom. Instead wait until you feel an urge to urinate.
Working with a pelvic physical therapist can be a great way to help you break this bad habit and retrain your bladder if you have already developed symptoms of urgency, frequency, or leakage. Check out Legacy Physical Therapy for information on how physical therapy can help and call us today for your FREE screening 636-225-3649.
Dear friend and patient of Legacy Physical Therapy,
Please consider the following important issues impacting private practice physical therapy clinics such as ours. After reading this I hope that you will take action and contact your state senator and representative on our behalf so that we can continue to provide you with the top-notch care you have come to expect from Legacy Physical Therapy
Health Insurance Companies set up financial contracts with all healthcare providers in order to establish operating and reimbursement standards. These contracts are solely based on the bargaining power of the healthcare provider and the needs of the insurance company. These contracts have no relation to the quality of service provided by the hospital or clinic.
Over the last 20 years, large hospital systems have been given more favorable contracts than private practice clinics, especially in the field of physical therapy. Based purely on the size of the organization, insurance companies would be more willing to listen to the needs of the healthcare provider. More often than not, the needs of large hospital systems were taken into consideration because of the number of providers and services the system provided.
Conversely, the needs of private practice clinics and their owners are rarely taken into consideration when contracting reimbursement rates and patient co-pays. Without the benefit of having hundreds of providers and a multitude of services, private practice clinic owners are unable to negotiate for the basic needs just to maintain operations. Requests for reviews and appeals to the insurance companies routinely fall on deaf ears. Health Insurance companies are impeding Fair Trade Competition by deliberately paying large hospital systems more than private practice clinics for the same services.
Thus, we are taking our fight to the state legislature. We are fighting for fair pay and fair patient co pay amounts. The insurance industry routinely discriminates against small businesses by paying hospitals as much as 100% more than they reimburse for the same services we provide. I’m asking that you please contact your state senator and representative and respectfully request their support by co-sponsoring the bills that are at the bottom of this post. If you do not know your state representative or senator you may look them up at www.house.mo.gov and www.senate.mo.gov in the “Legislature Look-up” but a 4 digit zip code extension is needed. Your 4 digit zip code extension can be found at zip4.usps.com/zip4. For quick reference for Kirkwood patients:
Rep Dwight Scharnhorst (district 093) represents the Kirkwood area – 573-751-4392
Senator Eric Schmitt (distircit 015) represents the Kirkwood area – (573) 751-2853
Thank you for your help!
Brooke Kalisiak and the staff of Legacy Physical Therapy
After finding out your specific State Senator and Representative, please email, send a letter in the mail, or call to ask for their support on the following bills that are active in the 2012 Missouri Legislative Session (January thru Mid May):
Senate Bill 644, Sponsored by Senator Kurt Schaefer: Requires health carriers to reimburse a physical therapist in the same amounts as paid to a licensed physical therapist for rendering the same services regardless of the setting or venue. (Equal Pay for Equal Services Bill)
Senate Bill 687, Sponsored by Senator Eric Schmitt: Limits the copayment, coinsurance, or deductible imposed by a health insurer for physical therapy services by a licensed physical therapist to that for services provided by a primary care physician or osteopath. (Fair Co Pay Bill)
House Bill 1355, Sponsored by Rep. Donna Lichtenegger: Requires health carriers to reimburse a physical therapist in the same amounts as paid to a licensed physical therapist for rendering the same services regardless of the setting or venue. (Equal Pay for Equal Services Bill)
House Bill 1134, Sponsored by Rep. Dwight Scharnhorst: Limits the copayment, coinsurance, or deductible imposed by a health insurer for physical therapy services by a licensed physical therapist to that for services provided by a primary care physician or osteopath. (Fair Co Pay Bill)
If I had a dime for every time I hear a woman say, “Yes I leak a little when I laugh or sneeze, but I just deal with it,” I would be a very rich woman! Let me start this article off right by dispelling this myth once and for all: bladder leakage when you cough, laugh, or sneeze is not a normal part of aging, and you do not have to just deal with it.
The National Institute of Health reports that 50 percent of all women having occasional urinary incontinence, with about 20 percent of women over the age of 75 experiencing daily urinary incontinence. Unfortunately these numbers are just estimates, because the sad fact is that many women never report their bladder control issues because of the social stigma associated with it. One study found that women wait an average of 7 years before talking to their doctor about bladder control issues, and that only 1 in 5 ever get help at all!
This is not just your grandma’s problem! Women of all ages may experience urinary incontinence. Leakage can be caused by weakening of the pelvic floor muscles, which form a sling around the vagina (birth canal), the urethra (tube from the bladder), and the rectum. Weakened pelvic muscles can be caused by aging, pregnancy, child birth, chronic constipation, and chronic coughing. Urinary incontinence is often a socially debilitating condition, which causes many women to have to give up activities they love. The good news is that most cases of incontinence can be cured or improved with proper diagnosis and treatment.
Types of Incontinence
1. Stress Urinary Incontinence: SUI may occur because of weak pelvic floor muscles and/or a deficient urethral sphincter, causing the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
2. Urge Urinary Incontinence: Urge urinary incontinence and overactive bladder is the urgent need to pass urine and the inability to get to a toilet in time. This occurs when nerve passages along the pathway from the bladder to the brain are damaged causing a sudden bladder contraction that cannot be consciously inhibited.
3. Mixed Incontinence: Mixed incontinence is very common and occurs when symptoms of both stress and urge types of incontinence are present.
If you experience incontinence, getting a prescription from your doctor to see a physical therapist trained in pelvic floor therapy is a great place to start. The truth is, pelvic muscle weakness can contribute greatly to urinary incontinence because of the lack of support and control. The therapist will provide a thorough musculoskeletal evaluation, assessing your posture, flexibility, core strength and alignment. From there the therapist will develop an individualized treatment plan that may include: pelvic floor muscle strengthening, bladder retraining, lifestyle modifications, biofeedback, and gentle electrical stimulation of the pelvic floor muscles.
Physical therapy is an appropriate conservative treatment option for urinary incontinence, but in some cases treatment for incontinence may include medication or surgery. The good news is that there are many effective treatments available and you do not have to live with the life-limiting problem of incontinence.
To learn more about physical therapy treatments for incontinence, please call Legacy Physical Therapy at 636-225-3649 to set up a free 15 minute screening.