165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Pelvic Health

Pelvic and abdominal pain: What kind of treatments help?

I've recently treated 2 ladies with significant pelvic pain. One patient is fairly young, and for some unknown reason seemed to develop pelvic floor pain, specifically by the soft tissue on and below the pubic bone, as well as in the bladder area. Sometimes the pain was referred down into her leg and sitting and walking were difficult. Chronic-Pelvic-Pain-Treatment

She has received 3 treatments consisting of gentle stretches as well as manual therapy/myofascial release to the fascia and tissue which are painful and tight. The major problem turned out to be a sprain of the round ligament on the right:

round ligament is shown in blue

round ligament is shown in blue

Another patient had endometriosis which caused significant scarring through her abdominal area, including on the bladder, bowel, uterus, and ligaments. Douglas_endometriose2 She received gentle stretches as well as core strengthening and has returned to a normal workout routine. She also has avoided another surgery and higher intensity medication.

If you have questions, please feel free to comment.

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

Physical Therapy…May I have a private room please!

When you go to a physical therapist have you been offered a private room or are you treated in an open gym, no curtains to provide privacy, with many other people in the gym?

As a patient YOU can choose what you want. When you go to your first PT appointment, make sure to let the scheduler know that you would like a private room, if you wish.

Many clinics have one or two private rooms and a large gym. It is less expensive to have an large open gym with a few private rooms than to have many private rooms and a smaller gym. Why? It is much more expensive to frame in, sheet rock, putty and paint walls then leave spaces open. Unfortunately you, if you are the patient, may be more likely to gently be guided to an open gym space due to the lest costly nature of this arrangement.

Recently my husband went with his buddies to go get coffee. He came home telling me they watched a lady receiving physical therapy in an open gym with lots of windows. They watched her on her hands and knees stretching her buttocks towards the window. Unfortunately they got quite a show.

What are the positives to private rooms?
1) you can have a candid conversation with your therapist about YOUR needs and wants.
2) You can move in physically awkward positions in privacy with your therapist. This is an advantage to you as you have more privacy; also your therapist may be more comfortable asking you to get into awkward positions (which may be helpful for your therapist to understand your problem) to assess your problem knowing she/he is not putting you in potentially embarrassing positions.

At Comstock Physical Therapy we have 3 private rooms and 2 other rooms in our gym which have full curtain coverage. Here is a video of our clinic on the inside. Take a look, you’ll see our private rooms.

Inside of Comstock Physical Therapy

Please feel free to request a private room as we are ready and able to accommodate your request and keep your needs in mind.

You’re kidding right?! Hip muscle strength helps bladder prolapse AND knee pain

Who knew?  The obtruator internus, a hip and pelvic floor muscle both, supports the bladder from below.  

When the bladder begins to slip down into the vagina that is called prolapse, and the obtruator internus, a HIP muscles can help support the bladder.

Ideally the pelvic floor muscles will lift the bladder…but another muscle supports the bladder, too. It is the obtruator internus which is a supporting pelvic floor muscles as well as a hip stability muscle. Look at the picture of a bladder to the right and below.

obtruator internus muscle next to bone

obtruator internus muscle next to bone

The bladder is the balloon looking object in the middle of the picture, and you can see the hip joints. The OI wings are the obtruator internus muscle underneath the bladder, helping to lift it. This particular picture is of a man, but the obtruator internus muscle lays the same way in a women. Look down and to the left to see the obtruator internus (in green) in the pelvis:
obtruator internus connection to pelvic floor

obtruator internus connection to pelvic floor

Interestingly, the obtruator internus muscle is very important for preventing knee pain as well as preventing plantarfascia. “Why?” See how the obtruator muscle wraps around the sit bone and attaches to the hip? It turns the hip and thigh out, which helps prevent the knee from rolling in (which causes kneecap pain).

obtruator internus posterior view attachment to hip

obtruator internus posterior view attachment to hip

The picture to the right is of the hip and thigh rolling in…the obtruator internus stops that movement AND helps the bladder.
knee cap pain due to hip weakness

knee cap pain due to hip weakness

If you have bladder prolapse, knee pain, or hip pain, or all 3, come to Comstock Physical Therapy to be evaluated by a therapist to get the help you need.

Pelvic Health Physical Therapy–Physical Therapy treats WHAT?

Okay, today we are discussing a very sensitive issue–Pelvic Health Physical Therapy. Having pelvic health issues can be intimidating–because, it is soooo personal. You may be wondering, what issues do people suffer that have poor pelvic health?

Lots of problems can happen down south. There are muscles in the pelvic floor (the levator ani aka pelvic floor muscles or PF) PF muscles can spasm or become weak, just like shoulder muscles, or any other muscle groups. The difference with these muscles causing problems, however, is that spasms here can cause other problems with how the pelvic organs function. Stress incontinence (leakage when you lift, cough, sneeze, run) can happen, often in women but also in men who have had prostate cancer surgery, from weakness.

Levator ani muscles, otherwise know as Pelvic Floor muscles

Levator ani muscles, otherwise know as Pelvic Floor muscles

Urge and frequency incontinence happens when the bladder muscles decide it is time for your bladder to let go, even if You don’t think it is time, and then… you leak. Medicine can be helpful for urgency and frequency, but they leave you with dry mouth side effects.

These muscles can also spasm causing a lot of pain and difficulty with fully emptying your bladder.

A lot of other pelvic health conditions can be treated by pelvic floor physical therapy…more tomorrow