In outpatient therapy, we often emphasize the importance of exercise, manual therapy, and movement strategies in recovery. However, sleep is often overlooked, not addressed thoroughly or never even mentioned. Sleep is essential for muscle repair, pain management, and overall functional recovery. Sleep affects recovery in several different ways from a hormonal level to how we process pain, and from coordination to inflammation. - During deep sleep, the body releases growth hormones that are crucial for tissue repair and muscle regeneration. These growth hormones will still be released without the deep sleep, but it will take a longer period of time. (Dattilo et al., 2011). - Poor sleep can increase pain sensitivity and decrease pain tolerance, making physical therapy exercises more difficult and uncomfortable. So often we become increasingly emotional and I’ve frequently seen patients feel depressed, think it will never get better and more. This significantly affects how our therapy sessions go as well as their consistency with a home program. (Finan, Goodin, & Smith, 2013) - Our coordination is another thing that can take a big hit from a lack of sleep. Not only is it truly more difficult because of a neuromuscular (brain to muscle) disconnect, but we become frustrated with ourselves (and our therapists!) more quickly. (Walker et al., 2002). - The big “I” word. Inflammation. Often in therapy we are combating inflammation in the first place and a lack of sleep can increase inflammation leading to a longer rehab. (Irwin, 2015). We are always happy to provide techniques for better rehab, even if it may seem to not be injury specific...like sleep!! VERY basic things that you can address first: Consistent schedule for sleep Sleep in a cool, dark room with LIMITED SCREEN TIME. Put those phones down! Breathing exercises – my favorite is diaphragmatic breathing. Light stretching. It can even be just 3-5 minutes of a couple relaxing stretches! Denise Schram, PT, DPT References: Dattilo, M., Antunes, H.K., Medeiros, A., et al. (2011). Sleep and muscle recovery: Endocrinological and molecular basis for a new and promising hypothesis. Medical Hypotheses, 77(2), 220-222. Finan, P.H., Goodin, B.R., & Smith, M.T. (2013). The association of sleep and pain: An update and a path forward. Journal of Pain, 14(12), 1539-1552. Walker, M.P., Brakefield, T., Morgan, A., et al. (2002). Practice with sleep makes perfect: Sleep-dependent motor skill learning. Neuron, 35(1), 205-211. Irwin, M.R. (2015). Why sleep is important for health: A psychoneuroimmunology perspective. Annual Review of Psychology, 66, 143-172.
Do you have or are dealing with... Difficulty with controlling your bladder or bowels? Pain in and/or around your pelvis or abdomen? Constipation? Pain with sexual activity? Pelvic Organ Prolapse or feeling of pressure and heaviness in your pelvis? Currently pregnant or more than 6-weeks postpartum? If you’ve experienced any of these, just know you aren’t alone! Up to 49% (or more) of individuals, female and male, experience one or more of these symptoms during their lifetime. While this may be common, it doesn’t have to be something you “just deal with” and Pelvic Floor Physical Therapy might be something worth considering! What is Pelvic Floor PT? Pelvic Floor Physical Therapy is a specialized area of PT, encompassing a thorough assessment of the of the body’s functioning in relation to bowel, bladder, sexual health, and movement in our daily lives. Your Physical Therapist has undergone additional hands-on training to specifically examine and treat the muscles and structures in and around the pelvis. Pelvic floor physical therapy is an essential resource for individuals dealing with various pelvic health issues, such as: Bowel or Bladder Incontinence Constipation Diastasis Recti – “separated abdominal muscles or abdominal bloating” Overactive Bladder Pelvis/Perineal pain Pregnancy and Postpartum Hemorrhoids Urinary retention or frequent UTIs/bladder infections Organ Prolapse Coccygodynia - “pain at or around your tailbone” What should I expect during an initial visit? If you’re considering pelvic floor physical therapy (PFPT), the evaluation process might seem a bit daunting. However, it is a crucial step in addressing the issues you may be having and developing the care plan that is best suited to help you •Initial Consultation and Movement Analysis: After spending some time talking with your PT about your symptom presentation, bowel/bladder habits, and medical history, they’ll take some time to look at how your back, hips, knees, core and pelvic floor are moving with daily movements like squatting, bending, sitting, walking, etc. • Physical Assessment: An external and internal examination of your pelvic floor may take place during this first assessment to best observe how your pelvic floor muscles move and function, determine strength, endurance and coordination, and identify if there is any tightness or discomfort of those muscles. *Before starting this portion, your therapist will describe in detail the entire process of the external and internal exam and ensure you know what to expect and that you know you are in control the entire time. They will ask you if you have any questions and confirm you want to proceed with this step. *This does not have to be performed on the first visit, as there are other ways to assess the pelvic floor.* • Goal Setting: At the end of your visit, your PT will then help develop a treatment plan to address any of the limitations or restrictions found during the evaluation to best meet your needs and expected goals. Education on your diagnosis, symptoms, body anatomy and prescribed exercises will also be discussed. You will always have the opportunity to ask questions during your appointments. What are 3 things I can do in the meantime until I come to PT? 1. Be aware of your breathing – try not to hold your breath when picking up things like groceries, your kids, heavy boxes, etc. Remember to take deep breaths to fully fill your lungs (think 360-degree filling of your abdomen, ribs and low back). 2. Stay hydrated – even if you find yourself having to go to the bathroom often, it is important not to limit your fluid intake in order to keep your muscles and joints hydrated. Try to limit beverages with a lot of caffeine, citrus, or carbonation to reduce irritation to your intestines and bladder. 3. Keep moving your body - Gentle movements like walking or yoga are great ways to prompt blood flow to the pelvic area which helps to nourish the muscles and tissues. However, avoid or reduce any overly strenuous activities that can increase tension to the pelvic floor like running or repetitive jumping (just for now!). Your pelvic floor therapist will help assist with returning to these activities that may worsen your symptoms. If Pelvic Floor Physical Therapy is what you're looking for or you aren’t quite sure if the symptoms you’ve been having are related to the pelvic floor, reach out to your doctor or give us a call to set up an appointment today! Annie Foss, PT, DPT
Do you have a scar that didn’t heal right or is painful? Scar formation is a natural process your body goes through when repairing damaged tissue from an injury or surgery. While many wounds heal on their own without issue, some have delayed healing or even get infected. This can result in hypertrophic scars that are painful and don’t move well. They also may have an irregular appearance that can make some people self-conscious. Dry needling, in addition to other physical therapy interventions, can be useful in improving the mobility and overall look of these scars. It can also decrease any pain associated with the scar as well. Dry needling is thought to be the most effective 6 to 18 months after injury due to tissue healing timelines, but it can also be beneficial in decreasing pain beyond that time frame. A well mobile scar allows that area to move more freely and leads to less pain and dysfunction later on in life. If you have a pesky scar that is painful or the appearance bothers you, book a consultation to discuss how dry needling may be beneficial in addressing your concerns. Don’t let scars hold you back from moving optimally! Bridget Juhnke, PT, DPT Sources: Rozenfeld E, Sapoznikov Sebakhutu E, Krieger Y, Kalichman L. Dry needling for scar treatment. Acupunct Med. 2020 Dec;38(6):435-439. doi: 10.1177/0964528420912255. Epub 2020 Mar 30. PMID: 32228036. Chmielewska D, Malá J, Opala-Berdzik A, Nocuń M, Dolibog P, Dolibog PT, Stania M, Kuszewski M, Kobesova A. Acupuncture and dry needling for physical therapy of scar: a systematic review. BMC Complement Med Ther. 2024 Jan 2;24(1):14. doi: 10.1186/s12906-023-04301-4. PMID: 38167051; PMCID: PMC10759514.
Low back pain is one of the most common ailments for seeking out healthcare and affects about 80% of the population at some point in their lifetime. It is the second most common reason for someone to see their primary care provider and accounts for billions of dollars spent annually. Physical therapy is widely considered one of the first, if not the first treatment in managing low back pain. Many episodes of back pain do take care of themselves, but others become chronic (lasting longer than 3 months).
1. The Mysterious TMJ
