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Heather and her staff blog about male and female chronic pelvic pain, prostatitis, incontinence, upcoming events and more

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What is Yoga?

Yoga is a form of exercise that utilizes movement for strength and flexibility, along with breathwork and mindfulness for reduction of stress and tension. Yoga has long been used therapeutically for a variety of neuromuscular, immunological, psychological, and pain disorders. It has also been linked to improvements in body awareness, improved cognition, flexibility and strength, as well as physiology (reducing stress hormones, improving cardiac function) (Schmalzl et al, 2015).

Prostatitis and Male Pelvic Pain

Chronic prostatitis, nonbacterial prostatitis, and chronic pelvic pain are all related conditions which negatively affect quality of life for the men who suffer from them. Symptoms vary, but are often described as a “headache in the pelvis” with pain symptoms affecting urinary and sexual function. The pain is real and their negative affects on quality of life are real as well.  The pain caused by nonbacterial prostatitis can be disabling, preventing participation in valued activities and causing isolation and depression.
According to Harvard Medical School, prostatitis accounts for about 1.8 million visits to the doctor’s office in the United States each year. Between 9% to 16% of men of all ages experience prostatitis. About 90% of these instances cannot be tied to an active bacterial infection. Prostatitis affects men of all ages, unlike benign prostatic hyperplasia (BPH) and prostate cancer, which predominantly affect older men.

Yoga, Pelvic Floor Dysfunction, and Chronic Pain

Yoga can help both strengthen and increase flexibility of the pelvic floor muscles and surrounding musculature to better function and treat issues such as pain with urination, pain with ejaculation, and pain with bowel movements.

Read more: Yoga Therapy to Ease Prostatitis and Chronic Pelvic Pain

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This article will review how prostatitis can cause or contribute to chronic pelvic pain and what pelvic floor therapy can do to help alleviate it.

The Condition

Chronic nonbacterial prostatitis is sometimes described as a “headache in the pelvis” with pain symptoms affecting urinary and sexual function. It’s a tricky condition because as “nonbacterial” suggests, the pain and inflammation is not tied to a known bacterial infection, which can confuse both the patient as well as their healthcare providers. Yet, the pain is real and their negative affects on quality of life are real as well.  The pain caused by nonbacterial prostatitis can be disabling, preventing participation in valued activities and causing isolation and depression.

Prevalence

According to Harvard Medical School, prostatitis accounts for about 1.8 million visits to the doctor’s office in the United States each year. Between 9% to 16% of men of all ages experience prostatitis.

Read more: Nonbacterial Prostatitis: Chronic Pelvic Pain in Men

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Happy Pride Month! Fusion Wellness & Physical Therapy is proud to be a supportive and inclusive orthopaedic and pelvic health center. Earlier this month, I attended the first ever PT-specific course for LGBTQ care in the US, with an emphasis on transgender care. The course covered many topics, notably pre-operative, intra-operative and postoperative recovery guidelines. While this is the second course I have taken on transgender care (with a third coming up in a few months), it was the first that was held primarily for the benefit of training physical therapists.

Read more: Transgender & Gender Nonconforming Pelvic Health and Orthopaedic Services at Fusion Wellness PT

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Girls Night Out: Better Sexual and Pelvic Health

Date:
Sunday, November 5, 2017

Time:
6:30-9:30PM

Venue:
The Rendition Room @ Vitello's
4349 Tujunga Ave., Studio City, CA 91604

Drinks and appetizers will be provided!

Read more: Girls Night Out: Better Sexual and Pelvic Health

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Most people experience occassional constipation. Constipation isn’t just the inability to have a bowel movement, and includes the difficulty associated with bowel movements. Travel, inactivity, illness, and certain over the counter medications taken “as needed” commonly result in short-term or acute constipation. Constipation lasting longer than three months is considered chronic constipation. Chronic constipation should be treated by a doctor to prevent health complications. 

Chronic Constipation: Are you and your healthcare practitioner talking about the same thing? 

Clear communication is essential to working with doctors, but the general public often has only a rudimentary understanding of medical terms - including constipation. There is often a gap between the physician and the patient’s perception of constipation which can lead to confusion. (1, 2, 7, 10) A study of people who thought they had constipation showed that only a third actually fit the criteria for constipation, while the rest actually had Irritable Bowel Syndrome or other gastrointestinal disorders. (9) So what are the criteria for constipation? 

Read more: Chronic Constipation 101

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Pelvic floor physical therapy is one of the best kept secrets in medicine.

Recently, I was on a plane flight and sat next to two women. They were very chatty with one another and quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer always used to be “I’m a physical therapist”. The past couple of years, however, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.

Read more: What’s Up Down There, Doc? 

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In my early days of being a pelvic floor PT, I was convinced I had the answer to all the woes of the pelvic floor. One word – Kegels. As I’ve developed professionally over more than 15 years, I realized Kegels have their place. However, they are not the answer for all things pelvic floor. They should be used, in general, if muscles are weak because they are overlengthened/overstretched, or in a good place, just weak. There are specific instances when Kegels (also known as PC or pelvic floor muscle contractions) are the answer. I’m a firm believer in doing a Kegel program combined with a core strengthening program that will address the bigger picture. Here’s who should be doing Kegels and why:

1) Most men and women that experience urinary incontinence

a.     A thorough physical exam can identify if postural dysfunction and weakness in your pelvic floor and what I call “pelvic floor accessory muscles” that are contributing to your incontinence.

b.     There are 3 primary types of urinary incontinence that physical therapy can treat:  

                                               i.     Stress Urinary Incontinence (SUI)

1.     Involuntary urine leakage with coughing, laughing, sneezing, exercise

                                              ii.     Urge Urinary Incontinence (UUI)  

Read more: Why you should be doing Kegels RIGHT NOW!

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What are Kegels?

Kegels are a contraction of a group of muscles known as "pelvic floor muscles", sometimes referred to as the "PC muscle". PC is short for “pubococcygeus”, the name of just one of the many pelvic floor muscles. 

However, over 15 years of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough.  Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels.  This finding has been confirmed by Bump et al in an August 1991 article from the American Journal of Obstetrics & Gynecology, Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”. While the article was published quite some time ago, the data is still relevant and referred to frequently in current research studies.  The results of that study on verbal instruction were 60/40 (60% could/40% could not perform a pelvic floor contraction or, Kegel, correctly). This article also stated that a very high percentage of women that were doing Kegels incorrectly were not only doing them wrong, but doing them in such a way that they were actually making their incontinence (or light bladder leakage) WORSE (about 25% of the women studied). I have seen this initial frustration with many of my own patients over the years, not realizing before they started physical therapy why they were getting worse. I continue to cite this study, as despite it’s age, it was really revolutionary in identifying why so many women think Kegels do not work.

But I'm a male with incontinence. Should I be doing Kegels, too?

YES! Men have a pelvic floor, too and should absolutely be doing Kegels if there is weakness in that area.

How do I know if I am doing Kegels correctly?

Chances are if you have basic stress, urge or mixed incontinence or light bladder leakage, and see no improvement in your symptoms, you may not be doing your Kegels appropriately. This is not to say that you don’t know how to do a Kegel, but you many not be doing the proper routine based on your strength levels.

How many do I do? How long should I hold them for? There are different types of Kegels?!

Read more: What are Kegels?

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I am proud to announce the official book release today of Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve. It is available on Amazon.com, iBooks and other retailers.

43% of women will experience pain during sex or other sexual problems – why isn’t this a public health concern?  http://www.prweb.com/releases/2014/09/prweb12156888.htm

Join us in helping to increase the awareness of female sexual dysfunction, including vaginismus, vulvodynia, vulvar vestibulitis, overactive pelvic floor and more. You are not alone if you or your loved one are experiencing painful intercourse. There is help!

 

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In my last post, “Why You Should Be Doing Kegels NOW”, I went over the various diagnoses that tend to benefit most from doing pelvic floor muscle exercises. However, there are MANY issues and diagnoses related to the pelvic floor that are NOT appropriate to prescribe pelvic floor muscle exercises for. In fact, with certain diagnoses, doing Kegels can actually be harmful and counterproductive to your symptoms. When treating patients, physical therapists should always keep in mind that there are proper and improper times to strengthen a muscle. Generally speaking, you should only strengthen a muscle that is weak and overly lengthened. If a muscle in a high state of rest (guarded, hypertonic, in spasm or with limited flexibility), the LAST thing you should do is continually contract it. This will only further shorten/tighten an already short/tight muscle and likely make your problem worse, or at the very least, prevent if from getting better. In the case of the pelvic floor, this could exacerbate symptoms such as painful intercourse, urinary urgency and/or frequency, and more.

Here are the primary diagnoses that I generally recommend avoiding Kegel exercises (and even core strengthening) with, at least in the early stages of treatment:

1)   Vaginismus
2)   Vulvodynia/Vulvar Vestibulitis/Vestibulodynia/Provoked Vestibulodynia
3)   Overactive Pelvic Floor
4)   Genito-Pelvic Pain/Penetration Disorder (GPPD)
5)   Introidal Dyspareunia
6)   Interstitial Cystitis
7)   Urinary Urgency & Frequency

The above diagnoses are frequently in need of muscle relaxation and stretching to get the muscle to

Read more: Why You Should STOP Doing Kegels NOW

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