These are common statements that are often heard from patients in our clinic.  While the occurrence of urinary incontinence is common among seniors, it must not be regarded as a normal aging side effect. It is a problem that can be successfully addressed and treated!

According to the National Association for Continence 25 million Americans have issues with incontinence.  Only 1 in 12 people will seek medical advice about it;  perhaps because it is an uncomfortable issue to talk about, or possibly because of the belief or acceptance that it is a normal part of growing older.
The fact is urinary incontinence is costly: economically, psychologically and physically.

• Incontinence is the second most common reason for nursing home admissions
• Isolation and withdrawal can occur due to the shame and fear of accidents
• Incontinence products are a billion dollar industry and patient cost can be anywhere from $50.00 to $1000 a year
  
• Urinary incontinence is strongly associated with fall risk in the elderly
  

The causes of incontinence can vary from an urinary tract infection to something more complex associated with a chronic medical condition.

• Dietary
  • Dehydration (concentrated urine can be a bladder irritant)
  • Intake of bladder irritants (caffeine, acidic foods, carbonated beverages)
  • Constipation
    
  • Medications
• Hormonal
  • The hormonal changes during menopause can result in a weakening of the urethral and vaginal tissues

• Neurological
  • The nerves to the bladder can be affected by diseases such as Parkinson’s Disease, Multiple Sclerosis, Stroke or Diabetes
• Prostate
  • An enlarged prostate can cause urinary urgency, hesitancy and incontinence
  • Post- prostatectomy is one of the most common causes of incontinence in males
• Musculoskeletal
  • Pelvic floor and core muscle weakness (including the lower back and hips)
  • Decreased mobility (the ability to make it physically to the toilet in time)
    

Stress Urinary Incontinence
This type of incontinence occurs secondary to weakness of the core muscles and fascial connections around the bladder.  The pressure on the bladder causes leakage during coughing, sneezing, laughing, and during exercise.  It can also occur when lifting or bending over.

Urgency Incontinence
This type of incontinence is associated with urgency and an overactive bladder (OAB).  There is a strong, sudden urge to urinate.  The bladder contracts and an involuntary loss of urine occurs.

Overflow Incontinence
This type of incontinence occurs due to an overflow of urine in the bladder. This can be due to a blockage at the urethra such as an enlarged prostate, poor sensation of the bladder, or the nerves to the bladder are affecting the ability of the bladder to empty completely.

Functional Incontinence
A person may have normal bladder control, however physically cannot make it to the restroom in time.
Regardless of which type of incontinence a person may have, nonsurgical management, such as physical therapy, is the first line of treatment.

Bladder Retraining
Bladder retraining involves different aspects depending on the issues/needs of the patient

• Keeping a bladder diary
  
  • Assesses the degree of urinary frequency and void intervals
  • Assesses appropriate urge sensation
  • Determines if there are dietary factors that may play a role in bladder dysfunction
  • Identifies adequate fluid intake
    
• Urge suppression techniques
  • Strategies to calm down or suppress inappropriate bladder urge
• Timed Voiding Schedule
  • Determining specific schedule to retrain the bladder
    

Pelvic Floor Muscle and Core Training
The coordination of the pelvic floor and abdominal muscles is very important to continence.  It is not just about doing kegels, but coordinating the entire core and postural system.

• Body mechanics
  • Learning correct bending and lifting techniques are important to decrease the intra-abdominal pressure on the bladder.
  • Proper toileting posture is also important for effective bladder emptying.
• Biofeedback
  • Biofeedback uses special sensors that help the patient to learn how to increase the awareness of the pelvic floor function.   It can be a tool to help strengthen or help relax these muscles.
• Electrical Stimulation
  • Electrical stimulation can also be used to help patients with stress incontinence as well as an overactive bladder.
• Functional training
  • Specific pelvic floor training to strengthen or to relax the muscles.
  • Making sure the functional unit of the diaphragm, the back, the abdominal muscles and pelvic floor work together in a coordinated and safe manner (avoiding adverse intra-abdominal pressure)

The bottom line is that non-invasive treatment options in physical therapy are extremely beneficial and successful in addressing symptoms associated with urinary incontinence.  In other words, there is NO reason that you should just expect urinary leakage to be a normal part of your life!  Especially when you can address these symptoms often in as little as 3 weeks with targeted exercise and training!

For more information or to schedule an appointment to see a pelvic floor physical therapist, please click below.

Healthcare for moms is ripe for a revolution. Currently in the United States, postpartum checkups occur around 4-6 weeks after childbirth and only last about 10 minutes. You may have a brief pelvic examination, talk about future birth control plans, and likely get an “all clear” from your doctor, stating you can return to activity as usual. This means sex, exercise, and work. And that is your postpartum care. No more follow ups. No discussion of common pelvic floor conditions women experience. No discussion about steps to take if problems arise.

Chances are you will not have your abdomen assessed for diastasis recti, a separation of your abdominal muscles that commonly occurs during pregnancy. You may feel and look like you are still pregnant and your diastasis will not be diagnosed. You may have pelvic floor problems like urinary leakage, painful sex, or pelvic organ prolapse and not know that diastasis recti and pelvic floor dysfunction often go hand in hand. You may not know that the crunches you are doing to get your abs back after the baby could be making this condition worse. And you may have no idea that pelvic physical therapy can help. Yup, you’re good. All clear.

Chances are you will not have your pelvic floor muscles tested by your doctor to assess for weakness or spasm. You may go back to running and leak urine. You may do jumping jacks and feel heaviness in your vagina like something is falling out. You may start yoga, which you hear is great for postpartum recovery and have embarrassing vaginal farts. You may get on a spin bike or stair stepper and have excruciating tailbone pain. And you may have no idea that any of this may be due to weak or tense pelvic floor muscles and pelvic physical therapy can help. Yup, you’re good. All clear.

Chances are you will not have a conversation with your doctor about returning to sex and the discomfort or pain many women experience after childbirth. Healing tissue from a vaginal tear or episiotomy may cause a pain with penetration during sex and maybe even cause some bleeding afterwards. Your vagina may be very dry, you can’t orgasm, or you may leak urine when you orgasm.  And you have no idea that pelvic physical therapy can help, so you just bear through the pain or avoid sex altogether. Yup, you’re good. All clear.

Chances are you won’t receive education on how to massage your C-section scar. You have bladder problems, groin pain, or constipation all stemming from your scar tissue restriction. You can’t wear jeans anymore, you avoid lying on your stomach, and you don’t like wearing your baby in a carrier because your scar hurts.  And you have no idea that pelvic physical therapy can help, so you just deal with it. Yup, you’re good. All clear.

Women’s bodies go through incredible physical, hormonal, and musculoskeletal changes during pregnancy and childbirth. As a pelvic health physical therapist, I have worked with women during pregnancy and the postpartum period for over a decade. I help educate them how to care for their pelvic floor muscles, inform that that any pain, leakage, or prolapse is not normal. I guide them on a safe return to exercise, sex, and activity to meet the increasing demands of their lives. 

Time and time again I hear, “I had no idea this type of physical therapy existed” or “why didn’t my doctor tell me about this sooner.” The postpartum care for women is in desperate need of improvement and the awareness of pelvic physical therapy needs to grow. Pelvic Physical Therapy should be standard care for every postpartum woman in the United States. I am baffled that medical professionals send sleep-deprived women home with bleeding vaginas, tender scars, sore breasts and a newborn baby to care for – and all they get are - Yup, you’re good. All clear.

Kegels. We all know the word. But do we really know what it actually, truly MEANS to do a Kegel, and why do we even care? I will tell you. And believe me, I have a love/hate relationship with the Kegel, which I will explain.
We have Dr. Arnold Kegel to thank, back in 1948 for coming up with the famous “Kegel” exercise. He was a gynecologist, and was looking for a non surgical way for women to help “tone” the pelvic floor muscles to help with urinary leakage after they had a baby. I don’t hate him for it. Being a physical therapist, I want all things conservative first, and YAY for starting with exercise. Good on ya, Dr. Kegel!

This opened up a new view on trying to help women after childbirth with staying dry, which is a great step forward in the ever-challenging path of providing comprehensive care for women postpartum (which I am sad to say, leaves something to be desired in this country). However, Kegel’s became the blanket approach for EVERYONE who reported any sort of bladder or bowel or pelvic dysfunction. Pain with sex? Kegel. Leaking urine? Kegel. Having increased urge and going to the bathroom all the time? Kegel. Back pain? Kegel. Pregnant? Kegel  And the list goes on….

However, I am here to tell you that kegels are not the answer to everything, and although they are appropriate for some people, they are not appropriate for all, and should not be thought of as such. Mind blown. I know. Stay with me.

A kegel is a concentric, or shortening action, of the pelvic floor muscles, which sit at the bottom of your pelvis. They lie like a basket, or a hammock, and attach front to back (pubic bone to tailbone) and side to side (sit bone to sit bone). Within these muscles, we find openings. In females, we have the rectum, the vagina, and the urethra. In men, we have the rectum, and the urethra follows the length of the penis and is past the pelvic floor, where it ends at the tip of the penis.

The pelvic floor has 3 main functions:

1) Support (holds us and our organs up against gravity)

2) Sexual (aids in orgasm and allowing vaginal penetration for women)

3) Continence (keeps us dry).

In a perfect world, as the bladder and rectum are filling with urine and stool, the pelvic floor muscles “turn on” to close the sphincters that hold in the urine and stool. We get the signal to either head to the restroom to pee or grab our phones for some reading material if we are going in for a longer stretch. The pelvic floor muscles then lengthen, or relax, and the bladder muscle (the detrusor) pushes urine out through an open urethra, all thanks to a relaxed and lengthened pelvic floor.

Now, if the muscles have lost a bit of strength, maybe say...I don’t know, going out on a limb here….holding a baby, plus weight, the placenta, organs, gravity, increased fluids, etc, FOR 9 MONTHS, in addition to the force of actually pushing a baby out, AND the need to lengthen and stretch to get out of the way to make way for the baby….we may see a bit of an issue with holding in urine, or stool. Not to mention if there was any perineal or pelvic floor muscle trauma or prolapse sustained during delivery! So yes, in this case, it is a good idea, probably, to strengthen your pelvic floor by way of the Kegel.

HOWEVER, in some cases, these muscles can be too short, or too contracted, and adding more contractions on top of an already contracted, or too short muscle, isn’t always the best idea. Think about trying to do a bicep curl when you’re already curled….the elbow isn’t going anywhere, and all that extra curling will prob make your bicep hurt!
Another issue I have with blindly prescribing Kegels...and we’ve all heard this: “Just do 200 kegels a day” or “ do your kegels while sitting at a stop light”... is that not everyone’s baseline level of strength and function is the same. Also, we don’t go to the gym and do 200 bicep curls everyday, or walk around carrying a 35lb pound weight with our bicep all day every day. We shouldn’t be prescribing set parameters without assessing. Because some people, may not need to do Kegels, in fact they may need to work on lengthening or stretching their pelvic floors. These muscles can be too short or tight, and oftentimes Kegels will, and can, make some symptoms and dysfunction worse.

There have been studies published in the literature that looked at women who were instructed to perform Kegel’s and like 30% of women don’t contract their pelvic floor at their first consult. So..bottom line is this: if you’re not sure, ask for help. Find a pelvic floor PT (yours truly) to assess and get you on the right track. Performing a Kegel the correct way is really hard, actually. The pelvic floor muscles have to work with a host of other muscles AND your breath AND be effective like all the time to keep us supported and continent. It’s not easy to get this contraction going correctly, and I’ve had high level athletes who have crazy body awareness have a really hard time getting a correct Kegel.

So there you go. Kegels are important, for sure, but in the right context, with the right person and situation. Click below to schedule an appointment today.  We can help you get that pelvic floor muscle working the way it should!

In the US over 37 million people suffer from migraines or chronic headaches.  For many, headaches can be disabling, with chronic headache sufferers being three times more likely to suffer depression as well. There is a treatment beyond medications that has been proven to help decrease the occurrence of headaches–physical therapy. Unfortunately most headache sufferers have never been told about this possibility. Physical therapy including exercise, relaxation techniques and posture retraining have been shown to be as effective as many medications in decreasing the frequency of headaches.

In order to understand how physical therapy can help alleviate headache pain we must first look at the two main types of headaches.  Cervico-genic headaches, or tension headaches, are the most common type of headaches. Secondly and often more debilitating are migraine headaches.

Tension Headaches
Tension headaches are caused by referred pain from the muscles of the neck and the base of the head. Most people may know about referred pain during a heart attack, when pain is referred into the right arm. This is the same mechanism that can cause headaches when the muscles in the neck are extremely tight or unbalanced. 

Let’s take a look at what a large majority of Americans do for most of the day: sit at the computer. When we sit slumped over the computer, the muscles of the neck–mainly the upper trapezius, the sternocleidomastoid and the suboccipital muscles at the base of the skull–all become extremely tight and over worked. This tension can cause pain and stiffness in the neck as well as refer pain to the head. Physical therapy can first relax the tension in the muscles with soft tissue mobilization or massage and joint mobilization which decreases acute pain. Exercises are then given to help strengthen the neck and postural muscles to allow these muscles to withstand the tensions of day to day life. Finally, posture retraining and relaxation techniques can help decrease extraneous tension on these same muscles to help the patient continue to manage the symptoms after discharge from physical therapy.

Migraine Headaches
The rational for physical therapy treatment of migraine headaches is a little more complex. Migraines are a “centrally mediated” pain. This means the central nervous system is involved. We know that migraines are caused by a trigger that causes a change in the way the cranial nerve 5 or the trigeminal nerve interacts with the brain stem.  The trigeminal nerve is the same nerve that also regulates sensation to the face and is responsible for TMJ functions of biting and chewing. For this reason we know that treating TMD (temporomandibular joint dysfunction) can lessen the frequency of headaches. Furthermore, the fibers of the upper cervical spine that regulate the neck muscles meet with the trigeminal nerve in an area of the brain called the trigeminocervical nucleus. Because of this convergence of the nerves, the neck muscle dysfunction can now become a trigger of the trigeminal nerve and cause a migraine. Treating the neck as mentioned above can be very effective in alleviating the pain of a migraine and decreasing frequency of the occurrence for many sufferers.

If you suffer from migraines or chronic headaches, there may be help. Physical therapy is a very safe and cost effective treatment of headaches that might just be the answer for you. Call us today or click below to schedule an appointment for a personalized evaluation.

Contribution by Erika Garcia, PT, DPT

At some point in your life, you have witnessed a fall, heard of someone falling, or have slipped and fallen yourself. But the question remains, why do people fall and will it happen to me?


To begin with, falls are correlated with balance. When we think of balance, we often think of a tightrope circus star or a ballerina spinning on her toes. However, balance is involved with the simplest actions, such as walking, standing, and even sitting. So how do we know if we have poor balance? If you struggle with the simple activities mentioned above, you will need a physical therapist to help identify the problems. Struggling with stairs, walking on the grass, or even looking back and forth at items in the grocery store could also be indicators of poor balance.

Unfortunately,  more than one third of adults 65 and older fall each year in the United States and 20% to 30% of people who fall suffer moderate to severe injuries” (APTA, 2018). This bleak statistic reveals the importance of balance and why you should be concerned about it. In addition, one of the main injuries involved with a fall is a broken femur, the bone that attaches your leg to your hip. In individuals older than 60, a broken hip that does not penetrate skin can lead to a 17% death rate and a complication rate of 54% (MoveForwardPT, 2013).

Thus, if you or someone you love is struggling with performing simple activities and requires assistance, seeing a physical therapist is necessary. Luckily, Illinois is now a direct access state, meaning you do not require a physician's referral to see a physical therapist. All you have to do is give us a call at Crystal Lake Physical Thearpy, Inc. and we will schedule you to work with one of our experienced therapists. By improving balance, quality of life is improved and falls can then be prevented. So if you have a fear of falling or have fallen in the past, please give us a call and we will be glad to help you.

Also, check out our Free Balance Training Workshop being held at Del Webb Sun City's Prairie Lodge in Huntley, IL  (in the Birch Room) on April 24, 2019.  Click below to register for our workshop as seating is limited!

Hip, pelvic and  back pain are very common during pregnancy and often continue after delivery. Moms-to-be think it’s normal to feel pain while pregnant, but this is not true! Check out these tips so you can make the adjustments to protect your hips and back.

1.  Use good lifting technique: never bend forward to pick anything up with your legs straight, avoid extreme reaching and avoid twisting your back.

 2.  For standing activities such as cooking, changing diapers, or even brushing your teeth; keep a small foot stool nearby and place one foot up on it, changing every 10-15 minutes.  If you are  standing in front of a cabinet, open the door and rest one foot inside of it!

3.  Avoid prolonged positions: Take a break from sitting or standing every 15-30 minutes

4.  Sleep on your side with a pillow between your knees.  If you are pregnant, lay on your left side.

5. Avoid activities that may strain the hips and  back, such as crossing your legs, standing with all of your weight on one leg, climbing stairs too often, maintaining any unbalanced  position (like carrying your child on one hip).

6.  Get in and out of the car by sitting into the car first, then turning to face the front.  Never reach across your car for bags or other items on the other side.

 7.  Get in and out of bed by rolling onto your side first, then raise yourself up.  Never sit straight up from lying straight on your back.

8.  Avoid holding your breath.  When lifting, tighten your core and pelvic muscles to prevent increased strain on your back and pelvic floor.  This is called a “pelvic brace”.

Following these tips can help reduce your pain and prevent further injury during pregnancy.  It is also important to continue your new movement patterns into postpartum to prevent continued or returned pain.   If you have any questions or if you continue to experience pain, contact us at Crystal Lake Physical Therapy by calling (815)893-8480 or click below to schedule an appointment.

Contribution by Alicia Magro, PT, MPT

What is the “core”?
The core consists of muscles that support the back and help maintain an upright posture including the pelvic floor, front and side abdominals and back muscles. Due to a growing belly it can be a challenge to keep your core strong during pregnancy and following pregnancy, 
 
Why is it important to keep your core strong during pregnancy?
A strong core improves posture which leads to decreased back pain. Research shows that more than 75% of expectant mothers experience back pain. A strong core can also improve with ease of labor and lead to a quicker recovery postpartum.
 
How to safely work the “core” during and after pregnancy?
Avoid laying in a flat position after the first trimester which may put pressure on the vein that returns blood from your legs.  This may interfere with the blood flow to the placenta and baby.  Also be cautious with doing forward planks or typical “crunches” during pregnancy or postpartum as this may cause stress on the pelvic floor as well as could lead to a separation in the abdominals known as diastis recti.

1. Bird Dog

• Stand with feet shoulder width apart
• Draw your stomach towards your spine as you lower down and exhale
• Avoid your knees going past your toes
• Repeat 10-20 times
  

6. Perform Kegels
Kegels are a way to engage your pelvic floor muscles.  It is best to attempt these first in sitting or lying down and then incorporate with all exercises. These are especially important postpartum to avoid pelvic floor issues including incontinence.

• Sitting in a neutral position with back supported and feet on the floor
• Imagine that you are trying to stop the flow of urine to engage the pelvic floor muscles. 
• Now imagine that your pelvic muscles are an elevator and you are lifting it up.
• Then slowly lower it back down. 
• Make sure to avoid tensing your stomach or leg muscles.
• Repeat this 5 times.  Do 3 times a day.

 
Keeping your core strong will make your pregnancy healthier and recovery much easier.  If you are struggling with pain or would like more help with exercise see your physical therapist for guidance.  They can tailor a program just for you and make sure to avoid injuries.

Click below to schedule an appointment or call us today at (815)893-8480.

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report." In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.  But for other pain management the CDC recommends non-opiod approaches like physical therapy.

Patients should choose physical therapy when:

1. The risks of opioid use outweigh the rewards. Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, experts agree that opioids should not be considered first line or routine therapy for chronic pain.

2. Patients want to do more than mask the pain. Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.

3. Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.  The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for these conditions. Consistent physical therapy for these diagnoses can be very beneficial in both managing and treating the pain and discomfort.

4. Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with non-opioid therapies, such as physical therapy.

5. Pain lasts 90 days or more. At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are "preferred" for chronic pain.

In August 2018 the State of Illinois became a direct access state for physical therapy.  That means that you no longer need a prescription or referral from your physician to have physical therapy services.  If you are interested in starting physical therapy give us a call today at (815)893-8480 or click below to schedule an appointment.