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511 Gordon Avenue
Thomasville, GA, 31792
USA

(229) 228-9019

THRIVE Physical Therapy and Fitness: Private Treatment Rooms, Manual Therapy, Women's Health, Chronic Pain, Spine Pain, Fitness Training, Weight Loss, Diabetes, Headaches, Sports Injury, Dance Recovery, Scar Release, Scoliosis, Balance Training, Vertigo, and more.

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You Know You've Been Wondering...

Dawn Muller

You may not be talking about this at your next party or at lunch with your friends, BUT…

 

You may be wondering.  There are certain questions that are hard to ask.  You aren’t sure if your mom is up to speed.  You are way too embarrassed to ask your spouse and your best bud doesn’t need to know.  You probably need to ask your doctor, but even that may cause you to turn three shades of red.  So, maybe it would be so much easier if someone just wrote a column about it.  This way you don’t have to actually ask, but you get the skinny on the issue.

Well, it’s your lucky day.  I am going to answer some of those questions and still try to keep this family friendly article about all things south of the belt line.

 

Is it normal to have to wear protection for exercise? 

No. While one in four regular female exercisers wear some sort of liner or pad, it is not normal and it is correctable without medication in 80% of cases.  Typically a combination of pelvic floor exercise, biofeedback, and a few lifestyle changes keep you dry as a bone.

  

Out of my way! I gotta go! Why do I have to rush to the bathroom like a running back on steriods?

There can be more than one reason for this urgency, but usually it is a combination of an overactive muscle around the bladder combined with a weaker than normal pelvic floor muscle group.  It can also be related to going to the bathroom too frequently, which can confuse the bladder reflexes.  The good news is that with some behavioral training it can often be corrected in less than two weeks.  Of all the things I do related to incontinence and pelvic floor training, this is usually the quickest and easiest.  Most of my clients are astonished that they have had to deal with this for years when the answer was so quick and easy.  Lots of you may be on medicine for an overactive bladder.  While for some of you that may be necessary, most of you could resolve this issue without the medicine.  The right training could save you the money, time, and side effects that come with these medications.  The most concerning side effect to me is the memory loss.  Most of us need all the brain power we can muster.  Another side effect of overactive bladder meds is constipation, which puts more pressure on the pelvic floor, making you more likely to leak!

 

How often should I have to go to the bathroom?

Most of us should be urinating every 3 to 5 hours.  If you have a history of frequent urinary tract infections, it will be less.  Also, you may need to go shortly after taking a diuretic, but the 3 to 5 hours is a good rule of thumb for most people.  If you are going more often, we can teach you how to get your timing to a more normal level and ensure that your urine is nearly clear, odorless, and exits in a steady stream.  It is not difficult; it just takes a little education, a watch, and some techniques to correct the pelvic floor to detrusor balance.  This process usually takes 2-4 weeks depending on how frequently you go to the bathroom.  Patients with benign prostate hypertrophy also get results with treatment though it may take a little longer.

  

What to do about #2?

Over the years, I have treated all kinds of #2 issues and the good news is that most people get REALLY good results.  Some of you swing from diarrhea to constipation, which is uncomfortable and makes it very difficult to make plans to go out.  There are others that are very constipated, often going days or weeks between bowel movements.  Not only does this increase your risk of colon cancer, it can be painful or at the very least, distracting.  Usually, improving your hydration and fiber is helpful.  Sometimes it is helpful to work with your doctor on your medicine and dosing, as pain medicines and anti-cholinergics (like for overactive bladder) can cause constipation.  Most often, it requires manual therapy to treat the muscles of the pelvic floor.  Specialized techniques relax the muscles and allow the sphincter to open with greater ease.  Occasionally, visceral mobilization is required for people who have had multiple abdominal surgeries.  Depending on the situation, we may use biofeedback to teach relaxation for the pelvic floor muscles or the muscles around the anus.  The biofeedback involves about 6 weekly sessions to retrain the muscles.  The training for the other treatments usually take 4-6 sessions.

 

Ok, here’s the big one.  What can be done about painful intercourse?

This is more common than you might think.  The reasons can be as varied as the patients.  Very often it is the result of post-menopausal changes.  Post-menopausal women usually respond to a combination of lubrication options, pelvic floor training (most often the person is weak in the pelvic floor, has muscle loss, and changes in sensation), and manual therapy to deal with trigger points, muscle spasms or tenderness.  Biofeedback can be used for both strengthening and relaxation.  For some patients, your doctor may recommend hormonal replacements in combination with other treatments.  Other patients may have solely muscle spasms.  This could be from weakness (believe it or not), injury, pregnancy, hormonal changes, or low back problems.  The treatments will be very individualized.  Every patient will need to be instructed in ways they can improve their symptoms based on the cause.  The goal is to get everything working normally.  Seventy percent of patients with painful intercourse can return to normal “activities” with proper treatment.

 

So while you may not be talking about this at your next dinner party or over the water cooler, there are options and treatments that are safe and effective.  Ask a lot of questions, do your homework, and get the relief that is available.

 

 

Dr. Dawn Muller, PT, DPT, MTC, Cert DN is the owner of Thrive Physical Therapy and Fitness, LLC.  She has been practicing 30 years.  She has been treating men’s and women’s health dysfunction for 18 years.  She is a frequent provider for these issues for Mayo Clinic, as well as many local physicians and surgeons.  To make an appointment, call 229-228-9019.

 

 

 

 

 

Hope for Headaches

Dawn Muller

Most of us experience a headache from time to time. As a matter of fact, according to the American Council for Headache Education (ACHE) 95% of women and 90% of men will experience at least one headache this year.  No big deal, right?  Well actually, there are a significant number of our friends, neighbors and co-workers who have 2 or more headaches a week.  This group of sufferers will lose time at work and school due to their pain.  There are many types of headaches, which will be discussed in a follow up article.  Migraine is a type of headache that makes normal activities nearly impossible for most sufferers.  According to the 2004 Global Burden of Disease Study, migraine on its own was found to account for 1.3% of years lost due to disability (YLD). Now that is a lot of down time whether you are the person with the headache or their boss, co-worker, or spouse.  

Most headaches can be treated effectively with physical therapy, lifestyle changes, postural changes, and medicine.  If you are one of the unfortunate fellows with the aching head, you probably want to know what you can do to reduce their frequency or prevent them.  Actually, there are many things that you can learn to do or avoid to reduce both the frequency and intensity of your headaches.  

Knowing what triggers your headache or what clusters of things trigger your symptoms can help you make better choices.  For many, that can be the different between a mild, short-lived headache and a whopper of a migraine.  

Here is a list of well-recognized Headache Triggers:

1.    Stress-some stress is unavoidable, but most stress can be managed or reduced with things like deep breathing, making different choices, creating margins of down time daily, etc
2.    Weather-temperature changes, barometric changes or bright sunshine in your eyes can trigger a headache
3.    Strong Smells- like paint, flowers, perfume or cleaning products
4.    Exercise-for tension or stress headaches, exercise can improve symptoms but for migraine sufferers exercise can trigger your pain.  Be aware that a bad headache during or immediately after exercise can be serious as it can also be a sign of a stroke or aneurysm.
5.    Poor Posture- slouched or forward head posture can pinch the nerves at the back of the head and decrease the blood flow causing a pain in the neck (pun) and head
6.    Hair Accessories- any girl who has ever worn their headband or ponytail too tight knows what I am talking about.  Enough said. 
7.    Fermented Foods like wine, sour cream, aged cheese, miso.  See #8 for more specifics.
8.    Tyramine Foods- according to healthline.com tyramines are naturally occurring compounds found in some plants, foods, and animals produced by the breakdown of the amino acid call tyrosine.  It can also be created when foods are aged or cured to prevent spoilage.  Tyramines tend to cause migraine headaches. Those that are sensitive should avoid cured meat, lunch meat, cheese (particularly blue, cheddar, parmesan and swiss), soy sauce, sauerkraut, kimchi, miso, and, unfortunately, chocolate.
9.    Wine- All of my friends will hate me.  Don’t shoot the messenger, but wine, particularly red wine, contains sulfites and tyramins. Both things can cause sensitivity in certain people.  
10.     Aspartame- this is an artificial sweetener present in many diet sodas and low or reduced calorie foods.  A few poor folks are allergic to aspartame but as many as 30 percent of women may be sensitive to aspartame, making them have a headache or muscle aching after ingesting the item.  
11.     Low Blood Sugar- particularly if you have had coffee or caffeine with a sugary food followed by a long period of time without eating. 
12.     Smoking- both the smoker as well of the victim of their second hand smoke may suffer from headaches triggered by the combination of the strong smell and the constricting of the blood vessels in the brain related to the nicotine.
13.     Caffeine- usually from too much.  A little can cure, too much can trigger a headache.  Caffeine withdrawal is also widely recognized as a headache trigger.
14.     Overuse of Pain Medications for your Headache-  This is called a rebound headache.
15.     Hormonal Changes- this is seen in teenagers, pregnant women, during ovulation or any time there is a swing in the hormones
16.     High Blood Pressure- there are other medical conditions that cause headaches but this is one of the most common. Usually it is associated with flushing of the head and neck.  See your doctor about this as soon as possible. 

Here is a list of options to Reduce your HEADACHES:

•    Keep a food diary and HA diary and see if there is a tie in to when you have a headache and what you ate. 

•    Manage stress

•    Proper sleep- 7-9 hours per night

•    Regular meals- Do not skip meals (See #11 in the Triggers list)

•    Treat the headache early

•    Regular exercise

•    AVOID YOUR TRIGGERS

As a Physical Therapist, I regularly see headache patients.  Most clients have a significant reduction in the frequency and intensity of their symptoms.  Some clients will get complete relief, depending on the cause and how willing they are to make changes.  Some of the tools I use to treat headaches are exercises to strength the postural muscles and core, flexibility exercises to reduce tightness in the chest, neck, head and shoulders, and muscle relaxation.  In many cases, we will work to improve posture, work station set up, and teach you ways to manage your symptoms. 

In certain, though less common, cases you should seek immediate medical advice.  According to the National Headache Foundation, go to your doctor immediately if:

•    You are having your worst headache ever
•    You are having your worst migraine attack ever
•    Your headache is accompanied by the following symptoms:
•    Unresolved loss of vision
•    Loss of consciousness
•    Uncontrollable vomiting
•    The pain of your headache lasts more than 72 hours with less than a solid four-hour, pain-free period while awake
•    You experience a headache or a migraine attack that presents unusual symptoms that are abnormal for you and frightening.


Dr. Dawn Muller PT, DPT, MTC, Cert. DN is a physical therapist with 30 years of experience treating headaches and pain.  She is the owner of Thrive Physical Therapy.  For an appointment call 229-228-9019.  

What to Expect from your Body when Expecting

Dawn Muller

Welcome to my world.  My current season of life includes baby showers, birth announcements, and playing with an ever-growing group of friends’ children, I have both professionally and personally discussed the role of a physical therapist during pregnancy. I often see women in my clinic that did not know they could have less pain and better function during their pregnancy.  Hoorah for the possibilities!

Some of the common  aches and pains during pregnancy include spine pain, hip pain, knee pain, and foot pain. Women may have difficulty walking, sitting, standing, sleeping, caring for older children, working, or getting dressed. As your baby (and baby bump) grows, your body experiences hormonal changes, particularly one called relaxin, that make ligaments and connective tissue looser. Subsequently, your posture, gait (the way you walk), and your range of motion can all change.  Physical therapy is a great option to address these problems through manual therapy, soft tissue mobilization, posture and gait assessment, recommendations for positioning, ergonomics for you workplace, and body mechanics for doing your activities of daily living. Individualized exercise prescription may include stretching and strengthening for muscles that are tight or weak.

Not pregnant yet? The American Physical Therapy Association recommends 5 ways to prepare for pregnancy.

  1. Strengthen your pelvic floor muscles. This is commonly referred to as Kegels. You want to be able to tighten the correct muscles, instead of your buttocks and thighs, as this can help prevent leaking during pregnancy. However, doing this incorrectly can worsen conditions such as incontinence, pelvic pain, and low back pain. A women’s health specialist in physical therapy can instruct you in how to perform these exercises safely and correctly.  We just happen to have one of those in our clinic!

  2. Prepare for “baby belly” by focusing on your core.  This can help prevent a diastasis recti, which is where the abdominal muscles separate vertically between the muscles that make a “6 pack.” This separation can contribute to low back pain, pelvic pain, and other injuries when other joints try to take up the slack from a weakened core.

  3. Breathe! Sounds easy, but most of us do not do this well. Proper breathing and relaxation techniques can reduce your stress and help with pain whether or not you are pregnant.

  4. Begin a regular fitness routine. Exercise helps many things in general, but specifically in pregnancy it reduces cortisol and increases your muscle and cardiovascular strength to have a healthy pregnancy. Once you are pregnant consider lower impact exercise, such as swimming, walking on even surfaces, biking, or using an elliptical machine. If you are already a runner, be aware that your ligaments loosen as you progress during pregnancy and you may develop different aches and pains. Also, to prevent organ prolapse with the jarring motion during running, you may want to wear undergarments to support your pelvic floor or compression shorts.

  5. Practice good posture. Good posture is helpful throughout the lifespan and can drastically change during pregnancy. A physical therapist can evaluate your posture and show you how to correct it for optimizing muscular balance.

Pregnancy is a miracle of life, but from what I’ve heard it can be a long 9 months. A physical therapist is an asset before, during, and after pregnancy in improving pain and function. For more resources on how a physical therapist can help you go to www.apta.org.