Pelvic PT, Men's Health Physical Therapy

Pelvic PT, Men's Health Physical Therapy

 

A healthy pelvis is a key part of optimal health, performance, and wellbeing. When there is pain or dysfunction in the pelvis it can effect sexual function, bowel and bladder control, and can send pain to the back, hips, and abdomen. This can severely limit our ability to focus at work, have sex and intimacy with a partner, and participate in sport and the active lifestyle.

Pelvic pain and dysfunction is a common problem for all genders but men can have more difficulty seeking care for their pelvicdysfunction due to the sensitivity of these issues and that few PTs have specialty training in treating the pelvis and even fewer providers treat men's specific pelvic issues.

Grant Headley is a Doctor of Physical Therapy with specialty post-doctoral training from the Herman & Wallace Institute in helping men overcome pelvic pain and dysfunction. He also personally has dealt with pelvic pain as a patient himself, he knows how devastating pelvic dysfunction can be and how difficult it can be to find help for these issues but also how dedication to finding the right providers, diligence with the right daily practices, and patience can lead to overcoming pain and finding even greater performance.

 

The first step to getting help is calling us for a physical therapy evaluation with Grant.

 All physical therapy sessions are one-on-one the entire 45minutes to 1 hour. In keeping with our standard practice at Bridgetown, you will never be passed off to another therapist. Each session is dedicated to optimizing your recovery and regaining your function to reach your goals.

 Treatment is performed in a private room to ensure the privacy of the patient.

During the evaluation we will discuss what issues you are having that are affecting your life, evaluate the movements and tissues, and plan a course forward that can include pelvic floor manual therapy, strengthening and mobility exercise, breathing and relaxation education, and building a personalized daily routine for you to be able to own the tools of your own recovery.

 

 

Common Issues that Pelvic PT can help:

 

Erectile Dysfunction

Penile or Scrotal Numbness

Post Urination Dribbling

Urinary Incontinence

Rectal Pain

Pelvic Pain with sitting or activity

Post prostatectomy pain or incontinence

Hypertonic Pelvic Muscle Dysfunction

Abdominal Pain

Hip Pain

Low back and Sacral pain

How to talk about...down there (hint don't say "down there")

A group of passionate and dedicated physical therapists has formed a study group to to add to move the conversation forward in sharing practical strategies to help people dealing with sexual pain and pelvic dysfunction. These wonderful people lend their own time to develop care strategies for the whole person, not just the pelvis in dealing with these intimate issues that effect how we connect with the signals in our body as well as how we connect with others.

In attendance is Jessica Thomas PT, DPT, MTC of OHSU

Kara Schuft PT, DPT of Good Samaritan Hospital and Whole Body Health

 Kara Schuft PT, DPT 

Kara Schuft PT, DPT 

 

Kate Jones of Good Samaritan Hospital

Claudia Hammerstein  who has been a physical therapist for over 30 years and also sees patients at Kwan Yin Healing Arts Center

Cyd Dashkoff of Good Samaritan Hospital

and yours truly.

For our first meeting we discussed issues surrounding helping people with pelvic and sexual dysfunction by going beyond the biomechanical, physiological, and tissue basis. These aspects are a foundation of our physical therapy training but we must also help people find a path to addressing psychological, motivational, aspects that will help the person get on a journey to taking responsibility for their condition to finding an outcome that is meaningful for them.

We identified several paradigms to work with

1. Motivational Interviewing- How to help people make connections to the behaviors that will help them move forward and put them into practice, and away from behaviors that keep them in status quo or going away from the direction they want to be.
This was the aspect most discussed tonight, as it poses the most unfamiliar territory compared to standard information
What is our role? -" I am not your mother" 
"I cannot do the exercises for you"

-"I am your coach"
-You only get out what you put in
These aspects hit on the fact that having fancy exercises do not matter if the person is not primed to change their state of mind to change their behaviors. It very much matters how we present the issues and the road map to what can help but it means nothing if the person does not connect with the biological and scientific information that we are spitting at them.

2. Educational- 
Pain Science Lorimer Mosley
Anatomy- what is our normal anatomy and which parts of the body may be the area that is painful
Visualization- how to visualize the parts of the body functioning normally, for instance colors of the pelvis associated with health and normal tension.
3. Orthopedic- This is information that is becoming more widely disseminated in courses, books, and PT schools. There is much more awareness about pelvic dysfunction among PTs and other doctors compared to even several years ago. Our group loves this info but is more focused on how to make this information accessible to patients. 
- Posture, 
-Biomechanics
-Orthopedic Exercises to strengthen and change the length of muscles and our options available to move and attain postures.

 

Another point discussed is the delicacy about how to walk the line between acknowledging how the person feels their body might be compromised in some way beyond muscle tension or behavioral habits, while also helping them to access the lessons of pain science in reducing fear based beliefs and behaviors contributing to their pain. "Yes I believe you that you feel something is wrong, but nothing is wrong that cannot be helped with some techniques." This is one message from the group

"Take responsibility for your behavior" How each of these therapists gets this message across is the true art in physical therapy. 

Other ideas mentioned:
Common rebuttal from patients who want a quick fix
Isn't there something I can do with my diet?
isn't their some pill, surgery fix, anything but paying attention to my body, that is too much?
Teach mindfulness, Dr. silvers says these people are dissociated,
Stephen Porges about Polyvagal freeze mechanism when under stress

Some initial quieting exercises mentioned.
light abdominal massage, contract relax, 
How to get comfortable with talking about "down there"

Our parting thoughts were to come up with a method to get our patients to be in touch and to touch themselves. Become comfortable with exploring their pelvis and vaginas and penises.

Stay tuned for the group's favorite quieting exercises, how to teach them to people. Also we are going to address more male and female specific issues and how to help the patient be comfortable with the process.

Integrating Pelvic Power with the Whole Body

When we are confronted by pain and dysfunction in the pelvis especially when it involves among our most important and intimate function of sex and urination and defecation there can be a proclivity to treat our bodies with more fragility than is necessary for recovery and challenge less when we need healthy and proportional challenge to learn how to integrate the pelvis with our body to move with full potential.

 

 

A few words about how me I came to be interested in this area…

 

My name is Grant Headley, my degree is as a Doctor of Physical Therapy from Creighton University in Omaha, and I practice at Bridgetown Physical Therapy & Training Studio in downtown Portland, OR. I also am a certified yoga instructor and use yoga to heal myself and teach others how to listen to their own body. My path to being where I am today started in my own love of pushing my body in training and transforming my body with exercise. I got into bike racing while earning my Exercise Science Bachelor’s at University of Iowa. While I was gaining connection to the people in the bike community and the opportunities being a competitive athlete opens up, I found myself disconnected from my own body, constantly in pain in my back, abdomen, and pelvis made worse with training or prolonged positions. This disconnect was amplified by intimacy. All the effort of hard training without any balance of relaxation or awareness of breathing left me a ball of tension. It took a long time to find help, multiple doctor exams finally led me to a physical therapist who specialized in pelvic pain and then to yoga that focused on alignment, breathing, and listening to the body. Years later I am still learning how to listen to my body and always will be. Now in a position as a physical therapist and yoga teacher I can help others learn to listen to their own body. My painful experiences in the past has turned into a great opportunity to help others.

 

    Some aspects of pelvic physical therapy have a specific focus; education about the muscles, bones, joints, ligaments, blood vessels, and nerves. As a physical therapist, I can play a role in helping the patient work from their current level of function towards the movements and activities they want to be able to perform in order to live their full life. I see my role as listener first, then educator, exercise trainer, manual therapist, and problem solver. For instance if a patient says that they love doing bike races but after a training ride or race, they are unable to or have painful sex with their partner, I help the patient find a way to take the activity of biking from something that diminishes their function to a healthful activity that improves their function in all ways. Physical Therapists with specific training in the pelvis can have specific cues and tools that help patients learn how to use their pelvic muscles to improve strength and the ability to relax. My experience also helps me identify when a patient needs referral to a medical doctor, psychologist, or other healthcare practitioner to provide care beyond my expertise.

 

 

    Other aspects of my practice that I think are important to learn for those of us with pelvic dysfunction and for everyone are breathing, proper alignment, diverse whole body mobility and strength.  As Dr. Kelly Starrett says, alignment of the joints relative to gravity for the task at hand is like making sure your tires are pointed straight down the road so that with each repetition we are not prematurely wearing out our bodies and stressing our joint structures. When aligned properly we get stronger and reduce risk of injury. A few cues and specific exercises that help a person ingrain better habits can go a long way to unlocking more power from the movement, relaxation instead of tightness, and finding a way for our exercise or daily postures help us rather than wear us out. As breathing is directly affected by our posture, as we learn awareness of breath it helps us find the best position for what we are doing. Awareness of breath also helps us calm under pressure, whether during a 10K run or a business deal. The pelvis is directly affected by our breathing. Deficient breathing and posture puts undue stress and tension on the pelvis muscles. In optimal circumstances the pelvis and diaphragm muscles work together as shape changers during breathing. If the pelvis is tight, it is hard to have full natural breathing. We may start to use the upper chest and neck muscles to compensate to get more breath, which may lead to increased stress breathing response and neck tightness and headaches for instance.

 

    Lots of people tell me they “forget to breath.” I know I do it all the time too. It is happening  automatically in the background so we need not be self-conscious of our breathing for it to happen. It may be helpful to think of breathing like a barometer for our posture, stress level, exercise intensity. It is a daily practice working towards being able to experience the full spectrum of human movement. Everyday we should work on moving through a range of movements and different challenges to keep the body able to adapt to different conditions. Movement teacher Ido Portal that specializing in one discipline shuts off our potential and leaves us vulnerable to gradual degeneration of our ability to experience the world through the body. Watching him move looks fun and fluid, full spectrum. The rest of us weekend warriors are leaving a lot on the table. Yes we have day jobs but we can work on our limitations everyday.

    Yoga encompasses a diversity of physical skills and different positions. It is not the end but a good beginning to a solid daily practice that will help us adapt to different physical demands from sports to moving heavy boxes. We challenge, alignment, strength, endurance, mobility, all while emphasizing breathing through holds and transitions.Yoga can be a good way to warmup and cooldown from weight lifting as it moves through similar range of motion with body weight. Likewise for running and cycling where yoga can give us opportunity to move through end range compared to repetitive mid range cycles in these repetitive sports. These activities are neither good nor bad for patients who have pelvic pain or dysfunction. It is all about listening to your body, being smart about progression, choosing a suitable load, being patient not to progress too soon while also allowing yourself to be challenged to the point of breaking position. The learning happens when we are challenged. If you are suffering from pain it is not something to ignore or hold on to but it can be the opportunity to learn all these aspects that cultivate focus, awareness, and most importantly how to listen to your body.