Tag Archives: physical therapy

RM Friend: Marisa Nickols

Meet RM Friend MarisaNickols, Co-Executive Director of Baby’s Bounty Montgomery County. Baby’s Bounty MC is a non-profit 501(c)(3) that provides safety, health and wellness essentials to at-risk infants up to six months of age who are born into poverty, homelessness, abuse, neglect, and other disadvantaged situations.

When Marisa was pregnant with her first child she noticed, “my husband and I had lots of support from friends and family. What we weren’t given, we were able to buy–whatever was needed.” Reflecting on her good fortune she “started to wonder what happens to new moms and families that don’t have the resources?” Marisa first heard about Baby’s Bounty when she caught a segment about the charity on the news. “I decided to donate my daughter’s things to the charity when she grew out of them.” She was surprised to hear a few months later the charity was closing its doors.

“I have a background in politics–and I thought those skills could be applied to running a charity.” The needed skills of organizing volunteers and getting a message out to the community overlapped well. Nickols reopened Baby’s Bounty 3 months after the doors were closed. In FY 2015-2016 Baby’s Bounty helped 127 babies, doubled that the next year and in the first 6 months of FY 2017-2018 have helped 220 babies in Montgomery County.

“Some mothers don’t have an infant car seat when it is time to leave the maternity ward.” Babies in need are identified by hospital case workers, Montgomery County or Health and Human Services referrals. Cribs for Kids is an organization that helps purchase Pack-n-plays (portable cribs) at a good price for the charity. Used infant car seats aren’t allowed to be donated; they have to be purchased and donated new. Monetary donations allow the Baby’s Bounty to purchase items for “Safe Sleep, Safe Travel, Health & Hygiene. The charity is funded through a combination of 2 grants from Montgomery County, donations and fundraising efforts. The Baby’s Bounty “Run Rockville 5k and Stroller Derby” will be April 22. Click here for the flyer.

To learn more about Baby’s Bounty of Montgomery County visit their website http://www.babysbountymc.org/

International Pelvic Pain Conference 2017

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Restore Motion physical therapists Carrie Cothran, Patrick Wenning, and Reshma Rathod attended The International Pelvic Pain Society Conference held in Washington DC October 11-15th. When asked to summarize her “take home discovery” from the IPPS Conference, Carrie Cothran replied, “Pain can be viewed as a neuro-immune response. Structures within the body that aren’t injured may still undergo an inflammatory reaction due to the tissue changes associated with pain. This in turn contributes to long-term protective responses that affect resting muscle tension and ability to do work. The protective responses that occur with pain make the body more vulnerable to injury.”

Patrick Wenning remarked, “At the conference, there was such enthusiasm for better understanding scientific knowledge of the pelvic floor. Most of the time, pelvic floor rehabilitation is new to people and to other PTs mainly because it is an area of the body that people don’t want to talk about. Discussion with fellow participants was frank and enlightening. They made me feel that I had something to contribute and that I made the right decision to pursue this specialty. I still have a lot to learn as the science continues to uncover more useful information!”

Reshma Rathod added, “Opioids don’t work with Fibromyalgia or chronic pain since the endogenous opioid receptors are already occupied due to changes associated with chronic pain. When opioids are given for acute pain, they interfere with mood, sleep patterns and contribute to headaches. Ironically, patients may want to continue on the opioid medication to address their depression, difficulty sleeping and headaches. The body’s dependence opioid medications ‘stick’ with the person making it more difficult to discontinue and cause more problems in the long run.”

Laser application in physical therapy

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If you have ever had physical therapy, you are aware that manual therapy techniques and exerciseprescription are usually the cornerstone of your treatment program. Perhaps you’ve also had experience with modalities such as ultrasound, electrical stimulation, and even laser therapy.

What is a laser?
There are two different types of lasers primarily used in clinical treatment, Class 3 and Class 4. They are classified according to their ability to cause retinal damage, thus wearing appropriate protective eyewear is a must when working with these lasers. Class 3 lasers emit power of 5 to 500 mW while class 4 lasers emit power greater than 500 mW.

Class 3 lasers are low level, low intensity, cold lasers as they cause no thermal effect in the superficial tissue when used. Class 4 lasers are high power and considered hot lasers as they do produce an increase in the temperature of superficial tissue when proper exposure time is exceeded.

Under proper and normal treatment protocols, class 4 lasers emit greater photonic energy in a shorter period of time than class 3 lasers without a significant rise in tissue temperature, allowing it to treat deeper tissues, such as ligaments, muscles, tendons and cartilage.

What types of conditions benefit from laser treatment?
Physical therapists use class III and IV lasers as a treatment modality. These different types of lasers, whether they are cold lasers or provide a thermal effect, such as red, near infrared, or CO2 lasers provide pain relief and aid in the healing process of many musculoskeletal and neuromuscular conditions.

These conditions include:

Neck and low back pain
Tendonitis
Bursitis
Capsulitis
Carpal Tunnel Syndrome
Plantar fasciitis
Migraine
Bell’s Palsy
Arthritis
Strains and sprains
Adherent scar tissue
Wound healing
Muscle spasm
Pelvic pain
Stress urinary incontinence

How does it work?
Lasers work by stimulating collagen synthesis to aid in tissue healing, limiting the formation of edema and hemorrhage, increasing/stimulating the production of ATP (the energy source for our cells), and accelerating the inflammatory process by reducing levels of painful inflammatory marker, decreasing neutrophil influx, and decreasing oxidative stress on the body.

The use of laser for vaginal health is becoming increasingly popular among women who experience vaginal changes secondary to aging, childbirth, and hormonal fluctuation. These changes in vaginal tissue can contribute to loss of sexual gratification, dyspareunia (pain with intercourse), pelvic pain, and stress urinary incontinence. By stimulating collagen synthesis and reducing inflammation, pain is reduced and intravaginal tissue is strengthened, improving continence.

Please consult your physician for additional information.

Image: www.pixels.com

RM Friend: Susan Hurson, MD

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Originally from Long Island, Sue Hurson has been a Washington, DC transplant since receiving her undergraduate education from Georgetown University. She worked at the National Cancer Institute for 6 years before attending Georgetown Medical School. While at the Cancer Institute she worked on projects that developed Taxol and Carboplatin for use in the treatment of cancer. She finished her residency at the Washington Hospital Center.

When asked why she chose OB/GYN, she recalls experience during clinical training drew her to gynecology. “I felt I could make a real difference in women’s lives by taking care of women though the continuum of life; I liked the combination of obstetrics, medical and surgical interventions.” Sue was drawn to medicine early in life. Her father was a physician and she volunteered as a candy striper as a teen. Dr. Hurson has practiced in Washington, DC for 25 years, she discontinued obstetrics in 2015 to focus on gynecology.

Sue Hurson’s practice philosophy is to forge a partnership between patient and physician to guide her patient through to optimal health. “Sometimes patients don’t know what to ask. I try to tell women what to expect, real ‘education and empowerment.’ To tell you what you need to know before you need to know—sometimes, as a patient, you don’t even know what to ask.”

She became interested in integrative medicine because of its focus on mind, body, and spirit. She says, “Functional Medicine is putting it all back together so the systems are connected and integrated because they all impact each other ~integrated specialization.” She uses a team approach with other physicians and practitioners such as acupuncturists, physical therapy, nutrition counseling, mental health and health coaching. She guides and encourages her patients, “Be the best you can be at your age, the body will change, knowledge is power.”

What is her most frequent recommendation for women to stay healthy? Sleep! She adds she more fully appreciated the benefits of sleep first hand after she stopped delivering babies to focus exclusively on GYN. “Get enough good quality sleep. It impacts so many areas of health. Prioritize sleep. There is better resilience and improved immune function with proper sleep.”

As told to Miriam Graham, PT, DPT, MBA

Gail Wetzler PT, DPT, EDO, BI-D

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Reshma and Miriam first met Gail when they attended her Gynecologic Visceral Manipulation class sponsored by the American Physical Therapy Association (APTA) in 2005. She has been a teacher, mentor and friend ever since. Gail is a leader and innovator in the development of new courses for women’s health, manual diagnostics, visceral/structural disorders and integrative therapies for animal health. She teaches these courses for the American Physical Therapy Association, The Upledger Institute and Equinology. She is the Curriculum Director for the newly developed Barral Institute of Education Research and Manual Therapy. She also is currently the co-developer of the new MSAR (Masters of Science in Animal Rehab) at Western University.

She established her private practice in 1979. Her fields of study include osteopathic manual techniques, exercise physiology, women’s health, functional assessment, movement analysis, laser/modalities, psychoneurobiology, nutrition/digestive dysfunctions, anatomy, animal rehabilitation and integrated manual therapy.

While Gail loves to talk about physical therapy and all of the new exciting concepts that are improving people’s lives, she is equally passionate about the animals in her life. She loves her new 12-acre ranch in Denver and was able to relocate her two horses when she moved from California. She and her husband are happy to be near their children and grandchildren. She is in the process of setting up a “menagerie.” She now has dogs, cats, and goats, in addition to her horses and humans, so she can enjoy her whole family!

A 1973 graduate from Long Beach State University, Gail gained her orthopedic, acute and administrative background at Hoag Hospital Physical Therapy Department as outpatient clinical supervisor.

Publications include chapters in the following books: Diseases of the Temporomandibular Apparatus by Douglas Morgan, D.D.S., William Hall, M.D. and S. James Vamvas, D.D.S., Visceral Manipulation and Low Back Pain (IFOMT) and Therapeutic Management of Incontinence and Pelvic Pain by J. Laycock, PhD, FCSP and J. Haslam, MCSP, SRP.

Gail’s research includes: “The Effect of Functional Integration on TMJ Disorders”, with Dr. Mark Reese, “The Visceral Relationship to Low Back Pain”, with Dr. Stanley Paris and “The Effects of Manual Therapy on the Brain”, with Dr. Daniel Amen, Dr. Jean Pierre Barral, and Dr. Alain Crobier.

Playing for Two

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There are moments in an athlete’s career that are life changing; winning your first title, becoming world number 1, or finding out you are going to be a mother. For some female athletes, motherhood can be an exciting time; for others finding out you’re with child can leave more questions than answers. How will this impact my professional career? My lifestyle? Or even my training? Can I still compete while pregnant? For a long time, the American College of Obstetrics and Gynecology (ACOG) has recognized the importance of exercise during pregnancy. Unlike old beliefs, exercise is now known… For more information, click on PhysicallySpeaking-Playing for two

Written by: Reshma Rathod, PT and Thu Tran, MD for WTA (Women’s Tennis Association)

Manual Therapy Treatment for Concussions

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Following a concussion, symptoms such as headaches, light sensitivity, dizziness, cognitive difficulty, emotional irritability, depression, and sleep disturbances can often linger. Waiting for the symptoms to improve is a frustrating experience that can impact all areas of an individual’s life. Physical therapists skilled in manual therapy including Craniosacral Therapy, Visceral Manipulation, and Neural Manipulation have observed improvement in many clients’ symptoms post-concussion. These specific manual therapies are gentle therapies that follow the osteopathic principles that structure and function are interrelated. Craniosacral therapy improves the motion restrictions in the craniosacral system which consists of the meninges, bones, and cerebrospinal fluid from the head to the coccyx (base of the spine). Visceral manipulation is a manual therapy developed by a European osteopathic physician Barral that uses gentle, but specific manual forces to improve the mobility of the organs and the connective tissues. Barral Neural Manipulation works to improve the fascial mobility that surrounds all of our nerves allowing the freedom of motion needed for optimal function.

A recent study published by Gail Wetzler and colleagues confirms manual therapy can improve concussion recovery. In the study of 11 male retired professional football players, these specific manual therapies resulted in statistically significant improvements in pain intensity, ROM, memory, cognition, and sleep. For specific changes observed, here is a link to the research study. http://online.liebertpub.com/doi/abs/10.1089/acu.2017.1222

Gail Wetzler PT was here at Restore Motion this weekend teaching the therapists who already have trained in these manual techniques how to better use these skills to treat individuals with post- concussive symptoms.

Written by: Stephanie Bloom, PT

“For information on what to do if you or your loved one sustains a concussion, please refer to https://www.cdc.gov/traumaticbraininjury/recovery.html”

Image Source: https://www.flagspin.com/youth/youth-flag-football-concussions

Is this Backpack Too Large?

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What to look for in a Backpack:

Wide, padded shoulder straps distribute the weight over a larger area around the shoulders. This avoids that “cutting into the shoulders” feeling.
Chest and waist straps also help distribute the load of the pack. Use of a chest strap (and/or waist strap) decreases load that would completely weigh on the shoulders if it were not used.
Padded back cushions the load as it rests on the back. Some backpacks feature no padding directly over the spine – This is favorable because it creates a comfortable “cut out” for the spine bones. It decreases load contact directly over the “spinous processes” of the bones.
Multiple compartments even out the load and are preferable to one large cavernous compartment. It makes retrieving items easier as they don’t all fall into one single “pit” of the pack.

Consider the size of the backpack wearer—the overall length of the backpack should not go below the waist of the wearer. Appropriately sizing the shoulder straps to distribute weight evenly over both shoulders and using the chest or waist strap can help the pack sit at the waist of the wearer.

Wear the pack with both shoulder straps not just one strap over one shoulder—Really! Wearing the pack on one side contributes to neck, shoulder and hip strain in addition to back pain.

Avoid filling the pack too full. It is too full if the wearer has to lean forward to bear the weight. This can contribute to bad posture and back pain. Full packs can cause havoc when the wearer turns and unknowingly knocks into people or priceless artwork.

Rolling packs have their advantages and disadvantages as well:

Some school lockers aren’t big enough to accommodate the rolling packs.
Need to be carried over stairs or rough terrain.
May be a trip hazard.

When using a rolling pack remember to switch arms frequently and to engage core/abdominal muscles to balance the strain on the body.

Written by: Miriam Graham, PT

MAPP: Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain

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Malassezia spp. Skin Microbiome. https://skinmicrobiome.wordpress.com/tag/malassezia/

MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Finds That Fungus In Urine Might Be Linked to Urgency and Pain.

One of the most promising lines of research in urology today is the study of the biome, the diverse population of bacteria and fungi that live harmoniously in the human body. In previous MAPP Research Network studies, IC patients were found to have high levels of candida/fungi in their urine during flares (1). Another found that IC patients are deficient in some important bacteria in our bowel while having higher levels of other harmful bacteria (2). This latest MAPP Research Network study now links changes in fungal communities with the symptoms of urinary urgency and pain (3).

Researchers obtained urine specimens from 12 IC patients, 17 Over Active Bladder (OAB) patients and 14 patients without urinary symptoms. DNA was extracted, deep sequenced and compared to multiple fungal sequence databases. They found that patients with more severe symptoms, regardless of the symptom type, had decreased fungal diversity. Individual symptoms were associated with distinctive species of fungi. Patients with severe bladder pain had altered levels of Malassezia spp. composition while patients struggling with incontinence were inversely correlated with Wickerhamomyces spp.

The researchers concluded that the urinary microbiome is altered inpatients struggling with lower urinary tract symptoms, and that the loss of diversity in the microbiome correlated with worsening symptoms. Specific fungal patterns were found in patients with the symptoms of bladder pain and urinary urgency but interestingly this did not correlate with a diagnosis or medical condition. The researchers concluded, “These results suggest the intriguing possibility that particular microbial patterns maybe associated with specific symptoms, not necessarily diagnoses. This could lead to new diagnostic and treatment algorithms for patients struggling with lower urinary tract symptoms.” Clearly, there is a need for greater testing for fungi in urine screening. Bacteria may not be the root problem in some patients. It is time to consider the roll of fungus in bladder dysfunction.

Adapted from Jill Osborne 8/10/17 Interstitial Cystitis Network Blog, Research https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

References:

Osborne J. Could IC Flares Be Caused By Candida – New research study finds higher rates of candida rather than bacteria during IC flares. IC Optimist Winter 2016.
https://www.ic-network.com/could-flares-be-caused-by-candida/
Osborne J. The DIPP Mystery – Why are IC patients deficient in some good bacteria. IC Optimist Summer 2016.
https://www.ic-network.com/dipp-mystery-ic-patients-deficient-bacteria-gut/
Journal of Urology, April 2017 Abstract MP29-10 Alterations in the Urinary Fungal Mycobiome in Patients with Bladder Pain and Urinary Urgency
https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

Ursula Sukinik, Doula and Entrepreneur of Birth You Desire

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Ursula is not only a certified childbirth educator, but is also a birth doula, a birth assistant, a doula trainer, and a mother of two teenage boys. Known for her easy laughter, radiant energy and knowledge of the birthing woman; to say that she is an inspiration is an understatement.

She is a true believer in honoring women’s bodies and the natural process, Ursula not only inspires her students to better understand how choices affect well-being, but she takes the mind-body connection to a whole new level with her practice as a birth worker. Ursula has personally worked with thousands of women during the birthing process.

With this passion, she owns and runs Birth You Desire where you can find a list of doula training, childbirth classes, TENS rentals, workshops and speaking engagements in the DC Metro area as well as choose a doula to support you at your birth.

Ursula’s sons are going to college this fall University of Pittsburg & St Mary’s College of MD. She loves German Shepard dogs and her current dog’s name is Ohana Koa (called Koa, ko-ko, or when bad… Ko-ko loco). She is an avid gardener & hiker in her spare time.

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Our Restore Motion Friend, Ursula Sukinik, doula and entrepreneur of Birth You Desire, suggests how to stack the deck for an uneventful vaginal delivery. Adapted from her BYD blog below, are 10 easy ways to avoid and reduce your cesarean risk.

Prepare yourself. Take a comprehensive childbirth class, learn your choices.
Practice good body mechanics through out your pregnancy.
Have a supportive and educated labor partner. Your partner is your anchor. No matter how wonderful your birth team is they cannot replace the love and security you have from your partner.
Let baby come when they are ready, avoid unnecessary inductions and subsequent interventions.
Build a tool kit of coping methods and practice them. Relaxation is the cornerstone to spontaneous birth.
Labor at home as long as possible with provider permission when applicable.
Avoid continuous monitoring when at your birth place if possible. If continuous monitoring is necessary ask for a wireless monitoring to facilitate coping skills.
Use medications and interventions wisely. There are many tools for labor and they all have their place.
Labor upright and change positions frequently whenever possible. An active mother is an active baby.
Consider hiring a professional Doula to assist you in your birth.

Adapted from intellectual property of Ursula Sabia Sukinik/Birth You Desire. Used with permission. Do not reproduce or distribute without written permission from owner. Copyright 2011. All rights reserved.