June is Pelvic Organ Prolapse (POP) Awareness Month. My goal with my blog today, is to create the space to discuss what you may be experiencing when it comes to symptoms surround POP.

POP can occur due to a variety of things, such as pregnancy or heavy lifting.  These are activities we shouldn't shy away form, rather recognize.  Pelvic organ prolapse is related to the descent of a pelvic organ, including the bladder, uterus or rectum, into the vaginal space.  For example, the bladder will descend into the vaginal space as the anterior vaginal wall loses it's ability to create support.  Tissue can become visible at the opening of the vagina. The infographic from My PFM is a great visual of a cystocele, or prolapse of the bladder.

The thought of a POP can be quite concerning for anyone.  Not only the symptoms but what you may hear or read regarding activity of what can or should not be done.  However, everything you hear or read should be discussed with your healthcare provider.

Research has demonstrated that pelvic floor muscle retraining is key in assisting the recovery from POP.  Like most injuries, the rehabilitation process is important to assist with a return to activity and quality of life. 

Symptoms can include:

• lower back pain
• urinary urgency
• pelvic pressure or heaviness
• a bulge seen at the opening of the vagina.

Treatment can include numerous strategies, such as pelvic floor muscle retraining from an internal or external technique, breath control and pressure control, and overall global conditioning.  Exercise and education are key. Having a healthcare provider, such as a Pelvic Health Physiotherapist as part of your team, will assist with your overall rehabilitation process and return to activities.  

We are hear to help with any questions you may have. Please reach out for a chat!

~ Michelle, Physiotherapist

References:
https://www.mypfm.com/prolapse

After spending “virtually” all weekend expanding our knowledge at the “Treating and Training the Female Runner” course with Physiotherapy Clinician and Educator Julie Wiebe, my colleagues and I are excited to use our new skills to assist our clients in achieving ALL their fitness, wellness and recovery goals.

Though the course has equipped us with increased problem-solving skills to assist our well-deserving pregnant and postpartum moms to achieve their sport specific fitness goals, including Cross-Fit and running, the underlying principles can be effectively applied to empower ALL of our client populations to reach their full potential. And thankfully so! 

As I find myself surrounded by peers of a different age cohort, as I continue to learn and grow, I realize that these new concepts are just as applicable to where I am at in life. I am at the stage of accepting menopause, and all its glorious hormone related changes that can affect us as we mature. Thank God for research and support, as we continue to challenge ourselves beyond previously held beliefs to grow through discomfort, to a place of acceptance and positive change.

As we age and go through life’s cyclical changes, we ALL develop strategies.  Whether internally imposed or resulting from external sources, we all develop alignment, breathing and movement strategies and beliefs that allow us to function to the best of our known ability. Repeated regularly these strategies can subconsciously become our “go to” that will either allow our bodies to operate efficiently or afford us unexpected signs and symptoms as we progress through life.  And I am no exception when it comes to some much-needed work in that department.  These strategies can become so imbedded in us that they are often difficult to recognize without looking at them from a different lens, or from what Julie Wiebe might call, a new set of eyes.

As physiotherapists our role is to provide you with that new set of eyes as we assess and establish what your strategies are, and where your current limits lie.  We will explore with you what you value most and build upon your current successes, with the aim that through education and support we can empower you to progress safely toward achieving your current and future goals.

Through neuromuscular retraining strategies we can work with you to:

**Optimize the alignment of your pelvis, as Lindsay mentions in Donald Physiotherapy’s recent Facebook post where she discusses the importance of addressing the postpartum “mom bum,” to gain better access to the pelvic floor muscles. Muscles that she so clearly explains are important for more than just improved continence.

**Optimize your breathing strategy, to allow for improved access to your diaphragm, not only as an efficient respiratory muscle for oxygen exchange, but also as a muscle important in central or core stabilization and posture control. In fact, the diaphragm, when trained to be used effectively also helps:

• maintain mobility in your ribs as well as your upper and lower back
• aid circulation
• restore balance
• improve gastro-intestinal function which aids in reducing constipation
• regulate intra-abdominal pressure to help absorb impact during WB activities, as well as
• balance your sympathetic and parasympathetic nervous systems, assisting to regulate heart rate and emotional response

**Optimize engagement of your deepest abdominal or “transversus” muscle so that it works together as a team with the diaphragm, pelvic floor, and deep spinal “multifidus” muscle to assist in:

• stabilizing and controlling the spine, allowing for simultaneous functional movement to perform tasks like lifting and carrying safely, and
• the management of diastasis rectus, that enables for maintenance and restoration of the strength and control necessary to return to functional meaningful tasks and performance goals in a timely manner.

It is this deep abdominal muscle’s vast attachments extending throughout the ribs, pelvis and spine and its slow tensioning action which make it such a powerhouse for controlling this region. This is in stark contrast to the obvious quick and bulging bracing that is created by the superficial abs.

From perhaps well-intended verbal cues of “tighten your tummy” to less well-intended visual cues in fitness magazines that promote perpetually flat abs, what one may have thought back then is not what we know right now.  What it comes down to is really getting to know, appreciate and listen to what your body is telling you so that it can continue to serve you well into the future.  Come and ask us about the benefits of neuromuscular retraining strategies and let us show you how using central control as a foundation for ALL your performance fitness and wellness goals can benefit you and your family.  Our commitment to growing in knowledge transfers into our commitment to serving you.

~ Elizabeth - Physiotherapist
​
References:
www.juliewiebe.com
https://www.facebook.com/DonaldPhysiotherapy/posts/3045234788890061
 

​Nearly every physiotherapy treatment program will include the prescription of exercise to assist in recovery and rehabilitation. This is received by people in a variety of ways. Some are excited, while others see it as the unfortunate thing they have to do until they get better. 

I believe that there are some misconceptions about the role of prescribed or therapeutic exercise in physical therapy and individual’s treatment. It is never with the idea of punishing someone or a part of their body. No therapist wants to punish you, they don’t even want to give you a hard time if it is difficult to find the time or the motivation to perform the exercises. They really just want to help.

Therapeutic exercise is prescribed for one powerful reason, because nothing else can provide what it does. There is no pill, no surgery, and no quick fix that can provide the wide range of benefits that learning to work with your body can (although these things do have their place). 

Is it harder than some interventions? Yes. 

Does it require attention, time, and effort? Yes. 

But it can literally change lives. Therapists want to help you achieve your goals, and very little can compete with the power of changing tissues, minds, and activities through exercise and education.

For a significant amount of conditions you cannot simply hit the reset button and go back to the way things were before. In the case of progressive or gradually worsening conditions, the status quo wasn’t good enough to begin with. You will need to adapt. Therapeutic exercise gives the opportunity to develop the relationship with that part of your body and get to a better place than you were before. Let me just repeat that, where you were before may not have been good enough. The upside to this is that nearly all tissues can change, grow, and be improved by the application of exercise. 

Now, more specifically, what’s the point of the different things you’re being asked to do?

Neural adaptation. This is the first thing that we can typically expect once someone has begun to do any kind of active movement/exercise. The way that we are wired, the more often you use something, the more easily the nerves will trigger and the more coordinated the collection of nerves and muscle fibers will work together. While the first few weeks of any exercise program will not actually make the muscles any bigger, the increased nerve activity can increase the strength or function of an area relatively quickly. Particularly if someone is recovering something they already had. For some people, the symptoms will reduce significantly during this time period. They will be and feel stronger, but mostly because of neural adaptation and the decrease in pain.  

Tensile Loading (Post-Surgery/Injury). The loads that we use are sometimes too small to provide the stress necessary for muscle growth. However, following an injury or a surgery the tissues don’t necessarily need to be bigger, they just need to be introduced to stress in a predictable way so that they can get used to being put under pressure. Even a couple of pounds can be very useful in the initial stages of recovery, for the neural adaptation reasons mentioned previously as well as to prepare for the strengthening that can come later. Most people end their therapy at this point, particularly if the symptoms have reduced sufficiently for them to resume their normal activity. In their mind, they have returned to normal and can continue on. This is partially true, but leaves out a significant consideration. 

Strength & Hypertrophy. Not as many people take their therapy to this point. As such, it is used less frequently in the rehabilitation setting. This is the amount of exercise and load that it takes to actually grow a muscle and develop its strength beyond what it was capable of doing previously. This can be accomplished with body weight and lighter bands if the repetitions are sufficient, but it is a considerable amount of work. This requires that the tissue undergo enough stress to cause an adaptation. For people who are not familiar with activity and exercise, this can be quite challenging to accomplish, and frustrating to experience without some education/guidance. This is the type of change, however, that can last for years. 

Having a New and Positive Experience with your Body. Throughout all of these stages there is this idea. What therapists hope for most of all as you engage in any activity and exercise, particularly with the thought of improving your situation, is that you will take this opportunity to feel something new and notice something that you hadn’t previously paid much attention to. At first this focus is usually on the painful aspects of the condition, but if you invest your time and mental energy into these exercises, you will begin to develop a sense of your limits, a sense of what’s safe, and an ability to adapt to your situation. There is no perfect number of repetitions or technique (although a certain amount is required for anything to change). Instead, consider finding a way to make the exercise more comfortable or find a way to be more consistent through experimentation and curiosity. 

Your body is not out to get you, it’s always doing the best it can, but it does require some input. 

-Trent, PT

Many of us have been socialized to believe that aging goes hand in hand with illness, frailty and loss of function. But does it have to be this way? Is it just that our bodies get wrinkly and withered and there’s nothing we can do? Or is it that we lose fitness and we believe that is what will happen because that is what happened to grandma and grandpa, and mom and dad and so it happens…a self-fulfilling prophecy if you will.

How many times have you heard someone say “I’m too old to…” or how many times have you had this thought yourself? And if we are honest with ourselves does your inability to…perhaps play with your grandchildren on the floor or my inability to skateboard for example, have anything to do with your age or my age as I approach 50? For me personally, is it more a consequence that I’ve never learned this skill(true), I’m afraid of falling(true), and I am out of shape(perhaps also true)? If I had the desire to learn a new skill physical or otherwise, I should be able to learn it on some level regardless of my age. I may require a skilled coach and invest some time at the gym building some muscles and improving my balance, but I should be able to learn to skateboard should I have the desire. After all, I’m not aspiring to be Tony Hawke, but skateboarding down the road alongside my boys would be a great achievement in my eyes.

The scientific definition of aging is “the sum of all the mechanisms that alter the functions of a living thing, prevents it from maintaining physiological balance and eventually leads to the death of said organism. In the human body and most other living things, the process is complex, gradual and depends on many biological factors. This natural process can be amplified by external factors throughout a lifetime (pollution, food, smoking…)”(Cavallasca,2017) What a negative view of aging! Why is there no mention of increased wisdom, strength of character, and improved confidence that is often noted to go along with growing older….hmmmm.

Aging occurs more or less quickly based on a number of factors. Our bodies become less efficient and effective at DNA repair, our telomeres shorten, impact of our environment, protein malfunction, mitochondrial dysfunction, oxidative stress, cell senescence, and stem cell exhaustion.( Cavallasca,2017)Now that is a lot of contributory science that is beyond the scope of my current knowledge base and indeed of this blog! But another important factor is indeed whether he have pessimistic beliefs about aging or positive beliefs about aging. (Fan, May 2007) Among many scientific papers on the subject, the Irish Longitudinal Study on Ageing, having over 8500 participants, found that negative beliefs about ageing were associated with both declining mental and physical function. (TILDA publication papers)

How many examples of people do you know who are aging well?
Have you heard about Harriette Thompson who completed her 15th marathon at age 91 and she ran her first marathon at age 76! Or,how about Jacinto Bonilla—a 73-year-old Brooklynite, who participates in CrossFit, which he started 6 years ago. How about 88 year old Germany native, Johanna Quaas, who is the oldest active gymnast in the world. Quaas was born in 1925. In 2012, she earned her name into The Guinness Book of World Records as the oldest gymnast in the world. The grandmother and mother of three, has been married to Gerhard Quaas, a gymnastics coach, for more than 50 years. Then there’s Nola Ochs, who at age 95 earned her college degree. Ochs became the oldest person on record to graduate from college when she received her diploma from Fort Hays State University alongside her granddaughter. She began pursuing a degree at age 65 (when FHSU was still known as Kansas State College) after her husband passed away. Thirty years later, through a combination of online and in-person classes, Ochs reached her goal and crossed the stage to receive her college diploma. What about Fred Mack, who celebrated his 100th birthday by skydiving for the second time! Mack’s first skydiving experience occurred at the age of 95. (Coxwell,2014)

These are just a few of many “aged” individuals to say the least! While their level of tenacity and joie de vivre isn’t what typically comes to most of our minds when we think of being in our elder years, why isn’t it?? Wouldn’t we rather be having fun living to our fullest potential  than sitting around and watching the world pass us by?

So what do you wish to be doing? What have you always dreamed of, or wanted to do or try? What is stopping you? If your fitness levels or your perceptions are holding you back, we can help! The aging body responds to exercise in the same way our younger bodies do. You can become more flexible, stronger, bigger muscles, better balance and confidence, better posture etc. You need only desire, an open mind and elbow grease! Let’s age well together!

~ Lisa, Physiotherapist
 
 
REFERENCES
https://tilda.tcd.ie/publications/papers/

Beliefs about aging and later life health and well-being among the elderly in Taiwan, T.D. Fan, May 2007, University of Texas Libraries.

Age is Only a Number; Amazing Accomplishments by 70, 80 and 90 Year Olds, June 25, 2014 by Kathleen Coxwell
 
Aging 101: Biological causes of aging, By Julie Cavallasca,10 January 2017