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Core and the Pelvic Floor

There are only two reactions to “core exercises” – either you LOVE them or you HATE them. The muscles that are commonly referred to as the “core” are the front abdominal muscles – the rectus abdominis (6-pack), transverse abdominis, and obliques. They’re what everyone wants, but are incredibly hard to achieve without a strict and clean diet…or an incredibly high metabolism. What’s not commonly thought of as the “core” though, are the OTHER muscles and structures that make it up. The core is made up of your respiratory diaphragm at the apex of the abdomen, the abdominal muscles in the front, the lumbar paraspinal muscles in the back, and the pelvic floor muscles at the base. These groups together help keep your body strong and stable, as well as performing other duties we won’t touch on here. And these muscle groups can be exercised in a myriad of ways – both the traditional “core” exercises (such as crunches) and not so commonly thought of exercises (such as squats). What I seek to do with this blog is hit on 4 commonly performed exercises that strengthen the core and how they impact the pelvic floor. These exercises are: low front planks, sit-ups (butterfly), bird dog, and squats.

Low Front Plank

The plank is great for activating the spinal muscles as well as the abdominal muscles. However, is an exercise that brings to mind a “NEVER do that” connotation. Many believe that due to the impact this exercise can have on the pelvic floor, it’s an exercise that should NEVER be done. But I don’t believe that are true “nevers” in life. Planks can really help wake up the abdomen – whether used as a warm-up or a strengthener. To say you can “never again” do a plank is ridiculous. But at the same time, jumping into a 5 minute plank 2 weeks postpartum is also ridiculous. It’s something that needs to be consistently performed and increased at a safe progression.

The reason the pelvic floor can be affected is because of possible pressure created on it while in the plank position. If your abdomen and low back isn’t taking the brunt of the demand, then your pelvic floor may take on more of that work. So, rather than jumping straight into an “as long as possible” plank, maybe do short intervals first – making sure the pelvis is tucked and there isn’t sag in the low back. Then progress from there!

Sit-Ups

This is what first comes to mind when trying to predict what others will think of when considering “core” exercises. What I think of first when I consider a sit-up in a workout is “why do I want to add a sit-up in?” If it’s because I want them to get better at sit-ups or because they have a sit-up test coming in the future, then I’ll likely throw it in there. If it’s because I want them to feel like they’re really moving, but also be able to slow down the amount of movement, then I’ll likely throw them in there. If the reason is because I want to do core work, I might choose another exercise that will bank in on more muscle groups at the same time.

The sit up will target specifically the abdominal muscles – and possible the hip flexors depending on how you’re set up in this movement. It doesn’t really activate the low back or the pelvic floor as much – meaning it won’t assist in co-contracting different muscle groups. Because of the increase in intra-abdominal pressure, it also means that if you’re not strong enough for this exercise it will put more pressure on the pelvic floor. If the pelvic floor (like with the plank) isn’t ready for that demand, then it’ll cause issues (either in incontinence or eventual pain).

There’s some concern with diastasis recti with sit-ups. With a diastasis recti, there’s a split in the rectus abdominis muscle – what is traditionally considered the “6-pack muscles.” This occurs in 100% of women in the 3rd Trimester, due to the amount of space required for the growing fetus. However, in most women it either resolves completely or is asymptomatic. Diastasis remains in 32-46% of women, causing pelvic floor dysfunction or low back pain. However, what we’re looking at when deciding on if sit-ups are appropriate is the absence or presence of that pelvic floor dysfunction or low back pain. In the absence of low back pain/pelvic floor dysfunction, with a baseline strength, and with having a benefit to performing sit-ups, then get it!

Bird Dogs

Bird dogs is one of my favorite exercises for “core” – it encompasses so many parts. It challenges balance, it challenges the abdominal muscles, it challenges the low back muscles. It’s versatile, you can add so many things to it – from combining bands to weights to increasing hold times. You can add pelvic floor contractions with it, and add pelvic floor relaxation to it. Like I said, it’s incredibly versatile!

The biggest benefit there is to adding a bird dog in, whether as a warm-up to ensure the low back and abdominal muscles are firing well before getting into movement, or as part of a core-circuit, is that it enhances co-contraction behaviors in the muscles. This muscular co-contraction means everything is going to work and move together better. With the core being made up of specifically 3 different muscle groups – this is vastly important when considering a “core” workout.

Squats

Squats are likely the least-thought of core-exercise. However, studies show that squats – especially heavy squats – increase the activation of low back muscles (especially the lower portion of the back). And that activation of the trunk musculature on heavy squats, creating a ballooning effect, can increase the stability within the squat. However, now that we’re getting into heavy squats and the intra-abdominal pressure pattern for heavy squats – it’s a great time to talk about what happens to the pelvic floor with this activity.

When the breath is held in the lungs, the diaphragm is kept in a descending position. Because of its relationship to the pelvic floor, that means the pelvic floor is held in a stretched position throughout the movement. Like any other muscle group, if it’s held in a stretched position it has a harder time contracting and assisting to hold up. Meaning that incontinence within this movement is likely – or pressure creating prolapse – due to the forces on the pelvic floor. Does this mean it will definitely happen to you? NO! But like everything else in this blog post, you have to train for that. You can’t move from squatting 105# to squatting 300# and not expect things to fail out on you or at the very least to have some sort of issue. It also means that you need to train specific motions within the squat to keep your pelvic floor from failing (which in itself would be a separate blog post).

SO! We’ve gone through the 4 core-muscle strengthening exercises that I chose. What do you do with this information now? Use it! Plan your programming with your core in mind – plan your patient’s exercises with the core in mind. What the core actually does, what muscles actually make it up, how it works in conjunction with other muscles, and the multiple ways that the core can be challenged. A body goes through a myriad of movements throughout the day – and most of the time they aren’t the exact same movement. Meaning you, your patient, your athlete – their life is variable, and as such – their exercises need to include variability!

References:

Gluppe, S., Hilde, G., Tennfjord, M., Engh, M., Bo, K. Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther, 2018; 98 (4): 260-268

Ko, M., Song, C. Comparison of the effects of different core exercises on muscle activity and thickness in healthy young adults. Phys Ther Rehabil Sci; 2018, 7(2), 72- 77

Tillaar, T., Saeterbakken, A. Comparison of Core Muscle Activation Between a Prone Bridge and 6-RM Back Squats. Journal of Human Kinetics, 2018; 62, 43-53

Olsson, A., Kiwanuka, O., Wilhelmsson, S., Sandblom, G., Stackelberg, O. Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life. BJS Open, 2019; 3: 750-758

Garcia-Waquero, M., Moreside, J., Brotons-Gil, E., Peco-Gonzalez, M., Vera-Garcia, F. Trunk muscle activation during stabilization exercises with single and double leg support. Journal of Electromyography and Kinesiology, 2012, doi: 10.1016/j.jelekin.2012.02.017

Hamlyn, N., Behm, D., Young, W. Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. Journal of Strength and Conditioning Research, 2007; 21(4): 1108-1112

COVID-19 Update

3/29/20

Recent events have brought on unprecedented times for our state, country, and world.  As you are aware, The City of Columbia has issued a “Stay at home” order  to close all non-essential businesses in an effort to reduce exposure and promote social distancing to all Columbia residents. As per federal and local guidelines, outpatient physical therapy was classified as an essential operation. 

After careful consideration, it has been decided by Vertex PT Specialists to significantly reduce in-office visits at this time and convert a large portion of physical therapy appointments to a telehealth/virtual care platform effective Monday March 30th and extending for 2 weeks through Friday April 10th. If you have an appointment scheduled for this coming week and you have not been contacted yet regarding this change, we will be contacting you shortly to review options.

This 2 week period will allow our state and local governments to continue to fight this global pandemic without risking continued exposure to this deadly disease.  This decision is the next step made by Vertex PT Specialists in order to limit exposure and risk. Each physical therapist will continue to have limited in-office hours for patients deemed appropriate. This decision guarantees a continued reduction of people in the facility at one time, allowing for more adequate spacing of patients and continued high levels of cleaning and sanitation. We encourage all patients to continue their physical therapy appointments via telehealth/virtual care with your provider over this interim period. While we feel each and every patient’s care is essential, we also believe in taking as many necessary precautions at this time to reduce infection risk for patients and providers. For those who will be continuing physical therapy in the office, our providers will give you a questionnaire inquiring on recent travel, possible illness in those who you live with or have had close contact with, and your adherence to social gathering limitations. We also ask that when arriving for appointments that you please wait in your vehicle until your scheduled appointment time and to not bring additional people into the facility to minimize contact with other patients and staff.  Vertex PT Specialists and their providers reserve all rights to refuse in office treatment to any patient whose answers do not meet the requirements set by our company. These patients are encouraged to perform telehealth/virtual care visits at this time and take the necessary steps to ensure safety before returning to the facility. 

While we understand this decision may appear abrupt, we feel this is in the best interest of the health and safety of our staff and patients. 

Below are some frequently asked questions: 

What about my appointments which are scheduled for next week?

– Our staff and/or your physical therapist will be reaching out to you with information on your appointments, telehealth/virtual care and continued physical therapy. Please feel free to call our Millwood office at 803.851.3506 or our Cayce office at 803.973.0100.

I am post-operative and/or my condition necessitates in-office visits, what should I do? 

 – We understand that some post-operative and more complex patients may continue to benefit from hands-on skills provided within the office. Therapists will be reviewing their schedule to determine the best time for these in-office visits to occur for those in a critical period of recovery.

What is the cost of telehealth/virtual care visits?

 – Current policies, procedures, billing coding, and coverage of such visits remain highly varied from insurance to insurance. We will guide you through this process before initiating your appointment with your provider.

This decision is continually being monitored and any changes  will be relayed through continued email, text message, or phone communication.

We appreciate you understanding these changes. We look forward to continuing in-person visits for all patients in the near future when it is safer for all parties.

– Vertex PT Specialists management

Breast Cancer Fundraisers

October is breast cancer awareness month and we’d like to invite you to participate in several fundraisers we are sponsoring.  As some of you may know, Jim’s wife and our former billing coordinator Nora Floyd has been battling breast cancer since her diagnosis in April of 2018.  She is a fighter and has been doing well with everything so far and we want to continue to support her!

We’re sponsoring a team for the Palmetto Health Breast Center Walk for Life and Famously Hot Pink Half Marathon, 5k + 10k runs and we’d love for you to join us at the walk/run or donate to the cause.  Follow the link below for more information on this!

http://events.palmettohealthfoundation.org/site/TR?pg=team&fr_id=1140&team_id=10256

We’ve also created a special “pink edition” Vertex T-shirt (see picture below) that is co-branded with our training partners (Athlete’s Arena) and will be donating all proceeds from the sales of these to the upcoming Walk for Life fundraiser!  We are selling the T shirts for $20 and they are available for pre-order and purchasing in person at our clinic.  Please let us know by replying to this email or giving us a call if you would like to purchase one!

Thank you to everyone for your support and we hope you have a great day!

5 Things You May Be Doing That Aren’t Great for Your Pelvic Floor

Your pelvic floor is a set of muscles that make up the base of the pelvis. It functions to control bowel and bladder, add stability to the spine, and support the organs (among many other functions).  Both sexes have a pelvic floor, however they obviously look a little different between male and female. I focus only on Women’s Health, so for the purpose of this blog post – we will only focus on the female pelvic floor! It needs a lot of attention, however you could definitely be taking your self-care too far. So, lets delve into 5 things you may be doing that could be causing harm to your pelvic floor!

1. Using “Feminine Cleansing” Products

The vagina was designed to take care of itself without the assistance of perfumes, washes, or douches. The tissue can maintain it’s own pH levels, hydration, and bacterial levels – which is why some discharge from the vagina is totally normal! Large, copious amounts of discharge, colored discharge, or foul smelling discharge are signs of an issue going on – and are reasons to visit your doctor. And these symptoms can be brought on by using products that your vagina didn’t need. Water and mild soaps are fine, however strongly perfumed products can be irritating to the vaginal (internal and external tissues).

2. Using a Menstrual Pad for Urinary Incontinence

They’re MENSTRUAL pads for a reason, not incontinence pads! The vulva (or the external tissues of the vagina) can be irritated by pads, causing irritation, redness, and discomfort. If you’re experiencing incontinence, this is a reason to see a doctor – and definitely a pelvic floor physical therapist! Regardless of the number of children you’ve had, you should not leak with any motion. And strengthening/mobilizing the tissues of the pelvic floor and surrounding hips can definitely help to stop the leakage.

3. Tolerating Painful Sex

Pain during sex is not “normal.” One of the 5 functions of the pelvic floor is sexual appreciation, or the ability to participate in and enjoy sex. Studies have shown that the stronger the pelvic floor, the better the sex. Pain with sex can be caused by irritation of the vaginal tissues, dysfunction within the muscles, and hormonal changes. It’s a reason to talk to your doctor and seek out a pelvic floor physical therapist!

4. Not Drinking Enough Water

Water intake directly affects the function of the bladder and the bowels. Adequate hydration is required for normal bowel function, which helps eliminates wastes – but has also been implicated with pelvic pain. The Mayo Clinic recommends that women drink 11.5 cups of water/day. This recommendation changes with levels/intensity of exercise, health, pregnancy, and breast feeding. For more information on this, visit the Mayo Clinic website (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256).

5. “Hover Peeing” In a Public Restroom

I know…sometimes public restrooms are definitely gross; but squatting is not the answer! To allow the release of urine from the bladder, the pelvic floor has to be able to relax. In a 90 deg squatting position, the pelvic floor will be active (and attempting to hold urine). So, squatting and attempting to urinate will cause a confusing disconnect in the sphincter (or control) muscles of the pelvic floor. So, rather than squatting – use the toilet covers or make your own out of toilet paper. Save your squats for the gym!

One Final Note:

These suggestions are obviously not all encompassing. There are situations where one of these MAY be the right answer for you. If you have any questions or concerns, don’t hesitate to reach out; either to myself or to a pelvic floor physical therapist in your area. You should never feel embarrassed about any questions you have regarding your vagina or pelvic floor – we all have one!

Dr Tristan Faile, PT, DPT, OCS

Pelvic Floor

What combination of muscles is the most active during all activities of daily living, yet tends to be the most neglected or misunderstood? The CORE! Your core is made up of 4 major muscles/muscle groups: possibly the most forgotten of which is the group of muscles that make up the Pelvic Floor.

 

The pelvic floor serves 5 purposes. It stabilizes the lower portion of the core – assisting with stabilization of the LE and the spine. It supports the organs, keeping them from falling with gravity. It helps with drainage of blood/lymph from the legs. It provides control of bowels and bladder – allowing you to either hold or empty. And it is vitally important in sexual appreciation – either allowing or improving the sexual experience.

 

So, what happens if the pelvic floor isn’t functioning correctly? Keeping in the order used above – the pelvic floor functions to stabilize the body/spine. Without it, your body will have to depend on other structures to assist in stabilization. If you ask a muscle that typically would only fire with quick motions to begin firing for a majority of the day…it can lead to pain or dysfunction of that muscle group. This is similar to asking a sprinter to participate in a marathon – without the proper training, that sprinter may not be able to adequately adapt. The pelvic floor supports the organs – instead of the strong hammock that should be the pelvic floor muscles, there’s an inside out tent. This can lead to organ prolapse. The muscles making up the pelvic floor assist in helping move out fluid from the legs back to the heart. Without this function, there could be fluid build-up or swelling in the legs. The pelvic floor assists in maintaining bowel and bladder function. Without the proper control of the bladder, you may feel you need to urinate more frequently – or you may notice that you have a hard time making it to the restroom on time. You could feel that you’re not emptying your bladder all the way or you leak with sneezing, coughing, jumping, squatting, or running. Or it’s possible that you notice you’ve had some urine leakage you weren’t aware of. Very similar issues occur without proper bowel control – including constipation, difficulty with bowel movements, or having a bowel movement without realizing it. The final function of the pelvic floor is sexual appreciation. It is the ability to have sex or engage in any sexual activity. It is not normal for a woman to have pain with sex, nor is it something any female should have to endure. Also, has been proven in the research that individuals who have a strong pelvic floor have better sex overall.

 

So, what if any of these (not exhaustive examples) of dysfunction of the pelvic floor applies to you? Pelvic Floor Physical Therapy can help. It can assist in relaxing the pelvic floor, decreasing pelvic pain, reducing an organ prolapse by at least 1 grade, decrease or eliminate urine leakage, and improve overall quality of life. If you’re reading this blog thinking about yourself – reach out! I’m happy to answer any questions or assist in finding a Pelvic Floor therapist in your state!

 

-Dr. Tristan Faile

 

PBFR Monthly Membership

Vertex PT Specialists is proud to offer Personalized Blood Flow Restriction (PBFR) via the FDA approved Delfi Personalized Tourniquet System (PTS).

We currently have 5 spots available for PBFR monthly memberships at a rate of $50/month.

Your monthly membership includes:

  • Screening to ensure you are appropriate and have no contraindications to use the Delfi PTS
  • Training on operating the Delfi PTS for upper and lower extremity exercise protocols
  • Training on the evidenced based strength, endurance, and cell swelling PBFR protocols

Upon completion of initial training, your membership will allow you to come in and use the Delfi PTS 3 days per week during regular office hours at our Millwood location only.  Please note, PBFR is already included as part of the rehabilitation process, therefore you do not have to be an established patient to sign up for a membership.

In addition to being a powerful tool to improve and enhance the recovery of our patients, the Delfi PTS is also scientifically proven to increase strength and hypertrophy at very light loads (20% of 1 rep max).  This means that an athlete can make considerable gains without causing muscle damage, making the PTS perfect to use as a supplementary tool and/or on rest days.  More info on this topic can be found at vertexpt.com/pbfr.  For well-trained endurance athletes, PBFR has been shown to increase VO2 max by 11.6% in as little as 2 weeks!

If you’d like to sign up for a membership, or need more information on personalized blood flow restriction, please email us at info@vertexpt.com or call us at 803.851.3506.

 

 

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TMJ Dysfunction Case Study

Temporomandibular Joint Dysfunction Case Study

14 year old male baseball player presented to Vertex with a chief complaint of left sided jaw pain that occurred after being hit on the chin by a ground ball at practice.  Additionally, he complains of his jaw “locking” and “clicking” with end range mouth opening, specifically while eating.

Clinical Exam:

Palpable Click with opening and 25mm left mandibular deviation (ipsilateral)

Apical breathing pattern

Decreased left upper cervical rotation (+ left cervical flexion rotation test)

Tenderness to palpation left masseter and left medial pterygoid with patient reported familiar pain

 

Treatment:

HVLAT directed to bilateral C1/C2 with + cavitations.

Upper and mid thoracic HVLAT

DN with electrical stimulation to left masseter, medial pterygoid, and joint capsule.

Manual TMJ distraction

Home Exercise Program:

Cervical SNAGs, cervical retraction with over-pressure applied to maxilla, postural resets, diaphragmatic breathing

Patient Education:

Postural considerations; specifically with school and smart phone use consisting of spending less time in forward head posture in order to minimize mandibular retraction.

Result:

Chief complaint of “click” and “locking” resolved within session. 25mm deviation reduced to <5mm.  Patient followed up 6 weeks later and maintained treatment effect.

Biering-Sorensen Test

 

The Biering-Sorensen test is used for evaluating the isometric endurance of the hip and back extensor muscles. It is a great tool for predicting if a patient/client is at risk for nonspecific lower back pain. This can also act as an important training tool before someone begins a program that involves deadlifting. The two things that you will need for this test are a timer and a GHD machine, which can be found in most gyms. Begin by having the person being tested get on the GHD machine in a horizontal prone position with their arms crossed over the chest, chin tucked, and the upper edge of the iliac crest on the pad. Make sure the person contracts their glutes and abdominal muscles to help maintain a neutral spine. Once they are in this full position, start the timer and see how long they can hold it. Stop the timer and end the test if the shoulders drop, they no longer can hold the position, or when 240s (4min) has been reached. Refer to the table below to see what category they fall in.

– Jeff Spraker

 

Males Females
Healthy 198s 197s
Prior Low Back Pain 176s 210s
Current Low Back Pain 163s 177s

 

Demoulin, C., Vanderthommen, M., Duysens, C., & Crielaard, J. M. (2006). Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine73(1), 43-50.

Join Vertex’s 2017 MuckFest Team!

 

Join Vertex and Run with a Purpose

What?       

MuckFest MS, a 5km Obstacle Course Race (OCR) with over 17 obstacles.

Visit www.MuckFestMS.com for more info.

Where?

Concord Speedway

7940 U.S. Hwy 601 South

Concord, NC 28025 (Less than 2 hours from Vertex)

When?

Saturday, May 6, 2017

Why?

The “MS” part of MuckFest MS stands for multiple sclerosis, an unpredictable, often disabling disease of the central nervous system that interrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million worldwide. This is the reason we come together—to rally friends in support of people living with MS in our community.

How Can I Help?

Run, Volunteer, or Donate (or all three!) today.  100% of all donations go directly to the National MS Society, providing research towards treatment, prevention, and a cure for MS.

 

Contact: Dr. Reed Handlery at reed@VertexPT.com

 

You can join or donate by visiting:
main.nationalmssociety.org/goto/Vertex

 

2017 CrossFit Open

Good Luck to all of our friends and patients who are competing in the Open starting this week!