Amy Stein DPT | IPPS : Pelvic Floor Physical Therapy | Pelvic Health Summit

Amy Stein DPT | IPPS : Pelvic Floor Physical Therapy | Pelvic Health Summit


(music) – Welcome back to the
Pelvic Health Summit. I’m here with Amy Stein,
doctor of physical therapy, a leading expert in pelvic
floor dysfunction, pelvic pain. She’s the past President of the International Pelvic Pain Society as well as the author of Heal Pelvic Pain, which is her book. Amy also sees her
patients in her practice, Beyond Basics Physical Therapy, where she treats men, women, and children in her two locations in Manhattan. Welcome. – Thank you. Thank you for having me. This is a great opportunity. – I’m excited to have you here. Let’s hop in. Tell us what is pelvic
health and pelvic pain, from your perspective
as a physical therapist. – Sure. As a physical therapist, we are experts in the musculoskeletal system. We look at the pelvic
floor, at the muscles, the tissues, at the nerves. We do look at the organs, but not in a medical sense. We look to see how they’re
moving, their mobility. We look at the body as whole, as well. Posture can play a role. Different diagnoses can
play a role in pelvic pain, like endometriosis, interstitial cystitis, or painful bladder syndrome, irritable bowel syndrome. All these different things can contribute to pelvic pain, or pelvic pain contributes, vice versa. They can contribute to each other. It’s really important for
someone that has pelvic pain to have a team, a
multidisciplinary approach, because typically there is more going on then just one diagnoses. – Awesome. Can you tell us a little bit where physical therapists fit into that team and who else might be on
the team of practitioners that can support a
patient with pelvic pain? – Yes. Typically, what we see is that we have a physician that is
familiar with pelvic pain, because not all physicians are, including gynecologists. They’re not trained as well
in the musculoskeletal system as physiatrists or physical therapists. Definitely having that
expertise is important, of a physician. Mental health provider
can be extremely helpful for some that are feeling
anxiety and stress. Physical therapist, pelvic
floor physical therapist, is key in the rehab process, because not all physical
therapists treat pelvic pain. That is an important point to know. Not all physical therapists
are trained the same either, to treat pelvic pain. We actually, an interesting
thing that we hear often, is that physical therapy
didn’t work for me, and that could be because the expertise wasn’t quite there with
the physical therapist, or they just weren’t familiar with pelvic health, pelvic floor
dysfunction, to begin with. Then, also other things
like health and wellness, so diet may be an issue
with some patients. Addressing the nutritional component, whether it’s dietician or nutritionist. Again, that is familiar with pelvic pain and the different GI symptoms that can go along with it, as well as the fitness part. Getting yourself moving, making sure you’re doing
some type of exercise, whether it’s walking, swimming, yoga, tai chi, something to get the blood circulating, the body moving, but also not increasing any pain. There’s that fine line and
that’s where the team comes in, because they could help guide you to a program that works best for you, cause everyone’s different. Everyone’s pain is different. One person may do well with yoga. One person may not do well with yoga. One person may be fine walking. One person may prefer to
do the elliptical machine. Really getting to know
the patient is important, and figuring out the
right program for them. – Wow, definitely. I love how you shared that
everyone’s pain is different. That’s so true. Finding a team that works
with you is so important. Can you share a little bit more about a resource where people can find some practitioners? I know you were the President of the International Pelvic Pain Society. Would that be a good place to start, and can you tell us a
little bit more about it? – Sure. The International Pelvic Pain Society is a good place to look
for a practitioner. It’s PelvicPain.org. There are other organizations. The National Vulvodynia Association, the Interstitial Cystitis Association, they have find a provider. For physical therapists, Herman and Wallace Institute and the American Physical
Therapy Association, women’s health section, they have a find a provider as well. It is important to do your homework and to find out exactly what
the practitioner treats. Whether it is a MD, DO, PT, whatever the background of the person is, it’s important to do some research to make sure that they are
familiar with your diagnosis. The International Pelvic Pain Society, it’s near and dear to my heart. It is a non for profit society. It started in 1995 with
a group of gynecologists that were meeting and trying to figure out what is going on here, and why are missing and misdiagnosing, and why are these people still in pain? That was in the 90’s. It was a small group and now
it’s over 800 practitioners, which is so exciting. I’ve seen a lot of growth over the years. We have a scientific
meeting that’s in October. That’s expanded a lot too, cause now we do a cadaver lab for educational purposes. We do a post conference course. It’s really exciting to watch it grow. It is a multi-disciplinary team, so it’s physicians, physical therapists, mental health care providers. It’s a great place to learn about the most updated research in pelvic pain. – Wow, that’s so important and exciting. We’ll link all that information
underneath this video so you can find it within the group. Tell us a little bit more
about the patient journey. When a new patient comes to you, what is their experience like? – The patient journey varies quite a bit, just like their pain
and symptoms can vary. We see patients, fortunately
some fairly quickly, so within three to four,
four to five months, that’s ideal. Typically, we see them after
five to six, seven years, which is, that has been researched that that is the average of how patients are able to find a diagnoses and get treatment. We’re hoping to decrease that number to again, five to six months is an ideal number for when we would like to start seeing patients, because the symptoms
can become more chronic the more they have the symptoms. The positive thing is that even if we see them five to seven years later, we still have had such a positive and profound impact on their symptoms, so regardless of when they come in, we have been able to
help a lot of patients. My practice, actually we’re celebrating our 15 year anniversary–
– Wow, congratulations. – this year, so we’ve
been around for a while. Since the beginning, treating pelvic pain, so we’ve seen the progression of care and the
multi-disciplinary approach. Back to the patient’s
journey, it is varied. Some patients it could be they had a baby and they had a tear and they’re in pain, and the pain hasn’t gone away. Some it could be the
symptoms have cascaded. It started with endometriosis, abdominal pain, pelvic pain, now they have irritable bowel
syndrome, bladder issues. Definitely honing in on
what they’re experiencing is an important part of the journey, and how to help them, and how to direct them to
the right practitioner. We actually see some patients that just come in from the
internet, from my book. Then what we’ll do is
we’ll help diagnose them from a musculoskeletal perspective, and then we’ll refer out to a physician, a urologist, gynecologist,
whoever it may be that they need extra care from. Then, we just help assist them along their healing journey. – Awesome, thank you for sharing that. Tell me a little bit more about the physical exercises that
you’re doing with people. Maybe we can start with a woman, and then we can also go into a man, and what that physical
practice looks like. Also, what they’re doing
in the space with you and then also what they’re doing at home. – Sure. We do see a lot of men in our practice, and that’s an important thing to note because a lot of people think it’s a woman’s issue, but it’s not. We see a lot of men with
nonbacterial prostatitis, so they actually don’t have an infection, but it mimics an infection. Women get similar symptoms. They feel like they have
a UTI or yeast infection, but in the end, the
tests come out negative. They actually have pelvic
floor muscle dysfunction, or nerve issues. The diagnosis and treatment from a physical therapy perspective is we do the evaluation. We look at the body as a whole. We actually look at the patient walking. We look at their posture. We basically look from head to toe to see what could be influencing their pain and their symptoms. We will also assess the musculature, as well as the bony alignment, to see if something’s off. If something is off in the
sacrum, male or female, women do tend to have, it is more common during childbearing to have more issues with
the sacroiliac joint because the joints are actually expanding, allowing to make room for the baby. We do tend to see more
with the childbearing, but we see men and women with potentially a lumbar
issue all the way up the spine, a sacroiliac issue, a tailbone issue. These are the ligaments
that connect in the pelvis. There’s a lot of ’em. This just shows two main ones. Then, the pelvic floor
muscles, which are here. Men and women have the same musculature, it’s just they have different
organs in that area. If you want to see this angle. We look at pretty much everything. The abdominal wall, the muscles
of the lower extremities, as well as the pelvic floor. The pelvic floor portion is both external, the external
area of the pelvic floor, but also the internal muscles. We do assess the muscles internally, similar to a gynecological exam or a urological exam. We also assess what the
patient is doing with, not only the external muscles, like are they tensing cause
they’re in a lot of pain? Are they scrunched up in a ball because they’re in a lot of pain? We see that commonly with
abdominal pain syndrome, so irritable bowel, endometriosis, because the area’s uncomfortable, so they tend to guard. We’re looking for that. We are looking for nerve irritation. We’re also looking to see how the muscles are functioning in the
pelvic floor itself. Are they contracting when
they shouldn’t be contracting? Are they relaxing when
they shouldn’t be relaxing? More so with pain patients, they’re contracting
more, they’re tightening, and they’re guarding because of the pain. We look at how they
work with those muscles. We use biofeedback with some patients, whether it’s with a machine, or just through palpation or a mirror, to show them what is going on with the muscles themselves. – Cool. I haven’t heard about biofeedback before. Can you elaborate? – Sure. Biofeedback is basically just, a lot of people know
biofeedback for headaches, so what’s going on in the muscles of the neck and the jaw area, that’s just one form of biofeedback. There’s also biofeedback
for the pelvic floor. We can actually see if the patient’s tone, so you should have a normal
tone throughout the body, where you’re able to stay upright, but your muscles aren’t going into spasming and you’re in pain. The biofeedback does allow us to see some of what’s going on. In the end, it is the actual feeling of what’s going on in the muscle because biofeedback doesn’t show if the muscle’s physically shortened, whereas with the touch, or palpation, we can actually feel what’s
going on with the muscle. It is a tool that we use. There’s external probes
that you could use, and then there’s also internal sensors that you could use to show
the patient what’s going on. We can use a mirror to show them what’s going on in the pelvic floor area. It’s definitely a helpful tool that we use for our patients, but it’s only one of the
many things that we do. You did ask earlier about a home program. That is very important. That is the first thing that
I go over with patients, because it’s so important for them to do whatever they can at home that will help with their pain and their symptoms. Whether it’s just starting with a gentle breathing exercise, a diaphragmatic breathing, trying to relax the pelvic floor. That is one of the first things that I give pain patients, or any overactive conditions. Gentle stretching they could do at home. My book and my video do go through gentle massages, gentle
stretches, breathing exercises. Those are all things that we will give the patient, usually over time, not all at once, cause it
also can be overwhelming. Then, getting into some
type of exercise routine, whether it’s just walking twice a day for 10 minutes, whether it’s getting in the pool and walking around a pool, using the elliptical, doing a yoga home program. Whatever works for the patient is what we try to implement. – That’s awesome, so very tailored to each individual and their needs. – Yes. – Can you tell us a little bit more about common myths that you’ve seen associated with pelvic pain
and pelvic floor dysfunction? – I mentioned one earlier. That is if they don’t feel like they’re improving with
the physical therapy, or they don’t feel like it’s quite right, then it could be that
that physical therapist doesn’t have as much training, and maybe they need to
get another diagnosis or another diagnosis from a physician. We’ve seen that before, another opinion. That’s one thing that I do want
to stress that to patients. Don’t give up and keep trying, keep looking for the right team, that I mentioned earlier. Then, also, for the pain patients, so there’s two different things that are typically going
on in the pelvic floor. There’s the overactive, or
hypertonic, or increased tone, so almost like the muscle spasm that you get in your neck or your back where the muscles
tighten and it’s painful, and you need to do more massages and a heating pad or a
hot bath or a hot shower. Those are one set of issues that a patient can experience with
pelvic floor dysfunction. The symptoms that we hear a lot with that are abdominopelvic pain, but also bladder, bowel, urgency, frequency, retention, incomplete emptying of the bowel and or bladder, so they feel like they’re always full or something like it
doesn’t feel quite right. They feel uncomfortable,
a lot of pressure. There’s also the sexual dysfunction that comes along with both conditions. For the overactive condition, it’s typically more pain. Sometimes there’s a hypersensitivity. Sometimes there’s a hyposensitivity
with sexual function. Really understanding that there’s a lot that can be going on with pelvic floor dysfunction, because the muscles, if I can grab my model, the muscles connect from
the pubic bone in the front to the tailbone in the back. There’s a lot of muscles here. The muscles surround the urethra, bladder, the anorectal opening, as well as the genital region. Again, it could effect bladder, bowel, sexual function,
and can cause pain. There’s a lot of things that
can be going on in that area. Both for women and women and children too. We actually see bladder and bowel issues, and some pain conditions with children. Then, there’s the other conditions, which is more the
underactive pelvic floor. That’s more the weakness. That is more what people are familiar with because they learn, people say do Kegels, do Kegels, do pelvic floor exercises. For the underactive pelvic floor, which is more leaking with coughing, sneezing, laughing, lifting, jumping, then it’s okay to do Kegels or pelvic floor strengthening exercise. The overactive pelvic floor conditions, which I just went over, Kegels can actually make it worse. That is a key myth or point that, if you’re gonna get anything out of what we’re talking about
in the interview today, then that is important to know, that Kegels can definitely
increase symptoms. It’s shortening the muscle. It’s tightening the muscle more. If you have, if you could picture having a back spasm and you’re doing dead lifts with a 50 pound weight, I don’t do dead lift, so I’m
not sure how much weight. It can make the spasm worse. It’s kind of the same idea. Kegels are a contracting of the muscles, so it can actually make the
overactive conditions worse. That is one myth. Another key point is
not getting constipated. That’s a common thing that
makes the pelvic pain, or abdominopelvic pain condition worse. Learning to control bladder habits, within the comfort of your own home. We tell patients if they’re going every 10 to 15 minutes, to try to decrease that frequency, but if they’re holding it in, that’s also contraindicated. You don’t want to hold it, because then again, you’re
tightening the muscle. You’re tightening or guarding the area. Definitely working with a expert pelvic floor physical therapist is key, because they could teach you all these little tips and little tools that you could apply immediately at home. – Wow, thank you. That was so much amazing information. I’m learning so much. Can you tell us a little bit about patient success stories that you’ve had, to give us a little bit of hope? – Sure. Success stories, there’s a lot. Fortunately. Fortunately, with men and women, there have been a lot of success stories. It’s been, again,
something just like a tear, I shouldn’t say just, but a tear with childbirth, a young dancer that had a hip issue that now has pelvic pain, or bladder frequency urgency, to the young male, Wall Street, lots of stress and anxiety going on, doesn’t feel like he can just go to the bathroom when
there’s a lot of activity, so he’s holding it in. There’s a lot of different things. We see sexual dysfunction, so pain with sexual activity. We see males that can injure, there’s injuries that occur
during sexual activity that people just don’t
want to talk about either. So, that’s another important key, a myth that we should try to get rid of, that it’s okay to talk about all the different diagnoses that we see. Then there’s also the stories of, sorry, I’m jumping a little bit. – No, jump all over the place. – Then there’s also
the stories that we get where they have had irritable bowel and endometriosis and Crohn’s Disease for years and years, and they aren’t having any relief. Then they try physical therapy and although it can’t correct, or although it can’t get rid of the Crohn’s or irritable bowel, it can significantly
reduce their symptoms. That’s a really important point to know, that a good hands on pelvic
floor physical therapist can work on the trigger points, the tight areas, can use that biofeedback to try to retrain the muscles, can give them a home program, and also make them feel empowered, that they can do stuff
on their own at home to help with their symptoms. Stories, I always have
this interesting story. I have a ton of stories. I’m not sure where to start, but some interesting stories. Mom, three kids, came to me more with urgency, frequency, some pain with intercourse
with her husband. That all improved fairly quickly, cause she had come soon
after her third child. During the treatment, and this is way, way back, during the treatment she said, “I don’t know if this is related, “but my orgasms are better
from the treatment.” I said, “Bonus!” Well, as a pelvic floor
physical therapist, at the time when I started, there weren’t a lot of
courses being taught. I was learning a ton from my patients. When she said that to me, I was like, “It makes sense. “All the muscles are connected there, “so good, great, that’s awesome.” Not only were her pain symptoms better, her bladder symptoms better, but also she was having she said the best sexual activity with her husband that she’d ever had. Awesome. – That’s amazing. I think so often when we’re in pain, we can just see to the end of pain. Imagining beyond that, where there’s actually an
improvement from your baseline is super inspiring. – Yes. I’ve had patients where totally fearful of getting pregnant because of their pain, and unsure if they would
be able to get pregnant, and we have many moms out there that we have treated with
one child, multiple children. Those success stories are
really, really warm too, because they didn’t think
they could have a baby, or they were afraid to
because of the pain. Lots of babies out there that we’ve helped along the way with the moms. Our male patients, we’ve again, had the gamut from the young late teens, early 20’s, had a stressful job. We taught them what to do with the bladder issues that were going on, or some say they have a
lot of pain with sitting. We’ll give them cushions. That’s another thing as a pelvic floor PT, we give them cushions for sitting, for the back, for whatever is going on, we can give them suggestions for home or for work. We’ve also had, I think
our oldest patient was 95. – Wow. – She came in on her wheelchair, but she was totally lucid. She kept just, she just said, “I have pain with sitting, “and it’s right in my rectum area.” We were able to help her. We gave her a program to do at home. We showed the nurse what to do at home, to help her with her pain and symptoms. She was totally, after
even just a couple visits, and again, 95 who’s had
this for a couple decades, and we were able to get rid of her pain. We were also able to give her tools and her healthcare provider, the nurse, at home tools that if
the pain did come back, what can you do? That’s a thing that patients have said to me over and over again, that they really appreciate. That they feel like now they could do something about their pain that has been misdiagnosed and mistreated over many
years, sometimes decades. – Super empowering. I know you were saying that obviously, the sooner is better, but even if you’ve been
dealing with pain for years, you can see improvement. I know we have to wrap up. Can you, I could talk to you for hours, there’s so much information here. – I could talk for hours. – Can you tell us where we can find you? Where we can find more information? – Sure. We have a website. BeyondBasicsPhysicalTherapy.com. We have a lot of social media with a lot of good information. We have a blog. Beyond Basis PT Blog. We have a lot of great
information for patients that they could use and learn from. Also, these are both great home tools that go through a home program. Various massage techniques, breathing techniques, gentle stretches, and then also how to get back
into the routine of exercise. It does not replace physical therapy or physician diagnosis or treatment, but it is a way to start
doing stuff at home. Another thing that I have patients do is, or people just in general, if they can’t find a provider, I even tell them, buy my book. It’s on Amazon. Both are on Amazon. Take it to your healthcare provider. Show them that this is
what you think’s going on. If they have any ideas of
where to go or who to go to, that’s another thing, that’s another option for areas that have less providers. – Awesome. Well, thank you so much. – Thank you. Thanks for having me. This has been a wonderful experience. – Thank you so much for joining us. Now I’d like to hear from you. Please share with us one
takeaway from the interview in the comments below. Give us a like, and share this group with someone who you think will benefit. Thank you. (upbeat music)

3 Replies to “Amy Stein DPT | IPPS : Pelvic Floor Physical Therapy | Pelvic Health Summit”

Leave a Reply

Your email address will not be published. Required fields are marked *