Why something so common is taboo in the world of sports

Posted 9/20/23 | 5 min. read

In the world of sports, achieving peak performance is a relentless pursuit. 

Athletes push their bodies to the limit with intense impacts, injuries, sweat and grit.

When you think about sports injuries, a sprained ankle or a torn ACL likely comes to mind. Maybe even a concussion after a hard hit in football, or an injured knee after a hard blow in lacrosse.

The typical injuries one might say.

But have you ever heard of pelvic floor dysfunction (PFD)? If you have, you might not know how much it affects athletes.

It’s a shadowed topic of discussion that tends not to get too much attention because it involves more personal issues to the body.

Pelvic floor dysfunction is a term used to describe symptoms, signs and conditions due to impairments (or limitations) in the pelvic floor muscles.

The true number of people affected is unknown, but PFD is a condition that’s a growing problem among U.S. adults – about 25 million – both women and men.

Pelvic floor dysfunction in athletes is common, occurring in 33% of all female athletes and 50% of those who play high impact sports.* But that does not make it normal. It’s a deeply personal issue for many of us, and for that reason, no one talks about it. 

But what’s the pelvic floor, you might ask?

It’s a group of muscles that sit in a bowl-like shape inside of your pelvis. It goes from your pubic bone to your tailbone and to the side of each hip bone.

It supports your abdominal and reproductive organs, stabilizes your back and hips, assists in sexual function, helps you empty your bowel/bladder and stops you from leaking urine, gas or bowel matter.

We’re still not done.

It also responds to changes in your intra-abdominal pressure which occurs with lifting, jumping, running, coughing, sneezing, breathing, etc.

So, your pelvic area is a lot more than just the bone structure.

It carries out many of your daily functions and is a supporter of some of your major organs.

Common symptoms of PFD

Pelvic floor dysfunction can display itself in many ways, and oftentimes people don’t realize they’re suffering from it.

Or, people may experience pain or other issues but won’t mention anything because of feelings of shame or embarrassment. In fact, 92% of female athletes never report their symptoms of PFD.*

For example, do you leak when you run? Approximately 48.58% of female adolescent athletes leak.**

Hunch over in pain or feel like you’re not completely emptying when taking a number two?

Cringe in discomfort rather than sigh in ecstasy from intimacy?

If so, it could mean that you suffer from pelvic floor dysfunction.

Some common symptoms of PFD are:

• Pelvic, low back, abdominal or lower extremity pain
• Urinary urgency, frequency or incontinence
• Fecal incontinence or gas
• Constipation
• Pelvic heaviness or bulging (“tampon falling out feeling”)
• Difficulty emptying bowel or bladder (having to splint or strain)
• Sexual dysfunction including pain and performance issues
• Hernias
• Muscle spasms in the abdomen

And, it’s important to note that none of this normal or anything you have to live with forever.

Common myths

Alright, you get a point for every myth about pelvic health you’ve heard before.

Here are some of the common misconceptions:

• The pelvic floor works in a vacuum.
• Kegels are the solution to incontinence and leakage.
• It’s normal to pee your pants as long as it’s only a little.
• You can only have pelvic floor problems if you have been pregnant or had a baby.
• You can only have pelvic floor problems if you’re a female.

If you haven’t caught on yet, none of these are true.

These myths also exist in the world of sports, and it’s time to shine a light on the pelvic health of athletes.

Considerations for athletic trainers – What to look out for

There’s a lot of reasons why athletes don’t speak up about the symptoms they experience, especially issues or pain related to pelvic health. 

One of the biggest reasons is they might think nobody else on their team is dealing with the same thing.

Or, they might think they will have to sit the bench because of their pain. 

They might think they can’t talk to their coach or athletic trainer about what’s going on either because, let’s face it, it can be awkward.

Imagine having to tell your athletic trainer the reason why you have to use the bathroom so much.

If you’re a female, try explaining to your male coach that you have to sit out of practice during menstruation because of the pain or inability to insert a tampon. 

This is when silence seems like a lesser evil than pain, doesn’t it?

But this is where the expertise of athletic trainers come in.

Athletic trainers play a crucial role in the health and performance of athletes. While they are well-versed in addressing musculoskeletal issues, they’re also vigilant about athletes’ pelvic health.

So if you’re an athlete, your trainers should be keeping an eye on if you:

• Take frequent trips to the bathroom 
• Avoid water before or during practice
• Are crossing your legs, keeping your hands at your private parts or want to sit down following a landing or sprint
• Avoid sitting
• Have a history of lower extremity injuries that may impact force absorption
• Experience low back, hip or pelvic girdle pain
• Participate in high durations of practice
• Avoid participating in sport during menstruation

And while the sports population is presumed to be ever fit and healthy, this is not always the case.

Pelvic floor dysfunction can affect any athlete, in any sport and in all ages and genders.  

It’s worth noting, though, that pelvic floor dysfunction is more commonly seen in gymnastics, volleyball, cheerleading and even hockey. Anything that involves repetitive high impact.

Strain from jumping, running and even weightlifting can put pressure on the pelvic floor muscles over time, making them ineffective at managing the physical load on the body.

Risk factors

While further research is needed, there are some common reasons why athletes develop pelvic health dysfunction - especially at a young age. 

The range is so wide, though, that it can be hard for athletic trainers or other health care specialists to determine how and when symptoms began. 

Some common reasons athletes may develop pelvic floor dysfunction: 

• Take oral contraceptives
• Have chronic constipation 
• Take caffeinated or acidic supplements that can affect their bladder
• Have had a lower extremity injury impacting absorption or mobility through the foot, ankle, knee or hip (such as an ankle sprain or ACL repair)
• Play a high impact sport
• Have poor abdominal bracing strategies
• Have had a tailbone or lower back injury
• Practice more than 7.5 or 8 hours a week, especially in pubescent years
• Have a history of pregnancy or pregnancy loss

As always, athletic trainers should be mindful of their athletes’ medical history while they’re in season. 

They should also try to note if other athletes are having the same symptoms but are hitting a dead end with their diagnosis.

A simple conversation can help someone open up more to what they’re going through and get to the bottom of what’s happening behind the scenes.

Building trust is the first step in an honest conversation.

Breaking the silence

Athletes are celebrated for their strength, determination and prowess in various sports.

Now they need to be touted for their courage, too.

Athletes may be scared to discuss the symptoms and issues they’re having, but finding someone who will listen and give them the confidence they need to keep moving forward with their sport is crucial.

If you have pain with inserting a tampon or problems with your menstrual cycle, talk to someone. 

Pain with sexual intercourse? Talk to someone.

If you have frequent pain in your hips or lower back, talk to someone.

If you suffer from incontinence and are embarrassed to tell someone that you “pee your pants,” talk to someone.

Don’t suffer in silence, decrease your physical activity or stop playing your sport because of pelvic floor dysfunction. Proper education and care will help.

Treatment

The first step before receiving any treatment should be having the confidence to… you guessed it, talk to someone. 

Bring the topic out in the open so you can find the best course of treatment for you.

If you start with your athletic trainer or primary care physician, they might recommend physical therapy.

Physical therapy can be an effective way to help with pelvic floor dysfunction.

Pelvic health physical therapy can look something like this:

• Strengthening of the weak pelvic, hip or abdominal muscles
• Coordination training for the pressure system such as your diaphragm, abdominal and pelvic floor muscles
• Movement re-training for sport-specific activity
• Patient education on posture, diet, pain science, etc.

There are more avenues of treatment, but these are the most commonly seen in athletes or patients with pelvic health dysfunction.

Proper pelvic health can enhance performance. Poor pelvic health in an athlete is the equivalent of a serious injury, like a torn ACL or sprained ankle.

Let’s step out of the dark and shine a light on pelvic health. Start the conversation today.

If you or someone you know are experiencing pelvic floor dysfunction symptoms, we can help.

You can quickly find a center near you or request an appointment to work with one of our experts.

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477953/ 
** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931053/   

When a ‘bump on the head’ requires comprehensive care

Originally posted on 2/9/2017; updated 8/18/2023 to include new data and information. 

As the start of another school year gets closer and the air turns crisper, fall sports enthusiasts are gearing up for another exciting season of football, soccer and other physically demanding activities. 

While high school sports provide countless opportunities for teamwork, skill development and competition, they also come with one particular downside: the risk of concussions.  

Yikes. 

Concussions can also happen outside the world of sports. Car accidents, slipping on ice, an elbow to the head or luggage falling out of the overhead bin are just a few out of a thousand other ways to get a concussion. 

It’s only somewhat avoidable, really. 

They can happen anytime and anywhere.

Whether it’s a less intense trauma or a severe trauma, the fact is any impact to the head, neck or body has the potential to cause a concussion.

The nature of concussions

It’s important to know what a concussion is and how it can impact your life if you’re suffering from one.

They can be quite the headache, literally.

Concussions are a type of brain injury resulting from a forceful blow to the head or body that transmits a force to the brain that leads to a temporary change in the way it functions.

This sudden movement can cause microscopic stretching and sheering forces to the brain.

What makes a concussion even more complicated is its invisible nature.

Unlike a cut or a broken bone where you can see physical trauma, a concussion can often go unseen until mild to severe symptoms begin.

Even if it just seems like a “bump on the head,” symptoms can vary depending on the impact to the head or neck area.

So, concussions are pretty serious and shouldn’t be taken lightly.

This is your brain we’re talking about, after all. This injury needs a lot of attention and care because your brain performs all of your daily functions.

Signs and symptoms

Recognizing the common concussion symptoms is vital for prompt treatment and safety. Athletes, coaches, parents, friends, family or other loved ones should be aware of indicators such as:

• Confusion
• Headaches
• Dizziness
• Difficulty thinking
• Nausea
• Blurred or double vision
• Sensitivity to light or sound
• Changes in sleep patterns
• Increased anxiety and irritability
• Ringing in the ears

Other severe signs can include:

• Amnesia surrounding the traumatic event
• Dizziness, or “seeing stars”
• Slurred speech
• Temporary loss of consciousness
• Delayed response to questions

Symptoms can begin right away, while others may not appear for hours or days after the injury. 

Any suspected concussion should be taken seriously. Athletes should be removed from play and evaluated by a medical professional, even if they don’t display symptoms right away. 

The same goes for anyone who took a blow to the head or the neck. Even if no symptoms are present, you should be seen by a medical professional to determine the severity of the trauma and if further treatment is needed.

Mindfulness

Imagine this. 

You open the door of your car and step out, but you drop something, like your car keys. 

You bend over to pick them up and then stand back up. 

BAM!

You crank your head on the hard car door. You might have just given yourself a concussion. 

You see? Concussions are usually unavoidable.

You might scold yourself after the fact and say, “How could I have let this happen to me?”, but sometimes they just happen. 

However, bringing awareness and education to this subject can help people be safer and recognize when they’re in a possible situation of getting a concussion. 

For athletes, wearing protective equipment can lend a false sense in thinking it can prevent a concussion.

Football, soccer, lacrosse and field hockey players should be wearing helmets, mouth guards and other appropriate head gear.

Not being safe in your sport can lead to skull and jaw fractures, or even cerebral bleeding. However, the amount of force to the head does not change the likelihood of a concussion.

Returning to sports and life

One of the most critical aspects of managing concussions in the athletic world is the return-to-play process.

In the past, the primary treatment for a concussion was total rest. You’d lie in bed in a dark room, avoiding light exposure from things like the television or a smart device. Also referred to as “cocooning,” this was a one-stop-shop treatment approach for anyone and everyone who suffered a concussion.  

But concussion symptoms and recovery time are unique for every person.

More recent findings show that after an initial 24-48 hours of rest, a combination of carefully and individually prescribed physical and mental activity is better than total rest. That doesn’t mean, though, that you should go full force into your previous activities.

Depending on your symptoms, some health care providers and physical therapists may recommend easing back into activity and some may recommend a longer treatment plan.

Also, sub-symptom exertion training is recommended to start 2-10 days after injury.

This training is designed specifically based on a specialty validated concussion exertion exam.

In basic terms, it’s a way to set a safe exercise program to help gradually return you to pre-concussion activity levels.

Once you get the “green light” from your health care provider to return to a full contact practice, that doesn’t mean you stop monitoring your symptoms. It’s crucial for an athlete’s parents and coach to watch for concussion symptoms each day after the athlete returns to make sure no further damage is done to the brain. 

Returning to normal, everyday life

So, you’re ready to get back into the swing of things. 

You feel good, but you still have some small, lingering symptoms after resting and taking it easy. You feel as if you don’t need any extra care or don’t want to take your home treatment a step further.

Does this mean you’re good to return to normal? 

Not really. 

Despite how or when someone sustained a concussion, the current recommendation to help is an active treatment and rehabilitation program. 

Through some of our treatments, we can help with: 

• Visual exercises, which helps increase visual clarity due to the eyes working inefficiently. This may involve doing eye exercises or complicated tasks of watching a busy scene with many moving items.
• Vestibular rehabilitation, which is used when the inner ears are involved. When you get a concussion, your equilibrium could be thrown off, so vestibular treatment helps eliminate dizziness and issues with balance.
• Neck treatments can address any neck pain or the many symptoms that can impact the neck after a concussion. Sometimes after a blow to the neck, the nerves in the neck stop communicating well with the brain, which can lead to fogginess, unbalance, headaches, etc.

One of the most important parts of getting back to normal is getting a thorough exam to determine the actual cause of your persistent symptoms.

Our concussion rehabilitation clinicians will do an assessment to develop a care plan unique to each person and case to get you back into everyday life.

Takeaways

Concussions are serious and can lead to persistent symptoms if not treated and examined properly by a health care provider.

But hey, there was just a ton of information thrown at you, so let’s break it down.

Here are some of the highlights of what you should do if you have or think you might have a concussion:

• Be vigilant about any post-injury symptoms. Early recognition of concussion can lead to faster recovery, even if it just seems like a small headache.
• Playing through a concussion increases the likelihood of having persistent symptoms.
• Knowing what to look for with symptoms and behaviors can help protect against a delayed recovery.
• If you think you or someone you know may have a concussion, speak out and remove yourself from the activity. Then, take it easy with relative rest for 24-48 hours. After this time, ease into gradual return to symptom-modulated activity and talk to your health care provider about physical therapy.
• The newly released international Concussion Consensus Statement recommends starting a specialized physical therapy program if you have dizziness, headache or neck pain 10 days after injury.

If you or someone you know have any lingering symptoms, we can help.

You can quickly find a center near you or request an appointment to work with one of our experts.

A how-to guide to stay healthy during the summer heat

Originally written on 7/20/2017 by NovaCare Rehabilitation and Select Physical Therapy. Updated 7/27/2023 to include new data and information.

The dog days of summer are upon us. You know what kind of days we’re talking about.

Hot.

Humid.

Air so thick you have to carve it with a knife.

And this summer heat is peaking just in time for fall pre-season sports training for high school and collegiate athletes.

Oof!

The good news is that you don’t have to stop exercising outside just because of the sweltering temperatures, but you do have to prepare, respect the outside elements and follow some easy tips.

Acclimate before you activate

As much as everyone wants to enjoy the sunshine, be outside and get back on the field of play, athletes of all ages and activity levels must prepare themselves to train in the heat.

Prior to the beginning of summer practices, athletes must go through what is called acclimatization.

Acclimatization is the process where the body adapts to heat in order to work most efficiently. To begin this process, an athlete must begin training in the “hotter” temperatures.

However, this must be done in a safe manner.

Meaning, don’t train in peak heat conditions. 

Beat the heat 

To help you acclimate while also enjoying your favorite summer sports and activities, here are a few tips.

• When possible, avoid outdoor exercise between the hours of 11 a.m. to 3 p.m. as that is considered the hottest part of the day. Limit high-intensity workouts to early morning or early evening hours when the sun’s radiation is minimal.
  • Activity during the hottest parts of the day will increase heat gain through the skin from the sun and decrease heat loss through the skin. This means the body is unable to disperse heat as fast as the body heats up — so choose your outdoor time wisely.
• Stay hydrated by drinking a glass or two of water before you head outside. If possible, carry a bottle of water or a hydration pack with you and take a drink every 15 minutes, even if you’re not thirsty.
  • Pay attention to the color of your urine. Pale and clear means you’re well hydrated; if it’s dark, you need to drink more fluids. Depending on your age and gender, athletes should be drinking a minimum of 11–16 cups of fluid per day.
• Water is usually the best option, but adding a sports drink into the mix for electrolytes can also help.
  • Proper nutrition supports sports performance and recovery. Fruits are a great source of carbs and extra hydration, so eat up.
  • Wear clothing that’s light in color, lightweight and has vents or mesh. Microfiber polyesters and cotton blends are good examples. The lighter colors will help reflect heat and cotton material will help with the evaporation of sweat.

Water sports – A remedy for being active in the heat

The summer heat means that many are headed to the nearest body of water with kayaks, surf boards and paddle boards.

Water sports are an excellent way to get in exercise and challenge our upper and lower body strength and balance.

Make a big splash

Here are a few tips to keep in mind for the water sports novice and seasoned pro alike.

• Always get in an adequate warm-up. While the temperatures may be warm, it doesn’t mean our muscles are. Dynamic stretches, like trunk twists, walking lunges and arm and leg swings, are a great way to get your blood circulating and muscles warm before hitting the water.
• Since water sports are heavily dependent on our shoulders, it’s important to strengthen those muscles to avoid repetitive stresses and impingements. Try arm circles, cross-arm stretches and wall slide exercises.
• Don’t forget the rotational mobility of your mid-back. Kayaking and other paddle sports involve a lot of thoracic spine rotation in order to propel you forward. Make sure you’re able to twist from side to side without pain.
• Last but not least is balance. Balance is an important part of maintaining an upright position while on the water. Practice standing on one leg at home. Once you’ve mastered that, try standing on a foam cushion and closing your eyes. Make sure you have someone or something nearby to hold onto in case you lose your balance.

When to call it a day

Sometimes, even when you have the best of intentions, you simply can’t beat the heat. Sometimes the heat beats you.

Picture this.

You're sweating. Your skin feels moist and flushed. You've got a headache. You feel dizzy, nauseous and exhausted, but your body temperature is near normal.

You may not realize it, but you're suffering from heat exhaustion.

This typically occurs as a result of excessive heat and dehydration. Blood flow to the skin increases, causing blood flow to the vital organs to decrease. The outcome is a form of mild shock, which can lead to heat stroke if left untreated.

Heat exhaustion vs. heat stroke

Heat illnesses are serious business.

They need to be taken seriously and treated quickly.

The main difference between heat exhaustion and heat stroke is core body temperature and symptoms. However, the common thread is that your body overheats and can’t cool itself down.

The telltale signs of heat exhaustion are:

• Body temperate of 101-104 F
• Pale skin
• Nausea
• Light-headedness/dizziness
• Weakness/fatigue
• Muscle cramping
• Rapid breathing/heart rate

If you suspect you or someone you know may have heat stroke, move to a cooler environment, preferably an air conditioned room. Loosen your clothing and remove any additional layers. Apply cool, wet cloths or sit in a cool bath. Take small sips of water to rehydrate.

And while heat exhaustion is quite serious, heat stroke is life threatening and requires immediate medical attention.

With heat stroke, symptoms can include:

• Body temperature above 104 F
• Dry, red skin
• Inability to sweat
• Confusion/altered mental status
• Dizziness or fainting
• Slurred speech

If someone you know is suffering from heat stroke, call 911 or go to a hospital immediately. Move the person to a cooler place, and immerse them in a cool bath or wrap wet sheets around their body and fan it. Make sure the person lies down, and watch for breathing difficulties.

Don't give the victim anything to eat or drink if they are vomiting or their level of consciousness changes.

Heat exhaustion and heat stroke can lead to death, so every moment counts.

The most important thing is to stay well-hydrated, make sure that your body can get rid of extra heat and be sensible about exertion in hot, humid weather. The hotter and more humid it is, the harder it will be for you to get rid of excess heat.

Tip: Pay particular attention to the heat index—a measure that combines air temperature and relative humidity to determine how hot it actually feels outside. The higher the heat index, the more caution you should take when exercising outside.

 

Stay cool and have fun

The summer season provides so many great ways to be outside, stay active and have plenty of fun. Keeping these tips in mind and putting safety first will ensure you’re reaching your activity goals.

And, if you’re outside or in the water having all that fun and happen to suffer an injury, a physical therapist can provide the necessary treatment to help you heal. Request an appointment to work with one of our movement experts near you.

Have a great summer!

Beat repetitive strain injury and get back in tune

Originally written on 6/9/2021 by: Rob McClellan, OTR/L, CHT. Updated 6/12/2023 to include new data and information. | 5 min. read

For many of us, our hands, wrists, arms, elbows and shoulders – or upper extremity – are an indispensable part of our everyday lives.

From laptop work to playing ball with the kids, from cooking a meal to swinging a golf club, upper extremity injuries and conditions will put a kink in your routine.

But for a performing artist, the overall health and well-being of their upper extremity is critical.

Consider an orchestra musician who plays the violin. The violin rests on the collarbone, cradled by the neck and supported by the left hand and shoulder. The right hand – all fingers placed correctly and grip strength considered – holds the bow. One stroke across the strings and bravo – a gorgeous sound erupts.

So what happens then if that shoulder is overly sore, or that right hand’s thumb or forefinger injured?

Cue the theme music from “Jaws,” folks.

Why are performing artists prone to injury?

Playing a musical instrument is emotionally, mentally and physically demanding.

In a musicians’ lifetime, up to 93% will experience musculoskeletal symptoms – pain, weakness, fatigue, aching and stiffness – when making music.

In short, musicians are at risk for career-ending injuries in the neck, shoulder, wrist and hand.

Musicians face unique challenges related to practice and rehearsal. Risk can occur when strenuous playing patterns are demanded in large segments of time, without rest or breaks.

Additional injury risk factors include:

• Inadequate physical conditioning
• Poor posture
• Abrupt increase in play time and patterns
• Poor techniques or a change in the instrument

Symptoms, whether intermittent or persistent, are seen most often when learning to play over the age of 50. And, in professional musicians, symptoms can present when increasing the complexity or time spent playing.

These symptoms are typically from repetitive strain injuries.

What are repetitive strain injuries?

A repetitive strain injury is an overuse injury. That is, you can hurt your body – namely your muscles, tendons or nerves – from repeating motion constantly.
For musicians, repetitive strain injuries are common and usually affect their upper extremity.

Common symptoms include:

• Pain
• Swelling
• Muscle cramping/burning
• Tremors/spasms
• Inability to control motion
• Numbness/tingling
• Stuck, catching or locking joints
• Inability to straighten fingers

Yet, repetitive strain injuries can be treated and prevented.

Self-care vs. professional therapy

Repetitive strain injury self-care does exist. From the RICE method – Rest, Ice, Compression, Elevation – to over-the-counter medical fixes, you may be saying, “Nah, I’ve got this on my own.”

However, self-care is a short-term fix that can lead to more harm than good. For the long- and short-term, the clear solution is a hand therapist.

Hand therapists are specially trained in the upper extremity and can determine the nature of your injury and work with you one-on-one.

After all, you wouldn’t want to jeopardize the long-term use of your playing “tools.”

Can hand therapy help performing artists?

Simply put, yes.

Hand therapy for musicians, or performing arts therapy, can help you heal properly.

And, hand therapists “arm” you (did you see what we did there?!) with the strategies necessary to not only heal from injury, but help you perform activities with less pain and chance for re-injury.

Our hand therapists have the skills needed to evaluate and identify abnormal sensation, poor posture and other causes of symptoms.

They identify risk factors and develop a rehabilitation program specific to your instrument, goals and play demand.

Throughout care, the hand therapist works with you to develop a return to normal play schedule that is timed incrementally and provides symptom management techniques during rest and after play.

We’ve come to the coda

As we come to our musical outro, we leave you with this: Hand therapists identify the root cause of injury, provide a whole-body approach to care and work in collaboration with music instructors to ensure continuity with proper technique and posture.

Education and early intervention is key, as early treatment leads to better outcomes.

So, don’t delay.

If you or a loved one are a musician and suffering from pain or discomfort while playing, request an appointment today and experience the power of hand therapy. Our certified hand therapists will help you get back to doing what you love – creating beautiful music.

Why pelvic health is important for oncology rehabilitation

While the pelvic floor is a mystery to many, it is important to your long-term health and quality of life.

But for those who have received a cancer diagnosis, the type of cancer and treatment regime can affect pelvic floor function.

But first, what is the pelvic floor?

The pelvic floor is a group of muscles, ligaments and tissue that form a sling to support the pelvic organs and spine. These muscles also help with control and coordination of bowel, bladder and sexual function.

Muscle control — the ability to squeeze and relax pelvic floor muscles — is key here.

Pelvic floor muscles contract to prevent bowel and bladder leakage. The muscles also relax to allow the bladder to empty completely when you void, empty the bowel without straining and have intimacy or pelvic exams without pain.

Pelvic floor muscles also support reproduction.

In women, pelvic floor muscles are the muscles that:

• Contract with orgasm.
• Support the uterus.
• Promote circulation of blood and lymphatic fluids

With men, pelvic floor muscles help to:

• Develop and maintain an erection.
• Support the prostate.
• Ejaculate during sex.
• Promote circulation of blood and lymphatic fluids.
• Prevent incontinence, or increased urgency.

Now, put it all together and pelvic floor dysfunction (PFD) describes bowel and bladder disorders, sexual disorders and chronic pelvic pain syndromes that affect the pelvic floor muscles’ inability to contract or relax appropriately.

What are common symptoms of PFD?

Unfortunately, pelvic health issues may go unrecognized and untreated. Indeed, people are often hesitant to share their concerns and, when they finally do, often wait several weeks or months to make an appointment with their doctor.

Common symptoms of PFD may include:

• Urgent or frequent urination or bowel movements. You may feel like you have to go right away or all the time. You may also fear leaving your home so that you can stay close to the bathroom. 
• Hesitancy or painful urination. You may also feel you need to ‘force it out’ to go or you might stop and start many times.
• Constipation, or pain during your bowel movements. Up to half of people suffering from long-term constipation may have pelvic health dysfunction.
• Straining or pushing really hard to pass a bowel movement. You may also find yourself changing positions on the toilet.
• Leaking stool or urine (incontinence).
• Feeling pain in your lower back or hips with no other cause.
• Feeling ongoing pain in your pelvic region, genitals, or rectum.

If you’re experiencing any of these symptoms, it can feel as though your quality of life has diminished.

But, there’s no need to accept this as your new normal.

How cancer and the pelvic floor can go hand-in-hand.

Many people with cancer simply aren’t told that treatment side effects can impact their pelvic floor. They may believe that their symptoms are a normal part of aging or are so grateful to be cancer-free that they don’t put two and two together.

Women with gynecological cancers, including uterine (endometrial), ovarian, cervical, vulvar and vaginal cancer, men with prostate and testicular cancer and anyone with bladder, rectal or anal cancer are most at risk for experiencing problems with PFD.

For example, radiation for gynecological cancers, which are located in the pelvic region, may cause fibrosis, a hardening of tissue that may narrow or shorten the vaginal canal. This may cause generalized pelvic pain and pain with intercourse.

Men who have radiation therapy for prostate cancer treatment, or who undergo a prostatectomy (the surgical removal of the prostate), may develop incontinence and/or erectile dysfunction.

Several types of surgery may also affect the pelvic floor, including:

• Tumor debulking to remove as much of a cancerous tumor as possible. 
• Hysterectomy to remove the uterus.
• Salpingo-oophorectomy to remove the ovaries and fallopian tubes.

Regardless of what caused your PFD, pelvic health therapy and cancer rehabilitation can help you feel your best.

How can pelvic health therapy help?

A pelvic floor specialist can help to develop a care plan to achieve the right mix of coordination, control and strength in the pelvic floor muscles.

Pelvic health therapy, whether it’s physical therapy or occupational therapy, aims to restore function and reduce pain. A pelvic health therapist will give you an assessment of your muscle function, posture, breathing patterns, strength and flexibility of your spine, hip and abdominals to determine contributing factors of any pelvic health issues.

Every person is different, so pelvic health therapy will look different for everyone. Some interventions you might experience can include:

• Therapeutic manual (or hands-on) therapy. 
  • Trigger point release: Trigger points are sensitive areas in the muscle or connective tissue that are painful when pressed. Trigger points may cause pain in the pelvic area. Trigger point release is a hands-on technique to relieve chronic pain.
  • Dry needling: This form of treatment uses a dry needle - a needle without medicine - to deactivate trigger points in the muscle, help reduce scar tissue and promote healing in the body. Dry needling is not acupuncture.
  • Connective or scar tissue mobilization: This form of manual therapy aims to break up fibrosis related to cancer treatment that may be causing stiffness, desensitization or pain. Besides gently breaking up the tissue, this type of hands-on therapy helps to stretch and relax surrounding muscles building essential flexibility.
  • Myofascial release: This treatment style helps to lengthen and reduce tension in the connective tissue.
• Biofeedback, which is commonly used to retrain pelvic floor muscles. This pain-free procedure uses special sensors to monitor pelvic floor muscles as you try to contract and relax them. The sensors provide feedback to you and your therapist about which specific muscles you need to strengthen to gain sensitivity or improve coordination of pelvic floor muscles.
• Pelvic floor exercises. Your therapist will prescribe exercises to enhance coordination, control and function of the pelvic floor and surrounding muscles like the back, abdominals and hips.

Talk to an oncology and pelvic health specialist today.

If you or someone you love has been impacted by cancer that has led to any sort of pelvic health issues, ReVital Cancer Rehabilitation can help.

Our compassionate clinicians are certified in oncology rehabilitation, and uniquely trained to treat pelvic health issues.

To request an appointment to work with one of our clinical team members or ask us questions about treatment, fill out our short online form. A member of our team will connect with you to confirm your visit.

How the ravages of history launched two profound professions

Posted 4/19/2023

When a doctor recommends occupational therapy (OT), rather than physical therapy (PT), many people don't at first realize there are two kinds of therapies.

It might also not be understood that there's a difference between them, or why a doctor prescribes one over the other.

As therapists, we get this question a lot.

For sure, there's a difference between the therapies and how they're used in healing and recovery. And the story is more interesting than you might imagine…

A short history of modern therapy

Movement and manual therapies can be traced back to ancient Asia, Greece and Rome. Those early practices included massage and hydrotherapy (water therapy).

Fast-forward to modern-day therapy which began in 18th century Sweden with the practice of orthopedics — the medical focus on bones and muscles.

A bit later, Hanrik Ling, developed the Swedish Gymnastic System (also known as the Swedish Movement Cure). His motivation? Having experienced the benefit of improved body movement through his practice of fencing.

At its core, Ling's system emphasized physical conditioning for its ability to improve health and body function. It combined lesser intensive floor-style of gymnastics with manual therapy. Ling's approach brought wide acceptance of his methods.

In 1813, the Swedish government appointed Ling to start the Royal Central Institute of Gymnastics (RCIG).

Ling's system became wider spread as graduates of the RCIG adopted its four core components:

• physical education
• fencing
• massage, physical therapy, physiotherapy
• dance performance

One more fast-forward to the 1920s. The polio epidemic was raging in the United States, especially among children.

During the epidemic, two schools of thought emerged.

One used the practice of immobilizing the limbs of patients believing limb movement and stretching would impair muscle recovery and cause more deformity.

A second practice re-introduced the Roman practice of hydrotherapy. Here therapists used exercise in heated pools to improve a patient's muscle recovery and movement.

Polio paralysis spurred working with patients to improve balance and regain muscle strength. The benefit of warm water was helpful as well as buoyancy – water supports body weight and reduces stress on the joints.

The practice – active polio therapy – helped grow a population of physical therapy (PT) specialists who became instrumental in treating polio paralysis.

These early PTs developed methods for assessing and strengthening muscles – methods still used today.

This piece of history gave the push to establishing the profession of physical therapy in the U.S.

Turning now to the topic of occupational therapy (OT), its history doesn't stretch back as far as those of physical therapy.

But its roots in America began to grown in the late 1800s. This happened primarily as a way to help individuals with mental illness by engaging them in meaningful tasks. Examples include gardening, painting and arts and crafts creation.

The U.S. military also began recognizing the importance of mental health services for wounded and traumatized soldiers to help them resume daily living.

This marked an entry for OT services in the treatment of individuals with mental and physical needs.

Three movements of thought were significant in the development of OT:

1. The consensus that mental health patients should be treated and not put in asylums or prisons.
2. The reemergence of the value of manual occupation and vocational skills over mass production.
3. The rise of thought that working with your hands to produce items of value can be beneficial to a person’s overall health.

During this time, mental health asylums changed to reflect these new ideas. They were ideas of humane rehabilitation and included craft and recreational activities to help patients return to society through their contributions.

These ideas were foundational for developing OT.

About 1915, a social worker named Eleanor Clark Slagle started the first formal OT education program at John Hopkins University in Baltimore.

Dubbed the "mother of occupational therapy" she trained more than 4,000 therapists and promoted OT within the medical community.

While PT and OT therapies were in their infancy on the two sides of the Atlantic, it was America's entry into the Great War in 1917 where they came together.

To summarize some of the above timeframes, it's worth a look at how it happened.

World War I and its transformation of therapy

World War I transformed medicine and contributed to the development of today's scope of medical care. 

The total number of military and civilian casualties in World War I was about 40 million.. and about 23 million wounded military personnel.

– Wikipedia

With the staggering number of wounded worldwide, orthopedics and therapists rapidly advanced to meet the need.

The course of thought was that society had a moral responsibility to help these soldiers return to a normal and purposeful life. Thus, medical specialties developed to fill this need.

The U.S. military hired a small group of women, calling them "reconstruction aides." In their roles they provided treatment by teaching occupation skills to the wounded. 

The initial 18 aides were trained in the latest European physiotherapy practices at the time. Aides were chosen from civilian women and women from the newly established profession of OT.

Both therapy groups expanded rapidly to help the soldiers with recovery.

Of the original 18 Aides, 16 went on to form the American Women's Physical Therapeutic Association. This later became the American Physical Therapy Association with McMillan as president.

– The U.S. World War One Centennial Commission.

The work of these aides brought the military to begin seeing disability in terms of capability in function, and not as limitation.

Their successes were many, helping wounded soldiers learn to walk again and freely move about in their environments.

These early therapists gave training in the use of arm prosthetics, adapted home and work spaces and taught crafts and vocational skills for mental diversion and future employment.

The convergence of today's therapies and practitioners

After WWI, occupational and physical therapy continued to advance.

And with their evolutions came recognition for the benefits they each provided.

But sometimes there was division in which to prescribe: occupational therapy vs physical therapy.

What became clear over time, with advances in the professions, is the benefit to individuals when providing therapies in tandem.

Today's occupational and physical therapists work together in the shared goal of improving an individual’s function through movement.

As individual medical treatments, the therapies, when used together, can have profound results.

Because of this they are recognized as separate but symbiotic professions.

Similarities include:

Working in a variety of settings

• Schools
• Outpatient rehabilitation centers
• Home health agencies
• Hospitals
• Nursing homes

Training in key disciplines

• Science
• Anatomy
• Kinesiology

Using similar therapy techniques

• Soft tissue mobilization
• Functional activities
• Strengthening
• Stretching
• Pain relief

Opposites attract, even in medicine

Even with similarities between the two professions, there are also key differences.

Physical therapy focuses on improving movement, flexibility and mobility. This includes improving physical motion required for a task.

Physical therapy has a unique approach to mobility – movement and muscle balance. It uses prescribed treatment techniques to maximize function, capacity and performance.

PTs work with patients before and after surgery to build strength and kick-start healing. Therapy uses movement to reduce pain, recover from an injury and promote balance to reduce the risk of falls.

The occupational therapy profession has a different focus.

That focus is on functional ability – the ability of an individual to do activities, work and tasks that are normally performed in everyday living and occupation.

That focus gives occupational therapy its name.

Occupation is defined as an activity that is meaningful and purposeful to the individual. It can include basic activities such as dressing, bathing or fixing a meal.

It can also include specific activities which are unique to the individual.

For example, you may be a high school teacher, home gardener, pianist or an electrician. Each occupation requires a unique set of activities. If those activities are compromised by illness or injury, OTs can help.

Your therapist will assess your current function and how to improve your ability to perform a task or modify it to help you complete it.

Now that you know more about the differences between OT and PT, should you need therapy you'll be able to spot the differences in what your therapist recommends.

Of course, it all depends on your condition, your needs, and personal goals.

But thanks to a long history of the disciplines, and more than a century of experience since WWI, PTs and OTs are specialists in your care.

Our job is to help get you back to enjoying the activities that matter to you.

If you or someone in your family might benefit from our therapies, request an appointment with us. We're here to help.

Updated on 3/17/23: published at an earlier date and updated with new information.

Sports medicine’s health care specialists on and off the field

You’ve seen them hustling across the football field or crouching beside a player on the sideline whose face is twisted in pain.

They don’t wear the black and white stripes of the referee, but their breed is just as easy to spot. And their presence on the field can be just as critical as a game-changing field goal, free throw or hat trick.

Enter the athletic trainer.

Often sporting khaki pants, a fanny pack and a polo or sports shirt in team colors, athletic trainers are recognizable in how they look and, more importantly, for what they do.

But if in your mind’s eye you picture an NFL or NBA game, it might surprise you to know the diverse places where athletic trainers work and the scope of work.

While most often associated with sports, athletic trainers are vital practitioners of medical care in many settings on and off the playing field, including the workplace and a few places that might surprise you.

Let’s dive in for a deeper look at these health care specialists.

Partners in injury and injury prevention

No matter the type of athletics, athletic trainers are at the center of a sports medical team – individuals trained in athletic health care.

The athletic trainer is generally first on the playing surface when a player goes down. They have precious little time to do an initial assessment to determine the type and severity of injury or medical emergency. In an emergency, they are the ones to signal for the team physicians and medics to come on the playing area.

For those on the sidelines or in the bleachers, whether game time or practice, athletic trainers provide reassurance in times of injury.

After all, injuries happen.

And if you’re an athlete, a weekend warrior or you have a physically demanding job, you may have more chance of injury than someone who’s not as active.

From athletic injury to onsite emergency care

Though it’s not something we like to think about when suiting up for a game or packing the SUV for a tailgate, medical emergencies can and do happen in any setting.

As part of a sports medicine team, an athletic trainer will know first aid, CPR and automated external defibrillator use (AED).

When NFL safety Damar Hamlin suffered cardiac arrest and collapsed on the field, CPR and AED were administered on the spot.

Emergency treatment lasted 20 minutes before Hamlin could be moved. The quick medical treatment put a spotlight on just how valuable athletic trainers are because of their skills in emergency medicine.

As first on the playing surface to assess the situation, athletic trainers inform the medical team of any life-threatening injury to initiate emergency medical care.

While the on-site response is critical, there’s also a tactical side to athletic training work that’s just as important in times of crisis.

We can put them in a short list of critical need-to-knows that in the face of emergency help the medical response teams stay calm, organized and effective:

• Emergency Action Plan to handle crisis situations
• Emergency phone numbers
• Ambulance access points at venues
• The working condition of onsite emergency equipment, like AEDs

Another thing that’s a must for all athletic trainers: great communication skills.

Athletic trainers are the source of communication between coaches and family when a player is injured. Their job includes reporting on the injury and expectations from the point of injury to next steps toward recovery.

Post-injury. Return to play. Return to work.

Okay, you’ve had an injury (ouch!).

You completed recovery and rehab (hooray!).

What comes next?

The next stage in post-injury progression is your return – return to play (RTP) or return to work.

This happens after your medical care provider is satisfied with your progress and clears you to get back to sports and physical activities. Working with an athletic trainer is essential in getting to this stage.

While an athletic trainer is first on the scene to assess injury, they’ll be in your corner to guide your recovery.

Your athletic trainer will do functional tests and look at your performance stats to gauge your readiness for activity, at what level and at what pace. There may be others in your corner that your trainer will coordinate to help with your full rehabilitation:

• Doctor
• Physical therapist
• Occupational therapist
• Nutritionist
• Strength and conditioning coach
• Massage therapist
• Sports psychologist

For you as an athlete, and depending on your injury, functional tests can include:

• Sprints
• Cutting drills (lower body injuries)
• Jumps
• Lifting and push-pull exercises (upper body injuries)

Athletic trainers use the stats to pinpoint any deficits remaining post-injury recovery, like limping or weakness, which could hinder you from safely retuning to play.

If testing is clear of any concerns, you’ll get the green light to return to full activity.

If there are areas of concerns, your trainer may plan additional exercises, or modify your activity level to help you improve on the deficits and continue toward full clearance.

Return to play is unique to each athlete and injury. The goal of functional testing and injury recovery is to ensure your safety on the playing field when returning from an injury.

Around the world, athletic trainers are looked to as trusted professionals playing a crucial part in health management and health care.

Multi-skilled and holding advanced certification to help athletes, performers and people across many job settings, athletic trainers bring benefits to health care. If you’ve been sidelined from work, missed out hanging with friends or playing your sport because of injury – or a repeated injury – there’s good news.

Working with an athletic trainer now can help avoid injury later. Put another way, you don’t have to wait until you’re injured to address the issue.

An athletic trainer can identify weaknesses or conditions that may be leading to your injuries and help correct them.

This approach is called prehab – preventive activity to decrease risk of future injury. Two important areas include:

Functional movement screens

Done by an athletic trainer to identify dysfunctional or painful movement patterns.

Exercises are taught to correct movement and any bad habits you may have acquired in compensating for pain. These can be done on their own or as part of a warm-up before activity.

For example, a proper warm-up using dynamic stretching can help increase blood flow to loosen muscles prior to activity, whether it’s working out or warming up before performing a concert or dance routine.

Recovery planning

Proper nutrition, hydration and sleep are all needed to keep the body in the right state for exercise. But it takes planning and discipline to adopt the right approach for your body and your activity level.

Your athletic trainer is your partner in injury prevention and can advise you on the right balance of all these things.

Athletic training: beyond the playing field

There’s high regard for the public work that athletic trainers do in helping individuals avoid injury and recover from injury.

Not surprising, then, are the standards that trainers are held to.

Athletic trainers must graduate with a bachelors or master’s degree and pass the Board of Certification Exam (BOC) to work with professional athletes. There’s also regular renewals on the certification to demonstrate continued learning and competence.

All this is to ensure that athletes are healthy and performing at their peak potential.

But think about the word “athlete.”

In a traditional sense – youth and high school programs to college and professional divisions – it conjures a playing field, ice rink, basketball court, you name it.

So this nugget may surprise you:

“Only 2% of all athletic trainers work in professional sports.”

~ ATYourOwnRisk.org

Athletic trainers work in all sorts of job settings and treat a host of individuals beyond traditional sporting venues, such as:

• Doctors’ offices
• Hospitals and emergency rooms
• Urgent Care centers
• Rehabilitation centers

Outside of clinical settings, there are many emerging job settings where athletic trainers are finding new opportunities in public safety, military schools and the armed forces, and in performing arts and aeronautics. There’s a whole program at Boeing called the Industrial Athlete program designed to keep employees who work in physically demanding jobs healthy.

Such specialty industries employ individuals who need certain levels of fitness to do their jobs. They also need training to reduce risk on the job and stay fit for duty.

Add to those, various commercial settings like airlines, warehouses, hotel/resort and theme parks, and an athletic trainer’s scope of practice broadens even more.

For each of these sectors athletic trainers will have specific training to provide medical care based on the unique activities, physical demands and requirements of the employees.

This article shares a small window into the immense discipline of athletic training. It’s a discipline that’s grown from its origins of sport athleticism to stretch beyond the sidelines and into patient and employee health care.

Around the world, athletic trainers are looked to as trusted professionals playing a crucial part in health management and health care.

No matter where you encounter them, athletic trainers share the goal of keeping active people safe, well and moving forward.

Click to request an appointment to work with our Athletic Training Services team. If you are am employer interested in worksite safety training, check out our WorkStrategies® Program.

Posted 3/15/2023. | 1 min. read

Saco Bay Orthopaedic & Sports Physical Therapy’s ReVital Cancer Rehabilitation program is making headlines!

ReVital Certified Physical Therapist and Program Director Nikki Langstaff was recently highlighted on News Center Maine for all of the hard work and dedication she and her team shows to patients. The news segment showcased why our ReVital therapy services are so essential for people affected by cancer.

Check out the full story to see how we helped a mother of two do what matters most.

Thank you, Nikki and team, for the passion and dedication you show the oncology community in Maine. Together, we are another step closer to achieving our mission - to make cancer rehabilitation the standard of care.

Posted 2/21/2023. | 1 min. read

Select Medical, Saco Bay Physical Therapy's parent company, today announced that Hyperice recovery technology has been integrated into more than 70 Select Sports Centers of Excellence across the U.S. to assist in the rehabilitative care of athletes. Additionally, more than 400 Select Medical athletic trainers use Hyperice technology in high school, college and professional team training rooms and on sidelines.

“The charter of our Sports Centers of Excellence is to help athletes of all levels prevent injury, achieve peak performance and recover quickly and safely,” said John Gilmour, national director of sports medicine for Select Medical’s Outpatient Division. “Our highly trained sports therapists integrate Hyperice technology into rehabilitative treatment plans that are customized based on each patient’s injury and recovery needs and goals.”

Select Sports Centers of Excellence services focus on restoring function, increasing strength and flexibility, optimizing performance and returning athletes back to play. Each center’s clinical teams are comprised of certified sports therapists who employ the most up-to-date, clinically-proven best practices that combine manual and technology-based therapies.

Hyperice technology devices help prevent injury, accelerate recovery, alleviate pain and enhance muscle and joint movement to meet the expectations of athletes of all ages and ranges.

To purchase Hyperice technology at the Select Sports Center of Excellence discounted rate, visit: https://selectmedical.performancehealth.com/.

Posted 2/14/2023. | 1 min. read

Select Medical today announced a joint venture agreement with AtlantiCare to own and manage operations of a new inpatient rehabilitation hospital and 13 outpatient physical therapy centers throughout the southeastern region of New Jersey.

Read the press release here...