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Why is Continuing Ed so Important? Reflecting on The Female Athlete Course

At Warman Physio our therapists focus on excellence. Providing excellent, comprehensive, up-to-date care, as well as a personable and compassionate care.

This is why going to courses, reading research, is so important… and being a little bit “nerdy” comes in handy 😉

 

This past weekend I took a course from Antony Lo, an outstanding therapist and physiotherapy educator from Australia, called The Female Athlete. This course was designed to challenge the status quo on current standard practice recommendations for women’s health related to Diastasis Recti, Prenatal, & Postpartum care.

During this course my belief system was challenged in some ways, and affirmed in others. My take-away from this course? First, we need more research in pretty much everything – we have far more questions than we do answers, and although we would like to have specific YES and NO answers for our clients’, everyone is individual with unique needs (not surprised here!) – basically, you are your own person, and the rules may not apply, and may need to be broken in your instance.

Another thing that we need to consider is pain. What is pain exactly?

 

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

What does this mean? Sensory and emotional experience – does anyone find they have more pain when they have more stress? How about if you have pain with something that doesn’t actually damage your tissue – like when your foot falls asleep and you get the painful pins and needles. We do not need tissue damage for pain, and no matter what is going on, your pain is exactly that, YOUR PAIN. Not the therapist, not your family, yours. No one can tell you that you don’t have pain, because it is your experience alone. Because of this reason, some pain can be resolved and changed very quickly, and some may take longer.

Last, our bodies are extremely strong, capable, adaptive, and resilient (SCAR)! We can change our perspective and make our weaknesses into strengths.

It boils down to WHY is continuing education so important? Why do we at Warman Physio put such an emphasis on continuing education? The answer is that it is our belief that being up to date, learning new information, making sure we are at the forefront of practice changes benefits our clients. We are open to education, views that challenge our current beliefs, and learning something new in expected, as well as unexpected ways. There are more ways than one that I find myself learning not only from colleagues and coworkers, but also from my clients and those I meet in day to day life. The curious mind, and attitude of intrigue, and being able to take new information and integrate it into practice is something that at Warman Physio we are striving for, not just on weekends we are learning formally, but every single day!

Do you think this is AMAZING? Have some questions? Want to tell me how it resonates with you? Send me a message!

 

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2018 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2016, 2017, & 2018. Haylie was also recognized as YWCA Women of Distinction for Health & Wellness in 2017. 
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Pelvic floor and your kid… what you need to know Part 1

WHAT? Pelvic Floor Physiotherapy and KIDS?

Pelvic floor physiotherapy is not just for adults. Even our little people have pelvic floors, and they do have issues with those pint-sized pelvic floors sometimes.

Ok sure, but what could they need help with exactly?

Pediatric Pelvic Floor refers to children under the age of 18. So we are looking at a wide variety of issues that can be addressed with pelvic floor physio.

  • Daytime Leaking (“Accidents”): leakage of urine in inappropriate places over the age of 5 can occur during the day and at night
  • Bed wetting (Nocturnal Enuresis): leakage of urine at night WITHOUT daytime symptoms or issues
  • Constipation: stools that are often infrequent and hard to pass (but did you know you can be constipated and still poop every day?!)
  • Poop Accidents (Encopresis): leakage of stool in inappropriate places

What should I be watching for?

If your child is having issues with any of the above, they may benefit from pelvic floor physiotherapy for kids. One of the biggest contributing factors to ALL of the issues listed above, is constipation itself.

How does constipation affect day time wetting, bed wetting, and poop accidents?

When we are constipated (and this is true of adults as well), our rectum stretches and stores stool instead of emptying fully. This stretching eventually leads the stored stool in the rectum to put pressure on the bladder. This irritates the bladder leading to increased trips to the bathroom, and accidents throughout the day. This same pressure is what can cause night time wetting; essentially the poop takes up so much space the bladder just has to void.

 

If a child is constipated they can’t have poop accidents though, right?

FALSE! Depending on how long this has been going on, the child may also still poop regularly. There are a couple ways poop accidents can happen.

As the colon is stretched, the normal receptors in the bowel that signal your brain that you need to poop don’t work as well, similar to a deflated balloon. The receptors need to be stretched against tension to work well. As your bowel collects and stores stool in the stretched out colon, you become constipated. But, softer liquid stool can sneak around the hard stool (this is called bypass). Sometimes people think their child has diarrhea when they see bypass and the idea that they are constipated seems far-fetched, but it’s true!

This can happen in young children, pre-teens, and teenagers. The longer constipation goes undiagnosed/treated, often the harder it is to resolve.

What does Pelvic Floor Physio for kids look like?

We require a parent or guardian to be present at all appointments with children for pediatric pelvic floor therapy. At the first appointment we will take a detailed history including potty learning statistics, diet, bathroom habits, social impact, among other things. We will also take a look at movement, strength, stability, and we usually do some sort of abdominal exam. Many children that are having issues have been poked, prodded, and had some scary procedures done, so at physio my goal is to make it fun, engaging, and not painful whenever possible. But this isn’t enough, we also need to make it something important for the child as well!

Giving them things that they can do to take ownership, and see change in – like a poop and pee diary – is very important. Ensuring that we are celebrating the successes, and down-playing the misses is also crucial.

Why is it important to address pelvic floor issues in childhood?

Clinically, we see a possible correlation between adult pelvic floor dysfunction and childhood issues. In the population of clients seen for pelvic pain conditions as adults (dyspareunia, vulvodynia), there is often a history of constipation and childhood toileting issues. Adults that have increased voiding frequency, urge incontinence, and a ‘weak bladder’ often speak of pre-teen and teenage issues as well.

What can I do?

Start out right, keep poop mushy, a peanut butter or hummus consistency is key. Often kids will start solids and become constipated, some will have one instance of constipation and have difficulty because they are scared of being painful (which leads to a vicious cycle). If your child has a history of straining, large stools (the whoa that might clog the toilet ones), works hard to get stool out, has poop ‘stains’ on their underwear, or has had multiple days without passing a stool, constipation could be an issue.

Regardless of how it starts, pelvic floor dysfunction in children can and should be attended to by a qualified physical therapist.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Adding pediatric pelvic floor. Warman Physiotherapy & Wellness has been nominated for the 2018 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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Endo and Pelvic Floor Physio

March was Endometriosis Awareness month, and we have provided some information related to endo for everyone on our social media (Facebook and Instagram). If you are wondering what endometriosis looks like for someone living with it, you can check out the story we posted earlier in the month. As promised here are some of the things that Pelvic Floor Physiotherapy can do for you…

Pain Science

Physiotherapists that work with pelvic pain conditions, such as endometriosis, have additional training specific to the actual science behind pain. Having this knowledge to give to our clients allows us to de-mystify pain, help us understand pain perception, and why the symptoms are occurring. Globally with pain science, one of the most important things to understand are there are no pain signals to the brain. The brain receives information from the body, and depending on what all those signals are saying, will determine if something is painful or not. Have you ever stubbed your toe when you are having a great day? It hurts SO MUCH. But, if you stub your toe while you are in the middle of an argument with someone, it doesn’t hurt the same; that’s pain science!

Everyone has heard a story of someone being in an accident of some kind and being able to get to a hospital (or civilization) before feeling pain.

How does this apply to endo? Endometriosis is the presence of uterine-like tissue outside of the uterus, within the pelvic bowl and abdomen (generally). Endometrial tissue contracts during menses to shed the lining of the uterine wall. If this tissue is outside of the uterus… it still contracts on the tissue it is adhered to.

Which brings us to….

Assist muscle tension

If you have a muscle that is contracting and creating more tension over time, and you aren’t stretching it, eventually it becomes tighter. Have you tried stretching tight muscles? How about making them contract more?

Here is where we talk about what happens in a painful body – when we have abdominal and pelvic pain, we try and protect the area. This protection leads us to adopt a fetal position. Tightness develops in the abdominals, hip flexors, pelvic floor, and diaphragm, which plays into the pain cycle. Pelvic floor physiotherapists will work with each woman to obtain appropriate length, strength, and coordination of the muscles in the abdomen and pelvic bowl.

Tight muscles are often painful muscles.

Provide self-assistance tools

We are here to help you, help yourself. Giving you tools to reduce pain for between episodes, things to try during painful episodes, and ultimately manage your pain.

Some things that could be helpful include: stretching your hip flexors, deep breathing, yoga, meditation, using a wheat bag, and releasing muscles using an acupressure ball (or tennis ball).

 

Endometriosis can’t be cured by physiotherapy, but the symptoms can be managed. Contact us today to see how we can help you, or use the Book Now section to schedule your assessment today, and take control.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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A Journey with Endometriosis… From someone WITH Endo

For Endometriosis Awareness Month, we wanted to give our readers a true story to hear from. The individual that wrote this story has not been seen at the clinic, and is in no way affiliated with Warman Physiotherapy & Wellness. She, like many others, wants to raise awareness, give some of her symptoms, and hopefully, help people understand that pain is NOT normal. Onto her story….

My journey with endometriosis began many, many years ago. I just didn’t know it. As a teenager I was riddled with crippling periods involving an extremely heavy flow, and excruciatingly painful cramps that I remember eating handfuls of Midol to help get through the day. I was told “welcome to being a woman, this is normal”. Hindsight is 20:20. It was the furthest thing from normal. Thankfully, I was put on birth control, which seemed to make my periods manageable. My actual diagnosis of endometriosis was not until Oct of 2017. 6 Months prior to this I started developing excruciating stabbing pains in my right lower abdomen. A walk in doctor triaged me to the emergency room thinking my appendix had ruptured. Blood work showed no signs of infection, IV pain meds were given and an x-ray image did not show anything concerning. I was sent home with pain meds and told that I needed to poop. Exactly one month later (a month between my period) I ended up in excruciating pains where once again I ended up in the emergency room. This ER doctor again thought for sure it was my appendix but this time ordered an ultrasound. The ultrasound showed a 4cm hemorrhagic cyst on my right ovary. I was sent home with pain meds, and another ultrasound requisition. I was told to go see my family doctor in 6 weeks. I was told that a hemorrhagic cyst is nothing to worry about that it can happen with ovulation. My anatomy background and my knowledge of how a body works from also being a vet tech gave me a feeling that something more was wrong. The pain experienced during this time nearly made me pass out. Breathing hurt so I would hold my breath. I knew something wasn’t right. A 2nd ultrasound 30 hrs later showed that my cyst had grown by a couple of centimeters but that the radiologist wasn’t concerned as it’s just a hemorrhagic cyst and they can happen during ovulation. I wasn’t ovulating, I was at the end of my period. Something wasn’t right.

 

I have a really amazing gynecologist. Let me say that again. I have an amazing gynecologist. When I went into pre-eclampsia with my daughter, this gynecologist delivered my daughter and I met the most compassionate doctor who actually listened. I knew I had to get in to see her and that as long as I could get in to see her everything would be ok. But of course because I hadn’t seen her in over a year I would need a new referral. Off to another walk in dr. Unfortunately, my gynecologist didn’t have an available appointment for months. My stomach ached, and my guts ached, I would bloat up as if I was 8 months pregnant. There was a time at work where I came to work wearing jeans and by the end of the day I left in scrubs because my button wouldn’t do up. I begged the receptionist to send my gynecologist a message, begging her to understand that every month I will end up in the ER from passing out pain due to this “no big deal cyst on my ovary.” My compassionate gynecologist heard my message and within days, I was booked an appointment with her. She ordered more tests, another series of ultrasounds. Cysts usually burst and go away or at least shrink; mine wasn’t. I was still having daily pelvic pain, daily gut aches. I was put on a birth control to hopefully stop my cycle and stop the stabbing/ passing out pain that came at the end of my period. My gynecologist mentioned that she thought I had a disease called endometriosis. I had honestly never heard of it before. I went home that night and did what most people do– I took to google. Symptoms of this disease was pelvic pain, which I did have prior to these episodes but chalked it up to the many bladder infections that I’ve suffered from. Extremely painful periods was another symptom, which again I had when I was not on birth control. Surely, this disease couldn’t have started at the age of 16. I kept reading, “many women with endometriosis suffer from infertility.” 2 years prior, I had a beautiful baby girl so I couldn’t much relate to that. Back pain can also be a sign of endometriosis. Sure, my back hurt, but I had also been diagnosed with scoliosis of my spine years earlier so my back pain was from that. “The feeling of your insides being pulled down”. My gynecologist asked me during one of my appointments how I was feeling. I told her “it’s like I’ve eaten Chinese food for all 3 meals a day. Like my guts are just so heavy they are all hanging below my belly button.”

I wasn’t convinced. I kept thinking that this disease would have shown up on my previous CT scan, my previous abdominal ultrasounds I’ve had for a tumor I have in my liver. Surely, it would have shown up when I had a previous laparoscopic surgery to remove my gall bladder.

I went in for surgery in October to have this cyst removed. Upon waking up from surgery, I was told I had endometriosis bad. Really, really, bad. I was told that it was so bad another surgeon had to be called in to help. I heard the words “you are the worst case of endometriosis I have ever seen”. My surgeon(s) spent hours cutting out the endometriosis that they could. They removed the cyst on my ovary that was larger than my uterus. They spent hours and hours cutting off endometriosis off major blood vessels, my uterus, this cyst. I was told when they opened me up they found a pool of blood in my abdomen. That is the thing with endometriosis, when you have your period and shed your endometrial tissue from the inside of your uterus, your endometriosis that has grown outside of your uterus also bleeds.

The bad news didn’t end there. If someone is going to have endometriosis it usually stays in your pelvic area. Attaching to and growing on your uterus, ovaries, bladder, colon, pelvic floor. In rare cases, endometriosis grows outside of the pelvis. I happen to be one of the rare ones. Many, many endometriosis lesions were found along my ribs and my diaphragm. My gynecologist had no idea that I had this disease this bad, and neither did I. After all the first ER doctor told me that pooping would solve all of my pain.

I read online that someone compared endometriosis to cancer. That it can spread like cancer does, the only difference is that there is no cure for endometriosis. There were days I was in denial that the diagnosis seemed like a bad dream. The one thing that brought that dream back to reality is that I still suffered pain. You see this disease has two options, cut it out and try to suppress it with medication. I am doing both. And yet it seems with myself and many others even with excision surgery and suppressive medication, there is still pain.

I look back at my journey of my diagnosis and I thank God each day that I did not accept “it’s nothing to worry about” for an answer. Thank God I insisted on seeing my gynecologist sooner vs months later. I am thankful every day for the medical background I have in my personal career that gave me the knowledge that “something isn’t right.”

 

 

My journey with endo isn’t over, I don’t think it will ever be over. I will be on hormone suppressing pills for the rest of my life. I will have more surgeries in the future, some life threatening ones where they shut down your lungs one side at a time. I’ve been sent for MRI and CT scans to see if they can find endo in my lungs. Yes, this endo can invade your lungs. I’ve often told people that endo is a silent disease. From the many support groups that I have joined; I’ve learnt that it’s not uncommon to go years without a proper diagnosis. Endo isn’t always detectable on MRI, CT, Ultrasounds, or X-rays. A laparoscopic surgery performed by an endo specialist is the proper way to diagnose endometriosis. I’ve even heard of some peoples endo only being found under a histological biopsy.

 

I truly believe there needs to be more endometriosis awareness seeing as how 1 in 10 women suffer from this disease. Heck, I was that 10% and I didn’t even know it. I am very open with others about my endometriosis hoping that maybe I can raise awareness and make someone realize that pain doesn’t have to be “being a woman.”

 

Wonder how Physiotherapy can help you with endometriosis? We will be completing our follow-up on what physiotherapy is capable of assisting with for those that have endometriosis before the end of the month. If you want to start now, schedule in with Kendra HERE.

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POP: Getting Those Pesky Organs to Stay Put!

This past weekend I received several messages related to pelvic floor dysfunctions that are not being taken at face value. “Well you’ve had kids”, “it’s all in your head”, “this is a psychosocial problem not  a physical problem”. I have said it before and I will say it again, women need to be listened to, trusted, and most importantly, respected when they bring problems to healthcare providers, family, and friends. Although it may seem helpful to say that “this is something that happens when you have had kids”, it can be less than helpful AND is often not the case.

Pelvic Organ Prolapse (POP), is becoming a more well known topic of discussion in various mom groups, and in particular postpartum fitness groups. A large part of the impression I get as I am tagged, mentioned, and participating in these various forums is there seems to be significant panic associated with POP. People become paralyzed, hyper vigilant, and fearful of movement (also known as Kinesiophobia). So let’s break it down to dispel some of the hysteria that seeps into many pelvic health related issues.

Your top three organs that prolapse are (typically) your bladder (cystocele), your rectum (rectocele), and your uterus (uterine prolapse). Although most commonly occurring after child-birth, even those without children can have POP. Let’s focus on pregnancy and post-partum phase.

During pregnancy your uterus grows from approximately 5cm in size (which would hang out below your pubic bone), to what seems impossibly large to house the tiny little growing miracle (all the way up to the rib cage). This feat in and of itself does a few things, but thinking of organs specifically – they get moved, pushed and pressed all over the place because there just isn’t room.

How is this possible? Imagine your organs are like little boats at the dock. The boats (organs) wouldn’t do well in inclement weather (movement) if they were tied tightly or cemented to the dock; instead they have ropes (ligaments) to attach and hold them in a relatively stable position relative to the dock (abdominal wall/pelvis/ribs), and the other boats. Your organs aren’t cemented in place either, they essentially float being guided by ligaments, general positioning and support from other organs and the pelvic floor, as well as all the other connective tissue. So, when you are pregnant and the uterus is forging its way through the pelvic and abdominal cavity, everything else is able to move into new positions to compensate.

 

Once baby is born (vaginal or C-section), the organs suddenly have a lot more space to move around in – their ligaments and fascia have stretched, and there is no longer a tiny human occupying the extra space. As everything settles into a ‘new normal’, if everything is coordinating well, the organs will be situated in a similar position to pre-pregnancy with some slight variance. If the pelvic floor isn’t able to support, or other muscles around the rib cage are having difficulty relaxing, we can get changes in pressure that contribute to pushing these organs down and create POP and various symptoms.

What do we watch for? Feeling of heaviness, falling down or falling out, pressure, discomfort, or bulging, difficulty inserting a tampon, or keeping a tampon in, are all common complaints of POP.

There is much that Pelvic Floor Physio can do to assist with POP, and in many instances resolution of symptoms is possible.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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