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How Physical Therapy Treats Genito-Pelvic Penetration/Pain Disorder

Genito-Pelvic Penetration/Pain Disorder

Sexual dysfunction influence a woman’s quality of life and relationship with her partner. For example, women with genito-pelvic penetration/pain disorder (GPPPD) have painful involuntary contractions of the pelvic floor muscles during vaginal entry, such as vaginismus and dyspareunia. The causes of GPPPD involve both physiological and psychological factors. These conditions may be present from the first experience with penetration, such as tampon insertion. In other cases, the symptoms develop later in life. 

How does Physical Therapy treat Genito-Pelvic Penetration/Pain Disorder?

Pelvic floor physical therapy works to modify the tone of the pelvic floor muscles through evidence-based techniques such as muscle training, manual therapy, as well as electrical and ultrasound stimulation. The PT may also guide a patient through the use of vaginal dilators to increase penetration tolerance. 

Pelvic Floor Muscle Training 

Muscle training works to strengthen pelvic floor muscles and relieve pain. For example, Kegel exercises improve symptoms that stem from weak muscles. Along with training from the physical therapist, biofeedback can help patients become more aware of their pelvic floor muscles by providing feedback on the exercises. The PT can guide patients in using vaginal dilators, which gradually stretch the vagina and improve mobility. Your physical therapist will be able to determine if you need to strengthen your pelvic floor, stretch your pelvic floor, or both.

Soft-tissue Mobilization

With manual therapy, the PT performs a series of external and internal techniques on the affected muscles. For example, she gently stretches the pelvic floor muscles to stimulate myofascial release. Likewise, massage and pressure reduce referred pain from latent trigger points. The therapist can also soothe external tension in the pelvis through connective tissue manipulation. 

Muscle Stimulation 

The physical therapist stimulates the pelvic floor muscles through thermotherapy, electro-stimulation, and therapeutic ultrasound. The application of heat relaxes the muscles and increases tissue resilience. Electro-therapy uses a low-grade current to stimulate the muscles to contract. 

Referring for Genito-Pelvic Penetration/Pain Disorder 

Pelvic floor physical therapy is an essential element in a multidisciplinary treatment approach. A PT spends time with the patient and can identify the underlying causes of Genito-pelvic penetration/pain disorder. Our pelvic floor specialist, Dr. Rachel Feldman, is well versed in women’s health. To make a referral, call our office at 201-833-1333.

Patellofemoral Pain Syndrome: Treating Anterior Knee Pain in Runners

Patellofemoral pain syndrome

Patellofemoral pain syndrome, or runners knee, is one of the most common causes of anterior knee pain. It makes daily activities like climbing stairs difficult for patients. While the syndrome is most common in athletes, females, and young adults, it can particularly affect runners. 

What Causes Patellofemoral Pain Syndrome?

It’s called runner’s knee because overuse from athletic training is a significant factor. Repetitive stress or sudden changes in activity can spark pain. In addition, misalignment of the knee cap, or patella, also plays a role. When the knee bends, abnormal tracking of the knee cap within the knee joint can lead to pain. Other factors include anatomical features such as foot deformities, different leg lengths, and being knock-kneed or bow-legged. 

Non-surgical Treatment

Rest, ice, and elevation go a long way for short-term relief. For some patients, orthotics and athletic taping can temporarily improve pain.

Many patients will benefit from physical therapy to strengthen the muscles in their legs, especially the powerful muscles of the hip and thigh. Ultimately, a physical therapist will create a plan of care individualized to each person, which may include manual therapy, exercise, and education about running techniques and joint loading principles.

Surgical Treatment

A vast amount of research exists that does not recommend surgical treatment for runner’s knee. Currently, there’s insufficient evidence to show improved clinical outcomes with surgery over less invasive strategies. For example, a meta-analysis from the BMJ revealed a lack of rigorous studies evaluating the effectiveness of surgery to treat Patellofemoral Pain Syndrome. Thus, physicians should rarely consider surgical interventions and only after all other measures have failed and imaging identifies features such as lesions, tendinopathy, or synovitis. 

Preventing Patellofemoral Pain Syndrome

The number one way to prevent runner’s knee from occurring or reoccurring is to maintain proper strength and flexibility of the muscles around the knee. For example, patients can incorporate hamstring and quadricep stretching and exercises into warm-ups, cool-downs, and cross-training. Runners also need to be cognizant of increasing training gradually and maintaining a healthy body weight to avoid over-stressing the knees.

Referring Patients for Care

Non-invasive treatments should be the first line of defense when a patient presents with pain in the front of their knee. Next, focus on rehabilitation exercises and prevention. At Churchill Orthopedic Rehabilitation, our experts can create a treatment plan tailored to each patient’s needs. Our running program gives athletes techniques to maintain conditioning and prevent injury. To schedule an appointment for physical therapy, call our office at 201-833-1333.

Painful Penetration: Symptoms, Causes, and Treatments

Painful Penetration

Some women experience painful penetration. As a result, they may be unable to wear tampons or enjoy sexual relationships. Several interconnecting factors involving muscles, tissues, joints, bones, nerves and skin may be involved. If you are experiencing pelvic pain, pay attention to what your body tells you and seek help.

Is it normal for sexual penetration to be painful?

Although it is unfortunately common for women to report that intercourse is painful, it is NOT “normal” and it is something for which there are treatment options. Sexual intercourse should not be painful. It is important to communicate with your partner—talk about what hurts and what feels right. Enjoy plenty of foreplay before attempting penetration. Some women find home remedies such as water-soluble lubricants, ice packs, or warm baths can reduce symptoms. For ongoing pain, seek help from a medical professional. Pelvic floor physical therapy has helped many women.

Painful Penetration During Intercourse

The medical term for pelvic pain associated with sexual intercourse is “dyspareunia.” There are many different physical and emotional factors at play here. For some, dyspareunia comes from hormonal changes and vagina dryness from menopause, breastfeeding, or medications. For others, the pain stems from infections, illnesses, or inflammation. Women can also experience dyspareunia due to emotional factors. In these cases, effective treatment includes cognitive-behavioral therapy (CBT) along with pelvic floor physical therapy.

Vaginal Muscle Spasms 

Vaginismus is when the muscles of the vagina tense up at attempted penetration. Experts aren’t exactly sure what causes it.

Symptoms of vaginismus include:

  • Discomfort or pain during vaginal penetration.
  • Inability to use tampons or tolerate pelvic exams.
  • Painful intercourse.

Treatment focuses on teaching the muscles to relax. Treatment may include vaginal dilator therapy, which uses rounded, silicone inserts to stretch the vaginal tissue progressively. Many women find relief through pelvic floor physical therapy.

Getting Help for Painful Penetration 

Many women feel uncomfortable talking about pelvic floor pain, and embarrassment prevents them from seeking help. But, you are not alone, and treatment is available. The most important thing you can do right now is talking to a medical professional. You don’t have to live with painful penetration—our women’s health expert can help. Schedule a consultation today.

Healing Pubic Symphysis Pain During and After Pregnancy

Pubic Symphysis Pain

During pregnancy, many musculoskeletal changes happen in a woman’s body. For example, widening of the pubic symphysis and sacroiliac joints occurs before childbirth. However, the process can cause pubic symphysis pain for some women and impair their activities of daily living.

How Does the Pubic Symphysis Change During Pregnancy?

The pubic symphysis is a unique joint at the midline union of the pubic bone. It resists tensile and frictional forces and can move minimally —2 mm shifts and 1-degree rotation. However, this joint is capable of remarkable changes during pregnancy. Relaxin and other hormones cause structural changes that increase the joint’s width and mobility. Separation between 4 to 9 mm is normal during pregnancy. We expect the pelvic girdle to return to normal before five months postpartum.

What Causes Pubic Symphysis Pain?

The hormone relaxin softens the ligaments and joints to ease labor and delivery. Movement of the loose joint can be painful for the mother. In addition, excessive widening beyond 10 mm leads to a rare condition called pubic symphysis diastasis. Risk factors include:

  • Obesity 
  • Hypermobility
  • Large fetus 
  • Rapid second stage labor
  • Intense uterine contractions
  • History of pelvic trauma
  • Forceps used during delivery 

What Does Pubic Symphysis Pain Feel Like?

The pain is different for each person. Some women may feel a pinch or ache. For others, severe symphyseal pain causes difficulties with activities of daily living such as walking, climbing stairs, or turning over in bed. In some cases, the patient feels sore in the creases of the groin rather than over the pubic bone. Pubic symphysis pain can be debilitating to mothers, especially if it doesn’t resolve postpartum. It can get so bad that some women require crutches or bed rest. 

How Do You Treat Symphysis Pubis Dysfunction? 

Several treatment options are available to relieve symphysis pubis pain and provide for postpartum recovery. Many patients benefit from supportive devices such as a pelvic support belt, a pregnancy pillow for sleep, or using a wheelchair or walker for reduced mobility. Other treatments include strengthening the back and core, soft tissue therapy, applying ice or heat, and simulation with a TENS unit. A physical therapist can design a safe and effective treatment program to meet patients’ needs.

Referring Patients for Pubic Symphysis Pain

Physical Therapy is a first-line treatment for Symphysis Pubis Dysfunction. The PT can develop non-invasive therapies to relieve pain and help restore mobility and function. Call our office for referrals at 201-833-1333.

3 Benefits of Trigger Point Therapy for Runners

Trigger Point Therapy for Runners

Painful and tender trigger points, which can feel like knots,  may develop in runners from repetitive stress on the muscle fibers. While benign, these trigger points cause discomfort and range of motion issues. Trigger point therapy helps runners manage their pain and learn about the body mechanics behind muscle knots. Trigger point therapy is a minimally invasive way to reduce pain and improve range of motion, which can in turn improve running mechanics and efficiency. 

What is Trigger Point Therapy?

Everybody is different, so physical therapists have a variety of techniques to target trigger points, such as soft tissue mobilization, which is similar to massage, and stretching. Your PT may also use manual treatments or instruct you in techniques you can do at home to treat the trigger points, such as stretching. One of the most effective treatments is dry needling, which involves a trained therapist inserting sterile microfilaments to simulate areas between the muscle fibers. Dry needling is gaining traction as a treatment throughout the US, and there is legislation in progress to allow physical therapists in New Jersey to use dry needling.

Benefits of Trigger Point Therapy for Runners

1. Reduced Pain

The main benefit of trigger point therapy is pain reduction. Muscle knots restrict blood flow and block oxygen from your muscles, leading to inflammation and pain. In addition, trigger points can refer pain to other parts of the body, making them difficult to locate. However, the physical therapist can pinpoint your pain and work to release the trigger point. 

2. Improved Range of Motion

Trigger points are essentially contracted muscles that won’t release. They limit your range of motion because specific muscles cannot stretch to their full length. This, in turn, affects the surrounding muscles. Physical therapy releases the fibers and improves mobility, which is crucial for runners. With a full range of motion, you can get back to training.

3. Minimally Invasive

Physical therapy offers a natural and holistic approach to pain management. First off, many trigger point release techniques are non-invasive such as soft tissue mobilization, stretching, and heat. Even dry needling is minimally invasive, requiring no medication or surgery. Your PT will work with you to develop a treatment plan you are comfortable with.

Get Started Today

Your PT will tailor a treatment plan that is right for your specific situation. During your first appointment, ask your therapist what you can do between sessions to maximize the benefit of therapy. Finally, you can manage your pain and get back your full range of motion. Contact our physical therapists to get started with trigger point therapy for runners. Schedule a consultation online today.

What to Expect from Your First Pelvic Floor Physical Therapy Appointment

First Pelvic Physical Therapy Appointment

It’s normal to feel a little apprehensive before your first pelvic floor physical therapy appointment. You may be wondering what exactly is going to happen. However, physical therapists always want their patients to feel comfortable and at ease. So, if you’re not sure about something, ask! “We want to take the mystery out of it for you and let you know what to expect,” said Dr. Rachel Feldman, a Physical Therapist at COR who specializes in women’s health.

How do I prepare for pelvic floor physical therapy?

Dress in comfortable clothing that allows for a full range of motion. Bring your ID, insurance card, and any pertinent records. Arrive 15 minutes early, so you have time to fill out any intake forms, or you may fill out your forms at home before you arrive.

Arriving at your First Pelvic Floor Physical Therapy Appointment

When you first arrive for pelvic physical therapy, check in to let the staff know you are there. They will ask for your driver’s license, insurance, and form of payment. They will usually ask you to fill out forms beforehand, so bring a list of any prescriptions or test records. The information will give your PT insight into your current condition and medical history.

Meeting the Physical Therapist 

After your PT has looked over your forms, she will meet with you to discuss your case. The therapist will ask questions about the frequency and severity of your symptoms. Your answers give the therapist a fuller understanding of your specific needs. Likewise, the PT will provide education about anatomy so you can better understand your condition. “At our clinic, this will take approximately 20-30 minutes…depending on the complexity of your case,” said Dr. Feldman.

Initial Evaluation

After the discussion, your therapist will perform a series of simple assessments. These tests involve observation and palpation of the core, back, hips, and ribs. The therapist will examine your range of motion and look for the cause of your pain. This initial evaluation will help your PT determine your strength, flexibility, posture, and mobility.

Internal Exam

Based on each individual’s comfort level as well as specific complaints, your PT may want to perform a quick internal pelvic exam in order to best assess the muscles. You have the right to refuse, or this can be postponed to a future session. If you agree to the internal exam, you’ll be given the privacy to change into a patient gown. When she returns, your therapist will evaluate the pelvic floor muscles using a single gloved finger. There will be no specula or other instruments involved. An internal evaluation helps your PT get a fuller picture of the health of your pelvic floor muscles. As Dr. Feldman explains, “This exam gives the best insight into the strength, control, and any painful areas in your pelvic floor.”

Scheduling an Appointment 

Pelvic floor physical therapy can help women with urinary incontinence, organ prolapse, pelvic pain, and more. Our experienced physical therapists are here to help you regain your quality of life. Are you ready for your first pelvic physical therapy appointment? Schedule a consultation today. 

3 Common Running-related Injuries: Risk Factors, Prevention, and Treatment

Running-related Injuries

Runners are prone to acute and chronic injuries due to trauma or repeated strain. Common running-related injuries include issues with the shin, knee cap, and tendons. Novice runners have a significantly higher risk of injuries—about 18 per 1,000 hours of running. In comparison, recreational runners average around eight injuries per 1,000 hours of training.

What’s the Best Way to Treat Running Injuries?

For effective treatment, every runner needs individualized plans based on their own running patterns and risk factors. First, a physical therapist can use a biomechanical analysis and functional movement assessments to identify contributing factors. Then, the PT can develop personalized programs based on the patient’s results.

Risk Factors for Running-Related Injuries  

The single most common risk factor is prior injury. Likewise, weekly distance and training frequency also increase the risk of injury. Therefore, reducing the running volume and adding cross-training could lower the chance of harm.

Common Running-related Injuries 

Medial Tibial Stress Syndrome (Shin Splints)

Commonly referred to as shin splints, MTSS is common in runners. It is characterized by generalized  pain on the inner side of the shin, also called the tibia. Risk factors include inexperience, a low arch, use of orthotics, higher BMI, and increased hip rotation. MTSS can be addressed with stretching, ankle strengthening, and activity modification/rest.


Achilles and patellar tendinopathy are two of the most common injuries among runners. Males and older adults are at a higher risk for developing tendon issues due to overuse. Other risk factors include poor running form, sudden changes in load, strength imbalances between muscle groups, and unequal leg length.

Plantar Fasciitis

Plantar fasciitis refers to pain in the bottom of the foot, which is typically experienced during the first few steps in the morning. The pain of plantar fasciitis comes from inflammation or degeneration of the fascia (connective tissue) in the foot. Risk factors include a high foot arch, tight Achilles tendon, and excessive pronation (flat foot). Treatments can involve stretching the plantar fascia and Achilles tendons, calf strengthening exercises, and working on mechanics of walking and functional activities like squatting.

How to Prevent Running-Related Injuries

Prevention of running-related injuries is not straightforward. There is no one-size-fits-all methodology. A research study published in 2017 indicated limited evidence for generalized prevention strategies. The authors concluded, “Individual treatment should be used in clinical practice.” 

At Churchill Orthopedic Rehabilitation, we offer a state-of-the-art running analysis program with a biomechanical analysis and functional movement assessments. In addition, Carley Schleien, PT, DPT, our running specialist, can develop individualized prevention and treatment plans based on each patient’s history and risk factors. To refer a patient, call our office at 201-833-1333.

Physical Therapy After a C-section Improves Patient Outcomes

Physical Therapy After a C-section

Cesarean section is one of the most common surgeries performed in the U.S. Women who undergo  c-section often experience low back and pelvic pain. Patients who go to physical therapy after a c-section see significant improvements in recovery. Still, postoperative PT is not standard following abdominal surgery like it is with joint surgery.

Should Patients Receive Physical Therapy After a C-section?

Postoperative rehabilitation isn’t limited to knee surgery. Abdominal surgery requires recovery as well. PT is especially important for postpartum women who are also caring for a newborn. A physical therapist can assess patients’ strength, alignment, and functional movement. Early intervention leads to shorter recovery times and improved outcomes. Patients may need movement modifications, and a PT can guide them in ….?

Research on PT following a C-section 

A recent article published in the Journal of Women’s Health Physical Therapy found that physical therapy improves patient satisfaction and outcomes following C-section surgery. The study followed 72 postpartum women who gave birth by c-section. The control group received the hospital’s standard of care, which included consultation, suggested abdominal exercises, and scar management information. The rest went through six weeks of physical therapy, including scar mobilization, stretching and activities for the back, core, and hips, plus home exercise training. 

Improved Outcomes and Satisfaction 

Researchers measured outcomes using a visual pain rating scale, disability index, and patient questionnaires. Participants who received PT reported significantly lower pain scores than the control group. Plus, they also had higher rates of patient satisfaction. 

Postpartum Care at COR

Physical therapy after a c-section is a critical element of postpartum care. Women’s bodies need time to recover following major abdominal surgery. So, our specialty-trained Women’s Health therapist creates individualized programs for cesarean scar restrictions and other postpartum treatments. To refer a patient, contact our office at 201-833-1333.