Marijuana and Chronic Pelvic Pain

Before you jump to conclusions… No,  I am not insisting you get “high”, but you have to admit that the title sounds way catchier than “CBD oil for chronic pelvic pain”. Many people still are unaware of CBD oil, its origins and benefits. Many are still cautious with regards to the use of marijuana products or by-products medicinally. So first let’s take a look at what CBD oil is.

CBD also known as Cannabidiol a substance that is extracted from cannabis/ marijuana plants. It is non-psychoactive and so does not give the infamous “high” unlike its well known counterpart THC (tetrahydrocannabinol). According to an article in the Canadian Urological Association Journal, “…THC (the psychoactive cannabinoid) stimulates appetite, reduces post-traumatic stress disease (PTSD) symptoms, and can be used as a sleep aid. CBD (the non-psychoactive cannabinoid) reduces inflammation, relieves anxiety, and reduces seizures. The combination of CBD and THC may act as a muscle relaxant, relieve spasms, reduce nausea, and relieve pain.”  Another article suggests that cannabinoids can suppress chronic inflammatory and neuropathic pain. One of the important benefits is that while it offers relief, it does not have the addictive properties of opioids and therefore may be a better option in the “fight” against the opioid epidemic.

So how does it work? First we need to know that the human body produces its own cannabinoids (endocannabinoids) and therefore has receptors specific to these compounds in the body. These naturally occurring cannabinoids are expressed in the nervous system and play a role in the function of the brain, immune system and nervous system including modulating pain and inflammation. Currently it is thought that CBD may attach to these receptors and/ or stimulate more of the body’s cannabinoids to attach. As such, there is research that supports its use in chronic pain conditions including migraines, fibromyalgia, IBS and more specifically chronic pelvic health conditions.

CBD comes in the form of an oil and can be ingested via dropper or mixed with beverages. It also comes in capsule form or can be administered topically (on the skin).  CBD is purported to reduce pain by at least 30-40% and since most individuals with chronic pain issues are looking to manage symptoms, anything that takes “the edge” off I’m sure is appreciated. As far as dosage goes, you want to speak with your medical provider and definitely make sure that you acquire organic and appropriately harvested and extracted.

 

References:
1. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors.
https://www.ncbi.nlm.nih.gov/pubmed/22585736

2. Medical marijuana for chronic urologic pelvic pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040614/

3. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/

4. https://www.practicalpainmanagement.com/patient/treatments/marijuana-cannabis/navigating-cannabis-options-chronic-pain

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Strengthening your lady parts…

One, Two, Three, Four….

That’s usually the sound of any person counting as they exercise, counting rep by rep… sometimes even with the addition of a little weight.

Well did you even know that there is such a thing called a vaginal weight? You heard me… VA-GI-NAL weights!

But before you go jumping to Amazon trying to get them to your house via prime, let’s take a moment to learn what they are, what they do and how they can help if at all. I’m sure by now that you have probably seen the videos of women lifting what looks like weights attached to a cord via their lady parts. Let’s not get extreme people!

The pelvic floor is comprised of several muscles and these muscles are what are typically involved in some of the issues that arise in women, such as prolapse, leaking and other conditions. Typically strengthening is one of the solutions but sometimes the issue is that the muscles may also be “tight” or held in a shortened position which is also less than ideal. Just know that a tight muscle is not a strong muscle and it is best that before you go trying what you see on Youtube, IGTV and all other fantastic stations of the “Inter-web” that you consult with a pelvic floor physical therapist to first know and understand what your issues may be and then how you should progress.

Going back to the pelvic floor muscles, they are just like any other muscle group, that can be overworked, strained or even damaged which could in-fact lead to the same issues you may be trying to avoid (so I won’t suggest you try lifting a surfboard or anything else crazy, but I digress).

One example of vaginal weights that I have used with some of my clients in the past is by a company called Intimate Rose. No I do not have an affiliate with this company, but I like the product, the material (silicone, hypoallergenic) and the quality. The weights are graded and are used gradually transitioning (with guidance, preferably from your pelvic health therapist) from the lightest to the heaviest. They can be used, when a person is appropriate and able to, for progressing strengthening for issues such as incontinence, pelvic organ prolapse and even for promoting improvements in the bedroom (the latter of which may be more anecdotal than research based). Note that the weight of this system is no more than 4 oz max!

Again this is not necessary for everyone and also understand that you can strengthen the pelvic floor adequately with out them and have a well functioning pelvic floor. More is not always better!

As always, if you have any questions, email me or you can message me via the website
or you can message me on the facebook page

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Chiropractic Care vs Pelvic Physical Therapy for Pregnant Mommas… Do we need to choose?

So recently a colleague of mine wrote a beautiful article (see article here). In the article she detailed the confusion some women have when it comes to the disciplines of pelvic physical therapy or physical therapy in general and chiropractic care, as well as how each or even both may be beneficial during pregnancy.

Recently I had the pleasure of speaking to a wonderful chiropractor and friend, Dr. Chelsea Drda of Atlanta Natural Health Clinic in Chamblee Georgia (Atlanta metro area). Dr. Chelsea and I were able to also clear up some of the concerns women have, detail some of the issues that chiros solve as well as those solved by pelvic therapists and most importantly detail how they both can compliment each other.

Take a listen here as we dive into this question: Chiro vs Physical Therapy

As always, reach out if you have any questions!

Wishing you great health and wellness…

Dr. J

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Hip Impingements

This one is for all my crossfit moms.

So you have had your baby and you go back to lifting… but you notice that you are having a pinching pain in your hip… maybe you noticed this prior to lifting, with walking, stairs, air squats etc.

Since the pain or discomfort is at the “front” of your hip, you feel like your first line of defense should be to stretch your hip flexors… RIGHT!

Well you might be dealing with a hip impingement. Basically what that is, is a situation where the head of your femur tracks too far forward in the socket and causes some pinching. Based on the way most people stand, they tend to stand with their hips pushed forward (resting on the ligaments) which puts the hip in somewhat of a slight extension and hence a contributing to this impingement position. It may be triggered by other positions including sitting and the way you are performing daily activities as well. So what can you do.

First of all strengthen your hips! Yup I said it. Your glutes… your hamstrings… you lateral hip muscles. The more strength and stability in that area the better, especially posteriorly because those muscles are usually weaker. You can do things like bridges, advancing to single leg bridges, one legged sit to stand transitions, single legs dumbbell or KB deadlifts. Stretching your piriformis muscles. Try this… sit in a chair, cross one leg over the other and the thigh. keep your trunk nice and long vs slumped and lean slightly forward.

Secondly, posterior glides to the hip are helpful. Take a band (I like the black one), place it around your hip with the other anchored and feel the resistance against your upper femur. Progress to increasing your flexion as tolerated. I recommend doing these on days when you may have a squat work out to really get the hips well stretched.

Lastly, your squat position. Personally deep squats were harder when I dealt with this issue. Focus on keeping the knees out and ensuring external rotation of the hips as well as squatting to a comfortable depth and then progressing with the depth as tolerated.

Let me know if you find these tips helpful. They worked well for me and others!

Cheers!

 

 

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Cesarean births… the impact of that scar!

According to HealthGrades, “almost 1.3 million pregnant women have their babies by C-section in the United States each year.” Another article cited as many as 1 in 3 births are cesarean births.

There are many reasons why a woman would need to have one including: a poorly progressing labor, medical issues that affect mom or baby, emergency intervention to save the life of mom and baby and so on…

That being said it is treated as just ‘another surgery’. If you missed my FB video on cesarean sections, check it out here: The Infamous C-section

What I really want to talk about today though, is the impact of that scar after birth. When you have a cesarean, it’s by no means superficial. An incision is made through the abdominal wall and then through the uterus, cutting through at least 5 different layers of tissue. When these tissues heal, like any other surgery or scar, there is the possibility of several things including: a non – healing wound, infection, keloids, scar tissue, decreased sensitivity to the area or even hypersensitivity or increased sensitivity and impact on surrounding tissues including pelvic floor. WOW!!!!!! Do they tell you any of this after a C-section!?!?!?!?

So what can you do?

1. Once given the all clear at 6-8 weeks by the physician and once the incision has healed where there are no openings, you can go ahead and start some gentle massage to the area. Start firstly with light touch above and below the incision along its length, followed by actually touching on the incision. For some women, there is a huge disconnect as there is trauma, both emotional and physical, associated with a cesarean birth. For some women they have to come to terms with feelings of inadequacy because this was not the way they intended birth to be. As such, some women have a hard time touching or connecting with that scar. So it is truly more than just “a scar”. For some women this could be the beginning of some serious emotionally healing and self love.

2. Once you have reached the point where you can touch the incision, above and below with minimal discomfort, then start making small circles first above the incision, along its length, then below, then on the incision itself.

3. If that works well then progress to gentle mobilization of the incision and surrounding tissue. Hold below the incision with one finger and then gently pull on the opposite side of the incision with another finger (using opposite hand). So what this should look like is lets say we start at the right side of your incision. Take the right thumb and place it under the right side of the end of the incision. Using the left thumb or index finger, place it on the tissue on the opposite side of the incision relative to the right thumb and give a GENTLE pull or stretch in the opposite direction. Move along the length of the incision.

Try these techniques. As always if you need help, the best person you can seek for such issues is a pelvic health physical therapist. I would love to assist you and am available to do video consults as well. I can also connect you with a pelvic health therapist closer to you geographically.

Take care,

J

References:
Self Magazine (photo)

HealthGrades

US National Library of Medicine: Medline Plus

ACOG: American College of Obstetricians and Gynecologists

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Fecal Incontinence… the stuff no one talks about

According to the National Institute of Child Health and Human Development, fecal incontinence is the recurrent and involuntary loss of stool or flatus (gas). Often times one of the main causes post partum is obstetric trauma or pudendal nerve injury.

Different studies have shown at least 1 in 4 women having fecal incontinence within 6 months of child-birth. 25% is a pretty high number and that is only what has been reported, so then why does no one hear about this and most people have no clue!

It’s already bad enough that women struggle with issues of urinary incontinence which in itself still has yet to gain the respect for what it is and it’s effect on society but instead it has been normalized and relegated to something that women should just “deal with”.

Truth be told, how many of YOU would be willing to divulge such information if you were being plagued with such an issue? Think of the social isolation these women feel. They wouldn’t want to go into public for fear of being malodorous. They may start to shy away from social activities, events, their life as they knew it… I mean this could turn the most extroverted individual into the epitome of a “house mouse”!

And let’s not forget SEX!!! Come on now… we’re all doing it! And the last thing you want to think about is “pooing” during sex. The embarrassment… the shame… am I painting a clear picture for you.

This is real! This happens to many women and can have such a tremendously negative impact on their lives and the saddest thing is they have no control. One of the main functions of your pelvic floor muscles is sphincteric, as in they control the sphincters of the bowel and bladder. Think of the knobs that control the flow of water out of your faucet at the sink. If they are broken, there is no “turning the faucet off”.

While this article is somewhat directed to post partum bowel incontinence, it should be noted that some research sites anywhere from 6-10% of men are affected and as much as 15% of the general population of older women. Two nursing home articles have cited a 45-47% prevalence among residents and so whether bowel or urinary, incontinence on a whole could very well be one of the leading causes of qualifying patients for nursing homes.

Bowel health is very important and bowel incontinence, just like urinary incontinence can be treated and is treatable. If this is happening to you, please contact a pelvic floor physical therapist to have this assessed and treated so that you can start to reclaim your life.

Remember COMMON IS NOT NORMAL!

National Institutes of Health State-of-the-Science Conference Draft Statement. Prevention of Fecal and Urinary Incontinence in Adults. December 12, 2007

Dey AN. Characteristics of elderly nursing home residents; data from the 1995 National Nursing Home Survey. Advance data from vital and health statistics; no. 289. Hyattsville, Maryland; National Center for Health Statistics 1997

Nelson R, Furner S, Jesudason V. Fecal Incontinence in Wisconsin Nursing Homes. Diseases of the Colon and Rectum Vol. 41, No. 10 October 1998

Guise, Jeanne-Marie MD, MPH; Morris, Cynthia PhD, MPH; Osterweil, Patricia; Li, Hong MD, MSPH; Rosenberg, Deborah; Greenlick, Merwyn PhD. Incidence of Fecal Incontinence After Childbirth. Journal of Obstetrics and Gynecology: February 2007- Vol 109, Issue 2, pg 281-288

 

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Opioid Use in Pregnancy

According to the research, the prevalence of low back and pelvic pain during pregnancy ranges from 68 to 72% and is an indication (for most physicians) for the prescription of opioids. Also reported was muscle pain, joint pain, and migraine. Research shows that Americans consume more than 99% of the world’s hydrocodone AND the use of opioids during pregnancy has increased in the last decade!

 

So what are opioids? Well, they are a type of prescription medication used in pain control. You may have heard of names like: Oxycodone (OxyContin®, Percoset®), Hydrocodone and codeine (Vicodin®), Fentanyl (Actiq®, Druagesic®, Sublimaze®), Morphine (Kadian®, Avinza®), Tramadol (ConZip®, Ryzolt®, Ultram®) or Methadone.

Most prescription opioids are currently classified by the Food and Drug Administration under category C for use in pregnancy, indicating evidence of potential harm to the fetus from animal studies AND THE ABSENCE of well-controlled human studies. One exception is oxycodone, which is currently classified in category B, indicating no evidence of harm to the fetus from animal studies and the absence of well-controlled human studies. Please note that none of these drugs have been tested on anything other than animals…

Side effects: altered fetal growth, low birth weights, pre-term labor, neonatal withdrawal or dependency,

An article published in 2017 by Medscape stated, “Opioid use during pregnancy has escalated, in parallel with the opioid epidemic in the general population… Medication-assisted treatment remains the preferred treatment because withdrawal is associated with high relapse rates and poorer outcomes.”

NOW… we all know that new moms may battle with lack of sleep, increased anxiety, post partum depression, pain due to the child birth process as well as the general changes associated with dealing with a new baby at home AND it has been stated that: “Women with opioid use disorder are dealing with all those things in addition to the challenges of their addiction, which — without treatment and support — can often lead to relapse.”

So what is the purpose of this post? You may ask. This conversation is way to deep to even scratch the surface with a blog post but it brings up a very interesting topic regarding changes in society and the use of medication as a solution regarding pain. What is pain? In an article by world renowned clinical scientist, Lorimer Mosley, written in 2016,  “Pain scientists are reasonably agreed that pain is an unpleasant feeling in our body that makes us want to stop and change our behavior. We now think of pain as a complex and highly sophisticated protective mechanism…Pain is only one mechanism by which we are protected.”

That being said, medication is NOT the only way. It may be a seemingly quick solution, but a temporary one and one that can have negative long term consequences, not only including addiction but including negative effects on other systems within our bodies.

What we need to do is look at pain differently. Change certain behaviors, including movement behaviors and begin to adopt new strategies within our lives so that we can continue to function whether it be for work, play, socializing, or just performing daily tasks. In some cases this may be simple. In others, especially those where persons have not engaged in much movement or activity for long periods, it may not be, but we owe it to ourselves to to try.

Most of you reading this have a vehicle. You perform the necessary maintenance to ensure that your money lasts. That your vehicle will endure and continue to ensure you and your family’s safety when in it. The same way that we maintain a vehicle we need to maintain our bodies. We only get one! Our nutrition, our activities, our life in general needs to be such that this machine we have called a body can endure as well.

So while there is definitely a place for medicine, let’s seek to move more, move better and enjoy moving, both for ourselves and our loved ones. For the moms reading this who may be in pain, there are solutions that can be utilized to address your mobility issues, whether this is during your pregnancy or after. Whether it is carrying the baby during pregnancy or after, carrying those car seats and strollers or bending over to lace those babies in those cribs. Let’s get you moving today!

Reference:
1. UT Southwestern Medical Center: An honest discussion about opioid use and pregnancy. March 28, 2017 by Robyn Horsager-Boehrer, MD
2. Guidelines on Opioid Use in Pregnancy Released by ACOG – Medscape – Jul 25, 2017.
3. Obstet Gynecol. Published online July 25, 2017. Abstract
4. Journal of Pediartic Genetics. 2015 June; 4(2): 56-70. Prescription Opioids in Pregnancy and Birth Outcomes: A review of the Literature. Mahsa M. Yazdy, Rishi J. Desai and Susan B. Brogly

 

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Why I Choose To See A PT For Pelvic Health (And Maybe You Should Too)

Who speaks about personal stuff in public? And by personal, I mean: peeing, pooping, sex, pain in your… you know… privates! Once thought to be taboo, pelvic health and women’s health issues have gained increased attention over the last several years. Although sometimes not as much as most of us pelvic health therapists would hope for, but at least it’s something.

Just think about it. If you broke your arm, you would see an orthopedist or an orthopedic surgeon and possibly have therapy. If your hurt your knee, ankle or even had a hip replacement, it would be the same. If you had arthritis and were dealing with pain or difficulty performing your normal day to day activities, you would see a physician and possibly go to therapy ( I would hope) to get you moving better. So then why is it so difficult when people have pain in the pelvic region to know that there is someone who can address those issues to.

There are several muscles ‘housed’ in the pelvis and they have many functions including supportive and sexual. When there is dysfunction, whether it be muscles being “too tight” or muscles being “too weak” or even trauma whether from birth or otherwise, there are things that can be done to address this. A pelvic health therapist one who had had additional training to treat these issues and many others and techniques may include addressing the muscles internally as some of the muscles are not easily assessed otherwise. Education in breathing, postural, body mechanics are also key and integrated into functional and daily tasks.

Did you know pelvic health therapists also treat pregnant and post partum women… oh yeah… they have a pelvis too! And men… yup they have a pelvic too! And children… you guessed it… they have a pelvis!

Although women are known to be the ones who commonly have issues related to the pelvic region, many men suffer from pelvic girdle pain (pain in the penis, testicles, groin or even rectum), incontinence and erectile dysfunction issues. Children may have issues as well with incontinence, specifically bed wetting and everybody can have issues with constipation which is an issue that can often lead to other problems.

Many pelvic health therapists also work with patients, both male and female who may be dealing with or have dealt with diagnoses of cancer, including breast, ovarian/ cervical (especially after hysterectomies) and prostate.

So, if you have: dyspareunia, vulvodynia, endometriosis, pudendal neuralgia, bladder pain, dysmenorrhea, you are a male with penile, testicular, groin or rectal pain, back pain, interstitial cystitis, prostatitis, urinary or fecal incontinence, child birth, pelvic organ prolapse, hysterectomy, prostatectomy, laparoscopy, cesarean birth (to name a few) then a pelvic health therapist may be someone you might need to pay a visit to.

 

 

 

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The Deep Core

Every one speaks about the core, but typically are only referring to the abdominal muscles when they do so. But it is so much deeper than that… so much deeper!

Your core is made up of the transversus abdominus, which is the deepest abdominal muscle, the multifidus posteriorly (in the back), your diaphragm at the top and your pelvic floor muscles.

For a long time abdominals were trained in isolation but we know that there needs to be a greater move to integrate these muscles and help the “core” to truly function like the stabilizing unit that it is. If one of these groups is not working efficiently then it can translate to inefficient functional movements, the things that you do on a day to day basis.

In a properly functioning unit, the core is activated even before you do just about any task. This system is always working, and functions in coordination with your breath.

Typically when you breathe in the diaphragm descends and your pelvic floor relaxes and moves downward. When you breathe out, as the diaphragm moves back up to its original position, the pelvic floor recoils. Optimizing this has much to do with your posture and as such postural awareness while performing tasks is key to being as efficient as possible with those tasks.

If you want to know more about this phenomenon, check out Julie Wiebe, PT via: http://www.juliewiebept.com/video/how-should-you-breathe/ who has done significant research in this area.

Try this exercise:
Sit on a chair, making sure that you are sitting directly on your sit bones. Back erect and palms wrapped at the sides of your ribs almost as if wrapping from the back to the front. If you want, you can take a wash cloth or a face towel, roll it and place it length-ways at your perineum, running from the vagina to the anus. Take a deep breathe in, feeling your ribs expand to the sides and your abdomen forward. As you do so, also pay attention to the pelvic floor descending onto the wash cloth/ face towel. Now breathe out slowly, feeling the ribs recoil, the abdomen reduce and the pelvic floor recoil from the face towel/ wash cloth.
Now try this again, but with the pelvic tucked, the shoulders rounded and in a slouched posture and consider these things:
1. Can you feel the same amount of excursion of the ribs? Are you able to take in as much air?
2. Can you feel the descent and rise of the pelvic floor onto and off of the wash cloth/ face towel?

This is a nice quick way to easily see and feel the connection between posture and the pelvic floor. You can also try this is standing, assessing for quality of movement based on the postures that you assume.

Feel free to comment or ask questions.

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The 3rd Trimester…Home stretch!

The 3rd trimester. Hopefully you are feeling fine. You may be a little tired, or you could be full of energy and vibrant. Normal gestation is considered 38-42 weeks and you are more than likely counting down the days until you see this amazing baby or babies.

During this time:
1. Your OB appointments increase
2. You may begin to experience a little more discomfort as the baby continues to grow
3. It may start to get more uncomfortable at night, either finding a comfortable position to sleep or even just having difficulty sleeping in general.
4. For others there may be a feeling of constant fatigue
5. Heartburn/ Reflux

Things to remember:
1. Posture is important. Continue to be mindful of your posture.
2. Breathing is very helpful, not only for relaxation but being in tuned with your breath can help in future with your delivery process.
3. Eat smaller portions to accommodate for any heartburn or indigestion you may be feeling. Be cautious of foods that might exacerbate this (spicy foods, citrus foods)
4. Continue to be as mobile as possible. If you are tired, then rest, but on the days when you have a little more energy then go ahead and try to move as much as you can- walking, maybe cleaning with a little music on (I have had some of my best workouts dancing while cleaning).
5. Be mindful of breath holding and also “doming” at the abdomen with activity.

In a previous article I spoke about DRA (diastasis rectus abdominus), something that according to current research literature is present within 100% of pregnant women. This is a stretching of the connective tissue in the abdominal wall and makes sense as the abdomen is growing and needs to accommodate the baby. The important thing here is to be mindful of activity and the things listed above #3 and 4.

Now is a great time, if you haven’t already, to reach out to a pelvic floor therapist. Not only can they work on strengthening and mobility exercises and strategies to prepare you for delivery but also efficient positions for laboring in, especially in lieu of any orthopedic issues or pains that you may be having. They can educate you on any type of supports that may be helpful at this time to better alleviate pain and assist with keeping you as mobile as possible during this phase. In addition, they prepare you for the fourth trimester, or the phase immediately after labor, with exercises to strengthen the pelvic floor, education on proper posture for breast feeding, lifting/ carrying your baby and for functional tasks at home.

As with all the other phases of your pregnancy, your nutrition remains very important. Balance is key. For most persons, they are no longer nauseated at the site or the odor of food. If you feel that you are unable to eat adequately adding a nutritional shake can be helpful to ensure that you get the proper nutrients and calories needed.

As the countdown continues, continue to enjoy this time. Make some time for ‘mama’ because soon your focus will change somewhat and that is perfectly normal. Allow your ‘tribe’ to help where they can and take the opportunity to rest and rejuvenate.

Congratulations!!!!!!

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