By: Kennan Wyne, PT, DPT

Everyone has had constipation at some point or another and it is uncomfortable, painful and embarrassing.  Chronic constipation and/or straining can lead to excessive stress on pelvic organs and nerves.  This may contribute to bladder dysfunction, pelvic floor dysfunction, and/or prolapse (bulging of structures occurring commonly due to weakened supportive structures).  Constipation is defined as infrequent (fewer than 3) bowel movements per week.  Normal stools should be about the size, shape, and consistency of a ripe banana.*

Listed below are tips to keep your colon happy.

Tip #1: Avoid regular use of laxatives and enemas.

Tip #2: Discuss fiber needs with physician/pharmacist/nutritionist. Typical recommendations for fiber intake are 25-35 grams per day. If adding fiber to diet remember to DRINK 6-8 cups of WATER to move stool through the colon. You may experience a bloating feeling and/or gas when adding fiber to your diet, but this should pass in a few weeks.  This may be eased by adding fiber SLOWLY to your diet.

• • Examples of high fiber foods are bran, shredded wheat, whole grain bread, and whole fresh fruits with skin (apples, raw veggies).

Tip #3: Proper positioning: Position yourself on the toilet to allow for maximal relaxation of your pelvic floor muscles by using a Squatty Potty or stool to obtain maximal knee and hip flexion (similar to a squat position) and leaning forward and supporting elbows on knees. NO STRAINING OR HOVERING as this increases intraabdominal pressure and pressure on the pelvic floor.

Tip #4: Regular exercise helps stimulate a sluggish bowel.

*Any persistent change in bowel habits, such as increase or decrease in frequency, size of the stool, blood in the stool, or an increased difficulty in evacuating, warrants a medical consultation.

Musculoskeletal diseases aren’t just widespread— they’ve also become a significant factor in the economy, with associated costs estimated at an amount equal to 5.76% of the US gross domestic product. That’s just 1 of the insights offered in the latest edition of a detailed report on the impact of musculoskeletal conditions across the country.

Advance-published sections of the US Bone and Joint Initiative’s (USBJI) 4th edition of “The Burden of Musculoskeletal Diseases in the US” are now being rolled out at the USBJI website. The report compiles extensive data on a wide range of conditions, including low back pain, neck pain, arthritis, osteoporosis, and injuries both in aggregate and among special populations, and includes insight on economic impact. The latest edition also features a new section on neuromuscular diseases.

According to USBJI, more than half of all adults in the US now report a chronic musculoskeletal condition—a rate that outpaces the prevalence of reported respiratory conditions (24%) and circulatory conditions including high blood pressure (42%). Chronic low back pain, joint pain, and disability make up 3 of the top 5 most commonly reported medical conditions, the report states.

In turn, musculoskeletal conditions have become a major factor in health care costs—an estimated $332 billion between 2012 and 2014, according to USBJI, with costs likely to increase with an aging US population.

Three chapters of the latest edition are now available, with more to be released in the coming weeks. USBJI hopes that the resources will help to highlight the need for more resources devoted to addressing prevention and treatment of musculoskeletal disorders.

“In spite of [the overall prevalence and significant costs], research funding for musculoskeletal-related conditions remains substantially below that of other major health conditions, such as cancer and respiratory and circulatory diseases,” the report states. “If health care costs in the future are to be contained, musculoskeletal diseases must come to the forefront of research.”

Take home message:  Invest in Prevention, Diagnosis, and Treatment to Improve Outcomes and Lower Costs.

Source: New Data on Musculoskeletal Disease Highlight its Position as Major Contributor to Health Care Costs

Even though they are keeping fit, up to 14% of American runners experience low back pain (LBP) each year. But runners can reduce their risk by developing their deep core muscles, say authors of a recent study in the Journal of Biomechanics (abstract only available for free).

While many fitness enthusiasts focus on their abs, they may neglect the trunk muscles they can’t see. “Improper function of this musculature may lead to abnormal spinal loading, muscle strain, or injury to spinal structures, all of which have been associated with increased low back pain risk,” say researchers.

To test this idea, authors used motion capture technology to collect kinematic data from 8 participants with no history of back pain and no recent injuries. The data, gathered while the participants ran, was used to create simulated full-body models in OpenSim, a software tool for modeling movement.

In the simulations, researchers gradually weakened the models’ deep core muscles, both individually and together. They found that when deep core muscles are weak, superficial core muscles, particularly the superficial longissimus thoracis (LT), tend to overcompensate, which may result in muscle injury or fatigue. And since the superficial LT was most often the muscle overcompensating for weak deep core muscles, it may be “most at risk for fatigue or injury” if deep core muscles are not functioning properly.

The authors believe that certain deep core muscles appear to be more important than others in runners. “The deep erector spinae required the largest compensations when weakened individually,” note authors, who conclude that “it may contribute most to controlling running kinematics.”

When all deep core muscles were weak, or when only the deep erector spinae was weakened, there was a significant increase in both compressive and shear spinal loading in the upper back, with a decrease in the lower back. Over time, this could result in damage to the spine and increase the risk of injury, authors warn.

Authors suggest further research using simulated models to examine core function in running. The study, researchers observe, “is the first step in providing evidence to support the common notion that poor core strength and stability may influence a runner’s risk of developing injuries such as LBP.”

Source: PTinMotionNews 1.19.2018 Core LBP Runners

Historically, the physical therapy profession began as an adjunct to medical practice. Considered a specialty, physical therapists use mechanical force and movements to remediate impairments and promote mobility, function, and quality of life by providing their expertise of rehabilitation within healthcare dimensions of promotion, prevention, and intervention to people, communities, and populations. This conservative, holistic (patient centered) approach comprises of an active engagement model of 3–steps:

1. to listen actively;
2. to think reflexively;
3. to reason critically.

In addition to clinical practice, other dimensions encompassed in the physical therapy profession include research, education, consultation, and administration:

We bridge the gap: On one side of the bridge, we draw from the connections we make from your story to frame and recognize what seems important to you. On the other side (the clinical side), we draw from your referring doctors. Thus we will have a clear sense of both sides which allows us to engage with the appropriate types of moral reasonings, particularly since you and your doctor may hold different definitions of end goals during rehabilitation.

We take care of business: Your choice to come to Carousel is like a new job each time; we first have to be hired, receive a performance review, and be promoted accordingly—so, in essence, it is our #1 job to inspire you through treatment goals. Our performance review is based on your treatment progress, and our promotion is when you graduate from therapy!

We need to hear from you: Your success story is Carousel’s peer review. Each success story sent back to Carousel is a report card for US! They keep us humble but also help us to make the changes when and where needed. And, it also lets us know that our product/service is working….. because, what we don’t know CAN hurt us!

So keeping Carousel running like a well-oiled machine is essential for improving your quality of life from every single aspect: initial contact for treatment to a successful discharge!

Motivating yourself to stick to an at-home physical therapy regimen can be tough, but it’s crucial for recovery. “The overwhelming  majority of folks tend to feel like, ‘Oh, I’ll just do it’ and fail to recognize that it’s really hard to change any behavior,” says Kevin Masters, clinical health psychology professor at the university of Colorado Denver. People can also face time constraints, lack motivation or simply forget.

“But if you want the treatment to work, it’s important to follow your PTs orders. In fact, the work at home is just as –if not more– important than the time patients spend in the clinic, says Jessica B. Schwartz, a PT in New York and spokeswoman for the APTA. “My work can only take them so far,” she says. But when patients are completely committed to their treatment plan, they’re going to hit this thing out of the park,” she says.

Here are four tips on how to do that:

1. Find a purpose: Identifying a broader purpose for being in good health-whether it’s going to the Olympics or being able to bike ride with your partner-is a great way to stay committed to your at-home regimen, Master says. When you link your treatment to the kind of person you want to be, it can help you stay motivated for the long haul, he says. PTs can help patients make the connection between the exercises and their purpose by setting smaller goals along the way, says Schwartz.
2. Meet your match: To build your connection, Schwartz recommends calling offices or clinics (in our case call Carousel!), “You have to find the right person and place for you,” she says.
3. Be Honest: Better than keeping mum or lying is simply speaking up. When you’re honest, you can better work together to figure out what’s holding you back-be it pain, time management, or just disinclination toward exercise-and how to overcome it, says Sionnadh McLean, an expert in movement and function at Sheffield Hallam Univ. in the United Kingdom. Any good physical therapist won’t judge, she adds.
4. Strategize: Time! is the No. 1 reason patients say they have trouble doing their homework. Masters says the “how” part of completing your homework comes down to being honest with yourself. But most exercises don’t take more than 10-minutes each day, Schwartz says, so it’s more often a matter of not finding time than not having time.

(a US News & World Report Article on the importance of finding the right physical therapist match can increas the likelihood of follow-through.) Aug. 31, 2015

Guest Blogger: Crystal Bondurant-Salisbury, L.P.T.A.

Do you ever feel like the “old dog” that can’t learn new tricks? Well, research says you can!

An article in the New York Times goes on to even suggest that not only can you learn new tricks, you can grow new brain cells. The human brain is an amazing thing that we once thought only grew from birth to adolescence, but actually continues to make changes until our deaths; if we exercise it correctly. The article, New Sports May Stretch The Brain, by Gretchen Reynolds touches on the latest updates you can make to your brain.

We have all heard that we should “exercise” the brain, keeping our thinker going so we can try to prevent the later-in-life issues such as dementia. There are an abundance of articles that have pushed us towards crossword puzzles, Sudoku, and word searches. But, but did you know exercise has a similar effect? New studies explain various ways to “update” your brain with exercise.  Activities, like running, were shown to increase the number of brain cells being made in the parts of the brain that are important for memory and thinking, but the most compelling evidence of change came with forming new motor skills.

If you have seen your friends playing pickle ball at the local YMCA, or your buddy just picked-up tennis, not only are they improving their muscle mass, they are more than likely growing their brains. So remember, there will be visible increases in the grey matter in your brain when you too pick your new sport! The research supports more benefit for new sports or activities versus the well practiced activities you have already mastered.

So, not only can the old dog learn new tricks, but you will grow new brain matter when you do. I hope you get out there and find your new sport and strengthen your brain. I might even see a new face on the pickle ball courts or in the Pilates class!

I thoroughly enjoyed the article. And, in my opinion, it was a quick read that was well-written, and very informative! ~Enjoy

Source: Learning a New Sport May Be Good for the Brain

Guest Blogger: Katie Reynolds, D.P.T., and Carousel’s Women’s Health Specialist

You are going 110% at your regular Ripped Class, or banging out burpees during strength and conditioning and….oops I think I just peed a little—-How Embarrassing! Truth is, look at your classmates, there is at least one other that just did the same thing; especially if they are mothers!

Leakage during high-intensity activities such as running, lifting, jumping is more common than you think. Most women think, “oh well, this must be normal after I pushed out a 9-10lb baby, right?” Wrong!! You may be fitting back into your clothes from high school, but you are missing out on the most important exercise….KEGELS!

Oh we have all heard this word and may have done them a few times in our life but we aren’t really getting the best out of the exercise. The best part? If you are doing this exercise correctly no one should know you are doing it! You shouldn’t be squeezing your cheeks and rising up, but tightening your pelvic floor muscles like you are holding back gas or going to the bathroom. There are also 2-types of muscle fibers “down there,” strength and endurance. So, to get the best benefit you need to exercise both (the best way is to do 15 kegels where you hold for 1-2 seconds, and 15 kegels where you hold for 8-10 seconds).

Can’t remember to do these….there is an app for that!!! That’s right –  they even have apps for kegel exercises! Just look it up and there are free ones, and paid ones.

So keep up with those kegels and even incorporate them with your exercise program, because they are part of the “CORE” muscles. Build your strength and do some of those jumps with very little leakage and not having to wear those bulky pads!

Women’s health week is a time where I like to encourage women to take care of themselves. We are always so focused on taking care of everyone else 1^st; children, spouses, parents, etc.; and leave ourselves for last. Well, it’s that time of year to schedule those important appointments of mammograms, dermatologist, gynecologist, etc., and start putting YOURSELF before others for once because you most definitely should not be peeing during Pilates!

Game developer and researcher Jane McGonigal is among 155 million Americans who plays video games, but for her it’s more than a hobby. In her new book, “SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient–Powered by the Science of Games,” McGonigal uses what she learned about the psychology of games to tackle life’s challenges.

How might this apply to that of Physical Therapy? Well, she took a page out of her own “game” book, and did was part of a speaker series on TED talks that I recently listened to and thought, wow! this really applies to how we focus on our patient’s recovery here at Carousel. The page goes something like this:

While at her home office, Jane said she stood up from her desk hit her head on an opened drawer from file cabinet and sustained a concussion.  It did not heal properly, causing her to have a myriad of symptoms including vertigo, and depression. She ended up spending 3-months in bed with strict orders to help stop the triggers/symptoms such as no reading, writing, video games, work (or e-mails), or running; in essence remaining still in her bed.

As you can imagine there was fall out causing doubt, fear, and isolation. How could she eliminate the fog of depression so that the anxiety she suffered from went away (which can make you turn on your inner most worst thoughts that you can’t achieve your goals)?  She turned her injury a game.

Now because she is a gamer; she likes to have goals like special missions and secret objectives. And, in her studies, she’s been researching the science behind gaming for a decade, and has a Ph,D. in this. She took what she learned, how the power of gaming the psychology of games help to tackle life’s challenges, and created SuperBetter. She explained that studies show that what we feel when we play video games is:

Being able to tackle tough challenges:

• Creativity
• Optimism
• Determination
• Resilience in the face of setbacks
• It’s easier to Ask for help

Why? The brain is taking a challenge seeking puzzle pieces, and overcoming obstacles that gets the neurochemistry of the brain excited, motivated, goal oriented. Resilience is your ability to stay motivated, curious and optimistic even in the face of a challenge….

• Physical resilience: Your body can withstand stress and heal itself.
• Mental resilience:  Focus, determination, and grit.
• Emotional resilience: You activate positive emotions when you need them most: Your Happy Place or seeing a picture of a baby animal.
• Social resilience: Your friends and family make you stronger (the power of touch helps you to release oxytocin (the trust hormone).

The SuperBetter method brings those real life psychological strengths to real life challenges; Rules to the game are:

• Challenge yourself – Make the decision to get help from your physician!
• Find and Battle the bad guys – Your Diagnosis.
• Seek out and complete quests – Friends & Family (to help you along your road to recovery)
• Recruit your allies – US!
• Adopt a secret identity – Create an alter-ego name (or go to your Happy Place).
• Go for an Epic Win – Successful Discharge from Treatment: becoming YOUR own Success Story!

The great news? We have all of the components to this game! And, better yet, we are always willing to play the game with you at any time. Even though we understand that this may not necessarily be the game you would like to play in tackling a challenge, as well as becoming the hiccup in your ever-so-busy agenda.

The best part of this game? You guessed it- it’s a win-win outcome! The end result is Post Traumatic Growth – learning how to overcome the doom that causes us to suffer, and be stronger, braver and happier……………SuperBetter!