Just Breathe

My mother used to always say “Take a Deep Breath” when I was angry at my sister, or upset about something as a child.   I never realized how very valuable that advice was until much later.  I teach breathing techniques to my patients every day.  We go over and over it everytime they come in.  I get into a rut with it and doubt it’s importance and then I do a little reading and google searching and am reminded of the amazing, beautiful importance of the diaphragm and its amazing ability to impact so many of our bodies functions.  It truly is at the heart of “holisitc” healing.  So these days when my children push my buttons, or I have had enough of traffic, or my phone seems to buzz constantly, I take that deep abdominal breath and think of my mother.  Then I remember all the things that are benefitted by that simple action.  I wanted to share all the reasons it is important to exercise the diaphragm muscle and just breathe.

First, lets review the normal mechanics of breathing.  The diaphragm muscle sits at the top of the abdominal cavity, separating the chest cavity from the abdominal cavity.  Upon inhale, it contracts pulling air into the lungs.  At the same time, the muscles between the ribs, the intercostal muscles  contract expanding the rib cage.  As we exhale, the diaphragm muscle relaxes and air moves out of the lungs.  The intercostal muscles relax and the rib cage gets smaller.

breathingThe pelvic floor muscles are a very important piece in this system as well, functioning alongside the diaphragm for breathing.  During inhale they relax and descend down. With exhale, they recoil back up, mirroring the movement of the diaphragm. This piston-like movement provides massage and movement to the abdominal and pelvic organs, helps to pump blood and lymphatic fluid through the trunk, it helps to aid in pelvic floor muscle healthy function and keeps a balance through the trunk musculature.

Taking even 5 minutes every day to practice abdominal breathing is beneficial to us as humans!  The more you do the longer the carry-over becomes greater and greater.  Abdominal breathing teaches self-soothing to allow for better stress management, less anxiety and better sleep.  It is calming to our bodies in a world of stimulation from phones, tablets, computers, and TV.  Abdominal breathing turns down our sympathetic nervous system. Wait! it sounds too technical but keep reading…The sympathetic nervous system is responsible for “fight or flight”, meaning if you walk up on a bear in the woods this system is what tells you to RUN! Of course like all things in nature, there has to be a balance, and the sympathetics’s partner is the parasympathetic system. We need a good balance between the two. When one is overstimulated (ahem, put down your cell phone for a minute and focus here!), we tend to live in that mode of heightened awareness.  This increases heart rate, blood pressure and decreases blood flow away from our organs to divert it to where it needs to be to get away from that bear.  Helpful when we really need to get away, but not helpful in our daily lives when really all we need to do is calm down.

Abdominal breathing favors the parasympathetic nervous system. It brings increased oxygenation to our blood stream, it slows heart rate and decreases blood pressure.  It turns the sympathetic nervous system down a notch, putting that bear into hibernation mode. This allows for decreased stress, decreased anxiety and improved cognition and brain function.  This improves blood flow to vital organs, keeping systems mo ving happily. It relaxes muscle groups, reducing pain and inflammation. In a world where we are going every minute it would greatly benefit everyone to take just 5 minutes daily and JUST BREATHE.

Here is how to do it:

Find a comfortable position, the one shown below should work for most people.  Do this at a time of day when you can follow it with a calm activity or are ready for sleep, as this is designed to soothe you and put you in a sedated state.  Place one hand on your belly and one on your chest.  Inhale through your nostrils, allow your abdomen to expand and blow up like  a balloon.20140904_093026

Exhale, and the abdomen falls down.  Repeat this for 5 to 10 minutes, feeling and allowing your entire body to relax.

Try working this into your day, every day and see and feel the benefit!

– Sarah Dominguez, PT, CLT

Urine leakage in the female athlete


I continue to be blown away by the number of young female athletes who are leaking urine during their sports activities.  I have heard that many women who leak think it is normal.  I also hear women say that it is normal for them to leak urine because that’s what women do. It is never normal to leak urine especially in a young woman who has not had children.  Urine leakage is a symptom that occurs when there are musculoskeletal dysfunctions within the pelvic girdle.  pelvic girdle

I would consider urinary leakage or incontinence to be a sports injury.  No, it may not be a sprained ankle or a torn ACL, but having urinary incontinence is a sign that there is something wrong with the stability system within the spine and pelvic girdle.  When a female athlete has knee pain, a coach, guardian or physician would suggest she see a physical therapist.  This is prescribed to help rehab her knee back to good health, because knee pain prevents an athlete from performing her best.  But what about a female athlete with urinary leakage?  Leaking urine can be embarrassing, frustrating and can greatly limit the athletes’ performance, therefore it is an important issue in the lives of these women.

The International Continence Society states stress urinary incontinence is the “complaint of involuntary leakage on effort or exertion or with sneezing or coughing”.  Some studies over the years have reported a prevalence of incontinence, up to 69% in the general population.  This occurs, due to the muscles and support structures in the pelvis being unable to withstand the pressure that is created in the abdomen with activities; such as coughing, sneezing or changing positions, like moving from sit to stand. You can read more about this on a previous blog, “Why do I pee my pants when I laugh”.

Recent research is showing a rise in incontinence in the young and athletic female population.  Having a teenager with urinary incontinence, just doesn’t seem right.  While it is more common for women who have had children to experience urinary incontinence, younger female athletes are also experiencing urine leakage with their sport. Young women who haven’t had children shouldn’t experience incontinence, right?  Well, no they shouldn’t but they do.

Risk factors for stress incontinence include: increased age, pregnancy and vaginal delivery, being a female, strenuous work, and exercise. A 2011 study that looked at urinary incontinence in female athletes found that a whopping 41% of elite female athletes experience urinary incontinence with their sport, and 95% of them would not dare discuss this issue. (Jacome et al)  Another study from 2006 found 29% of athletes studied had incontinence versus just 9% of their non-athlete counterparts. (Caylet et al.) Not all female athletes have incontinence, but there are sports which have a higher prevalence of incontinence in females; usually due to increased ground reaction forces through the body from landing after jumping or weight shifting movements. For example, one study found 0% female golfers had incontinence, while 67% of female gymnasts had leaking with their activity.  Leakage is reported both during competitions as well as practices for female athletes.

Research suggests female athletes have a stronger pelvic floor than the general population. So if they have higher pelvic floor strength, then why are female athletes leaking?  One theory suggests the added impact of repetitive stress on the muscles, ligaments and connective tissue can cause stretch weakness or overuse to these structures, causing them to become weak or fatigued and less able to control the increase in pressure which then makes them more likely to leak.

So, as I said before, a female athlete with knee pain would see a physical therapist for rehabilitation of the knee.  A female athlete experiencing urinary incontinence, with sport or daily activities, should do the same. It is stated in the literature that conservative treatment, namely pelvic muscle training should be the first line of treatment for stress urinary incontinence (Bo et al).  There is something wrong with her stability system, therefore, she should rehab it. It is important to bring this issue up in order to reduce the stigma associated with it, and get these athletes help.  Improving the function within the pelvic girdle can not only cure incontinence, it can greatly improve sport performance as well.  There are physical therapists who are specifically trained in pelvic floor rehabilitation, which is the kind of therapy a female athlete with urinary incontinence needs.  These physical therapists know how to diagnose impairments and improve the coordination of “the core” to ensure continence.

At Foundational Concepts, specialty physical therapy is what we pride ourselves in.  We treat pelvic floor dysfunction, prenatal/ postpartum pain and especially urinary incontinence in female athletes.  If you would like to learn more about pelvic floor physical therapy you can visit our website at www.foundationalconcepts.net or call us at 816-569-2802.

Please share this with the female athletes you know and the people that care for and work with them. Let’s encourage them to speak up and hopefully we can contribute to decreasing the rate of urinary incontinence in female athletes.

Amanda Fisher, PT, DPT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Hospital based outpatient PT more expensive than Private clinic


be informed in your healthcare choices!

Why is the tailbone (coccyx) so important?

Often during my conversations with patients, they will mention an old tailbone injury from a fall, an accident, or a challenging birth of a child.  Many times, the injury is blown off with an “It was just my tailbone.”  Oh, the little attention the tailbone gets!  How is this little bone so often involved with pelvic pain, urinary incontinence, constipation, and pelvic organ prolapse?  Let’s take a closer look at this little bone that gets so little respect.

The lack of coccyx support has far reaching consequences, beyond the pelvic floor.  Let’s start with the pelvic floor and expand outward.  The coccyx (tailbone) is the very end of the spine, attaching to the bottom of the sacrum, and is the anchor for the many of the muscles in the pelvic floor.  It is the attachment site for the levator ani muscles which are the muscles that form the bottom of the pelvic bowl connecting the pubic rami to the sacrum.  These muscles act as a support system for the sacrum, pelvis, rectum, bladder, and in women, the uterus.   When the tailbone has been injured, the angle of attachment for the levator ani muscles changes, causing tightness and spasm in some muscles and weakness in others.  This can contribute to hip and back pain with sitting, walking, lifting, bending and squatting. 

pelvic diaphragm

With decreased muscular support for the sacrum, external support must be provided to decrease the hypermobility and pain.  In many cases, this can be provided by a sacral support belt to stabilize the sacral iliac joints and to prevent sacral torsions and innominate rotations.  However, even with this external support, some people will continue to have a decrease in balance and proprioception due to the internal decrease of core, hip, and pelvic floor stability and strength.  This can lead to an increased risk of falls and injury with everyday activities.

SI belt

The coccyx and levator ani muscles also play an important role for lymphatic and blood flow to the trunk.  Changes in lymphatic and blood flow occur due to decreased or changed pelvic floor muscle activity.  In conjunction with the thoracic diaphragm, the pelvic floor muscles act as a pump for the lymphatic system, issuing fluid to the thoracic duct, the main drain for the lymphatic system.  A backup of fluid often occurs when there is poor coordination of the diaphragm and the pelvic floor muscles.  This will appear as abdominal swelling, bloating, or pelvic heaviness.  A pelvic floor physical therapist who also has a strong understanding of the lymph system can work to coordinate both diaphragm activation and relaxation patterns and to pelvic congestion management.

abdominal contents

With the changes in the pelvic floor muscles, patients will also have decreased support of the pelvic organs.  The weakness of the pelvic floor and core muscles lead to pelvic organ prolapse of the bladder, rectum and/or uterus.  Pelvic organ prolapse can contribute to urinary leaking, constipation, and pelvic heaviness.  If the prolapse is not advanced, often muscle strengthening and pelvic floor PT is successful in reducing the symptoms. 

The coccyx truly is our anchor and is not to be overlooked or taken for granted.  Pelvic floor physical therapy can make a world of difference when dealing with issues of the coccyx.  A hand’s on approach to treatment can assist in the decreased pain and improved strength of the muscles surrounding the tailbone. 

–Jennifer Cumming, PT, MSPT, CLT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

Fix your Baby Belly, and stop doing crunches, forever!

What is Diastasis Rectus Abdominus?  A Diastasis is a separation, the Rectus Abdominus is the abdominal muscle better known as the six pack muscle.  A separation, or tearing of the fascia in the center of this muscle, the Linea Alba, happens to many women during and after pregnancy.  This condition can be very visually unappealing, especially as we head into summer and swimsuit season.  Besides this tummy condition being quite displeasing to us moms, it is also a significant risk factor for back pain, pelvic girdle pain, incontinence and pelvic organ prolapse.  It often resolves on it own within 8 weeks. If it lingers, do not stress, it can be very successfully treated with exercise, education, awareness of postures and body mechanics and an abdominal binder.

Let’s begin with the anatomy.  The abdominal canister is a functional unit made up of components of the abdominal cavity that synergistically work together. It is made up of abdominal and pelvic organs that are housed by several muscles.  The

abdominal cannister2

diaphragm, the psoas muscle, the pelvic floor musculature, the transversus abdominis (TA) and multifidus muscles. These muscles all share associated fascial and connective tissue connections.  They are supported by boney structures of the thoracolumbar vertebral column and rib-cage and the pelvic bones.  There are many joints within the cannister which need stabilization during daily activities.  Improving the function of this cannister will provide spinal and pelvic girdle stability, support pelvic organs and restore continence or prevent incontinence.  The intricate relationship of these muscles is such that when one is injured and weak or painful and tight the entire system suffers and becomes dysfunctional.  In particular when the Rectus Abdominus muscle and it’s fascia is torn or separated by pregnancy, the front wall of this cannister is weakened. This allows for poor postural support, poor organ support and causes the other muscles of this unit to have to work harder in a disadvantaged position. abdominal wall


The image on the right shows a good example visually of what happens when there is damage to the abdominal cannister. The front abdominal wall weakness allows for posture to suffer, the rib-cage falls forward, the cervical, throacic and lumbar spines are impacted negatively, the pelvic rotates forward, causing pull on the Psoas muscle.  the Psoas muscle often responds by over recruiting itself to make up for the lack of support in the anterior wall and becomes tight and painful.  The poor posture also creates pressure into the pelvis, weakening the already insulted pelvic floor musculture and decreasing support for the pelvic organs.  All of the muscles of this unit share fascial connections so poor posture and poor positioning of one muscle effects every muscle in some way.  The many joints in the spine, rib-cage, pelvis hips and knees are all affected. When a joint is under constant stress cartilage is damaged and joints become painful.

Many women get to work exercising and most women start with crunches and abdominal work, that seems like a reasonable place to start, right?  If this applies to you, stop those crunches now and keep reading!  No more crunches!  Hooray!  What actually needs to happen is you need an abdominal binder and you need to wear it for a good 6 weeks with all activities and exercise.  Think of it like a cast for your broken belly, The binder brings the fascia back together and supports the weakened abdominal wall and allows it to heal in the correct position.  Crunches are a repetitive injury to an already injured tissue, as well as putting stress on the discs of the low back and putting you at risk for disc injury.  So, step one is stop those crunches and get an abdominal binder.  I marvel at old wisdom. Those uncomfortable looking girdles our grandmothers wore, were ahead of their times! They knew a lot more than we gave them credit for!  They weren’t going to have that unsightly belly bulge, so they bound it up, and in doing so, likely resolved their diastasis unknowingly.

The exercise progression that is appropriate for improving Diastasis Recti focuses on strengthening the Transversus Abdominus, Multifidus and Pelvic floor musculature together with improving diaphragm function.  As well, a skilled physical therapist can examine you to determine other musculoskeletal concerns that are also impacting your recovery.  Often a vaginal exam of the pelvic floor may reveal not entirely weak muscles, but also muscles that are in spasm, for which strengthening will cause more harm.  There may be tightness in not just Psoas but in other hip and pelvic muscle imbalances.  It is important to evaluate your system from head to toe to determine the best individualized exercise program for you. This will optimize your exercise efforts and save you time and money spent on programs that are not right for everyone.  We are all very different from our postures and structure to even our daily activities and our emotional state.  This requires an individual program to see best results.

Posture and Body Mechanics are a huge factor in improving that mommy belly.  When you stand with your head forward, and your shoulders slumped you let that abdominal wall hang and increase pressure on the torn tissue, pressure on the pelvic organs and stress on the spine, ribs and pelvic joints; not to mention the bind that puts the diaphragm in for full function.  You can exercise and stretch to your heart’s desire, but if you leave the gym and spend you day in a yucky posture all you have done is for naught.  You return to bad habits, force muscles to function in poor positions.  Your mom knew something all those times she told you to stand up straight. It is so important for improving your baby belly and protecting your body from injury and pain.

So stop those crunches, bind that belly and find a PT who is knowledgeable about Diastasis and pelvic girdle dysfunction after baby to help you design a program that will be optimal for you.  The results are fantastic with consistent follow through and dedication to the program.

Sarah Dominguez, PT, MSPT, CLT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.


Interesting article on meditation.




Because I’m Happy!

In the midst of moving to our new clinic location (happy) I wanted to take a moment to reflect on the year that has passed (happy).  Foundational Concepts turned one recently, on March 18, 2014 to be exact!  All the thoughtful processing, dreaming “big”, hard work, worry and care that went into opening our very own business has grown into a thriving practice.  I could not be more grateful. I could not be happier…like a room without a roof!

I have to begin with a very BIG thank you to Jenn, my business partner and dear friend. Had she not been sitting next to me one day,  and at the same time both said “we could do this on our own”,  the thought would still be just a dream. I would never have done this alone. Jenn is such a fantastic business partner.  She is a terrific clinician.  She is a great friend.  I am so blessed to be a part of this practice with her.

I am so thankful to all the wonderful physicians, psychologists, chiropractors and other healthcare providers who trust in us to care for their patients and help them on their road to wellness.  There are many options for physical therapy but you choose to send them our way, and for that I am grateful.  Both Jenn and I work hard to provide our patients with the best experience, and the highest quality of care. We combine years of experience with current evidence and a strong passion for what we do.  I appreciate the providers who recognize this and allow me to be a part of these patient’s healing path.

I am thankful for my husband, Sam and for Jenn’s husband Mike.  They have spent countless hours helping us along the way from financials to this website, to putting together furniture and taking the kids off our hands so we could work.  Their unconditional support from the start is phenomenal.  From day one, when i first mentioned to Sam what Jenn and I had been thinking I never heard “No”.  Your trust and willingness to take this risk with us is proof of your love and support for us.  I could not be more grateful, for there is no way I would be here without you.

I am thankful to every patient I have seen not just over this past year, but over my entire career. I learn more from you than can be taught in any textbook or course. I am grateful for your trust in me to help you find answers to your pain and dysfunction.  I am grateful you choose me to be a part of your team along the roadmap to better function and quality of life.  I enjoy each of your smiles, tears, and worries and I am humbled that you have shared them with me.  I love that I am able to lend a helping hand, a listening ear, a laugh, or a tissue along the way.  Thank you, Thank you for allowing me to really enjoy what I do.

Another HUGE thank you goes to Sushma Patel, owner of Bodies in Motion and Physical Therapist for allowing us the opportunity to open our practice with very little risk and overhead by sharing her space for the year.  She opened her PT clinic to us, allowed us use of the equipment, and her office staff and truly made us feel at home. We are forever grateful to you for helping us start off successfully.  We will absolutely find a way to “Pay it Forward” in some fashion as our practice grows. We learned from you and are so thankful for your generosity.

Last, I am thankful for all of those that I have met along the way this far in my career. Other therapists from whom I have learned, professors, researchers and students, have shaped my clinical career tremendously.  My dear friends who support me and love me and listen, you are amazing.  My three beautiful children who don’t understand now why this is so exciting and important to me, but will I hope when they grow up see what an accomplishment this is.  I hope most of all they see the importance of hard work, and pursuit of happiness and what it brings to your life.   My parents who have always shown support and love in my life, thank you.

Happy Birthday Foundational Concepts!

- Sarah Dominguez, PT, MSPT, CLT

Clitorodynia, say what? Klit-or-oh-di-knee-uhhhhh

Yes, it is a mouthful, and sounds something like a prehistoric animal.  But,  it is a very disturbing condition that many women suffer from and it is often mis-diagnosed or mis-treated. The clitoris is a powerful organ of sexual pleasure. The tip has thousands of sensory nerve endings, more than any other body part.  Women by design,  have  greater blood supply to the pelvic area. The clitoris provides the means of having multiple (or any) orgasms. Women’s sexual response has unfortuantely been defined by male standards, making our understanding of the clitoris and its function inadequate.  Too often women come to see us and say “I am really not very familiar with that area”.

Clitorodynia is a subset of pelvic pain in which pain is centered around the clitoris. It can be burning, sharp or dull pain that often limits clothing choices, time in sitting, biking and sex, of course!  The big question on our patients tongues is WHY WHY WHY???  There is often no particular injury that causes this condition.  It is likely irritation, compression or injury to the Pudendal nerve and particularly its branch called the Dorsal Nerve of the Clitoris. The dorsal nerve of the clitoris provides sensation to this structure.  When the nerve is held under tension, compression or injured directly it can be very painful.

dorsal nerve of the clitoris


This is a great illustration showing the nerves to the perineum and pelvis and you can see the Dorsal Clitoral nerve, as well as the Pudendal nerve and their path.  Nerves love movement. When you have tension in the muscles, tissues and fascia nerves are not allowed to glide and move as they are designed to and they become irritated.  As well, if you have chronic inflammation from chronic pain this affects nerves in a similar way, by irritating them with the inflammatory “soup” that becomes trapped in your tissues. Nerves also love blood flow.  Again, if you have muscle tension and tissue restrictions you do not have good blood flow.  As such, in chronic pain conditions blood flow is also poor. Activities such as biking, or professions which require long periods of sitting can reduce circulation to the perineum and aggravate the condition.  Nerves also love space. They are designed beautifully in fantastic canals of fascia and connective tissue. When these spaces are compromised, your nerves are not happy.  When you restore blood flow, movement, and give them back their space, the pain and irritation settle down.  The next question on our patients tongues is HOW do we do this?

There are many medications that your physician may prescribe to help with this pain. I am not a physician and so I will not discuss these in this blog. My experience with these drugs has been that they dull the pain to allow a patient to function at some level, but leave side effects to deal with. Medication DOES NOT address the cause of the nerve irritation, it simply treats the symptom. Other medical treatments that can be helpful are pudendal nerve injections and topical pain relievers.

Behavior Modification Therapy with a certified sex therapist can be tremendously helpful. Because the painful clitoris affects sexual function, and the brain is the primary organ for sex, a psychologist or licensed counselor who has experience with sexual disorders/pain syndromes is very important in your treatment.  When this goes on for months/years, there are often relationship issues that need to be addressed.  Stress is a significant trigger for this pain and counseling is a great way to learn better management techniques. Dealing with vulvar (that’s a fancy word for your external genital area) pain can feel embarrassing, limit your social activities and your relationships. If you have to take medications the side effects can cause problems and the stress of this builds in anyone. It is very important to manage this.

Physical Therapy (my turn!) is a great treatment for clitorodynia. Physical therapists are experts in nerve tension, compression, injury and rehabilitation for these painful structures. A pelvic physical therapist can palpate the pudendal nerve as it travels through the Pudendal canal (also called Alcock’s canal). They can palpate the muscles within the pelvic floor that house the superficial branches of this nerve to determine if they hold too much muscle tension or painful trigger points.  They can help you modify activities or exercise programs to better fit your needs an not aggravate your condition.  Plus we love to educate!  We will spend most of our time educating you regarding the anatomy and function of this area so that you can confidently return to healthy, pain free lifestyle.  At our sessions we will perform some manual therapy releasing tight muscles and tissues vaginally.  We will often use biofeedback as a tool to teach you how to relax these muscles using various techniques.  We will teach you to release these muscles vaginally through teaching a spouse or significant other, or use of  dilators or a tool called a crystal wand.  We teach deep breathing and relaxation techniques. We teach posture and body mechanics and how to modify these to reduce irritation to the involved tissues. We will also discuss sexual positions that may be more comfortable and less irritating.

The take home message is, please don’t let this very treatable condition go because it is embarrassing, or uncomfortable to discuss.  Be comfortable with your body.  I examine this area daily on many different women. The clitoris is a body part, just as equal (but definitely more sensitive) to the arm, elbow or wrist.  It was designed beautifully and serves a very important function.  There are answers, and if at first you do not find them in your first doctor you see, try and try again!  If you are reading this you are already on the right track!  Find a physical therapist who specializes in pelvic dysfunction, or a physician who specializes in pelvic pain, or a sex therapist. Each of these practitioners should have one of the other specialties that they refer to, or work alongside to help you find the right answer for you.

Sarah Dominguez, PT, MSPT, CLT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

Yoga and Stress for Women with Breast Cancer

Yoga Regulates Stress Hormones and Improves Quality of Life for Women With Breast Cancer Undergoing Radiation Therapy


For women with breast cancer undergoing radiation therapy, yoga offers unique benefits beyond fighting fatigue, according to a study by Chandwani et al published in the Journal of Clinical Oncology. While simple stretching activities counteracted fatigue, patients who participated in yoga exercises that incorporated controlled breathing, meditation, and relaxation techniques into their treatment plan experienced improved ability to engage in their daily activities, better general health, and better regulation of cortisol. Women in the yoga group were also better equipped to find meaning in the illness experience, which declined over time for the women in the other two groups.

  • Women who practiced yoga had a steeper decline in their cortisol levels across the day compared to women who practiced simple stretching exercises.
  • Women in the yoga and simple stretching groups reported a reduction in fatigue after radiation treatment.
  • Women who practiced yoga during the treatment period reported greater benefits to physical functioning and general health and were more likely to find life meaning from their cancer experience


Pelvic Girdle Pain during pregnancy and after baby

Visiting with friends for their daughter’s 1st birthday this weekend. Talking with her, I found out that she has had a great deal of pain for the past few years. She has pretty constant pain on her left side, very low back into her buttock and the back of her thigh.  She felt like this was just as good as she could expect to feel after having two children!  I had to share my very strong opinion about how important it is that we see a pelvic physcial therapist after baby to rehab our abdominal and pelvic region to prevent problems such as the pelvic girdle pain she is experiencing.bony pelvis anterior

Pelvic girdle pain during pregnancy and post-partum is common in 20-25% of women who are pregnant (Vleeming, et al) and 6-8% of women post-partum (Wu, et al).  Women typically experience pain near the sacroiliac joint, into the buttock, back of the thigh or pubic bone. It often is worse with sitting, coming up to standing, rolling in bed and prolonged walking.  The most common risk factors for developing pelvic girdle pain is a previous history of low back or pelvic girdle pain, and having had multiple pregnancies or deliveries. Of course! What can we not blame on pregnancy and/or delivery of those sweet little things?  They make our lives amazing, but leave our bodies like a war zone, and we are left to just hope and pray that things heal as they should. If you are left with pain or incontinence, well that is just the price you pay to have children, right?  Wrong!

If you are experiencing pain very low in your back, almost at the top of your buttock, over those “dimples” that you see over the sacroiliac joint,  then you may have pelvic girdle pain.  Pelvic girdle pain is the name for any pain that is in the pubic, sacroiliac, buttock or thigh region.  It is more common in women, especially in the childbearing years during pregnancy and after baby.  Usually women begin to experience it between 24 and 32 weeks into their pregnancy. If you experience it during pregnancy you may deliver and it goes away completely, or it may linger.  The good news is physical therapy is a great treatment for it, and you don’t have to listen to the “well, you are pregnant” excuses from those around you.  Especially after baby.  Don’t let them convince you that  you can’t expect to feel good after having children. You can! A women’s health physical therapist can get you there.

So what causes pelvic girdle pain during pregnancy and post-partum?  Not to harp on previous topics, but that “core” musculature that we seem to keep talking about blog after blog applies here too. It isn’t just your pelvic floor muscles that are impacted by pregnancy and delivery. The abdominal wall is compromised greatly to accommodate that bundle of joy that has taken over your body. The diaphragm is strained due to the changes in the size of your rib cage and forced to work harder (which is why you feel out of breath more easily). Your Lumbar spine accommodates the changes too, by appearing more “curved” like your belly is pulling it forward. So the “core” muscle function is greatly reduced during those nine months.normalvspregoabdomen  After the battle of labor and delivery (even if you have a C-section) we are a floppy mess! And really, even you skinny fit women know what I am talking about after baby, don’t pretend you don’t! We have all been there, somewhere between 2-6 weeks after delivery, standing in front of the mirror when you get up the nerve to look at yourself naked, or in your panties thinking “ugh, what happened to my body!?”

With the changes in hormone levels during pregnancy and after baby our musculoskeletal system is provided the ability to move and flex to allow for delivery of baby and whether you deliver vaginally or by C-section, you are still designed to be very flexible, which sets up the pelvic girdle for possible problems during this time in our lives.  Ligaments must accommodate the joint laxity that the hormones provide. Mens, et all found that women who experience pelvic girdle pain have 32-68% more motion in the pelvic joint when compared to healthy controls.  The muscles and ligaments are also under significant stress during pregnancy due to carrying 25-45 extra pounds.  This changes our biomechanics significantly. Our center of gravity is shifted from a more central location through the pregnancy center of gravitypubic symphysis to a more anterior location, which pulls us forward and forces adaptations at the head and neck, spine, pelvis and hips and knees.

With these drastic changes to our bodies, there are several structures that can cause pain. It is important that your health care provider rule out some other things that could be the culprit. Lumbar spine disc lesion and hip joint pathology can often mimic symptoms of pelvic girdle pain. A good physical therapist can rule these different diagnoses out, and help you find the appropriate practitioner.  It is also possible that bone or soft tissue infections maybe causing your pain. Urinary tract infections, deep vein thrombosis (or blot clots), certain obstetric complications are rare, but serious concerns that need to be screened for.  Finding a Physical Therapist who is knowledgeable and has experience in women’s health and pelvic therapy is important and will provide you with an accurate diagnosis and effective treatment for your pain.

Often treatment for pelvic girdle pain is just 4-6 weeks of therapy. After evaluating your body and determining the cause of your pain, your physical therapist will design a treatment plan of care to fit your needs. This usually includes manual therapy to the joint and tissues that are involved.  Strengthening exercises for the muscles found to be weak, and flexibility exercises for those that are tight and limiting normal body movements.  We often provide a lot of education regarding labor and delivery positioning and pain management.  Posture is important, and we will talk about that with you until we are blue in the face, but if you leave our clinic and go home and slouch all day you are undoing all our hard work!!!  We will spend time discussing the importance of care of your scar if you had a tear or episiotomy. We will discuss posture, and body mechanics when caring for baby and breast feeding. We will help to develop a great exercise program to get your core back to a fitness level that you would like.

Rehabilitation after baby is not a hope and prayer that you are one of the fortunate ones who don’t have a loose flabby tummy, back pain, incontinence or pain with sex.  It is up to you to seek out help for these concerns.  Unfortunately, our standards in the United States have not reached those in Europe where every woman sees a rehab specialist after baby to rebuild that war zone we are left with.  Our society leaves us feeling as though we are blessed we only leak a little when we sneeze and that well, what more can we expect?  I will tell you for certain, expect to get back to running, cycling, walking, swimming, jumping…whatever you want!  I can help you get there!  Don’t let it go, it is a fun and easy process of bringing balance back to your pelvis and abdominal region and that body in the mirror doesn’t have to be a disappointing one.

Sarah Dominguez, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.