Body Gears: Don't Ignore Your Pelvic Health

DR. MASA CHALUPA, PT, DPT, OCS WOMEN’S HEALTH THERAPIST NEWSLETTER The Newsletter About Your Health And Caring For Your Body Getting To Know The Body Gears Physical Therapy Team ® ®

from all walks of life face, and most specifically loves helping those experiencing pelvic pain. She is looking forward to completing further training to also treat men with pelvic floor dysfunctions and further honing her toolset.

Masa was born and raised in a Bosnian/Croatian household in Germany. In 1999, her family immigrated to Canada where she completed her undergraduate studies in Molecular Biology at the University of Waterloo. She played soccer, ran track, and played volleyball both in high

® Masa has been practicing as a physical therapist for the past 5 years in the Houston Texas Medical Center where she had the opportunity to work with patients with various orthopedic injuries. She also developed the center's Women’s Health and Aquatic Therapy programs and presented to resident physicians the role of physical therapy in the OBGYN setting. Masa is excited to join Body Gears where she can combine her passions for manual therapy and teaching. In her spare time, Masa likes to stay active doing yoga, HIIT training, running and intermural sports. She also enjoys traveling and exploring new areas in and out of town, cooking, and spending time with friends and family. Masa fell in love with Chicago during a clinical rotation in the Hyde Park area as a student and is looking forward to exploring this amazing city in every way and calling it HOME.

school and in college and she absolutely loves to exercise and be physically active. Masa has been fortunate to learn multiple languages and currently speaks 4 fluently (English, German, Bosnian/Croatian, and Spanish). After working as a Biologist for 2 years, Masa realized that she was meant to work with people more than cells and wanted to help people both feel better and perform better. She volunteered at several clinics and discovered her love for physical therapy. She graduated from Regis University in Denver Colorado in 2013 with her Doctor of Physical Therapy degree and completed her orthopedic specialization (OCS) in 2016. Masa has also achieved certification in Orthopedic Manual Therapy and has completed several Herman & Wallace pelvic health specialty training courses in order to treat women with pelvic floor dysfunctions. She enjoys treating a variety of pelvic health concerns that people

Find Masa at our Chicago West Loop clinic.

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NEWSLETTER The Newsletter About Your Health And Caring For Your Body

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What do back pain, urinary incontinence, and abdominal hernias all have in common? They can all be a result of the way you breathe! How can that be? Your diaphragm, the muscle connected to your lower ribs that helps you to breathe, is actually a core muscle. If it's not working right, it'll affect the rest of your core muscles that protect your back and abdominal area. What is the 'core' exactly? People refer to 'the core' all the time, but what are they really referring to? You can think of your core like a balloon: The top is your diaphragm, the front is your transversus abdominis muscles, the back is your multifidi muscles, and on the bottom are your pelvic floor muscles. They all work together to maintain a pressure system that allows you to breathe, stay upright, and regulate bodily functions. Just like a balloon, if you squeeze one side too hard, it will increase the pressure on the other sides. If those sides aren't strong enough or ready to take the pressure, that's when you can start to experience all sorts of different symptoms including back pain, DON'T IGNORE YOUR PELVIC HEALTH Live An Active Life Free of Worries! INSIDE: • Embarrassed to ask? Here are some answers • Body Gears News

• Exercise of the Month • Patient Success Spotlight

® or bearing down when you are having a bowel movement) which significantly increases the pressure in your abdominal cavity and can also lead to urinary leaks or even abdominal hernias.The benefit of your diaphragm having such an impact on your pelvic floor is that breathing re-training can be a highly effective component of pelvic pain and urinary incontinence treatment. Finally, posture and movement can also test your pressure system. Sitting in a slumped posture or standing with a big arch in your lower back taxes your core muscles and could lead to back pain. Even when you land from a jump, your organs exert pressure down on your pelvic floor. Should I hold all the sides of my core really tight all the time to prevent back pain, incontinence, and hernias? Don't waste energy trying to hold your core rigid because a rigid core can't adapt to pressure changes. With proper training, you won't have to consciously do anything! As long as your core muscles are strong enough, able to relax, and your resting posture is efficient, your core muscles will activate the proper amount automatically. Early training might require consciously activating these muscles if they've lost the ability to do so automatically, but eventually, your core will remember how to respond appropriately to changes in pressure all by itself. If you or someone you know is struggling with back pain, urinary incontinence, abdominal hernias, or pelvic pain, ask to speak with one of our Women’s HealthTherapists. Why suffer when you can ask for help? (continued inside)

incontinence, and even develop abdominal hernias. How do you 'squeeze one side too hard'?

There are all sorts of ways you test the integrity of your pressure system every day. Laughing, sneezing, and coughing are all ways the diaphragm exerts pressure from above. Those with a weak pelvic floor know all too well the leaking that can result from that increased pressure. The extreme version of this is exhaling against a closed throat (aka the valsalva maneuver

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Embarrassed to ask? Here are some answers. A lot of women feel too embarrassed to ask questions about their pelvic health. They either feel like they'll be judged for not already knowing the answer or they feel uncomfortable talking about the subject altogether. Well, no judgment here! We're taking the topic of pelvic health out from under the rug. Hopefully, knowing the answers to a few questions will give you the confidence to ask a few of your own. inguinal (through the inner groin - aka sports hernia), umbilical (through the belly button), and incisional (through a surgical scar). Like a prolapse, severe cases may require surgery, but because there is always a layer of muscle involved, physical therapy can be an effective form of treatment. Additionally, physical therapy is important in preventing hernias from occurring or reoccurring by ensuring that the core muscles that hold tissues in place are strong and activated.

Q: How often should I be peeing? A: Usually people who ask this question are concerned about an increase in number of trips to the bathroom rather than a decrease. Frequent urination can be due to a variety of factors and is classified as peeing more than 8 times per day. The healthy number of trips to the bathroom is 4-5 times per day. The bladder has a capacity of 300-400 mL and you should be peeing every 3-4 hours, though no more than once at night. In order to achieve this frequency of urination, you need to consume 25-30 mL of fluid per kg of body weight per day. If you're otherwise healthy but experiencing frequent urination despite normal fluid consumption, an over-consumption of bladder irritants could be to blame. Strawberries,alcohol,spicy foods,chocolate,andcarbonatedbeveragesare just a few things the bladder wants to get rid of quickly. On the flip side, decreased urination is considered an output of less than 400 mL of urine per day. This could be due to dehydration in women but is more commonly seen with prostate problems in men. If you're not sure whether the number of trips to the bathroom you're taking is something to be concerned about, ask to speak with one of our physical therapists about how to keep a bladder diary. Lukacz, E. S., et al. "A healthy bladder: a consensus statement." International journal of clinical practice 65.10 (2011): 1026-1036. Q: Should I expect to start leaking as I age or after having a baby? A: It is VERY common for leaking to occur during these times, but that doesn't mean ithas tohappenand itdoesn'thave tobeyournewnormal.Leaking ismost often due to weakness in the pelvic floor muscles; the muscles you would use to stop the flow of urine that can weaken with age and get stretched while giving birth. Coughing, sneezing, and jumping all challenge the pelvic floor muscles even more than gravity and is often when leaking occurs. This type of leaking is referred to as stress incontinence, whereas urge incontinence is leaking when the bladder gets too full. Those with urge incontinence will often experience frequent urination, sometimes by choice, to avoid any leaks. In this case, bladder retraining in addition to pelvic floor muscle exercises will be part of physical therapy treatment. Just like any other muscle, you can regain strength and control through exercise, which makes most cases of leaking 100% treatable with physical therapy. Dumoulin, C., and J. Hay-Smith. "Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review." (2008): 47-63. Q: Are prolapses and hernias the same thing? Are they as serious as they sound? A: No, these are different diagnoses but with sometimes similar causes. Prolapsesoccur inthevaginaorrectumsiteswhileherniasoccur intheabdominal or groin regions. There are different severities of both prolapses and hernias, but don't be scared because there is treatment available for every level! Prolapse refers to when organs lose their support and begin to fall, usually forward or down. Pelvic organ prolapse is the most common form and more of an issue after childbirth. Weakness in the pelvic floor muscles due to being stretched reduces their ability to hold the organs in the body, which means the bladder or uterus drops down against the vagina. Surgery may be required in severe cases, but because pelvic floor muscle strengthening and retraining is such an effective treatment, conservative management should be attempted first. Hernias refer to soft tissue pushing through a weak spot in the surrounding tissue that holds it in place. There are several different types of hernias such as

Bø, Kari. "Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction." World journal of urology 30.4 (2012): 437-443.

® Q: Is it normal to have pain during sex? A: No.There might be moments of discomfort which are normal, but significant or constant pain during intercourse is not normal. For women, vestibulodynia refers to pain at the entrance of the vagina and this can be generalized/constant or provoked/when touched. For a lot of women, the issue is overactivity of the pelvic floor muscles with difficulty relaxing them. It might seem counterintuitive, but these women might also struggle with incontinence because even though the muscles are very much on, they can't react well to changes in pressure from sneezing or a full bladder. In this case, physical therapy might include, biofeedback, dilators, and internal pelvic floor manual therapy in addition to pelvic floor exercises that emphasize both activation and relaxation. Additionally, some women experience postpartum pain with intercourse from a painful scar after an episiotomy or vaginal tearing. Physical therapy can help with a painful scar by mobilizing the scar tissue, and then re-training your scar to move with the tissues around it so that it is less painful during intimacy. Morin,Mélanie,Marie-SoleilCarroll,andSophieBergeron. "Systematic reviewof theeffectiveness ofphysical therapymodalities inwomenwithprovokedvestibulodynia."Sexualmedicine reviews 5.3 (2017): 295-322. If you’d like answers to your own questions, you can find at least one qualified Women’s Health Therapist at each of our 8 clinics.

Exercise of theMonth Try this movement if you're having trouble with leaking.

Super Kegal

Pelvic Floor Muscle Activation: Usea foam rollorafirmcushion toblock your pelvis and allow your back to curve slightly towards the floor. Being in this position will give your pelvic floor muscles an assist from gravity and your other core muscles. Perform a kegal contraction the same way you would stop the flow of urine. You should feel the muscles tighten together and draw up towards your head. Practice holding your kegal, working up to 30-second holds. Once you've mastered that, you can alternate marching your legs for 30 seconds ensuring no movement occurs above your hips (you might need to reset your kegal before lowering your leg back down).

Patient Success Spotlight

Body Gears News

A big Body Gears welcome to the SIX new PTs we've hired over the past few months! Dr. Autumn Neuharth and Dr. Karen Burnett can be found at our Oak Park clinic, Dr. Hannah Sutter-Balke is joining the St. Louis team, Dr. Jodi Tam is out in sunny San Diego, Dr. Masa Chalupa joins the Chicago West Loop team, and Dr. Bailee McGrath can be found in both the West Loop and Lincoln Park. Check out their bios on our website!

"I discovered Body Gears in my search for a Women's Health PhysicalTherapist for my pre & postnatal clients. When I wasn't seeing any improvement in my own postpartum recovery with another physical therapist, I started working with Body Gears. At 14 months postpartum, I received confirmation that I had between a Grade 1 and 2 cystocele (bladder prolapse). I felt a setback in my recovery, but with the help of Erica Burhop, I was able to see an improvement in my incontinence after just 4 sessions. This was the first time postpartum I felt success in my recovery! I learn something new with each session about my body. Body Gears empowers their patients to learn about the 'why' behind their symptoms, rather than just treating the symptoms. I recommend Body Gears to all of my clients, when I am unable to address their issues within my scope of work as a personal trainer. It has been wonderful collaborating with them as a fitness professional as well." - Suzanne K. (Mother & Body Gears Graduate) Body Gears empowers their patients to learn about the 'why' behind their symptoms

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To meet some of our friends in the community, check out all our women's health and lifestyle podcasts. Find us on Sound Cloud @BodyGearsPT

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Request AComplimentary Screening Schedule Your FreeDiscovery Session www.BodyGears.com | 877-709-1090 VISITOURWEBSITEORGIVEUS ACALL: This 20-minute appointment will allow you to meet a physical therapist, share your story, and complete a mini-assessment. The purpose of this screening is to answer two questions: 1. Which techniques will help you change your story? 2. How can Body Gears help you achieve your functional goals? Our physical therapists will be able to quickly provide you the information you need to take the next step. We hope it's with us! ® ® Whether you’re recovering from an injury, training for a competition, or you’re striving for better health, wellness and freedom of movement, Body Gears can help you achieve your optimum self.

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DON’T LET PAIN GET IN THE WAY OF YOUR PLEASURE

If you’ve never experienced anything different, it might be hard to realize that pelvic pain during intercourse is not normal. Sex can be many things but it isn’t something you should ever have to suffer through! Medically referred to as dyspareunia, pelvic pain can have a variety of causes that are treatable with physical therapy. Much of the time, this pain has to do with the position and/or tension of the pelvic muscles, fascia, scar tissue, nerves, and bones. The input of nerves into the muscles and skin within the pelvis, vagina, introitus, and perineum can also be a contributing factor. Dyspareunia can sound like a vague and daunting diagnosis, but if you break it down into disruption of your efficient alignment, tight muscles, and weak muscles, it sounds much more manageable (because it is!). As Doctors of Physical Therapy, we call these “mechanical” and “neuromuscular” issues. Imagine you have a sore neck and shoulders. You can probably assume that you were overusing your upper traps, using a compensatory motion to make up for weakness of a nearby muscle, or you were just sitting at your desk with poor posture… or all of the above! Now it makes sense why getting a massage on your neck and shoulders would be so painful. This idea is similar to what happens within the pelvis, but without the option of anyone being able to notice and cue you to “Relax, you look so tense!” If it’s your pelvic floor muscles that are over activating, using a compensatory motion to make up for a weak core, or have

inefficient alignment from the pelvic bones they attach to…or all of the above, then there’s a chance you will have pain during intercourse. Pelvic floor muscles are just like all the other muscles, except you can’t see them from the outside and people don’t often talk about them. So let’s keep talking about them! Another big thing to keep in mind are the nerves that run within the muscles, fascia and joints we just talked about, and remembering that they originate in the spine. As nerves exit the spine and continue to innervate the organs, muscles and skin of the pelvis, it is imperative that they have a path clear of restrictions. If these pathways are restricted by issues such as tight sections of the spine, a crooked tailbone, or tight muscles and fascia surrounding the nerves, this can contribute to pain and/or weakness within the area these nerves are intended to innervate. Our Women’s Health Therapists are experienced in creating a safe and supportive environment for improving your soft tissue and joint mobility that will maximize your comfort and overall wellbeing. We can help to ensure optimal function within the pelvis, helping you to overcome the frustrating pain of dyspareunia. If infection, vaginal dryness, skin irritation, or inflammation turns out to be the biggest contributor to your pain, we also work closely with other health professionals and can help you to assemble the best team to address your pain. Ask to meet with one of our Women’s Health Therapists to find out if you’d benefit from our brand of therapy.

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BABY SEASON IS NOW UPON US!

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Most babies in the US are born in September which means it’s pregnancy season! Remember to offer up your seat on the train because pregnancy can be downright uncomfortable. Something else you can do for the pregnant women in your life is to encourage them to seek help for any aches and pains or even birth position preparation. There’s no award for suffering in silence and why suffer when there are licensed and trained professionals out there to help! If separated abs, leaking, and organs slipping down are not topics you’re comfortable talking about, it’s okay because we are! Send the people you care about to us so we can show them a life without pain or embarrassment.

If you want to be able to give that pregnant stranger on the train expert unsolicited advice, check out our sleep e-book by clicking the link below. It’s free to download and works for people with and without a bun in the oven. Visit www.BodyGears.com and search Tips for Sleeping Comfortably for a link to your FREE copy and our 5 Tips for Sleeping Comfortably While Pregnant.

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