The H&D Experience

Gotta Go! (Drug-Free Solutions for Urinary Incontinence)

Can we blather about the bladder?
Look, here's what's normal:

• going 6-8 times in 24 hours
• an easy flow of urine that involves no discomfort
• being able to control the urge to urinate

Urinary incontinence then is any episode of involuntary loss of urine.

There are several different types of urinary incontinence:

• Stress incontinence (sudden, accidental leakage because of coughing or sneezing or laughing or perhaps even as a result of performing certain activities or exercises)
• Urge incontinence (this is accidental leakage that occurs because of a strong, uncontrollable urge -  like at nighttime, for instance, it just comes on and you can't stop it)
• Mixed incontinence (this would be a combination of stress and urge incontinence)
• Overflow incontinence (this results from the leaking of urine because the bladder has retained urine even after you have 'gone' and this generally is related to some kind of obstruction at the outlet of the bladder or an enlarged bladder or low pelvic floor muscle tone)

And who is incontinent?
Well, it happens to both women and men, but each type of incontinence may effect specific populations. For instance, stress incontinence is the most common type of urine leakage in women aged 30-50 (1/3 of women in 30's report leakage with exercise... 15% of women under 65have severe stress incontinence).

So if you recognize yourself in these symptoms, know you are not alone.  And know you can be empowered to do something about it.

What Causes Incontinence?
The causes may be several or various:

• weakness in the pelvic floor
• trauma (from a catheter, childbirth, surgery)
• recurrent urinary tract infections
• low estrogen states leading to atrophy
• menopause
• aging
• constipation and/or chronic cough
• being overweight
• medications
• spinal problems/nerve damage
• organ prolapse
• obstructions

And what can be done about it?
There are drug-free solutions to this!  Specially  trained physical therapists  (pelvic floor physical therapists) can provide a comprehensive  treatment plan that includes:

• Posture/position modifications which includes training:
  • strength/power of the pelvic floor muscles
  • endurance
  • flexibility
  • proprioception
  • function
• Instruction re: toileting techniques
• Instruction re: adequate water intake
• Information re: eliminating dietary irritants
• Breathing pattern re-training (in conjunction with our specially trained Yoga colleagues)
• Relaxation strategies (offered, again, in conjunction with our Yoga colleagues)

Take an active role in your health
Rather than withdraw from an active lifestyle or get pulled into or remain depressed about your current condition, know that you can make a difference!

Call 212-499-0848 and ask to speak to one of H&D's Pelvic Health Specialists and go, go, go back to an active, vivacious life.

The Basics of Balance

Recently, the NY Times ran a 2-part series in the Health/Science section on Preserving Balance and Dealing with Dizziness. These articles have spurred an outpouring of questions to H&D - one of the only physical therapy practices in the NY Metropolitan area that has a specially trained physical therapist whose specialty is balance training and helping clients suffering from dizziness.

We've asked H&D's James Gurley, DPT to share some of his knowledge with everyone in this forum. Jamie kicks this series off with an overview of the three main systems that influence your ability to balance.

An Overview

The three main systems your body uses to maintain proper balance are:

1) Sensory system

2) Visual system

3) Vestibular system

1) Sensory System:

Your sensory system detects motion of your arms, legs, and trunk and provides you with a sense of where your limbs are in space. This helps you maintain your balance by sensing the position of your body or when your body has moved. Example: If you lean forward or begin to fall forward, you would feel more pressure on the balls of your feet than on your heels.

2) Visual System:

Your visual system assists you in maintaining your balance by allowing you to see where you are in relation to stationary objects in the environment. Using the same example from above, if you lean forward or fall forward, you would see everything in front of you coming towards you and everything to the side going by you.

Both the sensory system and the visual system rely upon external information.

3) Vestibular System:

Your vestibular system in its most basic function, detects movement of your head. It is the only internal system your body can use for balance. Again using the above example of falling forward, your vestibular system would detect the movement of your head falling forward. You use this system for your balance the most when:

    1) There is conflict between the other 2 systems.

    2) There is diminished or inaccurate use of our vision and/or sensation from your lower body sensation.

As a specially-trained Vestibular Therapist, my focus is helping people retrain this aspect of their balance system. I'll explain more about this - and talk about minimizing the risk of falling the future posts. Feel free to email me with any questions you have in the meantime: jgurley@hdphysicaltherapy.com.

For Those Who Love to Exercise - But Hate or Don't Feel Safe at the Gym

Most everyone knows they should exercise. And once you've conquered the excuses for not starting, you might come up against one more compelling obstacle which keeps you from beginning...

You're not the sculpted, air-brushed hipster that all of the gyms seem to be courting.  Or perhaps you are, but you're sophisticated enough to want an exercise specialist training you, not a cookbook technician.

Where can YOU safely go?

We asked Vincent Metzo, Chairman of the Science Department and Dean of Personal Training/Exercise Science at the Swedish Institute, isn't there a better way?

And he said, "Well... yeah."  And that's how Your BodyWorks was created.   

Inspiring Stories from West Africa

In 2006, Charlene Goggin, Director of H&D's Your Healthy Spine program, mentioned that a mentor of hers, Dr. Oheneba Boachie-Adjei, was looking for a physical therapist to accompany him on a two-week trip to Ghana.

Dr. Boachie is the founder of FOCOS whose aim is to provide complex orthopedic and spine care to underserved communities. His birth country of Ghana has a dramatic need for such care - there are just 18 orthopedic surgeons for Ghana's 15 million people!  (By contrast, according to the American Academy of Orthopedic Surgeons, there are 20,000 orthopedic surgeons in the US.)

So for two 2-week periods last year, H&D sent Tonya Juge, PT down to Ghana with Dr. Boachie and his team of surgeons, nurses, aides and assistants. And then this year, from April 28 through May 12th, H&D's Tom Grunewald, PT was sent along. Below are reflections Tom and Tonya's reflections from their trips...

We Understand Pelvic Pain & Incontinence

Pelvic pain and incontinence are never easy topics to bring up. And it can be especially frustrating if when you do, you are met with blank looks or are pointed toward treatments that are not effective.

There is increasing evidence about the role that pelvic floor physical therapy can play in treating conditions ranging from urge and stress incontinence, to various manifestations of pelvic pain, of painful intercourse and of painful digestive conditions.

H&D's Pelvic Health and Wellness Program aims to provide the highest level of care and compassion to people experiencing these challenges.

DISCLAIMER: You do not have to disclose your first and last name - you can use initials or an alias to keep your identity confidential. Please share your opinions and experience, not your complete medical history.

What's Your H&D Experience Like?

At H&D, we're passionate about good physical therapy.

Not 4 or 5 patients an hour physical therapy. Not let me quickly check you out and have my aides keep an eye on you physical therapy. Not e-stim, cold pack, co-pay physical therapy. 

At H&D, we think good physical therapy requires 60 minutes of 1-on-1 care.  That's what it takes to understand what kind of care an individual needs - and to help people do the things they want to do and to accomplish the things they couldn't imagine doing.

This is the space to tell us and others what your experience was like.

DISCLAIMER: You do not have to disclose your first and last name - you can use initials or an alias to keep your identity confidential. Please share your opinions and experience, not your complete medical history.