General Information
This section of the website contains some relevant articles for the public to gain an understanding of how physiotherapy is practiced at Diane Lee & Associates - Consultants in Physiotherapy. The intent of this section is to educate, (empower through knowledge), and thus facilitate the management of your musculoskeletal syndromes. The pain and dysfunction we assess and treat at Diane Lee & Associates often occurs as a result of trauma (motor vehicle accidents) or sports/work injury, pregnancy and/or childbirth or simply due to maladaptive postures/habits and time. We practice evidence-based physiotherapy and these brief articles will help you to understand how this evidence is put to work to facilitate your treatment. We treat function, not pain, and by restoring optimal function your mechanical-based pain will improve. We hope you take the time to read a few of these articles to more fully understand the principles behind your treatment with us.
An abstract of each article is available to read directly in this section and the pdf file below each abstract contains the full article for downloading.
Abstracts
- Stress Urinary Incontinence - A Consequence of Failed Load Transfer through the Pelvic Girdle?
- Are you Really Contracting Your Pelvic Floor?
- Understanding Your Back Pain
Stress Urinary Incontinence - A Consequence of Failed Load Transfer through the Pelvic Girdle?
The research in the last decade has led to a clearer understanding of how load is transferred through the low back and pelvic girdle and from this research it is evident that low back pain and stress urinary incontinence have components in common. Recently, a multi-centered study in Holland investigated how common a combination of the two conditions (low back pain and stress urinary incontinence) was. In a study of 66 patients, 52% reported a combination of low back pain along with some form of pelvic floor dysfunction (voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation). Of these 52%, 82% stated that their symptoms began with either low back or pelvic girdle pain.
We now recognize that the factors which must be optimal for stability of the low back and pelvic girdle and those which must be present for closure of the urethra are the same. The goal of restoring motor control for the low back and pelvis is to ensure movement patterns that optimize the transference of loads through all the joints and organs. The result is stability with mobility, where there is stability without rigidity of posture, without episodes of collapse, and with fluidity of movement. In addition, the strategy used for stabilization should not induce excessive intra-abdominal pressure leading to bladder/uterus descent.
Your therapist at Diane Lee & Associates will give you a very thorough examination of the joints and muscles of your low back and pelvis as well as an assessment using real time ultrasound imaging to see what strategy you are using to transfer loads through your pelvis. An individual treatment program will be developed that is specific to your needs. Hopefully, you will learn to support the organs of your pelvis and keep them for a lifetime avoiding what we believe is NOT inevitable with time - stress urinary incontinence.
Are you Really Contracting Your Pelvic Floor?
The muscles of your pelvic floor are critical for optimal function of your low back, pelvis, uterus and bladder; yet according to Bump et al (1991) 50% of women do not know how to contract these muscles when given either a verbal or written command. This finding is not surprising since every vaginal delivery causes some soft tissue damage to the muscles of the pelvic floor and damage to their nerve supply in 80% of women, (Allen et al 1990). However, through the use of real time ultrasound imaging (see clinical services), it can be seen that even women who have not had children often have difficulty effectively contracting this muscle group. Ashton-Miller, Howard & DeLancey (2000) note that the prevalence of urinary incontinence is as high as 38% in women over the age of 40. It is unknown how many women undergo hysterectomy due to loss of function of their pelvic floor. We should all know how this muscle group functions and how to use it properly. Download this article to learn more about how to see if your pelvic floor is functioning effectively. If you are still not sure, come for an assessment where you can watch your pelvic floor work in real-time.
Understanding Your Back Pain
Back pain happens to everyone and for some is a life changing occurrence. The causes are as many as there are structures capable of producing pain; and every tissue in the body is capable of giving us pain. Help from the health care profession is sought when the pain is severe enough to interfere with activities we need, or want to do. What happens next depends on who you choose to consult. There are many health care practitioners who treat back pain - the family doctor, chiropractor, physiotherapist, massage therapist, acupuncturist, orthopaedic surgeon, neurosurgeon, anesthetist, rheumatologist, psychiatrist and psychologist to name but a few. Each approaches your problem from a very different perspective which is based on their formal training and their clinical experience. Their training/experience helps them to develop models some of which are based on scientific principles and some on long time common thought.
Back pain has been subjected to scientific research, so what does the research tell us. First of all consider the questions we have asked in the research. It's important to understand the question because it ultimately directs the answer. If one is interested in understanding "What structure is responsible for an individual's pain?" then the research will focus on specific anatomical parts capable of generating pain. Entire models for both assessment and treatment of the low back have been developed following this line of questioning. Highly sophisticated imaging techniques and surgical procedures have been developed to address this question - "What is hurting?". This would be useful clinically if only one structure was responsible for an individual's pain. Unfortunately, multiple structures are often the problem and it is not possible to identify them individually. So we see diagnoses such as 'non-specific low back pain". In other words, the pain is not specific to any identifiable structure however, your low back pain is acknowledged. Even if we did know what structure was responsible for the pain, this would not help us in treatment unless all we wanted to do was cut it out or numb it with an anaesthetic - sometimes this is necessary but rarely is this all that is needed.
What information would be gained if the initial research question was "Why is the low back or pelvis painful?" "Why is the back no longer able to sustain or transfer the loads, stand, sit, lift or twist?" To answer these questions, the research must explore how the region functions in order to appreciate why breakdown and pain have occurred. Much research has been done with these questions in mind and today we have a new model which considers both function and how emotional factors such as stress and anxiety can influence the pain experience. Download this article to learn more about the functional model we use at Diane Lee & Associates to treat back pain.
