Thinking about trying physiotherapy for endometriosis pain? Here’s what to expect
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Endometriosis is a condition that affects women and girls. It occurs when tissue similar to the lining of the uterus ends up in other areas of the body. These areas include the ovaries, bladder, bowel and digestive tract.
Endometriosis will affect nearly one million Australian women and girls in their lifetime. Many high-profile Australians are affected by endometriosis including Bindi Irwin, Sophie Monk and former Yellow Wiggle, Emma Watkins.
Symptoms of endometriosis include intense pelvic, abdominal or low back pain (that is often worse during menstruation), bladder and bowel problems, pain during sex and infertility.
But women and girls wait an average of seven years to receive a diagnosis. Many are living with the burden of endometriosis and not receiving treatments that could improve their quality of life. This includes physiotherapy.
How is endometriosis treated?
No treatments cure endometriosis. Symptoms can be reduced by taking medications such as non-steriodal anti-inflammatories (ibuprofen, aspirin or naproxen) and hormonal medicines.
Surgery is sometimes used to diagnose endometriosis, remove endometrial lesions, reduce pain and improve fertility. But these lesions can grow back.
Whether they take medication or have surgery, many women and girls continue to experience pain and other symptoms.
Pelvic health physiotherapy is often recommended as a non-drug management technique to manage endometriosis pain, in consultation with a gynaecologist or general practitioner.
The goal of physiotherapy treatment depends on the symptoms but is usually to reduce and manage pain, improve ability to do activities, and ultimately improve quality of life.
What could you expect from your first appointment?
Physiotherapy management can differ based on the severity and location of symptoms. Prior to physical tests and treatments, your physiotherapist will comprehensively explain what is going to happen and seek your permission.
They will ask questions to better understand your case and specific needs. These will include your age, weight, height as well as the presence, location and intensity of symptoms.
You will also be asked about the history of your period pain, your first period, the length of your menstrual cycle, urinary and bowel symptoms, sexual function and details of any previous treatments and tests.
They may also assess your posture and movement to see how your muscles have changed because of the related symptoms.
They will press on your lower back and pelvic muscles to spot painful areas (trigger points) and muscle tightness.
If you consent to a vaginal examination, the physiotherapist will use one to two gloved fingers to assess the area inside and around your vagina. They will also test your ability to coordinate, contract and relax your pelvic muscles.
What type of treatments could you receive?
Depending on your symptoms, your physiotherapist may use the following treatments:
General education
Your physiotherapist will give your details about the disease, pelvic floor anatomy, the types of treatment and how these can improve pain and other symptoms. They might teach you about the changes to the brain and nerves as a result of being in long-term pain.
They will provide guidance to improve your ability to perform daily activities, including getting quality sleep.
If you experience pain during sex or difficulty using tampons, they may teach you how to use vaginal dilators to improve flexibility of those muscles.
Pelvic muscle exercises
Pelvic muscles often contract too hard as a result of pain. Pelvic floor exercises will help you contract and relax muscles appropriately and provide an awareness of how hard muscles are contracting.
This can be combined with machines that monitor muscle activity or vaginal pressure to provide detailed information on how the muscles are working.
Yoga, stretching and low-impact exercises
Yoga, stretching and low impact aerobic exercise can improve fitness, flexibility, pain and blood circulation. These have general pain-relieving properties and can be a great way to contract and relax bigger muscles affected by long-term endometriosis.
These exercises can help you regain function and control with a gradual progression to perform daily activities with reduced pain.
Hydrotherapy (physiotherapy in warm water)
Performing exercises in water improves blood circulation and muscle relaxation due to the pressure and warmth of the water. Hydrotherapy allows you to perform aerobic exercise with low impact, which will reduce pain while exercising.
However, while hydrotherapy shows positive results clinically, scientific studies to show its effectiveness studies are ongoing.
Manual therapy
Women frequently have small areas of muscle that are tight and painful (trigger points) inside and outside the vagina. Pain can be temporarily reduced by pressing, massaging or putting heat on the muscles.
Physiotherapists can teach patients how to do these techniques by themselves at home.
What does the evidence say?
Overall, patients report positive experiences pelvic health physiotherapists treatments. In a study of 42 women, 80% of those who received manual therapy had “much improved pain”.
In studies investigating yoga, one study showed pain was reduced in 28 patients by an average of 30 points on a 100-point pain scale. Another study showed yoga was beneficial for pain in all 15 patients.
But while some studies show this treatment is effective, a review concluded more studies were needed and the use of physiotherapy was “underestimated and underpublicised”.
What else do you need to know?
If you have or suspect you have endometriosis, consult your gynaecologist or GP. They may be able to suggest a pelvic health physiotherapist to help you manage your symptoms and improve quality of life.
As endometriosis is a chronic condition you may be entitled to five subsidised or free sessions per calendar year in clinics that accept Medicare.
If you go to a private pelvic health physiotherapist, you won’t need a referral from a gynaecologist or GP. Physiotherapy rebates can be available to those with private health insurance.
The Australian Physiotherapy Association has a Find a Physio section where you can search for women’s and pelvic physiotherapists. Endometriosis Australia also provides assistance and advice to women with Endometriosis.
Thanks to UTS Masters students Phoebe Walker and Kasey Collins, who are researching physiotherapy treatments for endometriosis, for their contribution to this article.
Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney and Caroline Wanderley Souto Ferreira, Visiting Professor of Physiotherapy, University of Technology Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Yoga Therapy for Arthritis – by Dr. Steffany Moonaz & Erin Byron
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Two quick notes to start with:
- One of the problems with arthritis and exercise is that arthritis can often impede exercise.
- Another of the problems with arthritis and exercise is that some kinds of exercise can exacerbate arthritis.
This book deals with both of those issues, by providing yoga specifically tailored to living with arthritis. Indeed, the first-listed author’s PhD in public health was the result of 8 years of study developing an evidence-based yoga program for people with arthritis, including osteoarthritis and rheumatoid arthritis.
The authors take the view that arthritis is a whole-person disease (i.e. it affects all parts of you), and so addressing it requires a whole-person approach, which is what this book delivers.
As such, this is not just a book of asana (yoga postures). It does provide that, of course (as well as breathing exercises), but also its 328 pages additionally cover a lot of conscious work from the inside out, including attention to the brain, energy levels, pain, and so forth, and that the practice of yoga should not merely directly improve the joints via gentle physical exercise, but also should help to heal the whole person, including reducing stress levels, reducing physical tension, and with those two things, reducing inflammation also—and also, due to both that and the asana side of practice, better-functioning organs, which is always a bonus.
The style is interesting, as it refers to both science (8 pages of hard-science bibliography) and yogic principles (enough esoterica to put off, say, James Randi or Penn & Teller). This reviewer is very comfortable with both, and so if you, dear reader, are comfortable with both too, then you will surely enjoy this book.
Bottom line: if you or a loved one has arthritis, you’ll wish you got this book sooner.
Click here to check out Yoga Therapy For Arthritis, and live better!
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Dates vs Raisins – Which is Healthier?
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Our Verdict
When comparing dates to raisins, we picked the dates.
Why?
There are benefits for each fruit, but we say dates come out on top. See what you think:
In terms of macros, while they’re both dried fruits, dates contain more water (unless you leave them sitting open for a while), which will tend to mathematically lower the relative percentages of other components because they’re being held against water weight too. However, even though this is the case (i.e. dates are being mathematically disadvantaged), dates contain more than twice the fiber that raisins do (8g/100g compared to raisins’ 3.7g/100g).
While we’re talking macros, dates are also lower in total carbs, as well as obviously net carbs, and have a much lower glycemic index than raisins (dates have a glycemic index of 42, considered low, while raisins have a glycemic index of 64, considered medium; their respective glycemic loads are even more telling: 13 for raisins and just 2 for dates!).
About those carbs… For dates, it’s an approximately equal mix of sucrose, glucose, and fructose, while for raisins it’s 49% glucose and 49% fructose. Because sucrose is the only disaccharide here, this (as well as the fiber difference) is one of the reasons for the different glycemic indices and glycemic loads, since glucose and fructose are more quickly absorbed.
That’s more than we usually write about macros, but in this case, both fruits are ones especially often hit with the “aren’t they full of sugar though?” question, so it was important to cover the critical distinctions between the two, because they really are very different.
Summary of macros: dates win easily in every aspect we looked at
In the category of vitamins, raisins get a tally in their favor. Raisins are higher in vitamins B1, B2, C, E, K, and choline, while dates are higher in vitamins A, B3, B5, and B9, giving raisins a 6:4 lead here. In dates’ defense, the difference in vitamin K is marginal, and it’d make it a 5:4 lead if we considered that within the margin of error (because all these figures are of course based on averages), and the vitamins that dates are higher in, the margins are much wider indeed, meaning that both fruits have approximately the same overall levels of vitamins when looked at in total, but still, we’ll call this category a nominal win for raisins.
When it comes to minerals, dates have more magnesium, selenium, and zinc, while raisins have more copper, iron, phosphorus, and potassium. Nominally that’s a 4:3 lead for raisins, but if we consider that raisins also contain more sodium, it’s more like a tie here. If we have to pick one though, this is a very slight win for raisins.
Adding up the sections, we have one huge win for dates (macros) with two very marginal wins for raisins—hence, we say that dates win out.
Still, of course enjoy both; diversity is good for the health.
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Tight Hamstrings? Here’s A Test To Know If It’s Actually Your Sciatic Nerve
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Tight hamstrings are often not actually due to hamstring issues, but rather, are often being limited by the sciatic nerve. This video offers a home test to determine if the sciatic nerve is causing mobility problems (and how to improve it, if so):
The Connection
Try this test:
- Sit down with a slumped posture.
- Extend one leg with the ankle flexed.
- Note any stretching or pulling sensation behind the knee or in the calf.
- Bring your head down to your chest
If this increases the sensation, it likely indicates sciatic nerve involvement.
If only the hamstrings are tight, head movement won’t change the stretch sensation.
This is because the nervous system is a continuous structure, so head movement can affect nerve tension throughout the body. While this can cause problems, it can also be integral in the solution. Here are two ways:
- Flossing method: sit with “poor” slumped posture, extend the knee, keep the ankle flexed, and lift the head to relieve nerve tension. This movement helps the sciatic nerve slide without stretching it.
- Even easier method: lie on your back, grab behind the knee, and extend the leg while extending the neck. This position avoids compression in the gluteal area, making it suitable for severely compromised nerves. Perform the movement without significant stretching or pain.
In both cases: move gently to avoid straining the nerve, which can worsen muscle tension. Do 10 repetitions per leg, multiple times a day; after a week, increase to 20 reps.
A word of caution: speak with your doctor before trying these exercises if you have underlying neurological diseases, cut or infected nerves, or other severe conditions.
For more on all of this, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Exercises for Sciatica Pain Relief
Take care!
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Death by Sitting – by Carolyne Thompson
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You may be wondering: is this a lot of words to say “sit down less”?
And the answer is: there’s a lot more in here than that. Of course, yes, “sit down less” is an important take-away, but there’s a lot about the specific problems caused by sitting in chairs, the health risks are that are increased and how, and the early warning signs to watch out for.
After these chapters of woe, most of the book is given over to solutions; about taking standing and walking breaks, tying movement to productivity, why exercise alone is not enough to offset the damage of sitting, relearning ergonomic posture in the context of mitigating the harm, psychological shifts to break the habit of sitting, redefining social norms around sitting and socializing, rewiring one’s body and retraining better movements as well as postures to always immediately move out of if one finds oneself in, and much much more.
The style is light and easy to read, while still including scientific research as appropriate along with practical, actionable advice.
Bottom line: if you’d like to do better for your body than slowly killing it for however many hours a day, then this book has a wealth of advice far beyond the obvious (but important!) “sit less”.
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Get Better Sleep: Beyond The Basics
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First though, for the sake of being methodical, let’s quickly note the basics:
- Aim for 7–9 hours per night
- Set a regular bedtime and (equally important!) regular getting-up time
- Have a 2-hour wind-down period before bed, to decompress from any stresses of the day
- Minimal device/screen usage before bed
- Abstain from stimulants for as long before bed as reasonably possible (caffeine elimination halflife is 4–8 hours depending on your genes, call it 6 hours average to eliminate half (not the whole lot), and you’ll see it’s probably best to put a cap on it earlier rather than later).
- Abstain from alcohol, ideally entirely, but allow at least 1hr/unit before bed. So for example, 1hr for a 1oz single shot of spirits, or 2–3 hours for a glass of wine (depending on size), or 3–4 hours for a martini (depending on recipe). Not that that is not the elimination time, nor even the elimination halflife of alcohol, it’s just a “give your body a chance at least” calculation. If you like to have a drink to relax before bed, then well, only you can decide what you like more: that or actually getting restorative sleep.
- Consider a warm bath/shower before bed, if that suits your schedule.
- Wash and change your bedsheets more often than seems necessary. Or if that’s too onerous, at least change the pillowcases more often, which makes quite a difference already.
- Lower the temperature of your bedroom shortly before bedtime; this will help cue the body to produce melatonin
- Make your bedroom as dark as reasonably possible. Invest in blackout blinds/curtains, and remove any pesky electronics, or at least cover their little LEDs if it’s something that reasonably needs to remain on.
Ok, now, onwards…
Those 7–9 hours? Yes, it goes for you too.
A lot of people mistake getting 6 hours sleep per night for only needing 6 hours sleep per night. Sure, you may still be alive after regularly getting 6 hours, but (unless you have a rare mutation of the ADRB1 gene) it will be causing harm, and yes, that includes later in life; we don’t stop needing so much sleep, even stop getting it:
Why You Probably Need More Sleep
With this in mind, it becomes important to…
Prioritize your sleep—which means planning for it!
When does your bedtime routine start? According to sleep scientist Dr. Lisa Matricciani, it starts before breakfast. This is because the things we do earlier in the day can greatly affect the amount (and quality) of sleep we get later. For example, a morning moderate-to-intense exercise session greatly improves sleep at night:
Planning Ahead For Better Sleep
As for quality, that is as important as quantity, and it’s not just about “soundness” of sleep:
The 6 Dimensions Of Sleep (And Why They Matter)
“What gets measured, gets done” goes for sleep too
Sleep-deprived people usually underestimate how sleep-deprived they are. This is for the same reason as why drunk people usually underestimate how drunk they are—to put it in words that go for both situations: a cognitively impaired person lacks the cognitive function to realize how cognitively impaired they are.
Here’s the science on that, by the way:
How Sleep-Deprived Are You, Really?
For that reason, we recommend using sleep-tracking software (there are many apps for that) on your phone or, ideally, a wearable device (such as a smartwatch or similar).
A benefit of doing so is that we don’t think “well, I slept from 10pm to 6am, so that’s 8 hours”, if our device tells us we slept between 10:43pm and 5:56 am with 74% sleep efficiency because we woke up many times.
As an aside, sleep efficiency should be about 85%, by the way. Why not 100%, you ask? It’s because if your body is truly out like a light for the entire night, something is wrong (either you were very sleep-deprived, or you have been drugged, that kind of thing). See also:
An unbroken night’s sleep is a myth. Here’s what good sleep looks like.
So waking up during the night is normal, and nothing to worry about per se. If you do find trouble getting back to sleep, though:
How to Fall Back Asleep After Waking Up in the Middle of the Night
Be careful about how you try to supplement sleep
This goes both for taking substances of various kinds, and napping. Some sleep aids can help, but many are harmful and/or do not really work as such; here’s a rundown of examples of those:
Safe Effective Sleep Aids For Seniors?
And when it comes to napping, timing is everything:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Want to know a lot more?
This is the book on sleep:
Why We Sleep – by Dr. Matthew Walker
Enjoy!
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Most adults will gain half a kilo this year – and every year. Here’s how to stop ‘weight creep’
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As we enter a new year armed with resolutions to improve our lives, there’s a good chance we’ll also be carrying something less helpful: extra kilos. At least half a kilogram, to be precise.
“Weight creep” doesn’t have to be inevitable. Here’s what’s behind this sneaky annual occurrence and some practical steps to prevent it.
Allgo/Unsplash Small gains add up
Adults tend to gain weight progressively as they age and typically gain an average of 0.5 to 1kg every year.
While this doesn’t seem like much each year, it amounts to 5kg over a decade. The slow-but-steady nature of weight creep is why many of us won’t notice the extra weight gained until we’re in our fifties.
Why do we gain weight?
Subtle, gradual lifestyle shifts as we progress through life and age-related biological changes cause us to gain weight. Our:
- activity levels decline. Longer work hours and family commitments can see us become more sedentary and have less time for exercise, which means we burn fewer calories
- diets worsen. With frenetic work and family schedules, we sometimes turn to pre-packaged and fast foods. These processed and discretionary foods are loaded with hidden sugars, salts and unhealthy fats. A better financial position later in life can also result in more dining out, which is associated with a higher total energy intake
- sleep decreases. Busy lives and screen use can mean we don’t get enough sleep. This disturbs our body’s energy balance, increasing our feelings of hunger, triggering cravings and decreasing our energy
Insufficient sleep can increase our appetite. Craig Adderley/Pexels - stress increases. Financial, relationship and work-related stress increases our body’s production of cortisol, triggering food cravings and promoting fat storage
- metabolism slows. Around the age of 40, our muscle mass naturally declines, and our body fat starts increasing. Muscle mass helps determine our metabolic rate, so when our muscle mass decreases, our bodies start to burn fewer calories at rest.
We also tend to gain a small amount of weight during festive periods – times filled with calorie-rich foods and drinks, when exercise and sleep are often overlooked. One study of Australian adults found participants gained 0.5 kilograms on average over the Christmas/New Year period and an average of 0.25 kilograms around Easter.
Why we need to prevent weight creep
It’s important to prevent weight creep for two key reasons:
1. Weight creep resets our body’s set point
Set-point theory suggests we each have a predetermined weight or set point. Our body works to keep our weight around this set point, adjusting our biological systems to regulate how much we eat, how we store fat and expend energy.
When we gain weight, our set point resets to the new, higher weight. Our body adapts to protect this new weight, making it challenging to lose the weight we’ve gained.
But it’s also possible to lower your set point if you lose weight gradually and with an interval weight loss approach. Specifically, losing weight in small manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.
Holidays can also come with weight gain. Zan Lazarevic/Unsplash 2. Weight creep can lead to obesity and health issues
Undetected and unmanaged weight creep can result in obesity which can increase our risk of heart disease, strokes, type 2 diabetes, osteoporosis and several types of cancers (including breast, colorectal, oesophageal, kidney, gallbladder, uterine, pancreatic and liver).
A large study examined the link between weight gain from early to middle adulthood and health outcomes later in life, following people for around 15 years. It found those who gained 2.5 to 10kg over this period had an increased incidence of type 2 diabetes, heart disease, strokes, obesity-related cancer and death compared to participants who had maintained a stable weight.
Fortunately, there are steps we can take to build lasting habits that will make weight creep a thing of the past.
7 practical steps to prevent weight creep
1. Eat from big to small
Aim to consume most of your food earlier in the day and taper your meal sizes to ensure dinner is the smallest meal you eat.
A low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day.
We burn the calories from a meal 2.5 times more efficiently in the morning than in the evening. So emphasising breakfast over dinner is also good for weight management.
Aim to consume bigger breakfasts and smaller dinners. Michael Burrows/Pexels 2. Use chopsticks, a teaspoon or an oyster fork
Sit at the table for dinner and use different utensils to encourage eating more slowly.
This gives your brain time to recognise and adapt to signals from your stomach telling you you’re full.
3. Eat the full rainbow
Fill your plate with vegetables and fruits of different colours first to support eating a high-fibre, nutrient-dense diet that will keep you feeling full and satisfied.
Meals also need to be balanced and include a source of protein, wholegrain carbohydrates and healthy fat to meet our dietary needs – for example, eggs on wholegrain toast with avocado.
4. Reach for nature first
Retrain your brain to rely on nature’s treats – fresh vegetables, fruit, honey, nuts and seeds. In their natural state, these foods release the same pleasure response in the brain as ultra-processed and fast foods, helping you avoid unnecessary calories, sugar, salt and unhealthy fats.
5. Choose to move
Look for ways to incorporate incidental activity into your daily routine – such as taking the stairs instead of the lift – and boost your exercise by challenging yourself to try a new activity.
Just be sure to include variety, as doing the same activities every day often results in boredom and avoidance.
Try new activities or sports to keep your interest up. Cottonbro Studio/Pexels 6. Prioritise sleep
Set yourself a goal of getting a minimum of seven hours of uninterrupted sleep each night, and help yourself achieve it by avoiding screens for an hour or two before bed.
7. Weigh yourself regularly
Getting into the habit of weighing yourself weekly is a guaranteed way to help avoid the kilos creeping up on us. Aim to weigh yourself on the same day, at the same time and in the same environment each week and use the best quality scales you can afford.
At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.
Nick Fuller, Clinical Trials Director, Department of Endocrinology, RPA Hospital, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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