Cassie Dionne, PT

The Sex Coach You Didn’t Realize You Needed

We all think about it. Some of us talk about it, dream about it. What am I talking about?

I’m talking about sex of course.

I think it’s fair to say most of us would be more than okay with a little extra fun and passion in the bedroom. Which brings me to my question for you: are you getting the most out of your sex life, or could it be even more pleasurable?

I want to introduce you to the person out there who can help make your sex life even better. The sex coach you didn’t know you needed. The person who can help make sex with your partner more comfortable, more pleasurable and more intense. The person who has all the resources you need to take your sex life to the next level.

As a Pelvic Health Physical Therapist I can help you have the best sex of your life and I want to tell you how.

1. I teach the best sex positions for you and your partner based on your physicality.

Early in my career one of my favorite moments as a physical therapist happened when one of my clients (who had just had hip surgery) contacted me to find out what positions she could enjoy and which she should avoid while having sex with her partner that evening. Her surgeon informed her as to what day to day activities to be careful of but never once mentioned sex. Moreover they didn’t have that close of a relationship, so she wasn’t about to ask!

Sex is what we physical therapists like to refer to as an activity of daily living. Sex is an activity everyone should be able enjoy as much as possible, regardless of circumstance, physical limitations or injuries.

While this may be a more extreme example, the truth is we all sometimes have some aches or pains that can make sex sound a little less appealing as it may lead to discomfort during or after the fact. Some of us may also experience pelvic floor dysfunctions such as prolapse or incontinence that can lead to feeling awkward or unsure between the sheets, or just plain less into it.

This is where I come in.

As a pelvic health physical therapist, I know all the tricks. If sex leads to a sore back in the week following foreplay we can show you the best positions. In some cases, it is as simple as using your hands and not your elbows to support yourself while in the throws of passion. For example, if you’re someone who feels discomfort or pain in your back when you sit too long, one of the best sex positions for you is on all fours resting on your hands. Adopting this same position but resting on your elbows? This is actually one of the worst positions for you, along with – believe it or not – the missionary position. In contrast, if you’re someone that doesn’t enjoy lying on your stomach because of discomfort, the missionary position with your knees and hips bent up one of the better positions for you.

Together with my patients who experience discomfort during sex, we find the best sex position so you don’t have to worry about anything other than enjoying yourself.

2. You shouldn’t have pain or discomfort with penetrative sex.

Want a crazy stat? Nearly 1 in 10 women experience pain with penetrative sex (known as dyspareunia) with a quarter of these women experiencing this pain often. Women between the ages of 16-24 are the second largest group of women to experience this type of pain. Though some women assume it is because they partner is “too big” the truth is that that is rarely, if ever the case.

There are a number of reasons that penetrative sex might hurt you, but a common one comes down to the muscles of the pelvic floor being overactive, tight, or in spasm. The muscles of the pelvic floor, like all muscles, are meant to contract and relax throughout the day. For a lot of women who have pain with sex, those muscles cannot fully relax and instead are in a constant state of contraction. This leads to difficulty and pain for these muscles during penetration. This also leads to a more complex psychological pain cycle where after penetration has been painful our brain recalls this feeling and then resists it in the future because of the painful memory.

The good news is there is so much we can do to both relax overactive pelvic floor muscles and change this pain cycle! Our goal is not only to make your sex life pain-free, but to also make it as enjoyable as possible!

3. You can experience more intense and longer lasting orgasms (yes it IS possible).

I love my job. How many other health professionals can say that their female clients come to them so happy (sometimes with tears of joy) because their orgasms are getting more pleasurable and intense because of the right treatment, coaching and advice?

Yes – you heard that right. Part of my job includes helping women have more powerful orgasms. I’m confident that I’m correct in assuming that most women would be “ok” with experiencing more powerful orgasms. Research shows that working with a professional coupled with a pelvic floor exercise plan, improves the support function of the pelvic floor, increases blood flow, and stimulates the awareness (or proprioception) of our pelvic floor. Better functioning, stronger, pelvic floor muscles, contribute to increased sexual desire, performance, and both achievement and intensity of orgasm.

Plus, the improved proprioception and awareness of our pelvic does more than just improve our physical experience during sex. It also, quite simply makes us feel sexier. Trust me, when you feel your pelvic floor muscles functioning better and feeling sexy, you are more likely to experience mind blowing sex compared to if you’re feeling less confident in your pelvic floor.

4. I have all of the best resources and want to share them with you.

There is one more way I can help you spice up your sex life. I know where all of the coolest resources are regarding sex.

Strange but true fact: I am on a first name basis with the adult stores in town, know some amazing therapists (who can also play a huge role in improving your sex life), and I can guide you on additional strategies to up your sex game even more.

As an example, have you heard of OMGyes yet? This is an game-changing resource I direct many of my clients to. An easy, self-directed platform that teaches you how to find even more pleasure in your life – whether you are going solo or with a partner.

To sum things up: If you have any questions about any pain (back, hip, pelvic floor) while you’re having sex, if you’re unsure if your orgasms are as good as they could be, or you need some help finding new and awesome resources to spice up your sex life then find a pelvic health physio and lets see if we can make this activity of daily living even better for you!!

Should You Stretch? Or Stabilize?

As a physiotherapist I have clients come in all the time and tell me things like:

“I stretch ALL of the time and it doesn’t help” or “I always feel tight, no matter how much I stretch” or “I know I should be stretching more to feel better”.

So what gives? Why does stretching always feel like the answer, even when it is clearly not working? And why do most consider it the ultimate fix for all that ails them?

Stretching absolutely has its time and place. In fact, for some it can be hugely beneficial (though not always for the reasons you think!) and help to improve flexibility, pain, discomfort, and overall mobility. However, this is not true of everyone and it all comes down to the level of mobility of your joints.

You see, when it comes to our joints, they are either inherently mobile or inherently stable. And this mobility or stability runs on a continuum – you can’t have an entirely mobile AND stable joint, instead it lands somewhere along that continuum.

You see, when it comes to our joints, they are either inherently mobile or inherently stable. And this mobility or stability runs on a continuum – you can’t have an entirely mobile AND stable joint, instead it lands somewhere along that continuum.

For those of you who have more mobile joints (hypermobility) this means that it’s much harder for your body to find stability around a joint. Because of this your joints will move into much larger ranges of motion (think of the people you know that dance or do gymnastics, or who love yoga – they tend to be on the more mobile side of things). This excessive range of motion can lead to you being in vulnerable positions where your body could get hurt. Now, our brain is pretty savvy and will do anything to protect us from injury so what then happens is the body attempts to stabilize these hypermobile joints by tightening and engaging the bigger muscles of our body (think hamstrings, quads, calves, pecs, etc.) to limit the range of motion at the joint.

Enter why you may always feel “tight” and why you can stretch until the cows come home to no improvement or even to worsening pain and symptoms.

This is because the actual length of the muscle tissue isn’t short, it’s just that the brain won’t allow it to lengthen fully in order to protect you. In fact, your body can and will even throw down some trigger points protectively to find some of this stability where they otherwise lack it, yet another reason you constantly need to stretch.

What does this mean in terms of actually stretching?

If you are someone who has more mobile joints than the next person, what this means is that you may have to adjust how and if you are stretching and focus instead on training strength and stability in your smaller, stabilizing muscles. In other words: you will need to drop most of your stretching routine and adopt a much more strength-based rehab plan. Not only this, it will be important for you to train this strength and stability throughout the range that you have, not just in one stationary range of motion.

Though it may seem backwards and strange to you, strengthening and stabilizing will give your body the stability and support it needs and allow it to stop pulling the “parking brake” and tightening up muscles to protect you.

Where do you go from here?

Best thing to do would be to work with a physiotherapist and a qualified strength coach who can guide you on your next best steps. Finding good exercises that are safe are so critical. Resistance training through nearly full range of motion as well as using the Pilates reformer are two of my personal favourite options when it comes to training stability when someone is hypermobile and I would be happy to answer any questions regarding either of these modalities – if you have any, feel free to reach out!

An Easy but Oh-So-Effective Hip Flexor Stretch

As a physiotherapist who works both in orthopaedics and pelvic health I come across a lot… and I do mean a lot… of tight hip flexors.

With this, however, I also see a lot of people who are actively trying to stretch out their hip flexors. The unfortunate part, however, is that a lot of the times when people try to stretch their hip flexors they aren’t actually getting a good stretch because of the position of their pelvis and spine during their attempted stretch.

Enter my favourite hip flexor stretch:

Get into a half-kneeling position, with your back leg being the one you are about to stretch.
Hold a stick, dowel, or foam roller in front of you and actively push it down into the ground. This is a small, but important, step as it engages your core and forces the stretch to happen where we want it to.
Keep your body upright and posteriorly rotate your pelvis (think: squeeze your glutes as hard as you can). Almost everyone I have worked with can actually feel a stretch at this point, without even taking it further.
Then, keeping your pelvis rotated, glutes squeezed, and body upright, lean forward at the hips, holding at the end for no more then 2 seconds.
Return to the start and repeat 8-10 x per leg

Here you can see Coach Vanessa showing the proper form of this stretch!

Now, there is more to the story than just tight hip flexors.

Though I do love this stretch and find it hugely beneficial for so many people, I want to make one thing entirely clear: if you have tight hip flexors, they are tight for a reason. And you should figure out what that reason is and work towards solving the problem. How do you do this? Find out what muscles are out of balance by coming in to see me, a colleague, or a physiotherapist near you. Because you can stretch all you want but until you find out the root of the cause of those tight muscles… you will just have to accept this stretch as part of your new daily routine!

Five Bullet Friday: Women’s Health January 31, 2020

Happy Friday!

Today’s Five Bullet Friday:

1. Is it Time We Started Treating Endometriosis as if it Were Cancer?

2. The First Road-map for Ovarian Aging

3. How do you Explain to Someone How Muscle Imbalances Can Lead to Acute, Unexpected Pain?

4. Exercise has the Same Effect on the Brain as Coffee

5. Patient HANDOUT: All About Pessaries

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

—

1. Is it Time to Treat Endometriosis as if it were Cancer?

In an article published in the Journal of Obstetrics and Gynaecology Canada just this week, authors Matthew Leonardo and colleagues proposed that we need to have a shift in our mindset when it comes to the field of endometriosis.

Leonardo and colleagues discussed how since the establishment of gynaecological oncology as a sub specialty, outcomes for patients with ovarian cancer has very much improved, likely by the care managed by multidisciplinary teams in specialized units. Leonardo advocates that we now do something similar in the field of endometriosis. He advocates that we recognize complex benign gynaecology (that would include endometriosis) as a subspecialty.

By recognizing this subspecialty and managing care of women with endometriosis by a multidisciplinary team of dedicated and specialized health professionals, Leonardo and team expect there will be improved outcomes, including improved quality of life, for people living with endometriosis.

Ref: Mathew Leonardi, Alan Lam, Mauricio S. Abrão, Neil P. Johnson, George Condous, Ignored Because It Is Benign – It Is Time to Treat Endometriosis as if It Were Cancer, Journal of Obstetrics and Gynaecology Canada, 2020, https://doi.org/10.1016/j.jogc.2019.12.014.

2. The First Road-map for Ovarian Aging

Read an exciting new summary of research just published today on the discovery of how non-human primate ovaries age, with implications for human fertility:

“Infertility likely stems from age-related decline of the ovaries, but the molecular mechanisms that lead to this decline have been unclear. Now, scientists have discovered, in unprecedented detail, how ovaries age in non-human primates. The findings reveal several genes that could be used as biomarkers and point to therapeutic targets for diagnosing and treating female infertility and age-associated ovarian diseases, such as ovarian cancer, in humans.”

Read more of this exciting new research at the reference below!

Ref: Si Wang, Yuxuan Zheng, Jingyi Li, Yang Yu, Weiqi Zhang, Moshi Song, Zunpeng Liu, Zheying Min, Huifang Hu, Ying Jing, Xiaojuan He, Liang Sun, Lifang Ma, Concepcion Rodriguez Esteban, Piu Chan, Jie Qiao, Qi Zhou, Juan Carlos Izpisua Belmonte, Jing Qu, Fuchou Tang, Guang-Hui Liu. Single-Cell Transcriptomic Atlas of Primate Ovarian Aging. Cell, 2020; DOI: 10.1016/j.cell.2020.01.009

3. How do you Explain to Someone How Muscle Imbalances Can Lead to Acute, Unexpected Pain?

As a physiotherapist I oftentimes will see people who have a new onset pain that is related to a loner standing imbalance somewhere in their body. This can sometimes be difficult for people to understand: if they’ve had an imbalance for some time, why is it that all of a sudden there is pain without an appreciable event/injury that happened?

This is where I love to use the analogy of “the lazy man on the assembly line”.

Check out one of my articles here for the full analogy and how you can explain it to your patients!

4. Exercise has the Same Effect on the Brain as Coffee

A new study which was published in Nature Scientific Reports determined that just 20 minutes of exercises is as good as a coffee for your working memory.

In this study, researchers investigated the difference between caffeine and exercise when it came to working memory. What they found was the results were quite similar, but that overall exercise was better because not only were improvements in working memory similar after doing 20 minutes of exercise as compared to consuming a serving of caffeine, but exercise didn’t lead to the side effects of caffeine, or caffeine withdrawal.

Authors also note that if people are ever experiencing caffeine withdrawal, simply taking a brief, brisk walk will help reduce symptoms!

So, instead of (or maybe in addition to!) reaching for that cup of coffee in the morning, ensuring you get 20 minutes of exercise first thing can make a big difference in your memory and overall health!

Ref: Morava, A., Fagan, M.J. & Prapavessis, H. Effects of Caffeine and Acute Aerobic Exercise on Working Memory and Caffeine Withdrawal. Sci Rep 9, 19644 (2019). https://doi.org/10.1038/s41598-019-56251-y

5. Patient HANDOUT: All About Pessaries

Find a quick, concise and useful handout talking about what pessaries are and their role in the handout attached to this email!

Five Bullet Friday: Women’s Health January 26, 2020

NB** Sorry friends – I emailed this out on Friday but forgot to post it here… enjoy!

Happy Friday!

Today’s Five Bullet Friday:

1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?

2. Why Can’t We Talk About Periods?

3. Patient HANDOUT: Common Food & Drink That Can Worsen Incontinence

4. Our Biological Clock Plays a Crucial Role in Healing from Surgery

5. Teens with Obesity & PCOS Have More ‘Unhealthy’ Bacteria

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

—

1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?

A paper published recently in Nature Medicine showed that many cardio-metabolic disorders, such as diabetes, heart disease, and stroke, are alarmingly difficulty to successfully treat in women.

Author, Professor Eva Gerdts believes health services are not considering the biological differences between men and women when treating heart disease. She explains “men and women have different biologies, and this results in different types of the same heart diseases. It is about time to recognize these differences.”

According to their study, authors of this paper found that women are more at risk of receiving the wrong treatment because health service professionals fail to spot symptoms or risk factors that are unique to women.

What were these risk factors and symptoms the authors were talking about, exactly?

Obesity was one – as women and men store fat differently and the mechanisms behind this process being different in women creates an increased risk of type 2 diabetes and heart disease. After obesity, the authors spoke of the benefits of estrogen women have in impeding metabolic syndrome, but how this changes during menopause when estrogen decreases. Researchers also talked about the different lifestyle risks women experience, all of which can be read at the reference below.

Prof. Gerdts hopes that her research will incite action among the medical community and lead to future research to discover the best way to treat heart disease in women.

Ref: Gerdts, E., Regitz-Zagrosek, V. Sex differences in cardiometabolic disorders. Nat Med 25, 1657–1666 (2019). https://doi.org/10.1038/s41591-019-0643-8

2. Why Can’t We Talk About Periods?

Dr. Jen Gunter, OB/GYN, Pain Medicine, and author of ‘The Vagina Bible’ recently gave a TED talk on menstruation. Dr. Gunter is doing amazing things to empower women and teach everyone about their bodies. I love to share this information with clients and patients, and highly recommend her talk!

Check it out, here!

“It shouldn’t be an act of feminism to know how your body works,” says gynecologist and author Jen Gunter. In this revelatory talk, she explains how menstrual shame silences and represses — and leads to the spread of harmful misinformation and the mismanagement of pain. Declaring the era of the menstrual taboos over, she delivers a clear, much-needed lesson on the once-mysterious mechanics of the uterus.

3. Patient HANDOUT: Common Food and Drink that Can Worsen Incontinence

This is a handout that I use A LOT in the clinic. Check out some common food and drink that could irritate the bladder and lead to worsening symptoms of incontinence, urge, and/or frequency.

Shoot me an email if you’d like a copy of this handout! cassie@tayloredtraining.ca

4. Our Biological Clock Plays a Crucial Role in Healing from Surgery

A recent study from McGill University found that timing of medication – based on our circadian clock – dictates their effectiveness when healing from a surgery.

Researchers found that taking anti-inflammatories in the morning or at noon were effective in promoting post-operative healing and recovery, but that they were much less effective if taken at night. In fact, research shows that if the anti-inflammatories were taken in the afternoon or at night, they actually severely DETER healing and bone repair following surgery.

The reason for this finding – that anti-inflammatories can both promote healing post op (if taken in the morning or noon) or hinder healing post-op (if taken in the afternoon or evening) is based on our circadian clock genes that are involved in healing.

Inflammation, following surgery, is crucial to healing since part of the process involves both destroying any bacteria that may be in the area, and signaling to attract the cells that will rebuild the tissues. But the process is not a constant.

“There are periods of inflammation that are actually very destructive, and there are periods that are constructive and important for healing,” said Faleh Tamimi. “So many pharmaceutical companies have been trying to develop drugs that will inhibit the destructive processes during inflammation but not interfere with the helpful ones.”

He adds, “The idea that I came up with in the shower one morning is that we could perhaps use the circadian variations in inflammation to our advantage. The destructive component of the circadian rhythm as it relates to bone healing occurs during the day, when cells known as osteoclasts break down bones. The constructive cells, known as osteoblasts that rebuild bones are active at night. By limiting the use of anti-inflammatories to the mornings and giving analgesics at night for the pain, I thought we might get better results in terms of bone healing than if anti-inflammatories are given throughout the day.”

For more details, see the reference below.

Side Note: as a therapist this research is fascinating to me and I believe it will have huge implications in the use of both anti-inflammatories and ice in the future in terms of optimizing the healing stages post injury!

Ref: H. Al-Waeli, B. Nicolau, L. Stone, L. Abu Nada, Q. Gao, MN. Abdallah, E. Abdulkader, M. Suzuki, A. Mansour, A. Al Subaie, F. Tamimi. Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery. Scientific Reports, 2020; 10 (1) DOI: 10.1038/s41598-019-57215-y

5. Teens with Obesity and PCOS Have More ‘Unhealthy’ Bacteria

New Research published in the Journal of Clinical Endocrinology & Metabolism suggests that the microbiome may play a role in polycystic ovary syndrome (PCOS).

PCOS affects 6-18 percent of women of reproductive age and is characterized by elevated testosterone levels in the blood that cause acne, excess hair growth and irregular periods. Teens with PCOS often also struggle with obesity and have higher risk for type 2 diabetes, infertility and depression.

Researchers discovered that “in adolescents with PCOS and obesity, the bacterial profile (microbiome) from stool has more “unhealthy” bacteria compared to teens without PCOS. The unhealthy bacteria related to higher testosterone concentrations and markers of metabolic complications.”

This information can be useful in the future as a new path to treatment – looking at the gut microbiome. Future research is still needed.

Ref: Beza Jobira, Daniel N Frank, Laura Pyle, Lori J Silveira, Megan M Kelsey, Yesenia Garcia-Reyes, Charles E Robertson, Diana Ir, Kristen J Nadeau, Melanie Cree-Green. Obese adolescents with PCOS have altered biodiversity and relative abundance in gastrointestinal microbiota. The Journal of Clinical Endocrinology & Metabolism, 2020; DOI: 10.1210/clinem/dgz263

Five Bullet Friday: Women’s Health January 17, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

2. NEW Guidelines for Recurrent UTIs, 2019

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

4. Weight & Major Psychiatric Disorders Genetically Linked

5. Improve Sleep by Losing Fat from Your Tongue?

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

President of the American Association of Gynecologic Laparoscopists (AAGL) recently commented on the announcement from the US FDA which recalled transvaginal mesh used for the treatment of pelvic organ prolapsed (POP).

Dr. Fidela Paraiso explained that there is an important distinction that many people aren’t realizing: the FDA recalled surgical mesh for some – but not all – procedures related to pelvic floor disorders, which some media sources are not disclosing that subtlety.

Dr Fidela Paraiso furthers that the mesh itself is not defective and that the recall only applies to repairing of POP. It has not, however, been recalled when the mesh is inserted through an abdominal incision for POP repair, nor mesh used in midurethral sling procedures for the treatment of stress urinary incontinence.

For more details on the difference between the use of mesh for POP repairs and for the treatment of stress urinary incontinence, please see Dr. Fidela Paraiso’s full explanation in the reference below.

Ref: Click here for Link

2. New Guidelines for Recurrent UTIs – 2019

Uncomplicated urinary tract infection is one of the most common indications for antimicrobial exposure in otherwise healthy women. We are obviously concerned with overuse of antibiotics as it has led to drug-resistant organisms in the past 20 years. Because of this, new guidelines were created and published in the Journal of Urology in 2019 to help guide treatment of recurrent UTIs.

Note: recurrent UTIs are defined as two culture-proven UTIs in a 6-month period, or three culture proven events in 1 year. The following guideline is heavily focused on treating not only symptoms, not only cultures, but rather the important combination of symptoms combined with positive cultures. This new guideline is an important step in helping physicians reduce the “collateral damage” or over-prescription of antibiotics to slow the rate of development of antimicrobial resistance.

Ref: Anger, Jennifer & Lee, Una & Ackerman, Roger & Chou, & Chughtai, Bilal & Clemens, J. & Hickling, Duane & Kapoor, Anil & Kenton, Kimberly & Kaufman, Melissa & Rondanina, Mary & Stapleton, Ann & Stothers, Lynn & Chai, Toby. (2019). Recurrent Uncomplicated Urinary Tract Infections In Women: Aua/Cua/Sufu Guideline. Journal of Urology. 202. 10.1097/JU.0000000000000296.

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

The reported prevalence of heavy menstrual bleeding in adolescents ranges from 34% to 37%, authors Dr. Borzutzky and Dr. Jaffray note in their recent paper.

This can lead to anemia, fatigue, and hemodynamic instability which may result in ED visits, hospital stays, the need for transfusion and oral or intravenous therapies to stop blood loss.

Authors say it is important to distinguish the etiology of this in adolescent girls to guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both. They also note that historically the evaluation of heavy menstrual bleeding has been predominately the role of a primary care clinician or gynecologist, but given that a high prevalence of female individuals (specifically adolescents) with heavy menstrual bleeding have underlying bleeding disorders, hematologists should also have a prominent role.

Ref: Borzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr. Published online December 30, 2019. doi:10.1001/jamapediatrics.2019.5040

4. Weight & Major Psychiatric Disorders Genetically Linked

New research shows that there appears to be a robust genetic link between body weight and major psychiatric disorders, an international research team has concluded.

Using data from more than a 500,000 individuals with major depression, bipolar disorder, and schizophrenia, the investigators showed extensive genetic overlap between body mass index (BMI) and psychiatric disorders. Interesting, they found that although the genetic risk variants for major depression and bipolar disorder were primary associated with increased weight, the majority of genetic variants for schizophrenia were related to reduced weight.

Authors found this quite interesting, because essentially this meant that if people had a susceptibility for increased BMI they were also likely to suffer from depression or bipolar disorder, but for schizophrenia it was the opposite: if they were at risk of schizophrenia, they were less likely to be obese. They conclude that increased body weight in schizophrenia seems to be directed mainly by diet, lifestyle, and side effects of mediation, but that it is a completely different picture with bipolar disorder and depression.

Authors further conclude that, “aligned with epidemiological findings, [their] results underscore the importance of considering both metabolic and psychiatric factors when trying to understand and treat mental illness effectively.” They are hopeful that this could lead to more prediction tools and better treatment choices for individuals with severe mental disorders.

Ref: Bahrami S, Steen NE, Shadrin A, et al. Shared Genetic Loci Between Body Mass Index and Major Psychiatric Disorders: A Genome-wide Association Study. JAMA Psychiatry. Published online January 08, 2020. doi:10.1001/jamapsychiatry.2019.4188

5. Improve Sleep by Losing Fat from Your Tongue?

A new study published in the American Journal of Respiratory and Critical Care Medicine just this month discovered that reducing the amount of fat in your tongue improves sleep apnea.

Previous research has shown that obesity is a key risk factor for sleep apnea, and that those who are obese who suffer from the condition tend to have considerably larger tongues with a higher percentage of tongue fat than obese people who do not suffer from sleep apnea.

So, how do you trim down your tongue fat? It comes down to overall body fat loss, the study found. “This study shows reducing excess fat in general can reduce tongue size. [And] the more tongue fat you lost, the more your apnea improved”.

This leads authors to believe that tongue fat is a potential new therapeutic target for improving sleep apnea, and they suggest future studies explore whether certain diets are better than others in reducing tongue fat, and whether cold therapies might be applied to reducing tongue fat.

Ref: Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue Fat. American Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC

Five Bullet Friday: Women’s Health January 10, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. Fragmented Sleep May Trigger Migraine 2 Days Later

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

5. Women’s Health RESEARCH Opportunities Local and Online

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

Fragmented Sleep May Trigger Migraine 2 Days Later

A fascinating new study published in Neurology found that people whose sleep is fragmented during the night are at a higher risk of experiencing a migraine episode not the next day, but the day after that.

Authors Dr. Bertishch knew that sleep and migraines have been linked for a long time, both anecdotally and by scientific research, and wanted to look a bit deeper in to their relationship.

What they found that was sleeping for 6.5 hours or under each night, as well as having poor quality sleep, did not correlate with migraine episodes the next day or day following. However, having a fragmented sleep was linked with a 39% higher risk of migraine on the day after the fragmented sleep.

Further research is needed at this time to better understand this low sleep efficiency and migraine correlation going forward.

Ref: Suzanne M. Bertisch, Wenyuan Li, Catherine Buettner, Elizabeth Mostofsky, Michael Rueschman, Emily R. Kaplan, Jacqueline Fung, Shaelah Huntington, Tess Murphy, Courtney Stead, Rami Burstein, Susan Redline, Murray A. Mittleman. Neurology Dec 2019, 10.1212/WNL.0000000000008740; DOI: 10.1212/WNL.0000000000008740

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

Low back pain is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care, yet unhelpful patient beliefs about low back pain remain pervasive. This great, free to- the -public resource printed in the British Journal of Sports Medicine outlines 10 facts about our back and back health that everyone should know, especially those who are struggling with back pain.

Find this helpful info graphic along with the rest of the article at the reference below, or see attached to this email.

Ref: O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal:

Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yielded adverse outcomes, including pelvic pain and dyspareunia. Pelvic floor physical therapy (and medications and injections as necessary) in compliant patients experience significant improvement of their symptoms, and pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Ref: Abraham, Annie & Scott, Kelly & Christie, Alana & Morita-Nagai, Patricia & Chhabra, Avneesh & Zimmern, Philippe. (2019). Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal. Journal of Womenʼs Health Physical Therapy. 1. 10.1097/JWH.0000000000000140.

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

This is an older video, but one that I love to share because it is so well done. The Fuzz Speech, but Dr. Gil Hedley, is a fantastic explanation of our fascia, how important movement is, and what can happen to our bodies if we are consistently sedentary. Most patients very much love this video and learn a lot from it. I do say most, however, as Gil does show a cadaver at some point.. so your more squeamish patients may not enjoy the recommendation!

Check out this 5 minute video, here.

5. Women’s Health RESEARCH Opportunities – Local in Kingston, ON and Online

Some amazing and important research is happening right now at Queen’s University in Kingston, Ontario looking at a number of topics including:

Psychoscial and Treatment Factors Associated with Persistent Genital Arousal Disorder
Biopsychosocial Investigation of Persistent Genital Arousal Disorders in Women
Sexual Wellbeing of Women Using SSRIs
Sexual Wellbeing of Women Experiencing Depression Symptoms
Sexuality and Breast Cancer
Sexuality and Menopause

Some studies are available to online participants, while others are in lab. For more details for you or your patients, visit here.

Five Bullet Friday: Women’s Health – January 3, 2020

Happy Friday!

Today’s Five Bullet Friday:

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article in NEJM

2. Explaining Pain to Your Patients – A Physio’s Favourite Resource

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

5. PATIENT HANDOUT: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article NEJM

In this excellent review article in the New England Journal of Medicine, authors Cabo and Mattson discuss intermittent fasting and its many benefits for humans. They discuss previous nutrition animal studies that assumed that benefits came from calorie restriction, at the time not recognizing that the animals typically consumed their entire daily food allotment within a few hours after its provision, thus meaning they had a daily fasting period of up to 20 hours, during which ketogenesis occurs.

For humans, preclinical studies and clinical trials have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders. Positive outcomes from intermittent fasting extend past those of simply restricting calories and the beneficial effects involve metabolic switching and cellular stress resistance.

In this review article, it is recommended that physicians can advise patients to gradually reduce the time window during which they consume food each day with the goal of fasting for 16 to 18 hours a day. They can alternatively recommend another intermittent fasting protocol as outlined in the review.

Reference: De Cabo, R. & Mattson, M. New Engl J Med. 2019; 381: 2541-51. DOI: 10.1056/NEJMra1905136

2. Explaining Pain to Your Patients: a Physio’s Favourite Resource

One of my favourite resources to share with patients regarding why they experience pain and what to do about it comes from pain specialists in Australia. Check out the following video “Understanding Pain and What to Do About it in Less Than Five Minutes”

Check out this great resource, here!

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a group of connective tissue disorders associated with significant morbidity. A recent review suggests that in this population a higher index of suspicion for urorgenital problems is warranted in this population, with urinary, gynaecological and obstetrical complications reported as common.

This information is helpful to encourage early referrals to appropriate disciplines in this population, including pelvic health physiotherapists.

Reference: Gilliam, E, Hoffman, JD, Yeh, G. Urogenital and pelvic complications in the Ehlers‐Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet. 2019; 1– 11. https://doi.org/10.1111/cge.13624

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

A Task Force of representatives of leading societies, whose international memberships include clinicians assessing and managing sex steroid therapy for women, was established in order to create a global consensus position statement on the use of testosterone in women. This Guideline was published in December 2019, it addresses available evidence and states:

No cut-off blood level can be used for any measured circulating androgen to differentials women with and without sexual dysfunction
There are insufficient data to make any recommendations regarding the use of testosterone in premenopausal women for treatment of sexual function or any other outcome
The only evidence-based indication for testosterone therapy for women is the treatment of HSDD, with available data supporting a moderate therapeutic effect, in postmenopausal women
There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention

Reference: Davis, Susan & Baber, Rodney & Panay, Nicholas & Bitzer, Johannes & Perez, Sonia & Islam, Rakibul & Kaunitz, Andrew & Kingsberg, Sheryl & Lambrinoudaki, Irene & Liu, James & Parish, Sharon & Pinkerton, Joann & Rymer, Janice & Simon, James & Vignozzi, Linda & Wierman, Margaret. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism. 104. 10.1210/jc.2019-01603.

5. Patient Handout: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Toileting habits are something we don’t often talk about but that can absolutely encourage or exacerbate pelvic floor dysfunctions. See attached to this email a great resource for patient’s talking about common toileting mistakes and what they can do to correct them!

The Blessing & Curse of Slow Change Over Time

“The chains of habit are too light to be felt until they are too heavy to be broken”

– Samuel Johnson

Today we are going to talk about two sides of the same coin: change. More specifically, how insidious seemingly small actions or symptoms can build over time to the point where we wonder what and where things went wrong. Yet on the flip-side how we expect everything to revert back to its previous state in the matter of days or weeks.

As you read through this article there is one concept I want to really sink in and that is that the habits and changes that happen slowly and consistently over a long period of time are the ones that stick. These are the changes that we don’t see coming until one day we can no longer deny them.

This is a truly important and empowering concept because it means we have a whole lot more control over our own health than we may think. And the sooner we can understand this, the sooner we can come face-to-face with our own habits, then the sooner we can recognize how they may be influencing our life and make long-lasting, positive change.

Insidious Change Over Time

I am a pelvic health physiotherapist so I will speak often about issues women face when it comes to the pelvic health, but the concepts I’m speaking about today can be true for other aspects of behavioural change.

I’m so fortunate to work with and be able to help incredible, strong, powerful women who come to me for help with a variety of health issues ranging from minor to quite debilitating. In my years of working with these amazing clients one reoccurring story keeps coming up that sounds something like this:

“I don’t remember when it started. There was no one event or one memory I have of leaking/pain/discomfort. But somehow along the way it has become my normal. It has become something I now deal with everyday.”

“If I think back I can remember small incidents of leaking/pain years ago. But I just brushed it off. And then yesterday I completely emptied my bladder unexpectedly while I was at work and I could not stop it. It was so embarrassing and it was the last straw. I’ve waited long enough for help, enough is enough.”

“I skipped going to the gym when I was slammed with work while on deadline for a big project and somehow never got back in to my old habit again. That was seven years ago.”

These statements (or similar versions) may sound familiar to you. The truth is we’ve all likely said something to ourselves along these lines. I think it is almost some sort of invincible fallacy – we simply don’t appreciate how much things will effect us. If we experience something negative (leaking when coughing, pain during sex, or a tweak in your knee) or make a choice to skip something positive (going to the gym, going to sleep at a reasonable hour) we try to logically justify why it happened or why it wouldn’t matter for us, because we’re different! We say things like:

“Oh, my bladder must have been REALLY full just then, and wow, that was one STRONG cough. Anyone would have leaked a bit with that one!”

“I know I shouldn’t really strain hard to lift up this box or really push to have this bowel movement, but I’m in a hurry and it won’t make a difference if I do it just this one time, right?”

“I’m beat. I’m going to skip the gym just this one time. Don’t they say that sleep is more important, anyway?”

It’s logical. It makes sense to us. And it really will be just this one time (or so we tell ourselves). But then after we brush off that one time (that first episode of leaking, that first episode of pain, the first time we go against what we know we should do) then the second time seems easier to justify too. Then the third.

See where I’m going with this?

It’s insidious.

We either do it entirely unintentionally (whether it be because we don’t notice or we don’t think it matters), or we do it intentionally but ignorantly – not realizing just how much of an effect over time these choices can have on our health and wellness habits.

This is the curse of small, slow change over time because we simply don’t recognize how important each individual decision, or each individual warning sign our body is telling us, is. And when we finally realize, when we finally take an objective look at what we are experiencing, what our body is telling us, or how we are feeling, when we finally are ready to do something about it, to improve our health, our habits, that is when we need to take a hard look at the flip-side of the coin.

Positive, Long-Term Change Takes Time Too

Have you ever dropped a behaviour after only a few weeks (or days) because it just wasn’t leading to the results you wanted as quickly as you expected?

I think the truth is we all have. But remember, you didn’t lose your shoulder mobility in a week so it is going to take longer than a week to get it back. You took 9 months to grow your beautiful baby girl so it is going to take longer than 6 weeks to look like your pre-pregnancy self.

The magic pill doesn’t exist. That vibrating chair you sit on for 30 minutes that claims to make your muscles contract to the equivalent of “11,000 Kegels” isn’t going to cure your incontinence. That crazy restrictive diet you’re going on isn’t going to be sustainable. Going so hard at the gym you injure yourself and can’t continue is only going to set you back.

The truth is the magic pill to success really isn’t all that sexy. It’s doing things that are good for your body day in and day out. Making positive choices and working with a coach (like a pelvic health physiotherapist, an orthopaedic physiotherapist, or a fitness and nutrition coach depending on your goals) who can guide you, progress you, and support you as you consistently work towards your goals.

I’m not saying this is easy. It most certainly is not. You may go through periods where you think it isn’t working, where you think that nothing is changing and that all of your hard work has been in vain. But then, one day (just like we talked about earlier), you will realize just how far you’ve come and wonder when exactly it all happened. But this time you won’t be sad and frustrated, but proud and empowered.

Remember the power of small change over time. How negative habits can creep in without us realizing, or how the positive ones can overcome. “The chains of habit are too light to be felt until they are too heavy to be broken.”

Are you always Kegel-ing during exercise? Find out two reasons that may not be the best idea

As a Pelvic Health Physiotherapist I have the privilege of working with and helping so many awesome women, many of whom are struggling with incontinence during activities such as running, weightlifting, or sports.

When I first meet these women, I’ve found that so many employ various strategies in order to reduce their leaking during exercise. Some empty their bladder frequently between sets, some squeeze their legs together, and others try to hold a Kegel while they perform each exercise. Though each of these strategies are not ideal, today I want to speak specifically about the strategy of holding a Kegel during an exercise. Let’s take the squat for example: many women I have met will try to perform and hold a Kegel for the entire duration of their squat in order to reduce the amount of leaking they are experiencing.

Is this an effective strategy?

Squats are an awesome exercise but can be a little less fun if you have to think about your pelvic floor the entire time you do them!

Honestly – the answer is no.

Sure… it may do something. It may help some depending on your level of incontinence, pelvic floor strength, and body awareness. Or it may more help by easing your mind, because you feel you are doing something to help. But the truth is this is almost always an ineffective strategy to both treat and manage your exercise incontinence.

Why?

Because it fails to train two very critical aspects of how our pelvic floor should work during activity: descent and relaxation, and unconscious competence.

1. Descent and Relaxation

Our pelvic floors are meant to both contract and relax. For the most part when these muscles contract they ascend upwards and when they relax they descend downwards. Going through relaxation and contraction throughout the day, or throughout an activity, is very important for how effectively and efficiently our muscles can work, especially when extra stress or load is applied to them.

In order to think about this ascent (contraction) and descent (relaxation) of our muscles, I want you to think about catching a baseball for a minute.

When you go to catch a baseball, you don’t just stop your hand abruptly when you catch the ball, nor do you punch your hand forward in to the ball (aka ascend/contract). No, instead you actually absorb some of the pressure, or cushion some of the force by allowing your hand to move backwards with the ball (aka descent/relax). This allows a much smoother catch, doesn’t lead to pain or discomfort, but most importantly makes catching the ball EASIER! It means we actually exert less effort AND have more success.

Now, let’s go back to the example of incontinence during squatting. If you employ the strategy of performing and holding your pelvic floor throughout the entire squat then you are contracting the muscles the entire time… but remember, we need to allow descent of those muscles to cushion the pressure created during the exercise! So, if you aren’t allowing for this your muscles cannot actually work optimally. And though this may perhaps help to some degree in the immediate moment, it will not allow your muscles to work as effectively and efficiently as they should. What this usually translates to is a ceiling effect where maybe this strategy works “a little”, but will never entirely correct the incontinence.

2. Unconscious Competence

This topic – unconscious competence – is something that is very, very important to me. As a pelvic health physiotherapist I am constantly meeting incredible women who almost never stop thinking about their pelvic floor because they are always trying to manage their symptoms. They do Kegels during exercise, try to manage their abdominal pressure in any way possible, are nervous of doing certain exercises, and are basically always thinking about their pelvic floor.

One of my goals for each and every client I work with is getting to the point where you don’t have to THINK about your pelvic floor AT ALL!!! Constantly thinking about what your pelvic floor is doing during activity or exercise is EXHAUSTING! Not only that, truthfully it is not healthy and can drive pretty much anyone to feel anxious, nervous, scared, or even a bit obsessive.

Now, I’m not saying there isn’t a place to think about your pelvic floor during exercise – there absolutely is, especially in the beginning when you are learning about your pelvic floor, what it does, and how it should work. But, this is not a long term solution! This thinking is more short term and is geared to help you learn about your body!

Depending on your symptoms, pelvic floor coordination and body awareness, we will often go back to the basics at the beginning of your pelvic floor rehabilitation and ask you to consciously think about and control your pelvic floor. This is known as conscious competence, simply meaning that when you consciously think about it, you can contract and relax your pelvic floor as desired. However after conscious competence is achieved we must, must, must transition to training unconscious competence!!

This is a critical piece of rehabilitation that I often see skipped: training your pelvic floor to work when and how it should when you are NOT thinking about it!! Holding a Kegel during an exercise, like the squat, does not help you train those muscles to be unconsciously competent.

What to do Instead

I wish I had a cookie-cutter answer for this, but the truth is you need to work with a pelvic health and fitness professional who can guide you, will as we can guide you, give you exercises and techniques to make sure you don’t have to always think about your pelvic floor and can instead start enjoying activities and exercises again!

Once we assess your pelvic floor coordination and general movement we will be well equipped at walking you through the steps to go from conscious incompetence –> conscious competence –> unconscious competence!