Beyond Basics, an international leader in pelvic floor physical therapy in NYC since 2003, has helped thousands recover from pelvic floor dysfunction. We offer personalized, holistic care to relieve pain, enhance function, and prevent surgery while providing comprehensive recovery support. Our mission: empowering better movement, health, and well-being through the power of pelvic floor therapy. @beyondbasicspt
What role does pelvic floor physical therapy play in managing endometriosis, and how does it complement other treatments patients might be receiving?
Patients who are suffering with endometriosis often have significant pain throughout the pelvic region, abdomen, hips, and lumbar region, to name a few. When there is pain, there is going to be muscle spasm. Muscles contract to guard, or protect an area when there is pain. Pelvic floor physical therapy (PFPT) can decrease some of the muscle pain, as well as decrease other irritations to the musculoskeletal and nervous system to prevent pain and improve overall function.
In the specific case of endometriosis, we understand how the clinical picture of endometriosis can present and the overlapping conditions that often accompany it, which can run from specific pelvic pain, GI and bladder dysfunction, symptoms in legs, abdominal pain, to pain with penetration both superficial and deep. We ask questions to hone into the regions of the body as well as the systems involved to get an entire picture of the individual and identify what needs to be addressed through physical therapy (PT).
We help coordinate the core muscles, including the pelvic floor, to improve toileting and support overall function. Additionally, we address posture to reduce strain on vulnerable areas of the body, minimizing overuse and alleviating painful muscles. We also teach proper lifting and bending techniques to prevent injury and decrease strain.
We also have general knowledge from a physical therapy standpoint of dietary suggestions to help with bowel movements or decrease irritation to the gastrointestinal system. As physical therapists, we often see patients more frequently than medical doctors, allowing us to quickly adapt treatment plans based on individual needs. Additionally, we can help coordinate care with other professionals to ensure that all areas requiring attention are addressed effectively.
Is there any emerging research that excites you in the context of endometriosis or perimenopause care? How do you see these advancements shaping future pelvic floor therapy treatment options?
I am mostly speaking from my own knowledge, but I am particularly excited about understanding how nutrition can not only promote a healthy diet but also support immune and reproductive systems through targeted supplements and dietary choices. We are understanding more about how endometriosis affects the body and dysregulates the immune system. If we can support the immune system prior to and after surgery—or even without surgery—we may be able to reduce the disruptive and severe symptoms associated with endometriosis. More scientific research on how to best calm and support the immune and nervous systems, particularly before and after surgery, would be a significant advancement in providing holistic and supportive care for patients.
For example, it’s largely known that patients who acutely tear their ACL do not recovery well if they undergo surgery right away. A calm knee going into surgery will be less painful and will recover more rapidly if the person waits a period of time before surgery. This approach makes sense for any injury, but especially to those conditions that over excite and sensitize the nervous and immune systems, such as endometriosis.
Perimenopause has historically been under-discussed. What challenges have you observed in breaking the stigma around it, and how do you address those in your practice?
We now understand that perimenopause can start as early as age 35. However, there is considerable pressure in our society to look young, have high energy, and juggle multiple roles, whether that’s working full-time raising kids or both. For those with estrogen-producing ovaries, this pressure is compounded by the expectation to keep pace with their testosterone-producing counterparts, who are often held to different standards.
Some of the stigma of perimenopause that is challenging is that it is normal, considered not a big deal, to just quit complaining and get through it. There are also many camps who believe that hormones and hormone replacement therapy (HRT) are dangerous and cause cancer. We try to educate the best we can to our patients that there are topical options that have less risk and that even in 2023, the Breast Cancer Organization released information that topical estrogen is safe to use in those with breast cancer for treatment of menopausal symptoms.
At our practice, we prioritize spending an hour with each patient, taking the time to listen to their concerns and carefully assess whether their symptoms are related to perimenopause or menopause. We believe it’s essential for individuals to be directed to providers who specialize in these conditions so they can receive the comprehensive care they deserve.
What role do you think healthcare providers, including pelvic floor therapists, can play in normalizing conversations around perimenopause and encouraging proactive care to help women transition through these changing phases? How can pelvic floor therapy contribute to improving the quality of life for women experiencing perimenopause?
Pelvic floor therapists (PFT) fit into a unique position where not only can we discuss the clinical symptoms of perimenopause, but we can also help identify some physical signs of hormonal changes, specifically regarding vulvar and vaginal anatomical changes with decreased hormones. If we observe any of these signs and it aligns with the symptoms the patient is complaining of, we can direct women to the best clinician for further diagnosis and treatment.
PFTs are not authorized to prescribe hormone replacement therapy (HRT), but we can guide you to professionals who can. We can also identify if decreased testosterone is contributing to vestibular issues, low sex drive, and decreased ability to build muscle mass, and again direct to those who prescribe it.
Physical therapists play a vital role in restoring function and enhancing quality of life. Supporting women through perimenopause by minimizing symptoms and discomfort can significantly improve their well-being. Studies suggest most general practitioners rarely ask about patients' sex lives, despite patients wanting to be asked. Providers treating women should understand hormonal shifts and their clinical presentation to identify issues and refer patients to the appropriate care. What better way to positively impact lives than by guiding them through this challenging transition, helping them make sense of unfamiliar symptoms, and ensuring they receive the care they need?
Can you share a memorable patient story that highlights the transformative power of pelvic floor physical therapy for someone with endometriosis or during perimenopause?
Endometriosis can be a devastating diagnosis, and many suffer for a long time before they get any help. Along the way they often suffer from the psychological impacts of medical disinformation and gaslighting. Currently, endometriosis diagnosis and dissemination of information and the overall attention in the community has been impacted positively by those who may be experiencing symptoms.
Unfortunately, however, 20 years ago, we lacked the knowledge and advocacy resources available today, which often led to the mistreatment of patients. One such patient I saw had tragically undergone a hysterectomy and experienced the abrupt onset of medical menopause—all before I had the opportunity to see her.
Over the past eight years we’ve worked together, her the transformation has been extraordinary. She has been able to not only get proper pelvic floor therapy, but also hip pathology, neck pathology, and general body strengthening, all of which were contributing to widespread body pain and decreased function. She found a team of doctors who have successfully addressed medical needs that had not been previously diagnosed treated, which are mast cell activation, POTS, hormones dysregulation, thyroid dysfunction, sympathetic nervous system upregulation, mold allergy and exposure. As a result, she now is traveling internationally for the first time in 20 years—something she never thought would ever be possible.