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What If Sex Hurts? Interview with Sandy Hilton, PT, DPT

pain

I recently interviewed Sandy Hilton for the July issue of BossFit Magazine on the topic of sex from a Pelvic Health perspective. You can find that story here (the entire issue is devoted to sex – check it out!)

Sandy shared so much good information with me, and since the magazine articles are under 500 words I had to pare it down. I wanted to share the entire interview with you here. Enjoy!

Tell us about yourself:

I am a Doctor of Physical Therapy and have been practicing since 1988. I am the co-owner of Entropy Physiotherapy and Wellness, serving Chicago to restore hope and movement in those dealing with persistent pain, incontinence or painful sex. I serve as the Director of Programming of the Section on Women’s Health of the American Physical Therapy Association and am a member in several international organizations dedicated to providing top-notch health care.

What are some reasons that men and women might find sex to be painful?

Over 1 in 7 people experience pelvic pain and roughly 90% of those will have painful sex. There are multiple causes of pelvic pain in men and women. If it hurts in your pelvis, groin, belly, genitals or the hips during or after sex, you should see a physician for a good evaluation! Find a pelvic health specialist in your area, look for Urologists, Urogynecologists or Gynecologists who are experts in pelvic pain and sexual dysfunction. Common causes that we see in the clinic are related to stiffness of the muscles of the pelvic floor (those that you tighten when you do a Kegel), sensitive nerves in the area (from injury, repetitive use like long bike rides, following an infection or even sudden onset with no tracable cause), back pain and gut problems. Diagnosis like Vulvodynia, Dyspareunia, Pudendal Neuralgia, Prostatitis and Painful bladder Syndrome may all result in pain in the perineum and painful sex. Many endure this pain for years and treatment can be delayed by delayed diagnosis, insurance limitations or being incorrectly told that there is no help available.

What type of treatment can physical therapy offer for these issues?

Physical therapists provide essential care in eliminating painful sex. The right treatment plan starts with a thorough evaluation that includes your history, your goals and a full movement screen, check your strength and coordination and importantly, test the muscles and movements inside and around the pelvis.
It’s pretty common in painful situations to have a “non-relaxing pelvic floor”. We teach you to be able to tell when your pelvic muscles are contracted/held tight and how to relax those muscles again. This is the opposite of doing a Kegel contraction. Strength is important, but to be strong you need to be fluid, supple and coordinated.
Pain neuroscience education is an essential part of comprehensive treatment. Understand how the pain system works will give you daily reassurance and hope that the movements and function you have lost will come back with careful, coordinated treatment. We teach you to understand pain and ultimately, to change your pain. Part of this is learning to do Graded Imagery and Graded Exposure, tools that train your brain and your body (we really can’t separate those things!)
Other treatments may be using biofeedback (EMG) to show you on a screen the activity of the pelvic muscles, the use of dilators or vibrators for tissue stretch or relaxation, instruction in Mindfulness/Meditation and movement re-training that may include Yoga, Feldenkrais or Franklin Method exercises.

How long does it take to see progress?

I expect to see change from one visit to the next. It’s going to take some time, but really, you should see and feel measurable improvement each week. I think it’s faster to make change if you get to treatment quickly! I’d love to see people within the first 6 weeks of their condition rather than they typical “I haven’t been able to have comfortable or pleasurable sex for 5 years”. That’s way too long to wait before getting help!

What if the OB/GYN says the patient doesn’t need physical therapy (or says they need surgery?)

Some physicians don’t know what physical therapy can do to help. They may think that physical therapy for pelvic health is just teaching kegels – and I agree that wouldn’t be helpful for pelvic pain. When the doctor understands that physical therapy is a great way to get the brain, mind and body doing better, to bring the pain response down and restore healthy motion to the irritated parts, then they often are agreeable to a trial. If it isn’t a life threatening condition then a qualified pelvic health physical therapist is a sensible first try! See the Section on Womens Health “Find a PT” to locate one near you.

Besides pain, what are some other reasons that folks might avoid sex?

Incontinence will certainly play a part in wanting to avoid sex. Pelvic organ prolapse is another condition that may make it uncomfortable to have sex. For both men and women there may be changes in hormonal levels that make sex not interesting, not comfortable or you may be concerned with changes that come with age. There is help for many of these things, often with coordination between your MD and the physical therapist.

What if a patient says, “I had surgery to “fix” my problem, but I still have pain, why?”

Pain is a protective response that has to do with if your brain thinks the area where your hurt is in need of defense! If you’ve had a surgery and the pain persists, it may be less about what’s happening in the area and more about protecting it – this is all outside your conscious awareness, it’s a pretty cool system and we would die without the ability to feel pain. BUT – if you are stuck in pain, then you need to get to someone who can help you figure a path back to well being. It takes training the brain and the painful area both! There is hope. We wrote a bit about it here.

Anything else you want to mention about sex?

Sex and intimacy are an important part of life. It helps us to feel connected, wanted, appreciated and it is great for your pelvic muscles. Orgasms are helpful for staying healthy!

Thanks so much, Sandy, for sharing your expertise. You can find Sandy on Twitter at @SandyHiltonPT

 

Interview with Pedro Borrego: A Revolutionary Clinic Model

Pedro

Interview with Pedro Borrego

Pedro Interview with Pedro Borrego: A Revolutionary Clinic Model

Last week on Twitter a conversation started about Walk In or Urgent Care Centers for physical therapy, and quickly progressed to this question:

 

 

 

Talk to about that – he’s doing it in Spain.

We had a great conversation of over 195 comments, which led me to believe it would be well worth interviewing Pedro to find out more about what he is doing. In 1993, Pedro started the first physical therapy clinic in his town in Spain, and has grown it into a business which serves as a revolutionary clinic model for those of us in the US. I have known Pedro through social media and email for about 2 years now, and I am blown away by what he has done. I hope you enjoy the interview!

 

 

Q: First, Pedro, tell us about the education process in Spain to become a physical therapist.

A: Spain has become one of those countries in which physiotherapy education has improved since I went to University: I got my degree in 1992, a three years education in a recently established program in University of Salamanca. At that time the University didn’t offer a Master or Doctorate, so I got a foreign upgrade in General San Martin University (Argentina) and finished my first Masters degree in Healthcare Management. Nowadays this permits to me to teach as professor in the main private Distance University (UDIMA). In 2006 I reached my doctorate degree and I am preparing today a new doctoral thesis to fix the degree about physiotherapy in pelvic floor infectious and not infectious chronic diseases based in biofeedback.

Before I got my PT degree, most of PTs in Spain were also nurses, as their education program was linked to that profession. Nowadays, the evolution from 3 to 4-years education degree leads on to an independent PT Grade and direct access to Doctorate and Master Degrees.

Q: How long have you been practicing?

A: At the very first time I was sure I didn’t want to be ordered or directed by an obsolete system. Although I prepared a public examination to succeed to what it was supposed to be my first job in the National Center for Disabled Patients (and I got it!) I decided not to agree to the offer and open in 1993 Fisiomed, the first Physical Therapy center in Salamanca owned by a PT. Its 22 years now.

Q: What got you interested in physical therapy as a profession?

A: Well, it wasn’t what PT offered as a profession but as an aim to discover new perspectives in Healthcare areas, particularly in PT.

Q: Tell us about your clinic. Where is it located? How long have you been in business? Do you own the space or rent?

A: Fisiomed was open in 1993 initially as a renting place with 60 square meters in Salamanca Downtown (Spain): an office, waiting room, bathroom, two separate treatment rooms and a small gym. No one could foresee a new and bigger clinic 3 years later and just half a mile away. Today, a 500 square meters centre offers Physiotherapy, Orthopedic Surgery, Ophthalmology, Podiatry, Aesthetic Surgery, Speech Therapy, Psychology, and 3D-4D ECO imaging for pregnant women. www.clinica-fisiomed.com

Q: Explain the model of the clinic. What other healthcare providers work with you? Are you all part of the same business? How do you all work together? Are the other HCPs contractors?

A: The clinic is sustained in two main business models adapted to Spanish laws: self-employed and LLC (limited liability company). Health Ministry only allows HCPs to practice as a self-employed in the field related to your university degree, but LLC raises the views to work with other HCPs. And that’s what I did: LLC was founded by just one associate as CEO… and the same one a self-employed in PT.

The offers came quite soon: A surgeon leading the aesthetics procedures in Madrid but born in Salamanca, was impressed by the new Center, and then we signed the first contract.

All administrative staff and Physical Therapists are hired directly by the LLC, and they work as employers.

The others HCPs can choose between three open models: they are self-employers which lend a service to the LLC by renting a limited space by a fixed but flexible schedule by week (monthly payment), a percentage in benefits, or both systems. We make a market survey before we close the agreement and we value the proper model based in the specialty and interests of both LLC and HCP. We never duplicate two same HCPs unless they come as a team (like Orthopedic Surgeons do) but hiring the PTs allows me not to have to apply that rule in that unit.

But all HCPs in the clinic, including hired ones, are free on their professional decisions and duties under a manager’s baton to make things work properly, helped by administrative staff and a complex computer program which controls agendas, payments, percentages, patients, clinical history, providers, stocks, and logistics. The success doesn’t come from that, but from a personal and humane treatment and careful relations with patients and providers.

Q: What is the payment model in Spain? Do people use health insurance? Private or government funded? How do you get paid for treatment?

A: Private clinics work directly with patients. Most of them, like FISIOMED does, attend patients which use their private health insurances. Some of them, like members of the National Police or the Army, use their government funded insurance companies according to yearly accords with public statements like Ministries or regional/local public boards. The insurances pay monthly according to fixed rates accepted by providers.

We do also receive patients from traffic crashes who don’t have to pay anything at all as we are in an agreement with National Insurance Union managed by a web-based app that register the accident, the injuries suffered by driver and occupants, authorizations for clinical procedures (Ortho, PT, Xray) and assure the applicable payments coming from the insurance of the involved vehicles.

Q: In what way are each of the HCPs paid? Percentage? Salary? Per patient?

A: It depends on the model we fixed: renting pays a monthly amount, percentages goes from 20 to 35 % of rates, and mixed model reduces the rent and percentages to minimum with variable sums in each months depending on HPC activity. PTs and office staff receive a fixed salary.

Q: How do you market your clinic and services?

A: The beginning was costly higher than now, but marketing and publicizing is a must to be on the crest of the wave. It has obviously been a radical change in this, as 20 years ago there were no Twitter or Facebook, but our main power is our own patients.

Q: Do physical therapists need a physician referral to see a patient in Spain?

A: No. We do receive patients in a direct access system. This changes if we talk about insurances or Public Health. Reimbursements are compulsory justified by physician referral; insurances allow referral from any medical specialty; Public Health requires a referral from rehab-physicians except from Primary Care which referrals to physiotherapy come from PC Physicians integrated in the called PC Team.

Q: What has been the biggest surprise about this whole venture?

A: ¿Positive or negative? icon wink Interview with Pedro Borrego: A Revolutionary Clinic Model Let’s mention the first choice: the daily satisfaction to lead a team whose work turns into results in a better life for our patients.

Q: Where do you see the business heading in the next 5 years? Any big plans?

A: My head is continuously working and we are right know involved in both projects about computer assisted exercise program and iris laser aesthetic treatment to be included in our services. We just want to keep our MVV set and offering our best to patients and team members.

Q: What is the best piece of advice you can give someone who wants to start this model of business?

A: Be yourself, set your goals, never underestimate your rivals, and have a head for everything you decide to do.

 

Thanks so much to Pedro for taking the time to answer my questions. What do you think about this clinic model? What questions do you have for Pedro? Please leave comments and questions below.

 

Building Community Through Movement

Brian

 Brian 300x276 Building Community Through Movement

I have been fortunate enough to get to know Brian Finch, MSPT, CSCS (@AlpineAthlete) over the past year or two through social media. Brian is the Physical Therapy Clinical Manager for Rutland Regional Medical Center in Rutland, Vermont. He is an avid runner and skier with a passion for building community. I asked Brian to talk about how he has been instrumental in building community through Wellness activities in his town.

Brain shared the following:

I’m incredibly fortunate to live in a New England community that values cultural and educational richness. Our residents are so concerned about this, it’s not uncommon to hear the terms duty or role associated with community events. It’s quite understood that during the summer, the right thing to do is to buy your fruits and vegetables from the farmers’ market. It is also not uncommon for individuals to say things like, “It’s my responsibility to go spend $30.00 or $40.00 at the annual Art in the Park event.” Our community understands how participation is vital if we expect to have a robust cultural and educational environment. Many of my fellow friends and peers are actively mentoring our local high school students much in the same way that we take high school students & DPT students on a regular basis in my workplace.

A few years ago, several therapists began to think about community fitness and wellness in much the same light. We decided that it was really our responsibility to start attending events and talking up opportunities to our friends and families. Our local Parks and Recreation Department had a small series of trail runs and road races that would occasionally draw a couple dozen people. If you are not from New England, you may not know that running is the unifying force of nature in this part of the world. I was unaware when I moved to this part of the country, yet was quickly inducted into their cultural rituals. Nearly everyone runs or has a running partner or has a favorite lap or route in the area.

As a way to support community wellness, we began attending these races with good regularity and bringing our friends and family. It didn’t really matter where you finished, it just mattered that you showed up and had a good time. The bulk of these activities were held after work around 6 o’clock during the spring and summer, making it easy for folks to attend.

As a physical therapist, one of my greatest responsibilities to the profession is to help advance the groupthink around how we move as a society and how we take an active role in our own health and well-being. When the Parks and Recreation Department started noticing our regularity at their events, they quickly asked us if we had any interest in helping support or run them as well. We were excited because a typical evening event now drew 40 to 50 people.

We decided that it was our community responsibility to step up sponsor, facilitate, advertise and run some of these activities in the community that were getting people connected to jogging or walking. The events were appropriate for all fitness levels, as they were done in a looped fashion. An individual could show up and walk as little as one lap and socialize with the field.

This became the “Go Play” series of 12 races that included a mountain bike subgrouping, a cross country series, a mountain run trail series, triathalon, & a couple road races. We purchased an easy up tent and readily set up a table with refreshments and information. Individuals enjoyed this so much that they started bringing more people even when it was pouring rain! Throughout the crowd, we would hear chatter that “it’s our responsibility to show up and be healthy tonight.”

As we thought about fitness for all members of the community, we realized that we were not seeing the levels of younger adults and students that we were expecting. We decided that the right thing to do was to use our sponsorship of the series to not only promote to, but also to cover the entry of any junior athlete that was interested in participating. Additionally, we offered to cover the entry of any of our 1400 employees that work at our regional medical center.

Shortly thereafter, we had the Humane Society joining us and individuals were encouraged to bring their animals out to the activities. We had a number of vendors who decided they wanted to come and build a festival like activity alongside our tent. And most excitingly, we had developed a tailgating community after the event were people socialized and chatted about the events of the day and reflected on how we could engage the community further. By this point we are routinely seeing triple digit figures for participation and word-of-mouth was spreading.

Since then, several exciting items have come from this venture. The same teens that we enticed to come out and race set up their own Turkey Trot for Thanksgiving which raises over $2,000.00 for the Community Cupboard Food Bank. Locals are proudly driving around with “Go Play” series stickers on their cars. There is planned 55k ultra marathon for this fall. Unique to this event will be use of a small loop format, teams, multiple aide stations & a festival arena to promote the event. The event is more about socialization with a lesser focus on results. We’re plotting the 2014 version today and have already had businesses and vendors request be “looped in”. Most exciting is a commitment to develop a new “Get up & Go” series. The idea behind this is to have the same energy focused toward getting community members and former patients to come walk a quarter mile nature loop. What this has taught us is that community is everyone’s responsibility and shaping it can be the path to connecting folks to healthier life choices.

What are some ways your clinic has promoted Wellness through community activities?

 

 

 

#CSM2014 In My Shoes #VegasBaby

Red shoes

I returned from #CSM2014 on Saturday, and here I am two days later still trying to get my feet back on the ground! What a wild ride! This was my first CSM, and it did not disappoint. It was also my first time in Vegas (#Yikes).

I arrived on Tuesday and was lucky enough to be on the same flight as Jeff Hathaway (@ProActivePT). If you read my post on #PPS13, you’ll remember that I met Jeff in New Orleans and was quickly impressed by him. We got to have coffee together and then he was kind enough to drive me from the airport to #TheHouse.

If you haven’t seen it all over Twitter, #TheHouse was THE place to be. The group was gathered and arrangements were made by everyone’s favorite social coordinator, Jerry Durham (@Jerry_DurhamPT). The house consisted of Jerry, me, Chris Bise (@ptbise), Aaron Burkett (@ptfromou), Sturdy Mc Kee (@sturdy), TJ Janicky (@TJ_Janicky), Elise Burnett (@aahlease), Brooke Mc Intosh (@brookemcintosh), Larry Benz (@physicaltherapy), and Quinn Worden (@PTsAreHeros). I haven’t laughed as hard as I did with this group in a long time. The conversations at the house were amazing, thanks to the diversity of those present, and those who visited as a result.

Tuesday night was a whirlwind of events including the #DPTStudent event. I can’t even describe how impressed I am by this current group of students. They are bright, ambitious, eager to learn, opinionated yet respectful, and as Lauren Kealy said during the #CSMTwitterPanel “We are the future of the profession and we have damned good ideas!” I was fortunate enough to meet and talk with many of the students I have interacted with on Twitter, and I made some good friends in the process.

Other amazing events on Tuesday night included dinner with my friend, Patrick Myers (@PatrickMyersPT) and Jerry where we sang the 3 Best Friends song from The Hangover, the #solvept live party and #PTPubNight, where I got to meet two of my heroes: David Butler and Lorimer Moseley, two smart and hilariously funny guys who explain pain in ways that make sense to everyone.

Highlights on Wednesday included a great talk by Jerry Durham and Andy Lodato (@physiocarept) titled “The Success of the Profession Lies in the Consumer: Who Are They?” Great thoughts were shared and we had the benefit from learning from each other through plenty of Q&A time.

On Thursday I was fortunate enough to present as part of the #CSMTwitterPanel on Using Twitter for Branding Yourself and The Profession. This panel was led by the fearless leader Jerry #dbajd and included me for #CashPT, Sturdy for #bizPT, Kyle Ridgeway (@Dr_Ridge_DPT) for #acutePT, Chris Bise for #eduPT, Matt DeBole (@MattDeBole)for #DPTStudent, Jason Bellamy (@APTATweets) for #APTA, and Selena Horner (@SnippetPhysTher) for #solvept. We had a great discussion with a lot of good questions from the audience. I was really thrilled with the presentation and want to thank everyone for coming out at 8am to see us! We were all really thrilled that #CSMTwitterPanel was trending as #3 at the time of the talk!

Thursday and Friday were filled with plenty of naps in The Cave at The House followed by dinner and fun checking out The Strip and Freemont Street. I learned to never, ever wear your cute peeptoe stilettos to Vegas (#BlistersFromVegas).

The three themes that really stood out to me from #CSM2014 were the power of our words, the strength of the DPT Students, and the amazing ability of Twitter to connect. Many talks covered the power of our words in educating patients and providing support. The DPT Students showed us all that they are ready to be the future of our profession. And, we saw the impact of social media (Twitter specifically) for connecting students with other students from all over the country and with practicing PT’s, as well as connecting PT’s from every state and section with each other.

Already counting down the days until #CSM2015!

 

 

What Do You Love?

ubuntu-kids

What Do You Love?

 

As a private practice owner and health and fitness writer, I’m no stranger to the ups and downs of being an entrepreneur. I somewhat reluctantly took on this role back in 2003, when I first opened my private practice. I had been frustrated for months at my job in a busy rehab hospital, and thought that I could do better on my own. Without any formal business training, I sat down with a yellow legal pad and outlined what I wanted my business to look like.

Now more than 10 years later (with four years in the middle working for someone else), I find myself thinking a lot about the good, the bad, and the ugly of self-employment. A few recent articles have caught my attention, and given me food for thought. The articles cover topics we don’t often discuss as business owners: the risk, the sleepless nights, the stress of an empty schedule or a phone that doesn’t ring. After talking with many business owners over the years, I know that we all share the same joys and frustrations, and I think that we need to talk more openly about our struggles in order to support each other.

It goes against the grain for most business owners to talk about their struggles. After all, we take pride in our image. We want to appear in control and successful at all times. But this often comes at a great cost. This article discusses the psychological price of entrepreneurship in a candid fashion. It discusses the toll taken by lack of a steady paycheck, working long hours, risking security, and loss of time with friends and family. Several prominent business owners openly discuss their struggles with start-ups and failed ventures.

The same article points out that our strengths can also be our weaknesses:

 “People who are on the energetic, motivated, and creative side are both more likely to be entrepreneurial and more likely to have strong emotional states,” says Freeman. Those states may include depression, despair, hopelessness, worthlessness, loss of motivation, and suicidal thinking. The same passionate dispositions that drive founders heedlessly toward success can sometimes consume them.”

In the all-consuming frenzy of daily activities related to owning a business, it is often our own health that suffers the most. Many business owners neglect sleep, exercise, and healthy eating habits, adding fuel to the fire that stress causes to our health. When we refuse to talk openly about our struggles, we are left feeling isolated and alone.

For some entrepreneurs, these feelings come as a total surprise. Several years into owning a business, we may look around and ask ourselves, “How did I get here? I can’t believe that this is what I wanted, and now I’m so unhappy/stressed/apathetic/exhausted.” While I believe it is normal to go through periods where we question our decision to run a business, some people remain disillusioned and have trouble moving forward.

When we identify with our company to the point where it defines us as a person, that’s when we run into trouble. We have all heard sayings like, “When you do what you love, you’ll never work another day in your life.” While this is a lovely, romantic idea, I believe it couldn’t be further from the truth. Owning a business is hard work. Period. It is no wonder we experience disillusionment when we open a business expecting every day to involve unicorns and rainbows. There is no way around it: you will work more hours for less pay (initially) and be fully responsible for not only yourself, but also any employees you hire.

This article from Slate Magazine titled “In the Name of Love” discusses the problems with the “Do What You Love” philosophy:

There’s little doubt that “do what you love” (DWYL) is now the unofficial work mantra for our time. The problem with DWYL, however, is that it leads not to salvation but to the devaluation of actual work—and more importantly, the dehumanization of the vast majority of laborers.

The article points out that we should not forget that labor is something we do for compensation, and that most people in the world do not have any choice but to “work” to survive.

The article also makes the point that when we believe that we are “doing what we love” we have difficulty putting appropriate boundaries in place around our work. This is something that most entrepreneurs deal with at some time in their career. If we aren’t careful, our “work” hours extend to 7 or 8pm, and weekends, and holidays, and vacations…you get the idea.

Because we have convinced ourselves that we love our work, we forget to build a LIFE that we love in the process.

In the end, a life which lacks balance is no life at all. When we recognize our work as work, it helps us to re-engage in the business of living.

The closing paragraph of this article says:

If we acknowledged all of our work as work, we could set appropriate limits for it, demanding fair compensation and humane schedules that allow for family and leisure time.

And if we did that, more of us could get around to doing what it is we really love.

So, as usual, I have more questions than answers; but, I would love to hear from other entrepreneurs. How do you deal with the stress of running a business? Who do you confide in? What do you truly love, and are you dedicating enough time to it?

 

 

 

 

 

 

 

 

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