Pelvic Pain; PMS or beyond with the blues?

Guest blogger Elizabeth DeLozier SPT from SDSU
March 2016

Pelvic Pain can be due to many causes, with Physical Therapy at CTS treating myofascial, postural, biomechanical, and post injury (trauma, surgery) related pelvic pain. Often times we notice a cyclical nature of pain flares over the course of treatment, and some of our clients have a strong hormonal influence over the pain, related to PMS, or a more intense cyclical pain cycle PMDD.
We did some research this month to assist our clients who are presenting with cyclical pain flares that can be improved with Physical Therapy, Lifestyle and Nutritional interventions. Discuss the items listed below with your health care provider. Let us know if you suffer with PMS or PMDD and what you have found to be helpful.


PMS vs PMDD

What is PMS?
PMS, or pre-menstrual syndrome, is a broad term referring to physical, emotional, and psychological changes which affect women 1-2 weeks before their menstrual cycle and ease when they begin their period. Approximately 30-80% of women of reproductive age experience PMS. Symptoms include abdominal bloating, headaches, increased or decreased appetite, muscle aches or joint pain, fatigue, depression, and irritability.

What is PMDD?
PMDD, or pre-menstrual dysmorphic disorder, is a more severe form of PMS that affects approximately 3-8% of reproductive-age women. PMDD is characterized by significant mood disturbances and irritability which impair occupational and social interactions. The major risk factors of PMDD include a history of mood or anxiety disorders, familial menstrual or pre-menstrual disorder, and age in the 20’s or 30’s.

What causes PMS and PMDD?
Although researchers are unsure of exactly what causes PMS and PMDD, many women suffering from these disorders may have underlying anxiety or depression. Some researchers believe that the hormonal changes that trigger the menstrual cycle may worsen the symptoms of mood disorders. A recent study found that many women who exhibit signs of PMDD have low serotonin levels. Serotonin is a neurotransmitter involved in controlling mood, attention level, pain, and sleep. Women who believe they may have a mood disorder should talk to their doctor about treatment options.

Diagnosing PMDD
The best way to confirm a diagnosis of PMDD is charting daily symptoms. Women suffering from PMDD will experience a symptom-free phase between menses and ovulation. Well-validated studies on using symptom charting for the diagnosis of PMDD can be found below.
http://www.ncbi.nlm.nih.gov/pubmed/12012879
http://www.ncbi.nlm.nih.gov/pubmed/17470584

Non-pharmacologic treatments for PMS and PMDD can include:

• Lifestyle changes and nutritional supplements:
• Decrease nicotine, tobacco, and alcohol use in the 2 weeks prior to menstruation
• Decrease sugar, caffeine, and sodium intake in the 2 weeks prior to menstruation
• Ensure adequate rest: at lease 6-8 hours a night
• Regular aerobic exercise has been shown to be beneficial for women suffering from PMS or PMDD.

A large, multicenter study found that 1200 mg of calcium per day significantly decreased emotional and physical symptoms of PMS and PMDD.

Studies have found that vitamin B6 in doses of 50-100 mg/day are beneficial for women suffering from PMS and PMDD

Herbal supplements:
There is some evidence that 200 mg of magnesium and 400 IU of Vitamin E per day can decrease symptoms.

A recent double-blind, placebo-controlled study found that 1 tablet of chasteberry extract, also known as agnus castus fruit, significantly decreased PMS and PMDD symptoms of irritability, headache, anger, and breast fullness.

Gingko Biloba has been found to decrease fluid retention and breast fullness associated with PMS and PMDD.

More info about PMS and PMDD can be found at:
http://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd
http://www.webmd.com/women/pms/premenstrual-dysphoric-disorder
https://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/

The Happy Heart, The Healthy Heart

Maureen Mason, MSPT, WCS, CCI, PYT-C

February is heart health month, and I am writing this in honor of a dear friend who confided in me she discovered during a recent medical procedure that she has significant heart disease. She is now intent on, and practicing, heart health in mind, body and spirit. She may use medication and /or surgery, as needed, yet in her post op lifestyle she is on a health quest incorporating mindfulness, walking, and healthy eating daily. I want her to live long and prosper!

Sages throughout the ages offer strategies and methods for peace, enlightenment, and wisdom. Certain habits and practices help mind, body and spirit to thrive. Here are a few habits that can improve your health,and can specifically help your heart health.

Exercise regularly, 12 x per month or more.
Regular exercise may include the practice of yoga, either solo, or in a class that is safe and sound. A study published in research gate identified significant reductions in anxiety, depression, worry, and reduced salivary cortisol in women practicing Iyengar yoga for 3 months, compared to controls. Walking is also a wonderful form of exercise.Recent research is noting health benefits of yoga as similar to that of traditional cardiac training.

Maintain a good weight, BMI range 18.5 to 29.9
Calories count: Eat a diverse, Mediterranean diet. Eating a lot of vegetables, nuts, and good fats and proteins helps fill you up and nourish your body.

Practice meditation*: clear your mind
"Being", sitting or reclining, breathing, and cycling a mantra or prayer can calm and control the wandering mind. Use free guides, friends, or links in prior yoga posts here to develop a meditation practice. Research is showing improved mental and physical health in individuals who meditate regularly.

Alcohol: moderation
Women may benefit from one drink per day, men, 2 drinks. But alcohol use can cause impaired health by adding extra calories, upsetting blood sugar, irritating the throat, stomach lining, pancreas and liver, so if used, only in moderation.

Engage the positive with Spirituality, or Religious affiliation.
Reading uplifting literature or prose regularly, or having spiritual or religious devotions can enhance your life, and your health. Individuals that have spiritual or religious devotions as part of their life rate higher on compassion, forgiveness, and on heart health standards.

Comprehensive Therapy Services has resources to help improve your health, including free handouts on Mind Body health strategies, Meditation*, “Medicine Mind” mindfulness training, Doterra essential oils, pilates and other fitness classes, acupuncture and massage. Ask your therapist for resources to improve your heart health and self care. One on one private training is available for health and wellness in professional yoga therapy.

Ginger Garner is a a preventative health care leader with free mediation* podcasts and a gentle yoga DVD you can practice.She founded the Institute for Professional Yoga Therapy. The PYT-C after my name denotes my Professional Yoga Therapy affiliation and training, which has helped me practice self care and expand my integrative health care offerings to clients. She created PYT to offer medically based, safe, sound yoga programs. Here is her link: http://www.gingergarner.com

Research based articles on heart health:
Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program.
"Women suffering from mental distress participating in a 3-month Iyengar yoga class show significant improvements on measures of stress and psychological outcomes. Further investigation of yoga with respect to prevention and treatment of stress-related disease and of underlying mechanism is warranted."

Measurement of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart rate variability
During both supine rest and deep breathing, Isha Yoga practitioners showed well-balanced activity of vagal efferents, overall increased HRV, and sympathovagal balance, compared to non-Yoga practitioners. Hence, it may be postulated that Isha Yoga practitioners: have better exercise tolerance, their cardiac response to adverse conditions like day-to-day stress is improved following Isha Yoga practices the probability of them experiencing hypertension and other premature cardiac events like ischemia or infarction is decreased after the practice of Isha Yoga. However more studies should be conducted to explore these areas further.

Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women
Cardiovascular disease mortality was significantly lower among women in the top quintile of the Alternate Mediterranean Diet Score (RR, 0.61; 95% CI, 0.49 to 0.76; P for trend less than 0.0001).

Eat More! Optimal Nutrition for Health

Eat More! Eat Less! Optimize Your Nutrition for Health

Maureen Mason, MS PT, WCS, CCI, PYT-C   January 2016

   Choosing specific foods can reduce inflammation and pain, so here are medical guidelines recommended by the experts. Check with your health care professional for any questions or concerns. Add one new item per week to your current routine. 

Eat more for specific anti –inflammatory* effects:

Nuts such as Walnuts, Almonds, Flaxseed

Avocados   Mushrooms

Salmon, Sardines, Herring

Green Tea, Tart cherry juice, Red wine, 5 oz., and Soy

Spices Turmeric, Ginger, Cinnamon

Eat more for overall health: fresh fruits and vegetables, seeds and nuts and beans, low glycemic foods, “whole food” with no chemical additives, lean poultry, fish, and omega 3 enriched eggs. Balance good fat and protein and carbs to equalize blood sugar response after eating.

Eat Less

Processed food, fried food, meat, and dairy. Seafood such as shrimp and lobster can be pro-inflammatory. Gluten is in any wheat product and also used as an additive in many products, consider limiting if your provider advises. Dairy is associated with indigestion and IBS and many health care providers advise limiting to reduce indigestion. Alcohol and soda are big calorie items and associated with negative health indices. Overall portion size of items from this list can be reduced with benefit, such as having ½ of a donut vs. 3 donuts.

Notice how your stomach and digestive system react for hours after you eat. Notice energy levels, mental focus and clarity, and ease of sleep and waking.

*Anti-inflammatory effects occur on a cellular level with an optimal nutritional intake. Protein molecules called cytokines that are produced with injury act as part of the immune system. Cytokines circulate and sensitize nerves to pain and increase pain sensations. Omega 3 healthy fats and other items listed in the anti inflammatory list help dampen the cytokines and reduce pain signal production. Effects of food are cumulative, so choosing a regular grazing habit from the best items can help you feel better in the long term.

Nutrition Websites and Resources to help optimize eating habits

1.     1..Dr Ski Chilton advises we reduce our overall calorie consumption 20% -30% if overweight or obese; here is a link to his advised anti-inflammatory nutrition program, with a free information guide on healthy eating and suggested good fats: www.genesmart.com/pages/meet_dr__chilton/10.php

2. Here is a tremendous link Dr Michael Lara, a holistic psychiatrist, with his outline of slides explaining the inflammatory process and the role of nutrition, supplements, and exercise in health and disease: http://www.slideshare.net/mlaramd

3. Do you have “brain fog” after eating, or feel tired? Perhaps you are eating meals that have too high of a glycemic index. Check out this link for excellent detail as to why you may be on a glycemic roller coaster: https://www.raystrand.com/glycemic-index.asp Foods that are high on the glycemic index include: white bread, cereal, rice, white flour, potatoes, beer, fruit drinks, and processed foods.

4. Are you on the paleo trend? What’s the buzz? If you are a high level athlete you may need more protein to support your training, and some MD's are leaning towards plaeo, Here is a link to the Mayo clinics explanation and medical advice on the topic: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182

5. Do you really understand what the Mediterranean diet is? Here is the Mayo clinics profile and medical advice: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

6. Fact: Physical therapists treating pelvic pain, bowel and bladder problems, sexual medicine, and any musculoskeletal pain problem are directing clients towards self care and healing with optimal nutrition. Here are links to women’s resources for optimizing nutrition in relation to health concerns: http://integrativewomenshealthinstitute.com/blog/

Additional: Fluid and Fiber Management

Optimal fluid intake can be considered an intake of ½ of the body weight in ounces of water per day. A 150# individual may need 75 ounces of water per day.  Food and other fluid intake, temperature, age, and activity level all influence hydration need. Increased temperature and increased activity level both will increase the need for hydration. Signs of dehydration include fatigue, fainting, low blood pressure, falls, constipation, and dry, itchy, wrinkled skin.

Optimal fiber intake is 20-30 grams per day, ideally from consuming excellent nutrition with fiber rich foods.  Fiber supplements are extensive, but the easiest fibers to consume include prunes, plenty of fruits and vegetables, beans, nuts and seeds. Constipating, binding foods include toast, bananas, and applesauce.

Discuss these topics with your health care provider, and enjoy your food, with gratitude,

In health,

Maureen