Category Archives: Staff

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Perineal Massage & Pelvic Floor Preparation

Antenatal digital perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain. Women should be made aware of the likely benefit of perineal massage and provided with information on how to massage (Beckmann & Stock 2013).

This is based on a review including four studies (2497 women) comparing digital perineal massage with control. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing and women practicing perineal massage were less likely to have an episiotomy. These findings were significant for women without previous vaginal birth only.

No differences were seen in the incidence of first- or second-degree perineal tears or third- or fourth-degree perineal trauma. There was a reduction in the incidence of pain at three months postpartum in women who had previously given birth vaginally. No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or any type of incontinence for women who practiced perineal massage compared with those who did not massage.

The basic perineal massage technique is the woman or partner performs daily 5-10 minute perineal massage from 34 weeks. One to two fingers are introduced 3-4 cm in vagina, applying alternating downward and sideward pressure using sweet almond oil (Labreque 1994). Other descriptions are to perform massage for 4 minutes 3-4 times per week from 34 weeks, 5cms into the vagina and sweeping downward from 3 o clock to 9 o clock (Shipman 1997).

The Epi-No® has been designed to assist women with antenatal perineal release and it is recommended to use it from 37 weeks. It is recommended to insert the balloon 2/3rds into the vagina and to contract and relax the muscles against the balloon, which provides resistance. It should then slowly be inflated to the point of stretching and comfort each day and the muscles are stretched more. After the stretching phase the pelvic floor muscles are relaxed to allow the inflated balloon to be gently expelled from the vagina. A randomized controlled trial on this product showed that antenatal use of the Epi-No® device is unlikely to be clinically beneficial in the prevention of intrapartum levator ani damage or anal sphincter and perineal trauma as diagnosed with ultrasound imaging (Atan et al. 2016).

It has been shown that almost 60% of women who have never given birth report some pelvic floor symptoms (Durnea et al 2014) and clinically it can be observed that many women present with high tone and sometimes painful pelvic floor at this stage. At www.milltownphysiotherapy.com we teach breathing release for the pelvic floor from 34 weeks gestation and gradually increase to include perineal massage, connective tissue manipulation of the external perineum and extend to manual therapy of the deep pelvic floor muscles. We recommend 3-4 sessions as needed with a chartered physiotherapist with a special interest in women’s health depending on the resting position and tension of the pelvic floor. We teach a home exercise program for daily practice.

Groin Pain in Sport – surgery or physiotherapy?

 

A recent study by Enda King and Dr. Éanna Falvey the next head of the British and Irish Lions medical team, and published in the British Journal of Sports Medicine (BJSM) compared the research on physiotherapy versus surgery on return to play for Athletic groin pain.
Athletic groin pain has been shown to be quite prevalent among players involved in gaelic football.
They divided the groin injury up into pubic related, adductor related and abdominal related groin pain.
The review suggested better results and quicker return to play with physiotherapy rehabilitation over surgery for pubic-related groin pain.
They also found no difference between surgery and physiotherapy rehabilitation for the adductor and abdominal groups.
You can see why the groin comes under some strain with all the side stepping seen in Gaelic football, rugby, hurling and soccer. With Colm Cooper today retiring from Gaelic football I thought I would share some of the side steps, points and goals throughout his career.

 

Recurrent and over-use injuries in children

Is your child complaining of recurrent heel or knee pain with no specific cause and it gets worse with activity?
Aisling Dolan, one of our physiotherapists here at Milltown Physiotherapy, has a special interest in treating and managing such injuries, having done a recent thesis on this topic as part of her Masters.

According to her review of recent research, the rise in children participating in organised sports has brought about an overall increase in over-use injuries. With this increased participation rate, there is also a growing pressure on children to perform at high levels and this can lead to inappropriate levels of training intensity, frequency and duration.

“Calcaneal apophysits”, (more commonly known as “Sever’s disease”) is the lead cause of heel pain in children. This condition causes intermittent pain where the Achilles tendon joins the heel bone at the growth plate. When the load at this junction has exceeded its tolerance level, it can cause an inflammatory response. Other common symptoms can include tenderness on palpation of the back of the heel, swelling and pain provoked by activities such as jumping and running.

The growth plates can be weak links and prone to this injury due to an increase in muscle tightness which occurs during growth spurts and increased levels of sport and activity. Aisling’s research reported that physiotherapy modalities are commonly used to manage these types of overuse conditions. Successful physiotherapy management includes activity modification, manual therapy and a home stretching programme specific to each child’s needs.

Preventative strategies for these type of injuries include monitoring growth spurts, muscle tightness and ensuring that sport participation is managed appropriately with these variables.

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Postnatal pilates – Do you have difficulty controlling urine when you cough, sneeze, laugh or exercise?

The pelvic floor muscles have many different functions and dysfunction within them can present itself in many different ways. During a vaginal delivery the pelvic floor muscles have to stretch to three times their normal length, so it’s no surprise that they may need a little bit of help regaining their function post-natally.

Bladder

  • Do you have difficulty controlling urine when you cough, sneeze, laugh or exercise?
  • Do you have a feeling of urgency to go to the loo, which you sometimes can’t control?
  • Are you unable to fully empty the bladder and often have to go back?

Prolapse

  • Have you noticed any heaviness or aching around the vagina?
  • Have you felt any bulging in the vagina or felt that something might ‘come out’?

Bowel

  • Do you have difficulty controlling wind?
  • Do you struggle to completely empty your bowel?
  • Do you have a sense of urgency to empty the bowel?

Sexual

  • Do you experience discomfort or pain during intercourse?

Pelvis dysfunction

  • Do you have pain in any of the following areas: pelvis; lower back; hip; groin; abdominals?

If you are 8 weeks postnatal or over and the answer to any of the following questions is yes, then we strongly advise that you make an appointment to talk to one of our Women’s health physiotherapists.
The symptoms below are not normal because you have had a baby. It has been shown through research that practicing Pilates exercises has many benefits. However, Pilates exercises on their own will not strengthen the pelvic floor muscles: to be effective exercises must be taught and guided by a women’s health physiotherapist.
Thanks to our physiotherapist Stephanie Crossland for putting this information together

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Dr. Jan Dommerholt visits Milltown Physiotherapy sharing advances in dry needling

We were delighted to host renowned myofascial and chronic pain expert physiotherapist Dr. Jan Dommerholt for a course on dry needling in back and pelvic pain on Wednesday the 30th of November.

Dr. Dommerholt is a Dutch trained physio and a recognised expert in the physiotherapy diagnosis and treatment of persons with myofascial pain syndrome, chronic pain syndromes, and whiplash associated disorders. He has published several books, over 60 articles, and nearly 40 chapters in medical and physical therapy textbooks on myofascial pain, chronic pain conditions, fibromyalgia, complex regional pain syndrome, and whiplash.

If you’d like to know more about this therapy please have a look at our dry needling section http://milltownphysiotherapy.com/therapies/dry-needling/

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Urinary incontinence: why aren’t women talking about it?


“With one in three women affected after childbirth, it’s surprising to find that female incontinence is rarely spoken about”

A great piece in Monday’s Irish Times documenting patient experiences and also offering some advice from our Specialist Women’s Health physiotherapist and practice partner Maeve Whelan.

http://www.irishtimes.com/life-and-style/health-family/urinary-incontinence-why-aren-t-women-talking-about-it-1.2835293

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World Physiotherapy Day This Week


Physical therapists help add life to years

Physical therapists can help older people to be independent, improving quality of life and reducing health care costs. This is the message from thousands of physical therapists across the world as they prepare to take part in World Physical Therapy Day on 8th September 2016.

Every year, World Physical Therapy Day allows individual physical therapists and WCPT member organisations to celebrate their contribution to global health. This year’s event builds on the success of 2015, when thousands of physical therapists used the #worldptday hashtag on Twitter to unite events across the world.
This World Physical Therapy Day uses the theme “Add life to years” and the hashtag #addlifetoyears, following the World Health Organisation’s World Report on Ageing and Health which says that “maintenance of functional ability has the highest importance” for older people.

The World Confederation for Physical Therapy played a significant role in the consultations for the new WHO ageing and health strategy. “World Physical Therapy Day is the first opportunity since the adoption of the report for physical therapists to show how important the profession is in ensuring healthy and active older people,” says WCPT President Emma Stokes.
“The evidence of the clinical and cost-effectiveness of physical therapy for older adults is incontrovertible. World Physical Therapy Day, with its focus on adding life to years, gives physical therapists a great platform to communicate this message to older people, the wider community and health care policy and decision-makers.”

By 2050 the global population will include two billion people aged 60 or over, and 400 million aged 80 or over. Physical therapists have a key role in helping people with long-term conditions achieve their goals, fulfil their potential and participate fully in society.
“Every day frontline physical therapists are transforming lives through the application of their clinical skills and experience. This is particularly so when working with older people whose health needs increase as they age”, says WCPT Chief Executive Officer Jonathon Kruger.
“Enabling older people to maintain their independence and continue to participate in society is a key skill of physical therapists around the world. In the coming years these skills will be more in demand and the global profession is willing and able to meet that challenge.”

For more information, contact your national physical therapy organisation (see www.wcpt.org/members), see the resources at www.wcpt.org/wptday-toolkit or email Mia Lockner at mlockner@wcpt.org

Background information

    About physical therapy
    Physical therapists (known in many countries as physiotherapists) are experts in developing and maintaining people’s ability to move and function throughout their lives. With an advanced understanding of how the body moves and what keeps it from moving well, they promote wellness, mobility and independence. They treat and prevent many problems caused by pain, illness, disability and disease, sport and work related injuries, ageing and inactivity.

    Physical therapists are educated over several years, giving them a full knowledge of the body’s systems and the skills to treat a wide range of problems. This education is usually university-based, at a level that allows physical therapists to practise independently. Continuing education ensures that they keep up to date with the latest advances in research and practice. Many physical therapists are engaged in research themselves.

    More detailed information about what physical therapists do can be found on WCPT’s website: www.wcpt.org/policy/ps-descriptionPT.

    Campaign resources
    WCPT has pulled together a collection of additional resources on ageing including research supporting the role of physical therapy in promoting quality of life in older people and information for the public: http://www.wcpt.org/wptday-resources.

    About World Physical Therapy Day
    World Physical Therapy Day falls on 8th September every year, and is an opportunity for physical therapists from all over the world to raise awareness about their crucial role in keeping people well, mobile and independent. The day was established by WCPT in 1996, and marks the date on which WCPT was founded in 1951. More details and toolkit at: www.wcpt.org/wptday.

    About the World Confederation for Physical Therapy
    WCPT is the profession’s global body representing over 350,000 physical therapists/physiotherapists from member organisations in 114 countries. More information: www.wcpt.org.

Tara Murtagh

Welcome to the clinic – Tara

We are delighted to welcome Tara Murtagh to the clinic due to increasing demand. Tara has a wealth of experience, and also expert post graduate training in Pelvic Floor rehab and continence.

Tara is passionate about treating prenatal and post natal musculoskeletal conditions, pelvic floor and continence rehab, clinical Pilates, dry needling as well as exercise prescription and rehabilitation.
Welcome on board Tara!