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As with any major technological advancement, there is potential for wonderful and enriching use cases, and a myriad of ethically sticky situations. As Artificial Intelligence is rapidly expanding into various aspects of our lives, let's pause and take a look at how AI is infiltrating your healthcare. We'll also look at how to best reap the benefits, while protecting yourself from its pitfalls. Let's examine the use cases first, and we'll cover the risks and benefits along the way. Where you might be seeing AI in 2025: Marketing Materials Scheduling & Intake Phone Calls AI Scribes-Your Doctor Isn't Writing Your Notes AI Insurance Claim Submissions Marketing Materials The ability to generate images and write text with AI has rapidly enabled healthcare providers to create brochures, social media posts, and blog posts (though not this one!), without the need of marketing departments, graphic designers, and heavy time investments. That being said, patients should be aware that AI makes mistakes, and sometimes people are too reliant on the AI to produce high quality content. If a blog post seems repetitive, or is overly general, the odds it was written by AI are higher. While providers should be checking their work before publishing, some are not as careful as they should be when they are pressed for time. The California AI Transparency Act requires disclosure of content created with AI, but it is only a state law, not a federal or international mandate. As of 2025, it's important to know that the "rules of the game" are still being written for AI. It is likely that many of the rules will be established through litigation, not legislation. As state and federal legislators are trying to learn about this rapidly advancing technology, the world is already adopting it. While the legislators are "playing catch-up", many of the rules will be decided as judges interpret existing laws and attempt to apply them to this novel technology. AI companies are faced with a challenging dilemma. They can either wait for the legislation to be written, and risk falling behind their competitors, or they can choose the route of "asking for forgiveness instead of permission." Most AI companies are choosing to press ahead into uncharted territories, hoping to come out on top. Businesses are allured into using AI at every turn. While writing this blog post, our website host offers AI blog post writing tools to generate entire posts, design titles, outline the post, and provide tools to improve grammar and writing style. Although they weren't used for this this post, I have to admit, I did try them out to see what they can do. As a practice, we're committed to quality over quantity. At this point, the AI isn't a better writer than I am, but as the technology develops, that may change. As a consumer, it is ultimately up to you to protect your own interests. You most likely cannot rely on the government, or the AI companies to do it for you. Transparency is a vital part of our business model, and ultimately inspired us to write this post. We want our patients to be informed so they can make educated decisions about the role AI plays in their healthcare. While AI might save us time, it isn't worth it if it is ultimately at the patient's expense. Scheduling & Intake Phone Calls It's no secret that high quality administrative staff are hard to hire and keep in healthcare. They are frequently the lowest paid employees involved in your care. They also often bear the brunt of the responsibility to do unpleasant tasks like informing patients that their insurance is not going to cover their bill, or that they have to wait several weeks for an appointment. Replacing administrative staff with AI is attractive because after the initial set up costs, the AI costs less than paying an employee. It also has the advantages of being more efficient, as it is able to call multiple patients at once. The AI won't call out sick and doesn't need health/dental insurance. AI won't complain about working early/late hours when the patient prefers a phone call. The AI won't be ruffled if a patient is rude. Once you train the AI how to handle a situation once, it can do it consistently moving forward. This eliminates the issue of patients getting different/conflicting answers from different administrative staff. In light of the fact that this saves healthcare practices money, it is most likely one of the first changes you'll see of AI being integrated into your healthcare. Don't be surprised if you get a phone call from "someone" saying, "Hi, my name is Avery and I'm an AI assistant for ABC Clinic." Considering that even if you are talking to an actual person, most companies give the disclaimer that, "This call may be monitored or recorded for quality assurance and training purposes," there is not a huge difference for patients in making this change. Arguably, there is more room for improvement than risk, considering that the AI will be a forever employee. When there is no turnover, the AI employee just gets better over time, and that ultimately means smoother experiences for patients. AI Scribes-Your Doctor Isn't Writing Your Notes If you haven't encountered it yet, you soon will. A provider will offer you a consent form, requesting permission to record your voice during your visit. The request seems innocent enough, but there are several questions we ought to ask before signing consent to have our voices recorded. There are even more questions we should ask about allowing a new and developing technology to write legal documentation about our health. When it comes to recording your voice, it's important to ask both how the recording is being made, and how it will be used. Scarlett Johansson lent her voice to bring an AI assistant to life in the movie "Her" back in 2013. Fast-forward to 2024, and she found herself demanding answers from OpenAI for why "Sky", a voice model of ChatGPT, sounded eerily similar to her own. Johansson claims she had turned OpenAI down when they asked if they could use her voice. Her lawyers filed suit for OpenAI to reveal the process used to develop the voice to prove its origins. We may never have the answer. OpenAI denied wrongdoing but decided to discontinue using that voice ( 1 ). You could argue that they did so to protect their trade secrets and not reveal how they develop their AI software, because they wanted to avoid bad press and legal fees, or out of genuine desire to respect Johansson. Regardless of which view you take, it seems that in the midst of the AI technology race, there will be a balancing act of asking for forgiveness vs. permission. While you may not be famous like Scarlett Johansson, it's also important to recognize that if something goes awry, you may not have the financial and legal resources that she does either. Though you may not currently be famous, someday you might be. This question is especially important when considering allowing your children's voices to be recorded. Their futures are yet unwritten, and what seems insignificant now, may not be later in their lives. If a voice recording is being made, it's important to learn what software is being used, and what the security level of the software is. Recording a voice directly into an electronic medical record software, that is HIPPA compliant, affords more privacy protection than a recording being made using Google Voice. The second question we should ask is, "How is that recording used?" There are some obvious positives for doctors in decreased documentation time. There are some wins for patients in receiving more full attention from their doctors who aren't so busy writing their notes that they don't even look at the patient when they are talking. It's important here again to recognize, however, that AI is a developing technology and can make mistakes. Your provider should review the note the AI creates before signing off on it. The question is, will they really do it? Many a patient has gone to look at their after visit summary, and seen information marked that isn't accurate. This is in part because there are pre-set responses in electronic medical record documentation software that are sometimes carried forward into a note, even if a doctor didn't ask the question. If they forgot to unmark the pre-set, it is dropped into the note. The AI scribes may afford doctors more time to pay attention to these details and correct them. They may also lure the doctor into a false sense of security that the note is "probably accurate" and they might sign it without looking closely. While this isn't necessarily a worse situation than what already occurs in healthcare documentation, deciphering the causes would be more difficult. Pre-sets in medical records are standardized, and easily identified as a potential area for error in documentation. If the AI makes an error, figuring out the process of how it got there and what went wrong is more difficult. It's important to ask how your recording will be used, and who retains rights to that data. Will the recording be used to train the AI model? Will the recording be kept and stored as part of your medical record, or will it be deleted? Can you opt in/out of allowing your recording to be used to train the AI? Can you request the recording be deleted? For more information on the scenarios where this matters, see Legal Concerns for AI Recordings (coming soon). AI & Insurance Claim Submissions Companies using AI to streamline this process can save both patients and providers a lot of time, trouble, and money. If healthcare providers don't have to pay an authorizations specialist, a billing department, and a claims denial administrator, it will reduce the cost of providing healthcare services to patients. If doctors don't have to deal with writing denial appeal letters, they have more time to care for their patients. This software is attractive for patients and providers. Health insurers are not incentivized to make the process easy. If a claim goes through, they have to pay it out and they lose money. It's actually in their best interest to make the process difficult. If patients get frustrated and give up, when they just pay the bill, the insurer doesn't have to. If a provider lacks the time and staff and chooses not to fight the denial, they either eat the cost of the services and write it off, or send the bill to the patient, who is likely to be upset and complain. Even when patients or providers call in advance to find out a patient's benefits, insurers play a recording that says something to the effect of, "If our staff tell you something that conflicts with your policy, the policy is what we'll actually follow." It begs the question, "Why do we even call to get the benefits at all if insurers aren't beholden to what their staff tell us anyways?" The AI companies can cut through the middlemen and go right to the policy itself. They can then coach providers on which codes are reimbursable and which ones aren't, before the claim is even submitted. They can also go through a provider's past documentation and create a summary with all the information needed to fight the claim denial when it happens. Then the provider just has to review the letter the AI generates, sign, and submit it. While the benefits are huge for patients and providers, there are always risks to consider. As the AI gains access to your past medical records, how do they use that information? If the AI does such a better job at getting reimbursement from insurance companies, will they then increase the premiums for subscribers anyways? The answer may be yes, but keep in mind they may be developing their own AI as well. If they can eliminate the need to pay administrative staff to process claims, it may balance out. Fewer administrative costs may not make insurance prices go down, but it might keep them from going up. Closing Thoughts: While the use cases for AI in healthcare are likely to grow in the coming years, for now, the major risks patients should consider are: Misplaced trust that the AI is accurate (by doctors or patients) Lack of AI transparency to identify when/how it was used Lack of legislation Data ownership & privacy concerns Is your data used to train the AI? As consumers and businesses alike are caught up in the excitement of all the ways AI can make their lives easier, it's good to take a moment and critically evaluate each situation. It's important to ask questions and be a savvy consumer and ask questions. Once you have all the information, you can weigh the risks and benefits and decide for yourself. Disclaimer: This article on AI healthcare privacy is for educational purposes and should not be construed as individual legal or medical advice. You are encouraged to seek legal counsel when making legal decisions, and individual medical evaluation by a licensed healthcare provider for your individual medical needs. References: (1) Scarlett Johansson says OpenAI ChatGPT voice eerily similar to hers | AP News

The idea of switching up your bathroom habits can be unsettling. The longer you've been doing something a certain way, the more uncomfortable and burdensome the idea of change feels. If you've been using toilet paper your entire life, the idea of switching to a bidet might feel foreign, or even a little threatening. There's a huge commercial industry that wants you to feel that way. In a speech to a business summit in 2005, Jeff Bezos analyzed the psychology of learned helplessness with the invention of toilet paper. People lived for thousands of years without toilet paper, but after its advent in 1857, we can't fathom functioning without it ( 1 ). Though the COVID-19 Pandemic of 2020 wasn't primarily a gastrointestinal infection, anyone who lived through it remembers the toilet paper panic buying that ensued. Stores had to begin rationing toilet paper and limiting the number of packages people could buy at one time. They say that in times of crisis, we find out what we are really made of and what is most important to us. Apparently, toilet paper ranked high on the list for most Americans. Before deciding that you would rather just stick with the familiar approach of using toilet paper, at least take a few minutes to consider your options. Let's take a closer look at some pros and cons, to help you decide if a bidet is right for you. Hygiene-Does It Get Me As Clean? Cost-Does It Save Time & Money? Never Running Out of Toilet Paper Sustainability Septic & Sewer Friendly Cultural Sensitivity & International Travel Independence When Injured Obesity-Friendly Hygiene Sweat Management Dyspareunia & Urinary Frequency Swelling Management Menopause Conscious Hygiene-Does It Get Me As Clean? The first question to answer is about hygiene. The research on this subject is relatively limited. There are also a number of factors that may impact the answer. It's easiest to compare bidet use to some of our other cleaning habits. If you were changing a diaper for your child and got some poop on your hands, what would you do? Most of us wouldn't wipe our hand off with toilet paper and then put our winter gloves on to go outside and go on with the day. We'd typically opt for using soap and water to wash our hands, or at a minimum use a wet wipe to clean our hands off. If you apply a similar idea to your own hygiene after going to the bathroom, it may make you view using toilet paper and pulling your pants up differently. Next, let's compare it to taking a shower after doing some yardwork. If you have soil on your skin, wiping it off with a paper towel might be enough to get the bigger chunks of dirt. The smaller fine particles, however, may be better washed away with water. If your skin is sweaty and oily from working in the yard while it's hot out, oils and fats don't mix well with water. You may need soap and the friction of a loofa or washcloth to really get clean. We have to acknowledge that there are a variety of stool consistencies. If you are prone to fatty, oily stools, the better cleaning method may be different than a person who isn't. The same concept can be applied to cleaning off after a stool that is liquid, compared to one that is more solid. Which option is best to get you clean may be dependent on your dietary habits and general bowel health/habits. We also have to consider your bathroom cleaning habits and bidet features. If you are using a private bathroom that is cleaned regularly, and/or have a bidet that has self cleaning nozzles and a splash guard, the likelihood of bacteria on the nozzle being sprayed at your behind is much smaller. If you're using a bidet without those features in a high traffic public restroom that isn't cleaned very often, the answer might change. These comments are notably all based on logical assumptions. As of now, specific studies on these variables haven't been done. Research on what's best for cleaning your bottom hasn't been at the top of the list for the limited research funding grants available. We can fairly confidently assert, however, that your hands stay cleaner when using a bidet. There is less risk of contamination from stool onto your hands if you've washed away the majority of the stool before you dry off the water with a clean towel. If your bidet has a built-in dryer feature, there's no need to wipe at all. Going to the bathroom can be a hands-free experience. This is a major plus for parents of young kids who aren't great about washing their hands. It can also give some peace of mind for people who are concerned about infections. The idea of a hands-free bathroom experience can be comforting for individuals who struggle with OCD, and germophobia. For people who are at risk of infections, like those who have a history of frequent urinary tract or yeast infections, or perhaps have a transmittable viral infection like herpes, bidets reduce the likelihood of spreading infections by directly touching your pelvis. Cost-Does It Save Time & Money? Using a bidet requires some up-front investment to purchase one, but afterwards, you may be able to eliminate toilet paper costs from your budget. If you live with the child who uses 10x more toilet paper than they need, or a puppy who thinks it's fun to grab the end of the toilet paper roll and joyfully run around the house tee-peeing the dining room table, bidets can definitely save you some extra cash. The water comes right to your house anyways. You don't have to spend time, gas, and money going to get it at the store, or having it shipped to your house. It bears mentioning that your cost savings may be greater if you live in a place where water is more plentiful and less expensive to source. Never Running Out of Toilet Paper While we hope to never repeat the great toilet paper crisis of the pandemic in 2020, if you have a bidet, you won't be caught with your pants down. Bidets eliminate the problem of needing to continually purchase toilet paper. They're also nice if you live in a house with someone who has a habit of forgetting to replace the toilet paper roll. It is also one way to put an end to the family debate of whether the toilet paper roll should go over or under. Sustainability If you buy a bidet once, as long as your house still has running water, you're all set. Some people argue that using a bidet makes you less dependent on paper products and is more environmentally friendly. There is some debate about how true this is, depending on where you live, and how much toilet paper you use. If you live near the Great Lakes in the Midwest, water doesn't have to travel far to get to your home. That may not be as true for a person living in the desert regions of the Southwest United States ( 2 ). If sustainability is a major factor for you, considering your drying method is important. If you are planning on using a bidet then dabbing dry with toilet paper, you aren't getting as much in terms of savings. If you plan on using a clean towel to dry off like you would after a shower, it is likely more environmentally friendly. If you're purchasing a model with a built-in dryer, the energy to run that dryer is a factor to consider. While many bidet companies are using sustainability as a selling point in their marketing, you have to evaluate whether or not that is actually true for where you live, how you dry off, and how much toilet paper you use compared to how much water you use from your bidet. Septic Tank & Sewer Friendly If you aren't putting toilet paper and wipes into your toilet, less material is going into your sewer or septic tank that needs to be degraded. If you have a septic tank, this can mean longer periods of time between tank servicing and drainage, and a reduced risk of septic back-up problems. Even if you have access to the convenience of city sewer systems, that paper waste doesn't disappear on its own. The city handles the waste management for you (for a fee). Someone still has to deal with things like wet wipes that don't naturally degrade on their own and can clog up sewer systems. Cultural Sensitivity & International Travel Some places in the world don't use toilet paper at all. If you have friends from other countries, installing a bidet in your home can make guests more comfortable to know that they have options that are more familiar to them. It can also be nice to try using a bidet and get used to them before you travel abroad. International travel is meant to be a fun adventure, and bathroom anxiety can put a damper on your experience. Trying out a bidet in the comfort of your own home may be preferable where you can control the experience. Independence When Injured If you've ever hurt your back, your shoulder, your elbow, or your hand, going to the bathroom can be a painful adventure. The bending, twisting, and reaching required to wipe can all of a sudden be painful, or even impossible. After some shoulder and back surgeries, patients are given surgical precautions that forbid bending and twisting, or require them to not use their arm at all for several weeks. Some elbow injuries might make it hard to reach to wipe, and hand problems may make it difficult to hold the toilet paper. Even if you have a very close and supportive family, you still most likely would rather not ask for help with wiping your behind. Bidets are a cleaning option that let you get clean independently without needing to awkwardly call a family member for help. Obesity-Friendly Hygiene For individuals who are overweight or obese, it can also be difficult to clean their behinds fully after going to the bathroom. Carrying extra weight can make it difficult to bend and reach to wipe and clean your body well. Extra adipose tissue can also cause your skin to rub and bump up against itself. The friction on your skin can lead to chaffing and irritation, which can be painful if you have to wipe toilet paper across it. Sweat Management If you're someone who gets sweaty from your workouts, bidets can help you clean up between showers. If your gluteal cleft gets sweaty, or you are a male who experiences scrotal sweating, bidets can help keep your body cleaner and smelling more fresh. Dyspareunia & Urinary Frequency Females who experience pain with sex, also called dyspareunia, especially those who experience entry pain with initial penetration, sometimes have irritability in their skin. Reducing the amount of friction and pressure from wiping can be beneficial. When you stop and think about it, females generally wipe more often than males do due to the anatomical differences in the way they urinate. If you consider how raw the skin on your nose gets when using tissues to blow your nose while you're sick, it's reasonable to say that the same effect can occur for females with repeated wiping. If you are wiping to get clean rather than dabbing off water after using a bidet to get dry, it is likely more abrasive to your skin. This is especially important if you urinate frequently. If you struggle with urinary frequency, check out our Bladder Boot Camp post for an introduction to getting bladder issues under control. We should note, however, that if you are urinating frequently because of a pregnancy, there are some extra topics to discuss (see: Pregnancy Pro-Tips: Bidets & Babies (coming soon)). Swelling Management The cool water function on a bidet can actually be soothing for individuals who are struggling with swelling. This is a common problem for women during their menstrual cycle, and people with pelvic vascular diseases (also called pelvic congestion syndrome). It's also convenient for women who experience swelling and inflammation with sexual activity. Water does an excellent job of conducting heat and can help cool off areas that are painful and inflamed. It's also convenient for males experiencing epididymal hypertension (commonly called "blue balls") or women experiencing Blue Vulva . Instead of having to "take a cold shower", the cold can be applied locally instead. This can also be a game changer for people with inflammatory bowel issues, or difficulty emptying their bowels fully. If swelling in the pelvic floor is restricting the opening for you to pass stool out of the body, cool water can help reduce the swelling and make bowel movements easier. Menopause Conscious Bidets can be a good investment for aging people for more than just orthopedic reasons; to make life easier when managing injuries and recovering after surgeries. Menopausal hormone changes can lead to dryness and more fragile skin tissue for women in the vaginal and vulvar area. While there are treatments available for these issues, in the form of hormone replacement medication that can be discussed with a physician, not all patients are comfortable with these treatments. The dryness and changes in skin tissue that are common during menopause can make both wiping and sexual activity painful. If you can only tolerate so much friction on fragile skin, spraying with a bidet, instead of wiping with toilet paper, can help save your skin for sex. Bidets may also help to reduce friction on these skin tissues and make going to the bathroom more comfortable. Conclusions: In closing, there are many benefits to using bidets for different groups of people. There are a lot of factors to consider in whether toilet paper, or a bidet are right for you. This article is intended for educational purposes and is not a replacement for individual medical advice. If you would like recommendations based on your unique situation, click Book Online to schedule an evaluation appointment with a pelvic floor physical therapist. References: (1) Jeff Bezos on Learned Helplessness: How Toilet Paper Became a Business Lesson in Innovation (2) The Environmental Impact of Bidets Versus Toilet Paper | Popular Science

Welcome to POTS University, written by a doctor has POTS, for other POTS patients, and the people who are part of their support system. Making sense of POTS isn't easy for doctors or patients. It's a complex condition that can affect the body in a variety of ways, and the symptoms can fluctuate from one day (or even one minute) to the next. In an attempt to make a very complicated disorder simple for those who don't understand what POTS is: The current healthcare system is not always set up well to help patients with complex conditions. Unfortunately, modern day healthcare frequently functions more like a dictatorship where doctors tell patients what to do, than an allied partnership where they work together as a team. There are many reasons for this problem, but one of the biggest reasons is finances. In an effort to keep healthcare costs down, doctors are expected to see more patients in less time. While that makes sense from a business perspective, it leaves less and less time for doctors to listen to patients' symptoms. It also leaves less time for them to explain why it's important for patients to follow their instructions. As a result, it can sometimes feel like doctors are rushing to give orders, and haven't really taken the time to understand the problem before recommending a solution. POTS is a dysautonomia condition that is full of fluctuations. It's important for patients to understand how their body is responding in real time so they can make decisions about what to do accordingly. This puts the control back in the hands of the patient, instead of making them dependent on their doctor (who can't follow you around to work this out with you in real time anyways). If you're ready to do the more complex work of understanding POTS, we first have to understand a little bit about blood. Blood in many ways is the driving life force of the human body. It has a few different jobs: It circulates hormones, immune cells, oxygen, and nutrients to the tissues that need them. It helps waste products like CO2 and lactic acid to be removed from our tissues and carries them away to be processed by our organs to be sent out of the body. It helps regulate body temperature. To get blood where we need it to go, our heart and the blood pressure in our blood vessels need to work together. When our system is functioning "normally", our blood pressure is high enough that blood moves through efficiently, but not so high that our heart has to work extra hard to pump against the resistance. Our heart is able to pump blood with an appropriately strong contraction or beat, and the rate at which our heart is pumping isn't too fast or too slow. Most medical textbooks would tell you that normal blood pressure is 120/80mmHg, and a normal resting heart rate is 60-80 beats per minute if someone is sitting at rest in a chair. It is also normal that your heart rate and blood pressure change depending on the activities that you do. For example, if you stand up from the chair, your blood pressure will elevate slightly to make it easier for your heart to pump blood up to your head against the resistance of gravity. If you then decide to go for a jog, your heart rate and blood pressure should increase to accommodate the increased demand for oxygen to your muscles. For a POTS patient however, the relationship of heart rate and blood pressure is sometimes not so smooth. Like the name implies, the autonomic nervous system is supposed to work automatically. When it doesn't, we call it dysautonomia. We then have to take a step back to understand its purpose and function if we want to have a chance at redirecting it. POTS is complicated because a few different variables can be out of sync, and the standard "normal" blood pressure, may not be normal for your body. Many POTS patients have had BP that for years has been 100/70 at their regular doctors appointments. This may have been "their normal", even before developing POTS symptoms. Some people have naturally lower resting heart rates then others. Aerobic athletes may have hearts that are more efficient, so they can get the same result with a heart rate of 50 that another person gets with a heart rate of 80. While medical textbooks like to establish normative data, it is important to realize that many people are not "normal". This is why individualized care is so important for POTS patients, and doctors need more time to work with them and observe how their body responds to activity changes in order to learn "their normal". That is why physical therapists are an integral part of a POTS care team. They often see their patients for visits that are 45 minutes or longer, and they are experts in movement. POTS is difficult to appropriately test for and treat if you only sit in a chair for a 10-minute appointment with the doctor. Physical therapists on the other hand, have their patients up and moving, and have an opportunity to see how a patient's body responds in a variety of different scenarios. For now, in the interest simplicity, let's use "normal" as a baseline for a few scenarios. Let's assume a person who normally has a blood pressure of 120/80 and a resting heart rate of 60 beats per minute when sitting in a chair, then decides to stand up, a few different things can happen: ​ Heart Rate (beats per minute) Blood Pressure (mmHg) Common Result Normal 75 120/80 ​feeling good 1.) Low-Low 50 80/60 dizziness, fatigue, syncope 2.) Low-High 50 160/90 may be compensated, may be dizzy/fatigued or have headaches 3.) High-Low 120 80/60 compensated, may be dizzy/fatigued, chest pain 4.) High-High 120 ​160/90 headaches, chest discomfort While there are multiple types of dysautonomia in which the heart rate, blood pressure, and other autonomic functions aren't smoothly coordinated, the third scenario is what we classically think of as POTS. When a person changes postural position and stands up, their blood pressure drops, and their heart rate elevates. If our blood pressure is low, our heart rate goes up to ensure that we still get blood flow where we need it. That's one reason why some POTS patients' bodies will adjust (compensate) accordingly and respond with a fast heart rate when they stand up from a chair. Their body may not have increased its blood pressure to accommodate the added resistance of gravity pulling the blood down. If your brain recognizes it isn't getting enough blood, it panics and tells you heart to beat faster in hopes of restoring adequate blood flow to the brain. This can be uncomfortable for POTS patients. As your heart races, it can feel similar to an anxiety attack. While you may not be emotionally upset about anything, your body is physiologically anxious because it feels like the blood supply to your brain is threatened. (See Pain, POTS & "Panic Attacks" ) Unfortunately, many people with POTS are misdiagnosed with anxiety, and it can take a while to get the right diagnosis. If your body is able to adjust enough with an increase in your heart rate to get blood to your brain, you might not feel dizzy, but you may still have chest pain/discomfort from how hard your heart is working. After all, your heart is being asked to work pretty hard, and your body may not be getting the blood back to your heart very efficiently for it to get the nutrients it needs to do its job. The magic numbers for what your heart rate and blood pressure need to be, in order to get blood where it needs to go in a timely fashion, can vary widely. It can vary from one person to another, as well as based on the activity you're doing. That is why cookie cutter medicine doesn't work well for people with POTS. While there are a lot of variables that can affect these changes, the important things to understand are: Heart Rate and Blood Pressure work together to get blood to our tissues efficiently. What is "normal" for one person, may not be normal for another. We need to be aware of what our heart rate and blood pressure are doing, so that we can start to decide how to help our bodies adjust. If you want more information on how to adjust for different activities, check out our POTS Pro Tips series. We'll help explain for each activity how to help modify it to make it easier, and why the modification helps so that you can apply it to other tasks that are hard for you throughout your day. Disclaimers: This article is intended for educational purposes and is not intended to serve as or replace individual medical advice from a healthcare provider. If you are seeking personalized medical advice, please contact our office to schedule an appointment with a licensed medical provider.

For people who experience dizziness, many stop driving. While it is absolutely a safety concern (you shouldn't drive if you're currently dizzy), what happens when driving makes you feel dizzy? Maybe you wouldn't even call it dizzy, but you'd describe it as motion sickness or feeling car sick. Believe it or not, there's PT for that. While most people think of physical therapy as a place you go to exercise, you might be surprised to learn that you can exercise your eyes, use movement to correct problems in your vestibular system, and even train your nervous system to have better balance and position sense. Before you can effectively treat a problem, however, it's best to understand the cause. Let's take a look at: What Happens When You Drive Mixed Messages While Driving Reading In The Car How To Treat It What Happens When You Drive Driving is something that many of us take for granted, but it is actually a pretty complex task. In order to drive safely, our eyes have to move in a lot of different directions. We are continually scanning the road ahead, checking our mirrors, and glancing at the speedometer. Your proprioceptive nerves that sense position are on call too. They are sensing the position of your body telling your brain how much pressure your foot is placing on the pedal and whether your foot is angled towards the gas or the brake. Your nerves are feeling the shift of your weight to the side as you round a curve in the road. They also tell your brain that your weight is shifting back into the seat as you accelerate the car to move again after sitting at a red light. Then there is the non-obvious but very important vestibular system. The crystals in your inner ear tell your brain that you've turned your head to the side to check your blind spot before changing lanes. They also let your brain know if you've tipped your chin up as you look into the rear view mirror. Our brains are also hard at work judging distances between our car and another car. The brain is anticipating how quickly we need to adjust our speed to slow down for (or speed through) the yellow light ahead. Aside from the actual driving, it is trying to remember or listen for directions and thinking about all of the day-to-day thoughts we're processing at any given moment. If all of that isn't enough, keep in mind, that this assumes a fairly simple model of driving. It doesn't include the distractions of the radio, eating while driving, or the kids arguing in the back seat. Mixed Messages While Driving Driving is a reasonably confusing activity to the balance centers in our brains. The brain receives mixed messages that it has to sort out to help determine what is actually happening. For example, as you drive, your eyes looking at the road ahead tell your brain that your body is moving forward at one speed. At the same time, your peripheral vision sees things passing comparatively more quickly through the side window. The eyes are sending messages to the brain telling it that you are moving at 2 different speeds. At the same time, your nervous system tells your brain that there is solid contact between your bottom and the seat of the car. It essentially sends a message saying, "I'm sitting still in a chair." The vestibular system may chime in as you turn your head slightly to look at your rear view mirror and say, "We're turning to the right." It is hard work for your brain to prioritize which message to focus on. When the brain has a hard time reconciling these mixed messages, people feel dizzy, nauseous, and/or develop a headache. When you realize just how hard your brain is working, it makes more sense why people often complain of feeling tired after driving all day, even though they didn't do a significant amount of physical activity. Reading In The Car Many people who develop trouble with dizziness later in life feel a sense of frustration; that they ought to be able to read in a car without feeling sick because they always could before. Motion sickness from reading in the car, however, actually makes a lot of sense when you stop to think about it. The nerves in your body and your vestibular system tell your brain that you are moving along with the car. On a logical level as well, a person who is reading in a car knows that the car is still moving. At the same time, however, some of your nerves are telling the brain that you are sitting still, with a constant pressure of your bottom on the seat of the car. Their eyes are painting a picture for the brain as well. The eyes are looking at a page that isn't moving. Depending on the location of where you are holding your book or device, you may or may not have any competing information from your eyes with an awareness of what is happening outside the windows. To make matters more complicated, not only are your eyes looking at a page that likely isn't moving, but your eyes are moving repeatedly. They are tracking the words across the page and then jumping back to the other side of the page to begin reading the next line of text. Reading also prompts an added layer of complex sensory processing in our imaginations. A person may be visualizing a picture of what they are reading, or hearing the sounds of the voices of the author or characters in their heads. This can create a complex over-layering of information for your brain with conflicting realities, both based on physical sensory perceptions, and cognitive processing of imagined sensations. How To Treat It Though it may be unsatisfying, the honest answer is, "It depends." To address a symptom, it's best to treat the cause. This usually starts with an evaluation by a physical therapist who specializes in dizziness, or vestibular rehabilitation. The therapist will help determine which systems are giving the brain incorrect information, and develop a plan to both help the system(s) function better, and help the brain process the information correctly. If the problem is in the vestibular system, treatment frequently involves positional maneuvers to help align the crystals properly in the ear canal. It may also involve balance exercises with head movements to teach the brain to interpret changing information from the vestibular system how to adapt. If the issue is in the way your eyes are tracking the movements around you, the treatment looks different. The therapist may assign eye exercises to help the muscles in your eyes coordinate their movements more smoothly. These visual habituation exercises help the brain practice both how to move your eyes appropriately, and to better identify when the eyes have made a mistake. If your brain recognizes the mistake, it will quickly decide to rely on the other balance systems information, instead of the system it knows is malfunctioning. If the nerves in the body are not sensing your body position correctly, your therapist may assign a variety of balance exercises to try and fine tune the position sense in your body. If certain nerves are not functioning well due to being compressed, or getting poor circulation, they may tailor a treatment program to help optimize/restore the health of your nerves. If the nerves are permanently damaged, the therapist may help teach your brain not to rely on them and to use the information from the other systems instead. Lastly, sometimes the brain itself is the issue. Perhaps it can't sense right and left well (see: Seeking Direction In Pain: Why Telling Right from Left Is Hard ). Perhaps another condition like migraines or dysautonomia/POTS is temporarily limiting the amount of blood flow to the brain, making it harder to process information (see: POTS University ). Regardless of the reason, a skilled physical therapist can often help improve your symptoms by either rehabilitating the system that is not functioning well, or teaching you how to compensate for it. This article is intended for educational purposes and is not intended as a replacement for individual medical advice. If you are interested in being evaluated by a licensed physical therapist for your unique case, you can click Book Online to schedule an evaluation.

Whether you are going to the gynecologist for the first time yourself, or perhaps looking to make your daughter's first trip less awkward, this post is for you. You're not alone if the idea of going to the gynecologist yourself, or the idea of your child going, makes you a bit uneasy. Although women are typically more comfortable, and more frequent consumers of healthcare services than men, there are some appointments that women prefer to avoid. Reproductive and sexual health care visits usually rank high on the list of 'least favorite doctors' appointments'. Our relationships with our bodies around the topics of sex and reproductive health are complicated. Though there are many cultural and social factors that influence our views of ourselves, it's clear that this broken relationship with our self-image is a long-standing trend. It was perhaps captured best by the early Renaissance artist Masaccio in Expulsion from the Garden of Eden . The artist makes quite the insightful social commentary on the differences in how males and females view the less desirable parts of their humanity. The scene displays Adam and Eve leaving the Garden of Eden after they have sinned and eaten the fruit from the forbidden tree. The artist's portrayal depicts Adam covering his face (and emotional distress), while making no effort to conceal his genitals. Eve, in contrast, covers her body and leaves her grief-stricken face in full view. Many would agree in modern society, that not much has changed. Expulsion From the Garden of Eden - Masaccio, 1425 Although Renaissance artists were comfortable painting nude subjects on church walls and ceilings, many people throughout history haven't been. Ironically, fig leaves were added to this painting later by a generation that viewed the nudity of the subjects as inappropriate for display in public artwork (pictured, left). The leaves were removed in a restoration of the artwork to its original form in the 1980's (pictured, right). ( 1 ) If you are hoping to restore comfortability with your body before your first gynecology visit, check out our post: Reclaiming the Vulva (Coming Soon). In the meantime, let's cover some questions to ask yourself in advance to help you be as comfortable as possible with your gynecology exam. These can help you feel more in control for your upcoming visit. We'll also cover some comforting perspectives to put your mind at ease. Preference Questions to Ask Yourself Do I prefer someone that I already know and trust, or someone I've never met? Do I prefer to see a specialist, or ask my primary care doctor? Do I prefer a male or a female provider? Who do I want in the room? Comforting Perspectives Patients have privacy rights Providers' point of view Do I prefer someone that I already know and trust, or someone I've never met? Assuming that you have grown up with the societal norm that taking your clothes off in front of other people is not socially acceptable, having a gynecology exam can feel awkward. For a woman's entire life, she has most likely been taught not to show her vulva to other people. That line of thinking often doesn't magically disappear when it's time to go to the gynecologist. It may help to consider your upbringing and how you have learned to view your body. For people who have learned that they should only be naked in front of another person in a serious committed relationship, such as a marriage, the idea of seeing a total stranger for a gynecology exam may feel incongruent. Some people feel that due to the more personal nature of the exam, they prefer someone that they know well and trust. Disrobing in front of a complete stranger may feel more inappropriate than disrobing in front of a primary care doctor who knows you well. On the other hand, the closeness of a relationship may make some people feel more uncomfortable. Some people prefer to see a gynecologist because they have a close relationship with their primary care doctor, and it may feel awkward to them to see their primary care doctor on a regular basis knowing that they have seen their vulva. This is ultimately a question of personal preference. There isn't a wrong answer; it's about choosing what makes you more comfortable. Do I prefer to see a specialist, or ask my primary care doctor? Many primary care doctors feel comfortable performing what's called a well woman exam. Primary care doctors often treat patients with routine gynecological issues such as yeast infections. There are some pros and cons to consider about having your first exam done by your primary care doctor, as opposed to a gynecologist. Experience level: This is a double-edged sword. There are advantages to seeing a specialist who performs vaginal exams every day. They are very comfortable performing the exam. They have more specialized knowledge, which can be helpful especially, if you have concerns about your pelvic health. You should consider, though, that sometimes when a provider does something every day, routine can be blinding. Despite their best efforts, providers sometimes forget that just because they do this exam every day, doesn't mean that you do. A gynecologist may be more likely to rush, or may explain less about what they are doing because they don't realize that it isn't routine for you. Regardless of whether you decide to have your first gynecology exam performed by a primary care doctor or a gynecologist, you should always remind them when they walk in the room that this is your FIRST exam. The gynecologist may see you on their schedule as a new patient, but that doesn't mean they know that this is your first exam; especially if you are older. They may assume someone else has examined you before and you are just establishing with their practice as a new patient. To be clear, when we say "older", we mean older than 18. While in other contexts 18 wouldn't be considered "older", many women have their first gynecology exam younger than 18 either due to menstrual problems, or being sexually active. Reminding your provider that this is your first exam, encourages them to slow down and explain to you everything that they are doing. To a gynecologist, your visit is just another routine exam. As a person who is nervous about their first exam, it might be hard for you to imagine, but your exam is the easy part of your gynecologist's workday. It's similar to seeing your primary care doctor for an annual physical, rather than because you are sick and need advice on a symptom/problem. To the gynecologist, your exam is routine. In contrast, because a primary care doctor most likely does fewer well woman exams, they are generally less likely to rush. For them, this is a higher liability service. They are more likely to be careful to explain the exam well and be mindful of everything they are doing. Most healthcare providers live with varying degrees of underlying fear of lawsuits. When it comes to evaluating pelvic health, there is more opportunity for a patient to allege inappropriate behavior. Primary care doctors know this and most likely will be more conscientious accordingly. OB-GYNs, on the other hand, may be a bit thicker skinned to the idea of lawsuits. The American Medical Association reports that 63% of OB-GYNs have been sued at least once. ( 2 ). In their line of work, lawsuits are normative. It's more a matter of when they are sued, not if they are sued. This doesn't mean that most OB-GYNs are not good doctors. While some lawsuits are based on legitimate claims of neglect and malpractice, many healthcare lawsuits ultimately end with the provider being cleared of wrongdoing. If it gives you peace of mind to check out your doctor's record, medical licensing boards make any disciplinary action on a provider's license public records. A search engine query for the electronic licensing board in your state will typically yield an e-licensing website that gives you the opportunity to input your provider's name and check their record. Do I prefer a male or a female provider? There are some generational and cultural perceptive differences here. For those who grew up in the baby boomer and Gen-X generations, the majority of doctors were male. The idea of seeing a male gynecologist was so commonplace that women didn't think of it as odd. As Millennials and Gen-Z started to come of age for gynecology exams, female doctors were increasingly common. When given the option, some patients have strong opinions on preferring a male or female provider. Reasons people give for preferring a female provider include: She has a vulva too, so she would know what it feels like to have an exam and would understand better. Some people question why a male doctor would choose this specialty; they wonder if he is "a creep". Patients with a history of sexual abuse perpetrated by a male may feel more comfortable with a female provider. Religious reasons: some religions prohibit women from being touched by male doctors who are not their husbands or an immediate family member. Sexual orientation: some patients are more comfortable with a female provider if they identify as heterosexual. They may feel inappropriate having their bodies examined by a male provider. Reasons people give for preferring a male provider The belief that, because the male provider does not have a vulva, he will do a better job of listening and trying to understand. His lack of personal experience can be seen as a positive. The patient is concerned a female provider may be biased. The female provider may assume that because the female provider's body functions a certain way, that the patient's should too. Patients with a history of sexual abuse perpetrated by a woman may feel more comfortable with a male provider. Sexual orientation: some patients who identify as lesbian/homosexual may feel inappropriate having their body examined by a female provider. Who do I want in the room? For some, the idea of going into this kind of appointment alone is frightening. They may feel safer having someone they know and trust present during the exam to make sure that nothing inappropriate is happening. This is especially true for individuals who have experienced trauma and struggle with freezing responses in stressful situations. This may take the form of having a parent present, or it could be an older sibling, a friend, or a partner. If you are a parent trying to help your daughter prepare, this is an important conversation to have. A teenager may not want their parent to be present for this kind of examination. They may also be more comfortable with it and prefer it depending on the scenario. It's important to take time and explain the options to your daughter. For example, it is possible for you to be in the room with her for the exam, but not see her body. She may not understand this until you explain it. Remember, she has no frame of reference for what will happen at this appointment. Frequently, if parents are present in the room, they will be sitting next to their daughter. Their daughter will have a sheet across her lap that keeps her body covered so that the only person who can see it is the doctor and perhaps the medical assistant chaperone who is present. The medical assistant chaperone may be present both for legal reasons to protect the doctor, and to assist in documentation while the doctor is working. While talking with your daughter about the process is generally a good thing and creates a culture of openness, some teens may not want to have this conversation with their parent. If so, providing your daughter with a written explanation of what to expect during a gynecology exam, and giving her the opportunity to ask you questions afterwards, may make her more comfortable. (Coming soon, see: Understanding the Process-Your First Gynecology Exam) Comforting Perspectives Patients have privacy rights We often share details about our health with our doctor that we don't share with everyone. Doctors are held to legal standards when it comes to protecting your personal health information. If you share information about your gynecological health with a doctor, they cannot share it without your consent. There are a few exceptions to these rules in the fine print of your HIPPA privacy notice, but they are extreme cases. If you are not a missing person in a police investigation and a judge is not signing a court order to have your records released for example, your information should remain private. Providers' point of view While it may sound a bit cold, doctors are often expected to see a lot of patients in order to meet their productivity requirements and justify their salaries. The average doctor's appointment is scheduled for 10-15 minutes. You may get slightly more time as a new patient, but on the whole, many gynecologists won't remember you very well. If your gynecologist is seeing 30 patients in an 8 hour day, that makes 150 patients in a week, and 7,500 visits in a year. When a provider sees so many different people, things start to blend together. Keep in mind that if you are healthy, you will probably only see your gynecologist once a year. To put it plainly, even if you saw them in the grocery store, they most likely won't remember you. It may also be a comforting thought for you to recognize that, if you don't live in a small town, chances are, you have never seen your doctor outside of their office anyways, and most likely never will. If your gynecologist is an OB-GYN, they may also deliver babies. Babies come on their own time, and delivering babies means that you will work inevitably work some night shifts. If one of the other doctors in their practice calls out sick with the stomach flu, OB-GYNs don't have the luxury of cancelling deliveries and telling pregnant women to wait to deliver until the next day. If this happened to your OB-GYN the day before your exam, they may be coming to work pretty tired. If you add in the sleep deprivation factor, it's even less likely that your OB-GYN will remember your routine gynecology exam. Closing Thoughts: While these questions and topics help many people gain a sense of control over their healthcare experience at the gynecologist, and put their minds at ease, it isn't an exhaustive list. It's always good to ask yourself, or your daughter, "What do I need to feel comfortable?" and "What variables am I able to control to give myself more decisions?" Does keeping your socks on make you more comfortable? Going first thing in the morning after you've been able to shower? Knowing you have something to do beforehand to keep your mind distracted? There are many individual preferences that you can control to consider. This post is intended for educational purposes and is not a replacement for individual medical advice. You are encouraged to work with your team of healthcare providers, such as your primary care doctor, gynecologist, counsellor, or pelvic floor physical therapist, to find the best solution for your unique situation. References: (1) Expulsion from the Garden of Eden - Wikipedia (2) 1 in 3 physicians has been sued; by age 55, 1 in 2 hit with suit | American Medical Association

Are orgasms optional, or necessary? Is it different for males than females? The way we have historically answered those questions has been culturally dependent, and steeped in debates regarding morality, and sex differences between males and females. Before we take a look at the evidence in human anatomy and physiology for both sexes, it's important to acknowledge some of the psychosocial factors at play when we consider how our bodies are designed to work. Epididymal Hypertension-" Blue Balls '" Gorgeous Engorgement-Arousing The Circulatory System Blue Vulva Syndrome When To Seek Help Treatment Strategies Epididymal Hypertension-" Blue Balls '" The concept of epididymal hypertension, more commonly referred to as "blue balls", has long been recognized by males as an unpleasant experience to avoid. It has frequently been used to argue that sexual stimulation and reaching climax is a need, not just a desire. While it is healthy and normal to want to avoid pain in most circumstances, at times epididymal hypertension is used to justify morally questionable behavior. This can occur in the form of justification of self-stimulation, or coercion of a partner to assist in providing sexual stimulation. It's important to acknowledge that opinions on morality, as it pertains to sexual behavior, are diverse. While some people believe that anything goes, others hold beliefs that sexual stimulation should only occur in specific contexts, or that certain sexual behaviors are appropriate while others are not. On the note of coercion, however, it is generally societally agreed upon that individuals should retain a right to consent, or decline to consent to engage in sexual activity. Epididymal hypertension can be used to imply to a partner, that it ought to be permissible to expect that the partner assists in addressing the problem. It's insinuated that it would be cruel to leave a person experiencing epididymal hypertension in pain. Like many things pertaining to sex, we don't as often consider the double-standard applied to this concept. While epididymal hypertension has often been applied as a justification for males to need to reach climax/orgasm, it has received very little attention in females. Gorgeous Engorgement-Arousing The Circulatory System During sexual arousal, the human cardiovascular system goes to work in both sexes. In males, blood flow is directed to the penis. This process is called engorgement, and is generally considered a positive one that grows the penis to display its full size. The pressure of the added blood flow presses out on all sides, making the penis hard, and allowing it to hold its shape during penetration of a partner. In females, engorgement also occurs. Though less visually apparent, we should still think of the circulatory system's work of engorgement as gorgeous. The additional blood flow to the pelvis is helpful for the body to produce natural vaginal lubrication, supply the nerves and muscles in the area with blood and oxygen to work their best, and adds a little extra cushion for your partner to bump up against the bones in the pelvis during sex when your bodies meet. Like most things in life, the amount of blood flow that is good vs. bad exists on a continuum. Some blood flow is good and helps with the body functions mentioned above. For some individuals, even a little extra blood flow that causes some mild achiness is actually considered desirable. The mild ache creates a yearning for reaching climax that makes some people perceive the climax/orgasm as more enjoyable when it's finally achieved. This is typically referred to as delayed gratification, edging, or orgasm denial, depending on the length of time climax is delayed, and the level of engorgement and associated achiness or pain that results. While for some individuals this is a consensual process and part of enhancing sexual enjoyment, as previously discussed, coercion of a partner or non-consensual engagement in these activities is generally considered morally questionable or illegal. Blue Vulva Syndrome Unfortunately, the signs of sexism run deep even in the medical community. The fact that epididymal hypertension has a medical name beyond "blue balls", and the same phenomenon in women has simply been named to match the colloquial name in men, is telling. It's even more ironic that while epididymis in males can turn a bluish hue, females may not even experience this color change. One potential name option would likely be "vulvar hypertension" and are nowhere to be found on major medical sites. In fact, at the time of this writing, it's difficult to call blue vulva syndrome, "vulvar hypertension", because we can't find any research showing that the local blood pressure in the vulvar region during arousal has even been formally measured. Hypertension is the name for high blood pressure and typically refers to the pressure of blood against the walls of the arteries and veins. In both males and females, vasocongestion, is a term that refers to swelling in the blood vessels. One could argue that a better name might be "vulvar vasocongestion". Nomenclature aside, blue vulva syndrome can produce similar discomfort for women as epididymal hypertension can in men. The female pelvic floor is like a lot like a boat or a hammock. Its job is to support and hold up the weight of the organs above it. The added pressure of the increased blood presses against the nerves in the area, and can trigger a heavy, achy, painful feeling. Carrying the extra weight of the blood volume can also make a woman's muscles tired, sore, and overworked. When To Seek Help The good news about epididymal hypertension and blue vulva syndrome is that in most cases they are temporary. When the body realizes that it no longer needs the added blood flow in the pelvis and genitals, it will gradually shift the blood back into circulation around the body. The exact length of time this normally takes isn't well established, and it may depend on several factors, such as how much blood was redirected to the pelvis, how long the period of arousal lasted, or cardiovascular health factors like blood pressure and heart rate. This can make it difficult to decide at what point seeking medical attention for epididymal hypertension or blue vulva syndrome is important. Though not specific to epididymal hypertension, prolonged blood engorgement of the penis does have some accepted time frame guidelines. Anyone who has listened to a commercial for medications for erectile dysfunction can probably tell you that men are encouraged to "seek medical attention for an erection that lasts longer than 4 hours". We even have a name for this unwanted, prolonged erection: priapism. Women, on the other hand, who experience what is/was called pelvic congestion syndrome, are not so aggressively marketed to about what is considered abnormal and when to seek help from a medical provider. **Some are currently advocating that pelvic congestion syndrome be renamed "pelvic vascular diseases" in an effort to differentiate specific causes for the dysfunction in the circulatory system. A syndrome, by definition, is a simply a group of symptoms that occur together. Syndromes in medicine are disorders that the medical community does not currently understand the causes of. At this point, there is a lack of research on the subject; specifically in women to establish a guideline for when to seek care. Right or wrong, in these cases, the medical community often applies the guidelines they establish for men to women until further research can be performed. If greater than 4 hours is too long of a time for blood flow to be directed to the pelvis in males, it may be a starting point for establishing a guideline for women. It's important to acknowledge, however, that given the lack of clear guidelines, it's always best to consult with a licensed medical provider to determine if your experience of blue vulva syndrome, may actually be suggestive of pelvic congestion syndrome or pelvic vascular diseases. Treatment Strategies Prevention Orgasms/Climax/Ejaculation Temperature Control Kegel Exercise Bridges & Body Position Cremasteric Reflex/Geigel Reflex Massage Prevention It's worth mentioning that prevention is a viable treatment strategy. If it isn't a good time to engage in sexual activity for whatever reason, the best treatment strategy may be to not put the body in an aroused position in the first place. Orgasms/Climax/Ejaculation Assuming that the "prevention ship" has already sailed, we'll start with the most natural resolution-orgasms. When male and female bodies reach climax/orgasm, rhythmic muscle contractions often occur. These contractions repeatedly, rhythmically compress the veins and arteries that run into the muscles to supply them with blood. This allows the body to pump the blood out of the pelvis in both males and females and reset the system. In males, this is more obviously visible. The scrotal sac containing the epididymis and testes will decrease in size after ejaculation. In females, the area of blood engorgement is more internal, so the change is not as easily visualized. For individuals who have difficulty reaching climax due to orgasm disorders, or perhaps their sexual rendezvous was interrupted unexpectedly, other options exist. We can help encourage blood flow in the body using temperature, exercise, and body position. Temperature Control When cold is applied to the body, a natural circulatory effect occurs to aid in thermoregulation. The body will generally move blood inwardly into circulation to try and keep warm when exposed to cold. This can take the form of a cold shower, applying a cold pack externally to your inner thighs, pelvis, or genitals, or internal application. For women who experience vaginal swelling, products such as cool water cones , or thermal pelvic wands exist that can be inserted into the vaginal canal. Kegel Exercise Movement and exercise are another way to get your blood moving. While general exercise, like walking, can be helpful to get your heart rate up, pelvic exercise can better target the specific areas of swelling. Pelvic floor muscle contractions, often called Kegels, can specifically compress the veins and arteries and assist in pumping the blood out of the pelvis. While performing Kegels is the most common option, many people (close to half!) have difficulty performing a Kegel correctly based on verbal instructions alone ( 1 ). Women especially tend to have poor sensory awareness of how to utilize their pelvic muscles (See: Sensory Speed Bumps: Cultivating Pelvic Awareness in Women ). If Kegels aren't working for you, it may be best to schedule an evaluation with a pelvic floor physical therapist to make sure that you are doing them correctly. With verbal instruction alone, 25% of people actually perform the movement backwards and are unknowingly relaxing their pelvic floor muscles rather than contracting them (1). Bridges & Body Position Bridge Exercise: Image Credit HEP2go.com Another strategy that can be performed alone or with Kegels is to let gravity assist you. Moving the body into a bridge position either repeatedly and actively with your muscles, or once and placing pillows under the hips to support you, can encourage blood flow out of the pelvis. This can be a good recovery position for blue vulva syndrome, as well as for women who experience pain and pelvic heaviness after sex. Cremasteric Reflex/Geigel Reflex In males, if they aren't able to control lifting and moving their epididymis voluntarily, exercising the nervous system can be used to their advantage. The cremasteric reflex involves stroking or pinching the inner thigh and will result in a lifting of the scrotum, testis, and subsequently the epididymis. Repeated activation of this reflex and the subsequent movement may aid in blood flow to the epididymis. In females, its equivalent is called the Geigel Reflex. However, because women don't have a cremasteric muscle, it instead results in some tightening of an inguinal ligament. Unfortunately, it is most likely less helpful for improving blood flow in women than men. Massage Massaging the areas engorged with blood flow may aid in gently pressing the blood back into circulation. This can be performed on the external surface of the vulva, internally in the vagina, or on the external scrotal tissues. The challenge with utilizing this technique, is that if it is sexually stimulating to you, your body may continue to be aroused and send blood flow to your pelvis. Other techniques may be preferrable if you find the massage to be arousing. Closing Thoughts To address our original question, "Are orgasms optional, or necessary?" we have to ask the follow up question, "Necessary for what?" Neither epididymal hypertension or blue vulva syndrome are typically considered "fatal" or "life threatening". A person would be hard pressed to argue that an orgasm is necessary for them to live. If we turn to the question of, "Is an orgasm necessary to avoid pain and discomfort?," the answer to that question is also most likely, no. There are other strategies that can be used to manage the discomfort from the increased blood flow to the pelvis in both males and females associated with blue vulva syndrome and epididymal hypertension. It is also noteworthy, that pain itself is sometimes a part of life. While human beings generally prefer to avoid pain and discomfort, it is sometimes deemed worth suffering depending on the context. For example, many men and women choose to endure the mild pain and discomfort of swollen, blood engorged muscles after a tough workout at the gym for the purpose of making their bodies stronger. Some of them even come to enjoy that soreness. At a more intense level, people sometimes choose to undergo surgeries that will temporarily result in pain to obtain some kind of health or cosmetic benefit. Many women choose to endure the temporary pain of childbirth in order to accomplish a greater good of having a baby. When determining if achieving an orgasm is necessary to avoid the pain and discomfort associated with blue vulva syndrome or epididymal hypertension, each person has to consider the context of their personal situation, and if relevant, the wants, desires and needs of their partner. Disclaimers: As always, the above content is intended as educational content and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in a pelvic floor evaluation to discuss your unique case, click to Book Online and schedule an appointment. References: (1) Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction - ScienceDirect (2) www.HEP2go.com

Are foot fetishes really a neurological abnormality? Is chronic ankle pain that no one can seem to see, or fix, secretly a pelvic problem? Do twinkle-toes potty dances actually help kids hold it until they get to the bathroom? At first glance, our title might seem like a bit of a stretch. That is, until you realize that the nerves that supply your feet literally stretch down from your pelvis. The connections don't end there. While the cliche saying was that "all roads lead to Rome", in the human body, all nerves lead to the brain. Even your brain is organized in a way that the foot is right next to the pelvis. Foot and ankle problems and pelvic problems have a lot of overlap. If your experience in physical therapy has been primarily orthopedic, you may have been told that you need a lift in your shoe because your legs are different lengths and it's throwing off your pelvis. The neurological links between the feet and your pelvis, however, may be just as influential. Let's take a look at: The Foundation: The Nerves Out in the Body The Nerves in the Brain Foot Fetishes The Potty Dance Tibial Nerve Stimulation For Pelvic Problems The Nerves Out in the Body When it comes to nerves, it's easiest to think of them like a vast network of streets and highways (See: Nervous System Highways ). They are responsible for carrying information from the brain out to the body, and from the body back to the brain. Like cars on a highway, they transport many different kinds of messages. Some function as major highway thoroughfares like the sciatic nerve, which supplies the entire back side of the leg. Some of the nerves serve as smaller side streets so that every inch of the skin on the bottom of the foot has sensation. To help you with the basics, we'll look at two nerve maps. The first map highlights the bigger "highway" nerves. These are the major nerves that go down to the leg. Some of these nerves have more recognizable names, such as the sciatic nerve. These nerves trace back to the spinal nerve roots. Below each nerve, the nerve root levels are listed with "L" meaning lumbar, and "S" meaning sacral, to indicate which spinal level the nerves originate from. From there, the nerve roots connect into the spinal cord, which serves as the ultimate road back to the brain. The second nerve map covers the superficial nerves that go to the skin from the spine. They are medically mapped into what we call dermatomes. Each dermatome region corresponds to a different level of the spine. You may find some variation in dermatome charts online. That is, in part, because there is more variation in the smaller nerves to the skin between individuals. This makes sense when you think about how variable the paths are of the side streets in a neighborhood compared to major highways, which tend to follow more consistent structure patterns. Regardless of what dermatome chart you look at, generally speaking, the nerves labeled L4, L5, S1, and S2 will be mapped covering the foot and ankle. These correspond to the fourth and fifth lumbar vertebrae, and the nerves that exit in this area, and the first and second sacral nerve roots. The lower sacral nerve roots then supply the back of the upper leg, and the pelvis. The Nerves in The Brain Visualizing the brain can be tricky. The truth is that a lot of the parts of the brain look pretty similar. Figuring out which part of the brain is responsible for what function requires advanced research equipment. That's because brains, and the nervous system in general, are somewhat similar to the circuit panel and wires in your house. Taking a picture of the wires doesn't necessarily tell you what they do, or even if they work at all. Looking at the switches on an unlabeled circuit panel doesn't give you enough information to know what each switch does. If you've ever had imaging taken that comes back without any reason for the pain you're having, you aren't alone. That's because pain is processed in the nervous system. (See: The Invisible Illness: Why Can't My Doctor See My Pain? ) Your brain is both genetically one of the most individual things about you at birth, and it even grows, adapts and changes based on your life experiences. If you are a fine art lover more than an anatomy guru, you're in luck. An artist created a sculpture that proportionally displays the brain area, known as the homunculus, on a person. If we looked like the amount of space our brain gives to the different parts of our body, this is who we'd be: Image Credits: Sensory Homunculus - Etsy , and How your Brain sees your Body - Learn Somatics Like you'd expect, our brains give lots of space to our hands and our mouths. Think about the way that little kids learn and build a sensory map of their world. Anyone who has been around babies and toddlers knows they are generally curious to touch everything with their hands, and if possible, put it in their mouths. The feet are larger too, which makes sense given that they are also a primary way that we balance and serve as a touch point to gain information about the world underneath our feet. It's also no surprise that our brains allocate a significant amount of space to our genitals and pelvis. They are both important from a reproductive perspective, and a major sensory contact point for understanding the need to empty our bowel and bladder, not to mention sexual pleasure and function. Foot Fetishes On the note of sexual function, the cliche fetish that is most often talked about in jokes and media is a foot fetish. Have you ever wondered why it is feet and not some other body part? Why don't you often hear about an elbow fetish? In terms of what parts of the body are pleasant and desirable, you may not think feet would top the list. Feet are often sweaty and get dirty easily when you aren't wearing shoes. The irony of the fact that many people would consider feet to be gross makes it an easy source of humor in books and movies, that some people consider feet a point of sexual attraction. While cultural sensitivity would dictate that we should be cautious in making judgements and assessments about another person's sexual preferences, on some level, they are neurologically influenced. If you glance back at the map of the homunculus in the brain, you'll notice that tucked in the middle of the image, the genitals and the foot are right next to one another in the sensory cortex. If the lines between the two regions become blurred, and the two areas develop neural connections, it can become harder for the brain to differentiate sensations between the feet and the pelvis/genitals. This process of interconnection in the brain is formally called cortical smudging. While several people have proposed this theory, that sexual attraction and arousal associated with feet originates in the brain ( 1 ), as of yet, studying this exact connection hasn't been formally studied with brain imaging. Practically speaking, there are many medical questions vying for limited research funding grants. This particular one hasn't yet been a top priority to receive funding. The Potty Dance Have you ever noticed that the "potty dance" is fairly similar between children? Even if a child has no older siblings and hasn't seen anyone else do a potty dance? Most kids will squeeze their legs together, hold their hands over their lower abdomens, and develop antsy feet when they need to go. They tend to rise up on their tiptoes and bounce up and down. In truth, even for most adults, if you rise up onto your tiptoes, chances are, you are probably contracting your pelvic floor muscles at the same time. The tightening of the pelvic floor muscles function like a gate and help to close off the openings that allow emptying of the bowel and bladder. (See: The Gate Keeper ). These same muscles also help us to stabilize our pelvis as we try to balance while up on tiptoe. Performing heel raises is actually one of the recommended strategies for controlling urinary urgency in adults ( 2 ). The concept that movement is medicine can be powerful. There are many lifestyle and exercise strategies to control bladder problems that don't involve medication. (See: Bladder Boot Camp-Introduction ) Tibial Nerve Stimulation for Pelvic Problems Pelvic floor therapists treat patients with pelvic pain, as well as bowel, bladder, and sexual function problems. While some of their treatment strategies involve pelvic floor exercises, others focus on treatment in less intimate areas. New evidence suggests that electrical stimulation of the tibial nerve in the ankle, is actually a viable treatment option for overactive bladder symptoms in children and adults ( 3 ). The tibial nerve originates from the sacral nerve roots in the pelvis. It's believed that the shared neural connections between the tibial nerve, and the nerves that control the bladder are responsible for these benefits. Pelvic pain can have a huge impact on a person's quality of life. We tend to experience an elevated threat level with pain in areas that pertain to our vital functions, like the heart, lungs, head/brain, and reproductive tissues. There are many causes of pelvic pain, and many of these conditions are difficult to treat with traditional methods, such as medications, injections, and surgical procedures. Tibial nerve stimulation is an alternative treatment method that is less invasive than surgery and doesn't involve medication. In patients with interstitial cystitis (sometimes called "painful bladder syndrome"), instead of placing a nerve stimulator directly on the bladder in the pelvis, doctors have actually found it to be effective to temporarily apply nerve stimulation to the tibial nerve in the ankle ( 4 ). Nerve stimulation is designed to provide low grade electrical impulses like the ones your nerves normally use to communicate. These impulses help stimulate and distract the nervous system from other unpleasant sensations. Closing Thoughts More research on the connections between the feet and the pelvis is needed. Some pelvic floor therapists have suggested that tibial nerve stimulation may benefit patients with pudendal neuralgia. Pelvic floor therapists have anecdotally reported noticing a correlation between patients who 1.) have tense, sore, and tight feet, and 2.) have elevated pelvic floor muscle tone and pelvic pain. There are stories of patients who have an amputation of their foot and find themselves experiencing phantom pelvic sensations. Many of the pelvic floor therapists who observe these things, however, are busy trying to meet the demand for clinical patient care. There are relatively few pelvic floor therapists for the number of patients who would benefit from pelvic floor physical therapy. As a result, the therapists have difficulty allocating time to perform research and write case reports to publish the stories they hear from their patients. If you are experiencing foot or pelvic problems personally, please keep in mind that the above content is intended for educational purposes and is not a replacement for individual medical advice. If you are interested in receiving advice for your unique case, you can schedule an evaluation appointment by clicking Book Online . References: (1) There is scientific proof that foot fetishes are normal - Big Think (2) Tips for Improving Urge Urinary Incontinence - APTA Pelvic Health (3) Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome - PMC (4) First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome - PMC

For many women, pelvic sensory awareness is especially challenging. When beginning pelvic floor therapy, it is common for their nerves to misinterpret muscular trigger points as a bladder urge, or constipation/bowel fullness. They may even have difficulty identifying where pressure was applied to their muscles. It can often feel as though their nerves whispering so they can't understand what they are saying. Sometimes if even feels as though their nerves are flat out lying to them. While this can be frustrating, it doesn't necessarily mean that their body is broken. The nervous system is amazing in its ability to identify diverse sensations of temperature, light vs. firm pressure, vibration, sharp vs. dull touch, and pain. Our sensory awareness, however, requires fine tuning. Children are continually seeking to experience different textures, see different colors, and explore new things. This is crucial to developing their nervous system. When it comes to female pelvic health, there are often some sensory speed bumps that women encounter which can slow the development of their sensory awareness. Let's take a look at the development of pelvic sensation and coordination in women. Pelvic Sensory Awareness in Females: 1.) Potty Training: Bowel/Bladder Urge Awareness 2.) Toilet Hygiene Related Touch 3.) Menstruation 4.) Gynecologist Examination 5.) Sexual Touch Introduction 6.) Atypical Sensory Introduction Potty Training: Bowel/Bladder Urge Awareness When it comes to the pelvis, developing sensory awareness is complicated. In our early development, our bodies have very little awareness of our pelvis. We face our first pelvic awareness challenge as toddlers when we start potty training. The first step in being able to potty train is for the child to understand and identify the sensation of a full bowel or bladder. As children start showing signs of an awareness that they need to empty their bowels or bladder, such as running away and hiding behind the couch to poop, we know they are starting to feel what is happening in their pelvis. This initial phase is fairly similar for children whose sex assigned at birth is male and female. After children develop that awareness, the process has some significant differences. Toilet Hygiene Related Touch Due to the anatomical nature of male and female bodies, male children are taught to hold their penis and direct it into the toilet to urinate. This introduces a sensory awareness experience that is very different than that of female children. While male children are directed to touch their genitals, female children are not. This is a practical difference in the way we raise children, and doesn't have any sociocultural motivations around sexual function. While this is intended as a practical lesson in cleanliness, it establishes early a different foundational relationship with touch. Males are exposed to neutral touch of the genitals. It is normative for them to touch this part of their body on a daily basis. Females on the other hand, are taught to avoid genital touch. Female children experience external genital touch only through wiping with toilet paper, and not direct contact with their hands. A child's hands and their mouths are their primary sensory tools for interacting with the world. Children generally are curious to touch new things that they see as they explore the world. Our hands are an important tool for our bodies to build an understanding of the world around us. It is common that parents discourage both male and female children from external genital touch in public. Males are taught not to adjust their testes in front of other people (though many continue to do so discreetly even in public settings). Females are taught that scratching their vulvar region (commonly referred to as "the crotch"), is also not appropriate in public. Due to some basic differences in toilet training, genital touch for females typically does not occur as frequently. Internal genital touch especially, may not occur for a longer period of time. Generally speaking, children are taught not to stick their fingers into the holes in their bodies. Parents discourage kids from picking their noses, and sticking their fingers in their mouths, etc. Although some female children do engage in self-exploration of their vagina, many do not. Those that do engage in self-exploration are frequently discouraged from doing so by their parents and caregivers. Menstruation For many females, their initial experience with internal vaginal touch occurs at puberty. As females begin menstruation, inserting a tampon is often the initial introduction of internal vaginal sensory stimulus. Consider for a moment that this is happening at a time that most females are experiencing pain. Pelvic cramping associated with menstrual cycles serves to distract the nervous system from sensory processing due to pain and discomfort. The bloating that can occur with menstruation also applies some pressure to the nerves. This added pressure/constriction can also impact the ability of the nerve to send messages for sensory processing efficiently. Social factors further complicate the situation. As their bodies are growing and changing, puberty can be an awkward time for kids developmentally regardless of their biological sex. This isn't an optimal environment for the body to fine tune its sensory processing awareness. Gynecologist Examination Medical sensory introduction of internal vaginal touch is often just as complicated. The first trip to the gynecologist is often an anxiety producing experience (coming soon: Tips for Your Daughter's First Gynecology Visit). If a female is not having menstrual problems, this may not occur until the age of 18, especially if she is not sexually active. If she is seeing a gynecologist sooner, it is often because of menstrual problems, or for pregnancy prevention. In the event of menstrual problems, that female's introduction to medical related touch of her vagina is precipitated by the idea that there is a problem. This can further negatively impact her sensory processing development. If her first trip to the gynecologist is for pregnancy prevention due to sexual activity, there are many sociocultural factors at play which complicate the experience. Processing the emotional, social, and physical implications of sexual activity is complex. As a female tries to process all of these things at once, it isn't an ideal environment for sensory learning. Most people learn better when they are able to focus on a specific task. Asking a female to learn to develop good pelvic sensory awareness in this context would be similar to asking her to learn math, while sitting in a classroom with a math teacher, a science teacher, and a music teacher, all trying to give her instructions at the same time. None of us would be surprised if she left the classroom without a very good understanding of any of the three subjects. Sexual Touch Introduction It is difficult to discuss to full complexity of this topic at length here. Introduction of sexual touch for females can occur either by self-touch, or touch by another person. There are many implications for both contexts. A person's thoughts and feelings about sex are not developed in a vacuum. Females are exposed to a variety of ideas based on their family's belief system, and their culture. Most females are exposed to opposing views. They are told by some that sexual desire and activity is normal, natural, and should be completely without restrictions. They are told by others that there are very specific contexts in which sex is appropriate and inappropriate. For most females, these conflicting views create a certain amount of dissonance. It often feels impossible to be at peace with their decisions about their sexuality because they cannot please all of the different voices that have told them what to believe. They are frequently left with questions about what they personally believe is right and wrong. In the crowd of other voices, they often struggle to hear their own and determine what they believe. This conflict typically makes initial experiences with sexual touch confusing and overwhelming. If their brains are busy processing their emotional and cognitive thoughts about sexual touch, it doesn't leave much space for their brains to process the touch itself. Atypical Sensory Introduction In the unfortunate situation of childhood yeast infections, urinary tract infections, constipation problems, and/or sexual abuse, females develop sensory awareness in the pelvis that is negative and complicated. Pain and itching associated with infections can establish negative sensory awareness in the pelvis at an early age. In the absence of any experiences with neutral sensory stimulus, the brain may begin to expect that sensation in the pelvic area is a bad thing. In the event of constipation, children can have pain with pooping, which can also establish a negative internal sensory awareness in the pelvis. This can become a complicated and chronic issue that is self-perpetuating. Children who have pain with pooping often want to avoid pooping. This in turn leads to constipation, which produces further painful experiences with pooping. Children who develop what is formally called "stool hording" tendencies may require medical treatment by their physician or a pediatric pelvic floor therapist to help break the cycle. For children who experience sexual abuse, developmentally inappropriate introduction of these types of sensations are often confusing and overwhelming. Recovery from this type of trauma typically requires intervention by a trained mental health professional to retrain the brain how to process those experiences in a healthy way. Closing Thoughts: When you stop to consider how sensory awareness in the pelvis develops, it is not surprising that many females don't develop good sensory awareness in their pelvis. This can happen even for people who have healthy and normative developmental experiences. Fortunately, if you have trouble with your bowel or bladder, if you have problems with pelvic pain or with sexual function, the nervous system can be trained. Cultivating pelvic sensory awareness in women can still be achieved in adulthood. Working with a pelvic floor therapist can help address these issues. This article is intended for educational purposes to help you start a conversation with your doctor. It is not a replacement for individual medical advice. If you are interested in scheduling an evaluation with a pelvic floor therapist to discuss your unique case, click book here .

Ankle sprains are a common injury. They're so common that many people, especially kids, don't even seek treatment from a medical provider. Most people sprain their ankle and recover within a few weeks or months. They go on with life, and a few of them are lucky enough to never do it again. Unfortunately, this isn't the norm. Studies show that up to 75% of people who sprain an ankle will sprain that ankle again. ( 1 ) This is especially true if they don't do a proprioceptive rehabilitation program, like one prescribed by a physical therapist. People who already have "laxity" or loose ligaments in their ankle may be at an increased risk for ankle sprains in the future. This can occur due to a prior ankle sprain, or a genetic condition like Ehlers-Danlos Syndrome. To understand why, let's look at how an ankle sprain happens. The vast majority of ankle sprains are "lateral ankle sprains" where the ligaments that are injured are on the outside of the ankle. A person "rolls their ankle" into what a physical therapist would call "inversion". This puts a significant stretch on the ligaments that help hold the ankle stable. When the stretch becomes too great, the ligament may develop small tears, or in extreme cases, the ligament can rupture and tear completely. That is why it is usually best to go and see a physical therapist or a sports medicine doctor after an ankle sprain to determine how severe the injury is. (Coming soon, Ankle Sprains: When To See A Doctor) Ligaments function a lot like rubber bands. If you stretch them too far, they don't quite go back the same way. Fortunately, the human body has the ability to heal, unlike a rubber band. So why do so many people sprain their ankle again? The answer lies in our nervous system. There are nerves called proprioceptors that sense the position of our bodies in space. If you were to sit with your eyes closed and raised your hand in the air, you would be able to feel where it is in space without looking at it. That is because your proprioceptive nerves tell the brain that your arm is now up in the air rather than down by your side. Most of your proprioceptive nerves live inside your ligaments. When the ligament becomes stretched out, the nerves don't sense tension as quickly as they did before. This can delay your reaction time. When your ankle begins to shift into an unstable position in the future, you may not realize it until it is too late for your muscles to help you correct course. This can increase the risk of you to spraining your ankle again and again. As a result, the ligament doesn't ever get a chance to fully heal and return to its normal length. That is a problem for our brains. The second reason our nervous system is to blame for the tendency to sprain an ankle repeatedly is that the brain relies on expectation. Our brains develop certain plans for how we move. When a child first learns to walk, they often wobble and have to catch their balance. As they walk more and more, they get more stable and coordinated over time. The brain develops a certain plan for walking. It knows how much force each muscle needs to produce and at what time in order to create a smooth movement. When we sprain an ankle, the plans for how to move our ankles that our brains have developed for years all of a sudden don't work anymore. The old plans relied on the ligament to provide a certain amount of stability in the joint. Once the ligament is stretched out, it doesn't hold the same amount of tension to support the joint that it did before. Fortunately, the body has a back-up stability system. When the ligament changes, the muscles have to learn to adapt to work differently to stabilize the joint. If you had adequate strength in your muscles before, they don't necessarily have to get stronger in order to do the job of supporting your joint. They just have to learn how to coordinate their movement and strength in a new way. Developing new plans takes time and intentional repeated movement for the brain to build new habits. This is where physical therapists come in. They design targeted exercise plans to help you relearn how to use your ankle again. They look for coordination problems and prescribe exercise programs to address them. For example, a physical therapist might ask you to go up on your tip toes during your evaluation. After an ankle sprain, frequently, the ankle you sprained will bow out to the side or "invert" without you even realizing it. This is a position that can put you at risk to sprain your ankle again. To correct this, the therapist might give you exercises to practice that encourage your muscles to hold your ankle in neutral, such as squeezing a tennis ball between your ankles while you rise up on your tip toes. For a person who is otherwise healthy before spraining their ankle, the recovery process is fairly quick. With the right physical therapy for a few weeks, your muscles support the joint well and your ligaments can heal. Repeated ankle sprains don't have to be a part of your life. Ehlers-Danlos and Hypermobility For people with a Hypermobility Spectrum Disorder (HSD), the most commonly known of which is Ehlers-Danlos (EDS), recovery can be a bit more complicated. The baseline level of flexibility of the ankle ligaments isn't the only factor. People with hypermobility disorders may also have loose ligaments in the joints in the foot, as well as the knee. Your physical therapist should look at the mobility in your feet and your knees. They may give you exercises for those muscles and joints in addition to your ankle. Temporarily, they may also encourage different footwear or braces. Bracing is not the best option for everyone, and the type of brace is important. (See: To Brace or Not to Brace ). It's best to work with your therapist in finding a brace rather than simply buying one at the local drug store. It may even be necessary to evaluate your hips and pelvis. Many people with hypermobility struggle with hip and pelvic pain. Unfortunately, due to the more intimate location of those symptoms, they are often never discussed with a doctor. When it comes to the nervous system, however, they are intimately related. In fact, the part of the brain that processes information for the foot and ankle is right next to the part that processes information for the pelvis. If you are experiencing persistent foot and ankle pain, despite doing all the orthopedic rehab your PT has recommended, it may be time to see a pelvic PT; especially if you also have problems with urinary incontinence, bowel problems, or pain with penetration like using tampons or during intercourse or gynecology examinations. People with EDS that impacts the vascular system can also have problems with blood flow. Even for hypermobility patients who don't have vascular EDS, they also commonly have problems with Raynaud's phenomenon, or dysautonomia related conditions like POTS, which can impact their circulation and delay healing. In general, our bodies heal themselves naturally by sending nutrient rich blood to supply the tissues in repairing themselves. Most people who sprain their ankle notice swelling on the outside of their ankle that makes it stiff and sore. The ankle is far from the heart, and typically is lower than the heart for most of our day. As a result, getting good blood flow to our feet and ankles is challenging, and it may take longer for the swelling to go down in your ankle than it would if you had swelling in your shoulder. For people with hypermobility who also have circulatory issues, the body may need some extra help to get good blood flow to the ankle to help it heal. Elevating the ankle when you're sitting, using compression socks, and ice packs may be needed to manage the swelling. If this still isn't enough, a physical therapist certified in dry needling may need to help facilitate blood flow using dry needling to direct the circulatory system. For people with hypermobility disorders, delayed healing is common. The ligaments may not tighten back up easily, even if the muscles do hold the ankle in a good position and circulation is well managed. Balance and coordination training exercises may need to be a regular part of life for people with hypermobility. The healthcare system and insurance companies have traditionally seen physical therapy as a reactive treatment in response to an injury. People with hypermobility may need a different approach to consider physical therapy as a preventative part of their regular treatment plan. It is generally recommended to get an annual physical with your primary care doctor, and regular cleanings/exams at the dentist. For people with hypermobility, a preventative care screening appointment with a physical therapist may help prevent injuries before they happen. The best defense against long and inconvenient healing times is to prevent the injury in the first place. This is especially true for kids and adults who want to participate in sports. Disclaimers: This article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider. If you are interested in personalized recommendations for your unique situation, click to book online and schedule an evaluation appointment with a physical therapist. References: (1) Ankle Sprain: Pathophysiology, Predisposing Factors, and Management Strategies by Tricia J Hubbard, and Erik A Wikstrom

Getting a diagnosis of Hypermobile Ehlers-Danlos Syndrome can be challenging. There are many types of Ehlers-Danlos. Geneticists have been able to isolate genes for some types of EDS, but a gene has not been identified yet for hypermobile EDS. The Ehlers-Danlos Society has a diagnostic checklist form available to clinicians to help standardize the diagnosis process. It is not something, however, that is part of standard entry level education for most healthcare providers. To make matters more complicated, some of the criteria fall under different medical specialties, so individual providers can't always make a diagnosis without consulting other specialists. As a result, patients may have to invest significant time and travel into finding a healthcare provider who can make the diagnosis. In light of this added stress, in addition to the financial expense of healthcare, it's wise to at least look at the checklist yourself prior to going to the doctor. In this article we'll take a look at the diagnostic checklist step by step. Keep in mind that this article is not intended to replace individual medical advice from a licensed healthcare provider. It is simply intended to provide education to patients who are trying to decide if they should seek out a diagnosis. Contents: Criterion 1: The Beighton Scale Criterion 2: Other Signs, Family History, and Pain Category A: Other Signs Category B: Family History Category C: Pain And Dislocations Criterion 3: Exclusions Criterion 1: The Beighton Scale Image Credit: Ehlers-Danlos Society Diagnostic Checklist The Beighton Scale is a series of movements used to assess for joint hypermobility in multiple joints. There are a total of 9 points possible, and the number of points required to diagnose EDS depends on the patient's age. This is intended to account for the fact that our joints and connective tissues will typically stiffen naturally as we age. The first movement test is for finger mobility. The patient is instructed to pull their pinky back into extension as shown in the image. Normal extension range of motion for this joint is typically quoted at 30-45 degrees. People with hypermobility can achieve a larger range of motion because their ligaments don't place as much restriction on the joint movement. You can receive one point for the mobility of the pinky on each hand. The second movement involves bringing the thumb to the wrist. If the thumb can touch the wrist, a point is granted. Again, the patient can receive one point for each hand. The third test is for elbow mobility. When straightening out the elbows, normal range of motion is quoted at about 0-5 degrees. For people with hypermobility disorders, the elbow hyperextends, as shown below. A person can receive one point for each elbow. The fourth movement is extending the knees. Normal knee range of motion is considered 0 degrees of extension at the knee, though some sources consider up to 5 degrees to still be considered normal. To qualify for knee hyperextension, the measurement should be greater than 5 degrees. One point can be received for each knee. The final test is to stand with the knees straight, while bending down and placing your hands flat on the floor. This is worth one point and suggests hypermobility of the spinal ligaments. As an aside, some patients have comorbid conditions that can skew these test results. For example, the position of forward bending used to test for spinal ligament mobility, also puts an increased tension on the sciatic nerve. Some patients are limited by pain in the back of the legs, rather than a lack of mobility when performing this test. Others have a mobility restriction from a history of an injury. Perhaps a past injury such as a broken finger that did not heal well could be limiting their mobility. Unfortunately, many patients go years without a diagnosis. Other injuries happen throughout their lifetime that can skew the testing, and most people's joints will naturally stiffen to some degree with aging. As a result, in creating the diagnostic criteria, additional questions were added so that older patients can still be included if they would have met the criteria when they were younger. Criterion 2: Other Signs, Family History, and Pain Image Credit: Ehlers Danlos Society Diagnostic Checklist This criteria is broken into 3 categories, A, B, and C. A person must meet two of the three categories in this section to qualify for an Ehlers-Danlos diagnosis. We will spend most of our time talking about category A, because it is the most complex. However, considering B and C first may be helpful, because category A requires more medical testing. Category A will most likely involve working with multiple medical providers to order and evaluate the appropriate tests. If a person does not meet the criteria for B or C, pursuing diagnostic testing from category A may not be indicated. Category B: Family History Category B is the most straight forward, asking if a first degree relative has been diagnosed with EDS. This means having a parent, sibling, or child who have already been diagnosed. For many patients however, they are the first in their family seeking a diagnosis. They may be aware of a parent who was hypermobile, but that person was never formally diagnosed. Most patients receiving diagnosis meet the qualifications based on parts A and C. Category C: Pain And Dislocations Category C is also fairly straight forward, in that, it can typically be rated by self-report. A person only has to be able to claim one of the three statements is true to meet this criterion. Health care providers will ask their patients where they experience pain, and how long it has been going on. Many patients seeking diagnosis can truthfully check one of the first two boxes. The healthcare provider will also ask about a history of joint dislocations. To qualify for this point, it's important to recognize your doctor is looking for a pattern, and not an isolated incident. A child who dislocated an elbow one time, falling off of a bunk bed from considerable height, wouldn't qualify. The criteria specifically states that the dislocations have to occur in the absence of trauma, and they have to be recurrent. Some providers will take more liberty in interpreting this question than others. It is a judgement call to decide if the trauma that occurred would reasonably have caused a dislocation or not. A child who fell out of a standard height bed and dislocated their elbow may be seen differently than a child who fell off the top bunk. This criterion also notably gives some room for interpretation as to what qualifies as "frank joint instability". There are some people with hypermobility that experience what are called subluxations. Rather than completely dislocating the joint, in a subluxation, the joint pops out of place and then slips right back into place on its own. Some providers will consider that sufficient for this criterion to be met while others will not. Category A: Other Signs This category requires a person to meet five of the twelve options. This the category that may require your seeing multiple specialists to meet the criteria. If you are frustrated by being unable to find a single provider who can make a diagnosis, it may be best to take the checklist to multiple providers and ask them to sign it, attesting to the parts they feel they can competently test. Your physical therapist can complete the portion of the checklist with the Beighton Scale, for example, and then your cardiologist or dermatologist may need to confirm that the signs are present in your heart or skin. Then you can take the checklist back to your primary care doctor and they may be willing to formally give you the diagnosis. Let's take a look at the twelve options: "Unusually soft of velvety skin" - this is somewhat subjective. To accurately assess this, a provider would have to have spent a fair amount of time touching the skin of multiple patients to gain an idea of what "normal" softness is. The best providers to assess this are typically going to be dermatologists, physical therapists, and primary care doctors. "Mild skin hyperextensibility" - again, there is some room for interpretation as to what you define as "Mild". A healthcare provider will typically pinch the skin on the back of the hand and lift it up to see how much elasticity is present. Again, this will be best assessed by a provider who is familiar with skin and how it moves. "Unexplained striae distensae or rubae at the back, groins, thighs, breasts, and/or abdomen in adolescents, men, or pre-pubertal women without a history of significant gain or loss of body fat or weight" - this one gets tricky. Stretch marks commonly occur in women after pregnancies, so providers have to ask if female patients had the stretch marks before having children. Furthermore, statistically 70% of Americans are overweight or obese ( 1 ), which makes giving a patient a point for this option impossible for a large percentage of people. "Bilateral piezogenic papules of the heels" - these are small bumps, that are fat deposits which can be seen on the heels. Images of them can be found with a quick internet search. "Recurrent or multiple abdominal hernias" - this also leaves some room for interpretation. Many individuals have small abdominal hernias that don't cause any pain or loss of function which are never diagnosed. It is also common that they are found on imaging reports while looking for other problems in otherwise healthy individuals who do not have EDS. It is also worth noting, that in many women, after pregnancy, the abdominal wall is weakened from being stretched to accommodate the growing baby. This can lead to conditions like diastasis recti which is different from an abdominal hernia. To meet the qualification for this option, the hernias have to be either recurrent at the same location, or a patient has to have more than one abdominal hernia site. "Atrophic scarring involving at least two sites and without the formation of truly papyraceous and/or hemosideric scars as seen in classical EDS" - While you can compare your scars to an image search for papyraceous scars, which means "thin as paper", and hemosideric scars, which have a specific type of coloration change; this is best evaluated by a healthcare provider. Ideally you want to consult a dermatologist (though some primary care providers may feel comfortable evaluating this). This option can be difficult to assess for some patients, however, if they don't have enough scars. This is especially true of children who may not have had two injuries or surgeries that would produce a scar. "Pelvic floor, rectal, and/or uterine prolapse in children, men or nulliparous women without a history of morbid obesity or other known predisposing medical condition" - Prolapse is a medical term for a weakening in the supporting connective tissue to the extent that an organ displaces/falls because it is not well supported. Nulliparous is a medical term for a woman who has not had children. Prolapse is typically assessed by a gynecologist, or a pelvic floor specializing physical therapist. While it is understandable that prolapse is more common in women who have had children in general, this can be frustrating because it is yet another option that cannot be evaluated in many adult women. "Dental crowding and high or narrow palate" - this is ideally assessed by a dentist, orthodontist, or in some cases a TMJ specializing physical therapist who is accustomed to evaluating the inside of a patient's mouth. "Arachnodactyly, as defined in one or more of the following: (i) positive wrist sign (Walker sign) on both sides, (ii) positive thumb sign (Steinberg sign) on both sides" "Arm span-to-height ratio ≥1.05" - this is calculated by first measuring a patients' arm span from the longest fingertip on one side to the longest fingertip on the other side while the arms are maximally outstretched to the sides, also called the wingspan. This number is then divided by the patient's height. Measurements are taken either in inches or in centimeters. "Mitral valve prolapse (MVP) mild or greater based on strict echocardiographic criteria" - this is typically evaluated by a cardiologist, though some primary care physicians may be willing to order the echocardiogram as well. "Aortic root dilatation with Z-score >+2" - the aorta is a major blood vessel of the heart. This is also evaluated by a cardiologist, and involves imaging studies such as an echocardiogram, CT scan or MRI. Assuming that a person meets both Criterion 1, and two of the three categories in Criterion 2, there are still a few more factors to consider. Criterion 3: Exclusions Image Credit: Ehlers-Danlos Society Diagnostic Checklist This criterion is designed to make sure that other diseases and other types of EDS are not being missed. There are several types of EDS that can be tested for genetically. (See: Is Genetic Testing Right For Me? ) There are many conditions that can explain the presence of chronic pain. For this reason, if a person has already been diagnosed with another connective tissue disorder, or autoimmune rheumatologic disorder, the presence of chronic pain alone is not necessarily indicative of hypermobile EDS. In this case, a person is required to meet the qualifications of category A and B. Some patients read the second point of Criterion 3 and ask if fibromyalgia is considered an autoimmune rheumatologic condition. While there is room for debate on this subject, there are many providers who feel that patients have been misdiagnosed with fibromyalgia instead of hEDS. Lupus and rheumatoid arthritis can be diagnosed by blood tests for specific immune markers. Fibromyalgia on the other hand, is considered to be a diagnosis by exclusion. There are no objective tests for fibromyalgia, rather, doctors make a diagnosis if a patient presents with certain symptoms, and they cannot find another justifiable cause. The majority of providers therefore consider it possible that a person diagnosed with fibromyalgia may have had hEDS all along, and do not consider fibromyalgia as an autoimmune rheumatologic condition that should be counted as an exclusion when evaluating the second point of Criterion 3. There are many disorders and diseases to be considered, and we won't cover all of them here. This article is intended for educational purposes and is not a replacement for individual medical advice from a licensed healthcare provider. If you would like to be evaluated to screen for EDS and need an ally to be part of your healthcare team, click to Book Online today and schedule an appointment with an EDS specializing physical therapist. References: (1) FastStats - Overweight Prevalence ( cdc.gov ) (2) The Ehlers-Danlos Society, Diagnostic Checklist: https://www.ehlers-danlos.com/heds-diagnostic-checklist/

As a person with a hypermobility disorder, a physical therapist, and a gymnast, I'll admit that I approach this question with a degree of bias. I have a unique perspective because of my personal history. I was once working as a float therapist covering for other PTs and was intrigued to see a precaution listed in the patient's chart: "Ehler's Danlos - NO STRETCHING". While every case is different and each patient has unique needs, I found it a bit ironic that I would be treating someone with Ehler's Danlos Syndrome (EDS) who was being forbidden to stretch. In fact, I felt that if I followed the evaluating therapist's treatment plan, I would be a bit of a hypocrite. When a person has a connective tissue disorder like EDS or Hypermobility Spectrum Disorder (HSD), some of their tissues are too flexible. This could mean the tissues in their ligaments, their blood vessels, or any other connective tissue structure. Our bodies are reliant on these connective tissues for many functions. In the PT world however, we are primarily concerned with the way the hypermobility affects the ligaments, fascia, and muscle tendons. Many patients with hypermobility complain that they feel like they need to "stretch" to relieve tension. Before we can answer the question "Is it still safe to stretch when your connective tissues already have extra mobility?" We may first have to tease out what it means to "stretch". In technical terms, when a physical therapist talks about stretching, they are usually referring to placing a muscle in an elongated position to try and improve the overall length of the muscle. To a physical therapist, that is not a good thing for a person with EDS and hypermobility, they already have too much flexibility in their ligaments which can predispose them to injuries. When a hypermobility/EDS patient says they feel they need to stretch, they often are not thinking about a goal of making themselves more flexible. They are typically attempting to alleviate discomfort in a muscle. Unfortunately, the communication differences here can create disagreements between patients who want to stretch, and therapists who can't understand why they are doing something that the therapist believes is bad for them. There is a delicate balance in the human body between mobility and stability. The more mobility a person has, the more challenging it is to maintain good control and stability of their movements. Conversely, a person who has a high degree of stability, may find their mobility limited to the point they don't have the range of motion in their joints to perform daily activities like bending over to tie their shoes. Gymnasts are a perfect example of athletes who have to master the ability to achieve a high degree of flexibility, while also maintaining the stability to control their joints to perform various acrobatic skills. The point of the argument being, that the goal of being both mobile and stable can be achieved with the right balance of exercise training. People with Ehlers Danlos often struggle with feelings of tightness, tension and soreness in their muscles. This is common because their muscles are often working extra hard to help hold their joints stable to make up for the fact that their ligaments are not doing it naturally. Ligaments are supposed to work similar to rubber bands. If you place tension on them, they will naturally resist to try and pull you back into a neutral position. In people with hypermobility disorders, their ligaments don't kick in to stabilize their joints as soon, so their muscles have to do extra work. This can leave them feeling sore, tired and tense because their muscles are overworked. This is especially true if you have not worked with a skilled physical therapist who can teach you how to distribute the work load amongst different muscles to help minimize the strain on any one muscle individually. When a healthy person is sore after a workout, they tend to stretch to help themselves feel better. This can help promote improved blood flow to their tissues that aids the body in getting oxygen and nutrients to the tissues to help them repair, while moving waste products like lactic acid out. For that reason, stretching is a good thing and can help EDS patients feel better when done right. People with EDS need good blood flow to keep their tissues healthy just like everyone else. The purpose of stretching for a person with EDS is usually not to improve mobility. Overly aggressive stretching to increase mobility can be counter productive. If seeking to increase mobility, we should always work to ensure that the patient has the muscular stability and control to use that new range of motion safely. This is true of all people regardless of it they have EDS. If you have EDS and feel like you need to stretch, but it never seems to be enough, physical therapy may be able to help. While most physical therapists will evaluate a patient's strength and flexibility, there are other variables to consider when treating patients with EDS. Your therapist should take a look at you holistically to ensure that your circulation is allowing for your body to process waste products and provide adequate nutrients to your tissues. Sometimes your vascular tissues have been affected by your connective tissue disorder. They may also want to evaluate your nervous system to see if your nerves are sending messages to your muscles to hold them at too high of tension levels. There are many treatment options and variables that can be manipulated by a skilled therapist to allow a patient to stretch safely (i.e. changing the length of time, position, or intensity of the stretch), or better yet, to alleviate the discomfort that makes them feel the need to stretch in the first place. Every person's body is a little different. Individualized medicine that is tailored to you and your body is important. While this article is intended to help educate providers and patients on stretching and EDS, it is not a replacement for personalized medical advice. If you'd liked to schedule an evaluation for personal recommendations, click the booking tab above.

Low back pain is one of the most common chronic pain complaints. It's also a leading cause of disability in the United States, and a common reason people call off of work. If you know someone who struggles with chronic low back pain either periodically, or constantly, here are 40+ intentional gift ideas to let them know you care. But first, a couple of gift giving tips to help you choose the right gift. Budget is obviously a factor for most people, but you may also want to consider who you are buying for and how they feel most loved. Gary Chapman proposed in his book " The Five Love Languages " that we don't all give and receive love in the same way. Some people love receiving tangible gifts, while others prefer acts of service (like helping with the dishes), or words of affirmation. Others highly value physical touch or simply spending quality time together. Knowing the person you are giving a gift to can help you choose the best option. Gifts don't have to cost a lot to make someone feel loved. They just have to match the way that person likes to be cared for and show that you were intentionally thinking of them. Physical Gift Categories: If sitting aggravates their back pain If they know their posture is a problem For the active person who wants to keep moving Pain management for people who like to self treat Daily task aids/adaptive equipment For the person who can't sleep For the readers A few odds and ends Service Gift Categories Pain management Active experiences Help with daily tasks Thinking Outside the Box Back pain and tummy trouble Back pain and pelvic health Back pain and allergies Physical Gifts If sitting is a problem and aggravates their back pain: 1.) Heated seats: Did you know you can buy heated seat covers for cars, and even stadium seats ? This can help make it easier for people with low back pain to participate in life. You may not realize it, but they sometimes miss their child's football game because the back pain is just too much. They might be avoiding driving to take a vacation because by the time they get there, they'll be in so much pain that it wasn't worth it. 2.) Lumbar roll : It's amazing how much posture matters. Keeping the spine in good alignment can make all the difference. Some people with low back pain have weaker core muscles that have a hard time stabilizing their spine in good posture. This can happen for a variety of reasons, from abdominal surgeries that make incisions through the muscles, to pregnancies, which stretch them out, or plain old lack of exercise. Physical therapists often recommend lumbar rolls in the early phases of physical therapy to help make patients more comfortable while they work on their core strength. 3.) Exercise ball chair : Do they have back pain because of bad posture? Sometimes sitting on a ball can help. It's more cost effective than buying a fancy office chair, and it encourages active sitting to help strengthen the core muscles to better support your spine. If you are on the petite side, you may choose to forgo the fancy chair base and just opt for a ball with a ring on the floor. If they know their posture is a problem: 4.) Kinesio tape : This can help improve blood flow and encourage good posture. Keep in mind who you are buying for; some versions are specifically designed for people with sensitive skin and others are not. This can also take another person to apply the tape, and a little bit of skill to know how to do it. It may be worth consulting a physical therapist, or doing some research online about how to best use the tape. 5.) Upright GO posture trainer : This is more for the techy person on your list. Instead of a brace that your muscles become dependent on for support, this device will vibrate when the wearer starts to drift into poor posture to remind them to correct. It can be worn either with an adhesive pad, or attached to a necklace. 6.) Even Up shoe lift : If their back pain started because they have to use a walking boot, it may be making one of their legs longer than the other. Or if they are just uneven, you may want a heel lift that goes right in their shoe. For the active person that wants to keep moving: 7.) Infrared light is another option to help manage inflammation associated with chronic pain. This infrared light wrap is multifunctional; it provides infrared light, heat, and vibration functions. It also has a power bank option sold separately so they can wear it around while they're active throughout the day. 8.) TENS Unit : These are wearable devices that provide low grade electrical impulses to help distract the nerves from feeling the back pain. While you can buy them online, you should be aware that there are some precautions for using them. Make sure to read the instruction booklet that comes with your device. 9.) Recumbent bike : people who do regular aerobic exercise report improved back pain. A recumbent bike can keep the back supported while a person is exercising, making it more comfortable to do so. Ideally, the seatback will have some curvature for lumbar support. Don't want to buy one new? You can often find used exercise equipment online or at Goodwill, especially in January through March. People often put it up for sale after giving up on New Year's resolutions. 10.) Back braces and SI stabilizer belts . This may or may not be the right option. Check out To Brace or Not To Brace for more on when braces are a good idea. More options for the person who likes to self treat and wants a break from the pain: 11.) Back knobber : This is for the people who love deep tissue, trigger point massage. The back knobber lets you apply pressure to your own knots. 12.) Cupping set : If you don't mind looking a little colorful, (or you enjoy making up stories for your kids about how you were attacked by an octopus) some people love cupping. The idea is to improve blood flow to an area by applying vacuum pressure to the skin. There are many different kinds of cups, some are hard plastic, others silicone, some that are hand pumped and others that are machine/automatic pumped. Some newer models even have infrared light and heat therapy options. 13.) A percussor : These vibration guns are also called massage guns. Research shows that some frequencies of vibrations can help reduce pain signals, and can help reduce muscle tone/spasms. Ideally, the device will have a variable frequency control. They come with a variety of different attachment heads. 14.) Wall attachment for the percussor : Can't reach to apply the gun to your own back? Don't have a family member or friend to do it for you? No problem, try one of these mounts that can attach it to a wall. 15.) Anti-inflammatory cook books : They say you are what you eat. For people with chronic pain, food can absolutely be a form of medicine. Some people with back pain benefit from figuring out if they have food sensitivities that trigger increased inflammation. Ideas to help with daily tasks that are painful: 16.) Cleaning assisting devices: Think about their least favorite chores. Would they want a robot mop/vacuum, a self cleaning toilet bowl , a shower sprayer that sprays cleaner at the push of a button, or an electronic handheld scrubber? Maybe a self cleaning kitty litter box ? Or are they an outdoor lover who would want a garden scoot cart ? 17.) A reacher : Low back pain can make simple tasks like picking up the sock that fell on the floor seem daunting. Reachers can allow you to pick something light up without having to bend over. 18.) A bidet : If bending and twisting hurt, you can venture a guess that wiping after they do their business does too. While the idea of a bidet is strange to some, it can save you lots of money on toilet paper, and some models are even self-cleaning. Other features to look for are temperature-controlled water sprayers, and ease of installation. For the person who can't sleep: 18.) Wedge pillows for sleeping : Some people with back pain feel better with their back in a flexed position. If you're a back sleeper, this can be frustrating. A wedge pillow can either go under your knees to bend your hips comfortably, or under your back to prop your trunk up. 19.) Body pillows : This can help keep your hips in neutral alignment for side sleepers. 20.) Sleep hygiene tools : You wash you hands to have good hygiene and protect yourself from germs, but have you ever thought about good hygiene for your sleep? There are lots of things that can keep us from sleeping well. Consider setting up your sleep environment for success with a white noise machine , calming scent essential oil diffuser , or blackout curtains . For the readers: 21.) For the avid reader: " Everyone Has Back Pain " or " Fix your own back " 22.) Self care journals : When you're hurting all the time, even doing simple daily tasks can take a lot of effort. If the person on your list is someone who likes checking things off on a list, a self care tracking journal might do the trick. This is a gift that keeps on giving by encouraging them to be healthy on a day to day basis. If faith is important to them, or they have another special interest, try and find a combination journal . 23.) Symptom tracker journals : Is the back pain part of a bigger puzzle? Do they have back pain, but also have gastrointestinal issues like stomach or bowel problems? Is the back pain in part because of their job tasks? Do they know what makes it flare? If not, a symptom tracking journal might help them unravel the mystery and find patterns to help avoid back pain flares in the future. If they aren't a pen and paper kind of person, there are a variety of apps available you could gift them which track symptoms as well. 24.) Kindle Paperwhite : This allows them to get books online without having to go out. They can also get them from the library without going there in person. Most libraries work with an online lending app as long as you have a library card. A few odds and ends: 25.) Healthy snack baskets are always nice; some days you don't feel like bending over the stove to cook or stooping down to look in the cabinets if your back is hurting. 26.) Essential oils diffusers : There is growing evidence for aroma therapy in managing chronic pain. You can research which scents are best for their symptoms, or simply get them a variety starter pack. 27.) Encouraging jewelry: Some people like reminders to encourage them to keep going. 28.) Sassy shirts : Others prefer to deal with the unpleasant things in life with laughter and sarcasm. 29.) A letter of encouragement: In a world full of criticism and negativity, sometimes some heartfelt appreciation is more important than a physical gift. People whose ability to do things is limited by back pain sometimes need reminding that you value them for more than just the things they can physically do. Service Gifts Pain management: 30.) A Porcupine Party : Yes, we're biased! Many of our patients find that dry needling is helpful in managing their back pain. If they've never tried needling before (or already know they like it), we'd love to be a part of delivering your holiday gift. Book Here 31.) A massage: A vacation from your pain is important for your mental health. While one massage won't cure low back pain, a little bit of a break is a valuable thing. 32.) A float tank spa experience : For the person who is constantly busy and overrun, an hour of time to float and relax in a personal saltwater float tank may be just the thing to help them decompress. Active experiences: 33.) Aquatic exercise membership: Sometimes exercising in a warm therapy pool is more comfortable. Look into local aquatic arthritis classes, and water aerobics groups. As a pro-tip, the temperature of the water makes a difference. Most people with chronic pain tend to have preferences. Does the person you're shopping for prefer an ice pack or a heating pad? If they like the heat, look for a warmer therapy pool. 34.) Art therapy course/class: This can especially be valuable for people whose back pain is disabling. When you are unable to work and do daily tasks, it can create an identity crisis. In the United States, we live in a culture that defines you by what you do. If you can't work, being able to make something, can give you a sense of productivity and fulfillment that is invaluable. Who knows, you might start them on a new hobby that can be a side business for them down the road. 35.) Anti-inflammatory cooking classes Help with daily tasks: 36.) I've got your back card & housework help coupons: These are for the dad joke lovers! If you are able bodied and willing to help, (and perhaps don't have a big budget) this might be just the thing. 37.) Babysitting: Watching kids, especially young ones when your back is hurting, can be challenging. Little ones want to be picked up and held. They ask to be sat on the floor and played with. A few hours of childcare help is a precious thing for tired parents with sore backs. 38.) Housekeeping services: When you struggle with back pain, it can make doing the deep cleaning tasks hard. For some people with back pain, it drives them crazy that they can't get down and scrub their floors. Paying for a one-time professional cleaning service to do the deep cleaning may be a much-appreciated gift. Just make sure they know that you're giving it to them because you recognize the struggle and that it's hard for them to do it. You don't want to make them feel like you think they're a lazy slob. 39.) Offering to drive them places: Some people with back pain have a hard time being in the same position in a car to drive for long periods of time. 40.) Grocery delivery service subscription: If they will bring it in the house, it's even better. The grocery store involves lots of bending and lifting. If you can have the groceries brought to them, it can ease the burden of shopping. 41.) Noom subscription/meal plan subscription box: If they're interested in losing weight, apps like Noom combine psychology advice and nutritional guidance. Or if they're someone who just needs structure and to have fewer decisions in life, a meal plan subscription box may be the way to go. You can even consider shopping local. Some health food restaurants do meal prep services. Thinking Outside the Box Gifts Tummy issues are common with low back pain. If the person you know with back pain also has IBS, constipation problems, and food sensitivities, this gift guide (coming soon) may have more ideas for you. Pelvic health gifts: Another thing that is often not discussed is that low back pain is more strongly correlated with urinary incontinence than it is with obesity. The pelvis is the foundation for your back, after all. Think of it this way, you can't fix the Leaning Tower of Pisa by simply moving the top floor over. It's a foundation problem at its core. Due to the more personal nature of the subject, however, doctors are far more comfortable telling someone to lose weight than asking them about their urinary incontinence. If you have the kind of relationship with the person you know with low back pain to give them more personal gifts, check out our gift guide for pelvic health (coming soon) to help improve comfort during sex, and improve bowel/bladder health. Allergy management gifts: Did you know that there is actually a stronger correlation between low back pain and allergies than there is between low back pain and obesity? Because the way we breathe affects our core abdominal muscles, it can directly impact how our muscles hold and support our spines. If the person you know who struggles with low back pain has a nasally voice or lives on allergy medication, check out our allergy gift guide (coming soon). It may actually help their back. Hopefully this gives you some fresh ideas for the people on your shopping list. We encourage you to shop around and compare your options to get the best prices. As always, keep in mind that this post is for inspiration and educational purposes only. It is not a replacement for individual medical advice. Keep in mind that not all back pain is the same, and the recommendations above may not be right for every person with back pain. If you would like a personal evaluation to determine which strategies are best for your specific back pain, call our office or click Book Online to request an appointment.