Frailty is a syndrome in which a person becomes unable to deal with everyday stress placed on the body. Their muscles may lack strength and power. Their heart and lungs may lose the capacity to help them take part in daily activities and life events. These changes make it difficult or impossible to do things like bathe, dress, care for a family member, prepare meals, or attend social activities.

People of any age can become frail due to trauma, disease, persistent pain, or a reduction in physical activity. People who have more than one chronic health condition at midlife — such as high blood pressure, diabetes, heart disease, or stroke — are more likely to become frail as they age.

Physical therapists help individuals with frailty restore their overall mobility (movement), so they can return to desired activities. They help them improve their:

• Strength and flexibility.
• Aerobic capacity (the ability of the heart and lungs to get oxygen to muscles).
• Balance control. 

What is Frailty?

Frailty is the inability to perform daily activities due to factors such as muscle weakness and the loss of heart and lung capacity. Inactivity is a major cause of frailty. Inactivity can occur due to the presence of health conditions, an injury, or lifestyle choices. Being inactive, regardless of the reason, can cause weakness in all body systems. It only takes a few days in the hospital to experience a decline in the strength needed to move. Spending eight days or more in the hospital over a one-year period is linked to a loss of leg strength in otherwise healthy aging adults. Up to 30% of critical care patients in hospitals are frail.

When a person is not physically active, specific problems can result, including:

• Small, weak, and rigid muscles (known as sarcopenia).
• Stiff joints.
• Weakened heart and lung function (cardiorespiratory system).
• Balance problems and an increased risk for falls.

Frail people often are scared to perform activities or don’t want to do them because it makes them tired. This lack of activity increases frailty over time, creating a challenging pattern of physical inactivity and frailty. Some people do not understand how to improve their condition, so they continue to be inactive.

When a person becomes frail from lack of physical activity, they are at a higher risk of falling. Falls often cause injuries that can lead to hospitalization, disability, and death.

Signs and Symptoms

A person with frailty may experience:

• Severe fatigue, weakness, and/or exhaustion.
• Low energy.
• Weight loss.
• Difficulty standing, sitting, or walking.
• Trouble getting out of bed or a chair without help.
• Inability to perform simple household tasks.
• Poor balance or fear of falling.
• Feeling unable to work.
• Inability to socialize with friends and family.

How Is It Diagnosed?

Frailty can be diagnosed by your doctor or by a physical therapist. Your physical therapist will conduct a thorough examination to determine your:

• Lung (aerobic) capacity.
• Balance and posture.
• Fall risk.
• Flexibility.
• Strength.
• Mobility (movement).
• Muscle power.

Our Physical Therapists will ask you or a caregiver questions about your health, symptoms, and how well you move around. They also will conduct a hands-on examination and will observe your movements.

With health in sharp focus as a result of the pandemic, now may be a good time to look at the team of experts you have in place and see if there are any improvements you could make. You probably have a family doctor, dentist, and optometrist. Maybe you have some specialist physicians, a trainer, or a massage therapist. If a physical therapist isn’t a part of your healthcare team, you’re missing out on taking care of a big part of your health. To understand why you need a physical therapist, you need to understand what they do.

PHYSICAL THERAPISTS HELP YOU DO THINGS

The American Physical Therapy Association defines PTs as “healthcare professionals who diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.” So physical therapists help you do things that you have trouble with. That could be going for a hike, playing with your kids, or getting through a day of work without pain.

PHYSICAL THERAPISTS REDUCE PAIN

Chronic pain is a huge problem worldwide. A big part of that is low back pain. Statistically, around 80% of people will have low back pain in their lifetimes. Physical therapists are trained to treat pain without surgery or medications. If you have back pain, an arthritic knee, neck pain, or an old injury that won’t go away, a PT may be able to help.

PHYSICAL THERAPISTS KEEP YOU HEALTHY

The APTA goes on to say that “PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.” That means that a physical therapist can help you determine your risk for injury, choose the right fitness program, and improve the quality of your life by improving your health and ability to move.

PHYSICAL THERAPISTS CAN HELP YOU LIVE LONGER

It’s well known that the risk of many of the leading causes of death can be reduced by exercise. Some of these conditions would include heart disease, cancer, lung disease, diabetes, stroke, and reducing the risk of adverse COVID-19 outcomes.  Our PTs could help you live longer by helping you move better with less pain, finding the right exercise program, and helping you to make healthy lifestyle choices.

Do you avoid moving (a little or a lot) because you fear it will hurt? Does the fear of reinjury limit your activity? If so, you may be experiencing kinesiophobia. And you’re not alone.

As many as 50%-70% of adults — not just athletes — experience this feeling after an injury, accident, or illness. Kinesiophobia can result from personal experience. It also can be learned by watching or mimicking the behaviors of others.

Fear is a natural response to danger or the potential threat of danger. It causes normal physical changes in the body, such as:

• Increased heart rate.
• Rapid breathing.
• Elevated startle “jump” response.

Fear also can cause anxiety — the emotion felt when we think bad things might happen. And anxiety can cause fear, resulting in a continuous feedback loop. Ultimately, when fear and anxiety affect how we move it’s known as fear avoidance.

People who fear moving can have decreased confidence in doing daily activities and may:

• Change their normal movement to feel safe. Moving in ways we are not meant to — and using muscles or joints the wrong way — can lead to new pain.
• Decide that it is just better not to move at all. An inactive lifestyle can increase your risk of developing heart disease, diabetes, and obesity.

While avoidance tactics may seem to help at first, they can lead to long-term problems if continued. Movement and regular physical activity are essential for our hearts, muscles, joints, lungs, mind, spirit, and overall health.

Help Is Available

Physical therapy plays a vital role in addressing the fear of movement. Physical therapists can identify any contributing factors and teach you how to move safely. They, and the physical therapist assistants they work with, can help you get past your fear of movement.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement.

What to Expect From Physical Therapy

Physical therapy aims to restore function so you can do the activities you need and love to do.

During your initial visit, your physical therapist may:

• Measure your fear of movement or re-injury. The Tampa Scale of Kinesiophobia or a questionnaire can help identify the reasons for your fear. There are a variety of possible causes.
• Evaluate your overall strength, endurance, and balance.
• Ask about your personal goals.

Your physical therapist will use this information to design a personalized treatment plan that may include:

• Gradual exposure to activities that do not cause harm.
• A strength, balance, and endurance exercise program paced for your specific needs.
• Virtual reality activity exposure.
• Adapted yoga.
• Aquatic exercises.
• Patient education. Your physical therapist can help you better understand how your body should move.
• Guiding you through activities so you can focus less on your fear and improve your ability to move.
• Assistance and guidance to help you set quality-of-life goals.

Your physical therapist also may recommend cognitive behavioral therapy. This treatment can help you address fear or anxiety.

Physical therapists use the latest evidence to address each person’s needs, challenges, and goals to:

• Improve mobility.
• Manage pain and other conditions.
• Recover from and prevent injury and chronic disease.

Our physical therapists and physical therapist assistants empower you to take part in your recovery. They work with each other, other healthcare providers, and community partners to ensure you receive the best care.

This piece originally appeared in ChoosePT

Haven’t thought about having an annual PT exam? We’re biased, but we think you should. You see your optometrist and dentist regularly because your eyes and teeth are important. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly taxes done.

But what about the rest of your body? Have you lost range of motion or strength? How’s your balance and coordination? These all affect how you move. You might not notice small changes until you have problems like trouble lifting a heavy load, joint pain, or a sprained ankle from a stumble. An annual PT exam can catch problems early, then correct them before they lead to something bigger.

WHAT TO EXPECT

An annual PT exam is quick and easy. Your annual visit may include:

• A history of your injuries, as well as a health history
• Assessment of your strength, balance, flexibility, etc.
• A review of your movement goals (do you want to run a marathon? Get on and off the floor easily playing with your grandkids?)
• A review and update of your exercise program

HOW IMPORTANT IS MOVING WELL?

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Moving well can keep you healthier and help you live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also less likely to be hospitalized and less likely to have adverse events like falls.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s called the sitting-rising test. You can find the instructions and examples with a quick internet search.

Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything. So science says that moving well is incredibly important to your overall health. It’s also important for your quality of life. We think moving well is just as important as your teeth, eyes, and taxes. If you agree, get that annual PT exam scheduled!

 

REFERENCES

Why provide an annual physical therapy visit – https://www.apta.org/patient-care/interventions/annual-checkup

Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability – https://www.apta.org/apta-and-you/leadership-and-governance/policies/pt-role-advocacy

Ability to sit and rise from the floor is closely correlated with all-cause mortality risk — ScienceDaily

Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older – PubMed (nih.gov)

From the time we learned to walk we fell a lot, but our parents picked us up and we kept going. So, why on earth was it a natural instinct to break our falls with our hands, and, how come we never learned at that time how to fall without FOOSH’ing? Good question, right?

What is a FOOSH, and how can we not do it?

Well, FOOSH is the nickname for an injury caused by Falling Onto an Out Stretched Hand. These injuries ¹ are among the most common injuries affecting the hands and wrists that occur when trying to break a fall.

The severity of FOOSH injuries can vary greatly depending on various factors. These include:

• the force of your impact with the ground
• the type of ground you’ve fallen on
• the way in which you’ve fallen
• whether you have any existing health conditions or injuries affecting your hands and wrists.

FOOSH might be a silly Nickname, but it can have serious consequences.

FOOSH injuries often happen to people who participate in sports where falls are common, such as downhill mountain biking, skiing, and football.

But, really anyone can get a FOOSH injury if they fall on a hard surface and try to brace themselves with their hands or arms. Incorrect footwear can create tripping hazards and also lead to falls. So can scatter rugs and electrical cords in the home. A lack of balance or coordination, poor vision, or medications that cause drowsiness, may also cause falls with FOOSH injuries.

The Art of Falling Safely.

Believe it or not, there are ways to fall and not FOOSH. And we’re all going to fall down: The world is full of banana peels. So while avoiding a fall is job one, knowing how to take a fall when it’s inevitable is a crucial skill.

An article by Michael Zimmerman, AARP The Magazine, gives a 4-step explanation with pictures on the Art of Falling Safely with suggestions to help improve your footing and practice mindfulness. An added bonus in the article has a link on how to how to prevent falls in your home.²

The take-a-way is bittersweet. Remember – we’re all going to fall so let’s try to learn the art of it. However, there is still a 50/50 chance we’re gonna FOOSH, and if you do we are here to help you!

____________________

sources:

¹Treating and Recovering from ‘Fallen Onto an Outstretched Hand’ Injuries: https://www.healthline.com/health/foosh

The Art of Falling Safely: www.aarp.org/health/conditions-treatments/info-2017/how-to-fall-safely.html

 

Keeping up with physical therapy during the holidays is tough. There are so many other things to do – cooking, parties, shopping, travel, and visiting with family and friends. But if you’re in physical therapy over the holidays, there’s a reason. You’re having pain, or not moving as well as you want to. These issues place limitations on your life, which are going to affect your ability to do things – like cooking, partying, shopping, traveling, or enjoying time with friends and family. So even though keeping up with your PT this time of year is tough, it’s important. That’s why we’re going to give you our best tips to help you through the holidays.

PLAN

Some of what makes the holidays challenging is the crazy schedule. To survive this, you’re going to have to plan ahead. We’re not just talking about appointments on your calendar, either (although those are important). Here are some things to think about planning ahead:

Your PT appointments

Your schedule is busy during the holidays. So is your PT’s. Plan and schedule your appointments in advance. You’ll get the times and days that work best for you, and you’ll already have your PT appointments in your calendar to plan other things around.

Your exercise

Hopefully you have a regular time to exercise. With the holiday mania about to shake up your routine, that time may no longer work. Think about when you’re going to exercise ahead of time and you’ll stay consistent.

Your diet

Healthy eating often gets derailed during the holidays. Putting low quality fuel into your body won’t help you feel better. Think about planning what you’re going to eat ahead of time. We’re not saying to skip every holiday treat offered to you, but maybe think about which ones you really need to have, and which ones you can skip in advance. It makes saying “no thanks” to that third slice of fruitcake easier.

MODIFY

We’re realistic. We understand that life isn’t the same during the holidays as it is during the rest of the year. That’s part of what makes this time of year special! With that in mind, our next set of tips focuses on making modifications to help you get through the holidays successfully.

Your PT Plan

When you planned your PT appointments out well in advance, you might have run into some challenges. Talk to your therapist about how you might be able to modify your plan of care through the holidays to make it all work. Maybe you’re going to PT three times a week and you can only come twice a week for a week or two. Plan this sort of thing in advance with your PT and you can work together to come up with the best plan.

Your exercise

Exercise is so important, it made our list twice. Now that you know when you’ll exercise, you might have to modify your routine to make it fit. Again, we recommend talking with your PT to see what you can do. Maybe your home exercise program can be modified so you can do everything in the kitchen during downtime when you’re cooking up your holiday feast. Maybe you can reduce the number of exercises to focus on maintaining the gains you’ve made until things settle down.

Your schedule

In your planning in advance (see how important it is?) you might have found that your normal routine wasn’t going to work. If your PT appointments or exercise time is usually right after work and you’ve now got commitments during that time, maybe you can move them to the morning before work. If you’ve been exercising outside, the shortened days may move you into the gym. Be flexible and consider temporarily modifying your schedule and your routine to make it work better during the holiday season. You can always go back to your previous routine after.

The holidays are a special time of year. Keeping up with your health and your physical therapy can be challenging during this time. But you don’t have to fall behind. With some planning and flexibility, you can stay healthy, survive the holidays and head into next year with good momentum!

By: Jenifer Walker, PT, DPT, CHT

Since the title of our next blog is in the form of the question. The answer is, if you are currently experiencing any pain, swelling, or functional limitations with one or both of your hands, then the answer is an emphatic YES!

Most people these days know that when their back is bothering them, or they have elected to have surgery on one of the joints in their body, they can follow up with their favorite PT at Carousel.  But did you know that some physical therapists choose to specialize in the treatment of the hand and upper extremities?

CHTs are highly skilled in evaluating edema, pain, range of motion, strength & endurance, sensibility, activities of daily living, work activities, avocational activities, and sports activities.  We commonly manage conditions such as:

• • • • • • • Amputations
            • Arthritis
            • Burns
            • Disease processes
            • Fractures & dislocation,
            • Sprains & strains
            • Infections
            • Joint contractures
            • Nerve compressions
            • Nerve injuries
            • Rotator cuff injuries
            • Impingement syndrome
            • Tendinitis
            • And tendon injuries

One of the major skillsets developed by CHTs is the fabrication of customized orthotic devices for the upper extremity.

These are commonly required for carpal tunnel syndrome, cubital tunnel syndrome, tendinitis, basilar joint arthritis of the thumb, finger dislocations, finger fractures, tendon injuries, lateral epicondylitis, and joint sprain/strains. Orthotic devices are often required following surgery for the fingers/hand/wrist as well.

So, if you are unsure whether you should see a CHT, you can have a FREE consultation with me, and with your doctor as well! See you soon!

Recently we introduced you to Long COVID and all of the challenges it brings. This month we’re going to talk about what physical therapists can do to help people living with Long COVID. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis better known as Chronic Fatigue Syndrome (CFS) also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases. Here are a few of those strategies.

PACING

The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed “crash” of  PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their “battery” and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and less bouts of PESE.

WHAT ABOUT THIS PESE THING?

Post-exertional symptom exacerbation is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a “crash”. PESE is very common in people suffering from Long COVID. 75% of people who have Long COVID have PESE after 6 months. The activity that brings on the crash is something that the person could easily tolerate before their COVID-19 infection. Things like taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises may all now trigger a crash.

HEART RATE MONITORING

Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It’s based on your resting heart rate, which should be taken after you’ve been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you’re doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you “the burn” when you’re working out really hard. It also causes your muscles to fatigue more quickly – by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.

EXERCISE

What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, “toughing it out” or “pushing through it” won’t make them stronger. It will cost them days of their lives – leaving them barely enough energy to get out of bed or complete basic tasks. For long-term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart-rate monitoring, and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don’t overdo it.

As we learn more about the pathology behind Long COVID’s symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can’t afford to wait until science figures everything out about their disease. Fortunately, physical therapists have training and strategies that can help improve their lives right now.

Physical Therapy Is For Everyone!

Physical therapists are highly trained health care professionals. They are experts in human movement who are trained to evaluate and treat all kinds of musculoskeletal issues with exercise and other techniques. Everyone moves and everyone can benefit from exercise, so physical therapists can help people through their entire lives!

PHYSICAL THERAPY FOR CHILDREN

Physical therapists start treating some people very shortly after birth. Common reasons a baby might need PT include torticollis and cerebral palsy. Torticollis is a postural issue caused by a tight neck muscle. Babies with torticollis hold their heads tipped to one side. Cerebral palsy is a neurological disorder that causes difficulty with movement and coordination.

As children get older, some have trouble hitting their motor milestones – think of these as the “firsts” – sitting up, rolling over, crawling, standing, and walking. Physical therapists can help here too, using their expertise to help develop motor skills and coordination to get these children back on track.

PHYSICAL THERAPY FOR ADOLESCENTS

In adolescents, sports injuries become more common. Whether it’s an ankle sprain or an ACL surgery, a PT can help. The rapid growth in adolescents can cause issues too. Things like growth plate fractures, growing pains, Osgood-Schlatter’s disease, and Sever’s disease are all common in adolescence and are related to the changes the body is going through.

PHYSICAL THERAPY FOR ADULTS

As adults, a lot of us will have back pain – studies say up to 80% of us. Physical therapy is one of the first treatments recommended for back pain. Physical therapists also see adults for injuries – maybe from weekend warrior-type sports injuries, overuse, or from an accident at work. Some adults also start to show symptoms of diseases like multiple sclerosis, or myositis which also benefit from physical therapy.

PHYSICAL THERAPY FOR OLDER ADULTS

Later in life, people tend to have more health issues that impact their ability to move. Things like arthritis, joint replacements, strokes, and heart attacks are all things a PT can help with. Physical therapists also help people age better – keeping them moving with exercise programs that help reduce falls or helping them make adaptations and modifications to keep them in their homes safely.

Movement is a constant in life. As movement experts, PTs can help people of any age. Some specialize in treating pediatric patients, and some specialize in treating geriatric patients, but all PTs have the expertise to help people move better.

References:

https://www.cdc.gov/ncbddd/cp/facts.html

PT for pediatric ataxia – https://pubmed.ncbi.nlm.nih.gov/31392562/

Adult in workplace – https://pubmed.ncbi.nlm.nih.gov/32270086/

Adult myopathy (an example of something treated for adults, not geriatrics necessarily) – https://pubmed.ncbi.nlm.nih.gov/31115788/

The Role of a Physical Therapist in Healthy Aging – https://www.ncoa.org/article/the-role-of-a-physical-therapist-in-healthy-aging

How Physical Therapists Can View Normal Versus Abnormal Aging – https://www.foxrehab.org/pt-impact-older-adults-optimal-function

Nobody is going to be surprised to hear that Physical Therapists work with muscles. But we bet a lot of people would be surprised to learn that the muscles inside your pelvis are included. While the pelvic muscles don’t get as much attention as the biceps or hamstrings, they can still cause problems that need treatment. Here are a few examples:

URINARY INCONTINENCE

Urinary incontinence is the involuntary leakage of urine. More than 13 million people in the United States have this issue. There are different types of incontinence, but the most common are stress and urge incontinence.

• Stress incontinence is when leakage happens during coughing, sneezing, or laughing.
• Urge incontinence is a result of the bladder being overactive or unstable. People with urge incontinence often have triggers that cause the involuntary loss of urine, such as hearing running water.

PELVIC PAIN

This is defined as any pain that occurs either internally or externally in the pelvic or genital area. Both men and women can be affected, but it’s more common in women.

What’s the Cause?

Most incontinence is caused by issues with the pelvic muscles – either weakness or tightness. There can be other contributing factors like spasms that cause bladder contractions, or conditions like anxiety may increase the urge to empty the bladder.

Pelvic pain is also usually attributed to either tightness or weakness of the muscles of the pelvic floor. The pelvis is made up of three bones, forming three joints where they meet. These joints need to be stabilized by an outside force. The job of the muscles and ligaments in and around the pelvis is to  provide that stabilizing force. If the muscles are too tight, the joints will have an excessive amount of compression on them. Too loose, and the joints of the pelvis can experience shear forces. Both conditions result in pelvic pain.

WHAT CAN PT DO?

Because incontinence and pelvic pain are usually musculoskeletal conditions, physical therapy can offer a lot of effective treatments. Some examples include:

Exercise – Strengthening or stretching of the pelvic muscles or the core can help correct imbalances, improve pelvic stability and reduce pain.

Biofeedback – This involves using sensors placed on the body while doing exercise to help the patient identify which muscle groups are working and bring awareness to areas of tightness or weakness.

Education – For incontinence,  learning how the bladder normally functions can help you to understand changes that can be made to improve symptoms. Learning about posture and how to improve the alignment of the pelvis and the trunk can help to reduce pain and improve tolerance for positions like sitting and standing.

Manual Therapy – Joint mobilizations, trigger point release, soft tissue massage, myofascial release, and other techniques can help improve mobility of the pelvic joints, decrease tone in spastic muscles, and reduce pain.

If you’re experiencing pelvic problems, our specially trained physical therapists can complete a comprehensive evaluation, help determine the cause, and design a customized treatment plan to help.

 

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References:

1. Research (peer-reviewed)
   1. Geriatric incontinence – https://pubmed.ncbi.nlm.nih.gov/34519024/
   2. Assess Pelvic Floor Guide – https://pubmed.ncbi.nlm.nih.gov/34807882/
   3. Pediatric pelvic floor – https://pubmed.ncbi.nlm.nih.gov/10458431/
   4. Using PTs for Pelvic floor – https://pubmed.ncbi.nlm.nih.gov/35353916/
   5. Urinary Incontinence prevalence – https://pubmed.ncbi.nlm.nih.gov/35173077/
   6. Physical Therapy Treatment of Pelvic pain – Physical Therapy Treatment of Pelvic Pain – PubMed (nih.gov)
2. Articles and Content
   1. Pelvic floor muscles and training – https://pubmed.ncbi.nlm.nih.gov/35036386/
   2. Exercise in pregnancy (helping incontinence – one of the symptoms – https://pubmed.ncbi.nlm.nih.gov/34478617/