Women’s Health

Women’s Health

Women’s Health: Chestedness and Mid-Back Pain

By PPSM Staff

If your breast size is on the larger end of the spectrum and you contend with mid back pain frequently you may be wondering how to combat the musculoskeletal effects of your breast size. If you’re diligent about proper bra size and fit and know that you’ve covered your bases on that front but still have frequent issues with back discomfort you may benefit from some of these therapeutic correctives which you can do at home. As always, be sure to clear any new exercise regimen, regardless of the type, with your doctor to be safe prior to beginning.

Most people know that core strength is crucial for low back stabilization, but believe it or not strengthening your core is beneficial for mid back pain/ deconditioning. Elbow planks are a great core exercise that will also have the added benefit of helping you stabilize in the mid back because of the static positioning involved throughout the thoracic and lumbar spine during the exercise itself.

You’ll also benefit from exercises that have the effect of pulling your shoulder blades together and downward. This will most efficiently activate and strengthen your middle lower trapezius musculature. Try doing some sort of resistive rowing and lat pull downs to accomplish this. The rows can be done seated on a rower or with therabands. Both of these movements will recruit other musculature of the back as well because the lower trap is not a muscle you can isolate.

Stress Fractures

By PPSM Staff

Stress fractures in healthy individuals are usually the result of sudden increases in physical activity over a period of a few to several weeks.  Simply put, they are almost always a form of training error of doing too much too soon.  They usually occur in weight bearing joints in which the over activity causes microscopic fractures that do not have enough time to heel (activity>rest) and results in macroscopic bone failure (fracture). This in turn leads to eventual pain during activities and sometimes even with everyday activities depending on extent. Early diagnosis can be made by MRI, and usually after 4 weeks with x-rays.

Treatment is obvious rest for the time period until palpation, pain and scans clear usually around 6 weeks. Some may require a boot or brace depending on extent. Proper nutrition and supplementation (think leafy greens, healthy fats, Vitamin D, Fish oil), adequate rest and non-impact cardiovascular exercise can help expedite recovery.


By PPSM Staff

Thunder down under

A lot of women are embarrassed by feelings of pelvic pressure associated with pelvic organ prolapse. To understand exactly what is happening when you have prolapse, PT Julie Wiebe, makes reference to an inflated balloon in the abdomen. In order for the air to be properly balanced all sides of the balloon have to be intact and the pressure has to be equal. The pelvic floor acts as the bottom of the balloon. When the floor is weak (stressed part of the balloon) it is hyper response to increased downward pressure. Since we want to be practical here –let’s think of things that cause increased downward pressure on the pelvic floor. Constipation is a huge factor. Hard, dehydrated stool is really hard to pass and requires downward pressure. Drinking water and in taking extra fruits and vegetables can really help keep the stool soft. Also, picking up a heavy set of water bottles at the grocery store really adds extra pressure to your weakened pelvic floor. A pelvic floor PT can really help with prolapse management and education. The initial goal is to not make it any worse! Prolapse does not just happen to post-partum moms, women of all ages are in need of a strong, balanced pelvic floor!

Leaky Gut

By PPSM Staff

Do you experience digestive issues such as gas, bloating, diarrhea or irritable bowel syndrome? Do you suffer from seasonal allergies or asthma? Do you have a diagnosis of chronic fatigue or fibromyalgia? Do you have food allergies or intolerances?

If so, it’s possible that you may be suffering from a condition called leaky gut.

Leaky gut sounds like an unusual diagnosis, but it is more of a term used to describe what may be happening in many individuals experiencing the above listed conditions. Leaky gut is not the ONLY cause of these conditions, so please check with your physician for an accurate diagnosis.

So what is a gut?

The gut is usually another term used to describe the intestines. Naturally, the gut is permeable to tiny molecules. This permeability allows our body to absorb vital nutrients that we need to operate from day to day. The regulation of intestinal permeability to these vital nutrients is a natural function of the cells that line the intestinal wall. Although this seems like an easy process for cells to accomplish, there are often barriers that can stop the cells from doing their jobs.

Individuals with gluten sensitivity, often have gut cells that will begin to release zonulin, a protein that can break apart tight junctions in the intestinal lining. Gluten sensitivity is not the only culprit. Infections, toxins, stress and age can also cause tight junctions to break apart. Regardless of the reason, once the tight junctions are broken, leaky gut can occur.

The tight junctions are broken. What happens next and how does this affect us?

Leaky guy allows toxins, microbes, and undigested food particles to escape through the broken junctions which in turn, permit these substances to travel through the bloodstream to the rest of your body. This usually wouldn’t be an issue, except that each body is equipped with an immune system to protect us from foreign particles in the body. The escaped particles are marked as “foreign” by the immune system. Now the immune system will attack these substances in an attempt to protect us. This immune response can present in the ways listed at the beginning of this post.

Gluten is the main cause of leaky gut. There are other foods such as dairy, sugar, and excessive alcohol, which can contribute to leaky gut as well. Non-food related infections can also cause leaky gut, these include: candida overgrowth, intestinal parasites, and small intestine bacterial overgrowth (SIBO).

Can a leaky gut be fixed?

First, you need to remove the substances that are causing the leaky gut. Next, you will need to introduce substance/food to help your body heal. It is best to see a nutritionist or your physician to figure out the substances that are affecting you.

Getting Back in the Groove After Baby

By PPSM Staff

The body changes after a baby, said Dr. Beth Bossart of PSSM Wellness. The time to think about post-baby fitness is before delivery.

“Mothers can start to think about getting back into shape before their baby is even born. Maintaining a healthy lifestyle during pregnancy is extremely important both for mother and baby, and that does include exercise,” said Bossart.

Though she is quick to say anybody considering a fitness routine during pregnancy needs to clear it with an OBGYN, which is also true for women who need a C-Section or episiotomy. She said general guidelines for getting back into shape post-partum is to begin six weeks after an uncomplicated vaginal delivery.

Some of the workouts she recommends are light to moderate cardio, especially low impact workouts like walking, biking and elliptical. She said this should be done at moderate intensity which means, “You should be able to talk but unable to sing.”

She said the sweet spot is about 150 minutes per week, with incremental advancement to higher impact activities such as running.
Another consideration of bouncing back after baby is core strength. Bossart said Pilates and yoga are great for re-building core strength but jumping right back into a class might be difficult. She recommends starting at home or in the gym first to build confidence and skills.
“Finding activities that you like to do will help you maintain your program,” said Bossart. “And since that baby is brand new, you’re definitely going to want to spend more one on one time with them.”

One of her fitness recommendations to building strength and bonds with baby are mommy and me workouts. They can be done at the gym or through online programs. She said the important part of the routine is to work to your comfort level. For example, she prefers walking and hiking and said she would rather be out with a jogging stroller.

She said working moms will want to find a time which they are able to stick to most of the time. And each day can have a different activity, but scheduled ahead of time. Bossart said that anybody starting a new fitness routine should try to stick to it for at least a few weeks, so it will be easier to maintain.

One important consideration of new mommy-hood as that moms need to take care of themselves, according to Bossart. “The first few months staying at home with your little one are fantastic, however, you are constantly caring for someone else and you need to continue to care for yourself. Between the diaper changes and late night feedings you’ll need lots of energy and “me” time and working out can help you with both.”

The Physical Cost of Running: Common Injuries

By PPSM Staff

The glory of running and the defeat of injury are both well known to Dr. Mathieu Lentine, D.C.
Lentine was a competitive runner for nearly 16 years. He ran in high school, college and post collegiately. “I never liked to run but loved to race so that was what my training was always geared around,” Lentine said.
In high school and college he ran cross country and track and has ran every distance up through marathon. It was all of this running that led him to multiple knee injuries, one of which ended his college career.
Knee problems like his are common for runners. In fact the most common problem for runners is colloquially termed runners knee, though the technical term is patellofemoral pain syndrome. It is when the kneecap does not track/slide properly, especially with running. The tendons attaching to it can get inflamed or actually tear.
Another common cause of knee pain in runners is ITB syndrome. It occurs when the IT band that connects from the hip to just below the knee joint gets inflamed. This is caused by the motion of these joints during running. Also, small tears in the fascia from tight calves, low or high arches or sudden changes in running intensity can cause plantar fasciitis and result in severe pain in the bottom of the foot near the heel.
According to Lentine, problems like this can be life-long, as he is still slowed down by one of his knee injuries.
“I’m still dealing with it but physical therapy and being conscious of my movement, paired with proper training and progression, is crucial to getting back to running,” said Lentine.
He said that overuse injuries stem from a lack of mobility, muscle imbalance issues and progressing training too quickly, before the body is adapted to handle the volume/intensity or frequency of training.
He uses his own experience to emphasize the importance of doing stretching and mobility work prior to any workout.
“It’s not fun and it’s the easiest thing to neglect in a training program. However it is what keeps you running longer and with less or no injuries,” he said.
He also recommends starting slow and at a low distance. Runners can also try to mix up their routine by running on grass, gravel, pavement or the treadmill. He also recommends investing in quality running shoes which should be replaced every 300 to 400 miles.

Why Am I So Tired All The Time???

By Matthias H. Wiederholz

Fatigue is a common presenting complaint for so many patients. Frankly, primary care doctors just don’t have the time to properly evaluate people for fatigue. Why you ask? Simple – there simply isn’t enough time. Most primary care doctors have to see a patient about every seven minutes in order to make a profit. That’s possible if the primary complaint is a simple cold, but fatigue requires a much more in-depth assessment. Our Functional Medicine experts can certainly do the comprehensive workup that is necessary to uncover the root cause of your fatigue.

Simple causes of fatigue will likely be discovered with routine blood work done by your primary care doctor. These may include anemia, diabetes, electrolyte imbalances, or obvious thyroid disease. That said, starting with your primary care doctor to rule out these obvious causes is a great idea.

But what about those people who complain of fatigue and have been to the primary care doctor and still don’t have an answer? Some of these patients have been to multiple specialists and still have no answers. This is the perfect case for a Functional Medicine expert.

If the above obvious causes have not been ruled out, we will certainly order tests for these. But we will also look for more subtle causes of fatigue. Probably the most common cause I see in my practice is chronic stress. Most people probably don’t even know that you can measure the effects of chronic stress on the body. We do this with a salivary cortisol test that measures your cortisol levels four times throughout the day. This is your “stress hormone” and chronic stress will often result in adrenal fatigue or hypocortisolism. This takes a long time to correct, but identifying the cause is the first step. People who suffer from stage 3 adrenal fatigue will often have hypofunctioning thyroid glands as well. The dysfunction may not be obvious and you may have been told that your thyroid is normal, but subtle changes can still result in problems. And you may not have obvious diabetes, but this chronic stress may also affect your body’s sensitivity to insulin. This is called insulin resistance and we stage this into three stages as well. We can usually correct these factors with diet changes, stress-reduction techniques, and targeted supplements/herbs.

Another common cause of fatigue is hormonal imbalance. We discussed cortisol, thyroid and insulin, but here we’re talking about sex hormones (estrogen, progesterone, testosterone, etc). When these critical hormones are suboptimal or out of balance, a common complaint is fatigue. Testing for these hormone levels is simple and correcting imbalances often involves diet changes and bioidentical hormone restoration.

Less common causes for fatigue involve toxic exposures (heavy metals, plastics, etc) and chronic infections (Lyme disease and chronic viral infections).

Most causes of fatigue can be uncovered with a detailed history and laboratory assessment. Do not accept a diagnosis of chronic fatigue syndrome without first doing this comprehensive assessment. Ask to see myself or my partner, Joseph Jimenez, when scheduling your appointment. Our Functional Medicine expertise will certainly prove invaluable to you in your endeavor to feel well again.

Estrogen Metabolism: A Key Factor in Breast Cancer Risk Assessment

By Matthias H. Wiederholz

October is breast cancer awareness month. One aspect of breast cancer risk that is not discussed frequently is estrogen metabolism. This is not only important in women on bioidentical hormone restoration therapy, but also for young women who are exposed to endogenous estrogen, the estrogen their bodies make every day. This estrogen has to be metabolized just like any other hormone in the body.

The metabolism of estrogen involves two main competing pathways: 2-hydroxy estrone and 10-hydroxy estrone. There is one minor pathyway, 4-hydroxy estrone. Confused yet? It will become much clearer in a moment.

2-hydroxy estrone is considered the “good estrogen” in that it does not stimulate cell growth and is considered “anti-cancer”. The caveat is that phase two detoxification pathways are intact and healthy. This is called methylation and is measured in the 2-hydroxy estrone to 2-methoxy estrone ratio. These are simply urine tests. Factors that promote healthy methylation are SAMe, methionine, Vitamin B2, B6, B12, folic acid (in activated form), trimethylglycine, and reducing stress.

Studies show that 16-hydroxy estrone may increase the risk for breast cancer. High levels are associated with obesity, hypothyroidism, pesticide toxicity (organochlorines), omega-6-fatty acid excess, and inflammatory cytokines. The ratio of 2-hydroxy estrone to 16-hyroxy estrone is an important indicator of the potential cancer risk of a particular individual.

4-hydroxy estrone directly damages DNA and may be associated with an increased risk for breast cancer. Equine estrogens such as Premarin increase metabolism into 4-hydroxy estrone. Women with uterine fibroids often have elevated 4-hydroxy estrone levels. Methylation is important here as well as 4-hydroxy estrone can be methylated to 4-methoxy estrone which renders it inactive.

Basically we want more metabolism down the 2-hydroxy estrone pathway. We can accomplish this through moderate exercise, cruciferous vegetable intake, flax, soy, high protein diet, indole-3-carbinol, di-indolemethane, omega-3 fatty acids, B6, B12, folate, trimethlyglycine, rosemary, turmeric, weight loss (obesity decreases 2-hydroxy estrone). Reducing one’s exposure to xenoestrogens is also critical. Xenoestrogens are found in pesticides, synthetic hormones fed to animals, plastics, and cosmetics. Reducing alcohol intake is also important as alcohol interferes with the body’s ability to detoxify estrogen.

All of these pathways can be easily tested with a simply urine test. Call one of our offices to set up an appointment to discuss your risk and have your pathways tested today.