Physical Therapy and Posterior Pelvic Floor Health

The posterior pelvic floor is a complex region. When it is working right we don’t even think about it, but when it goes awry our bodies become overwhelmed. Many of our women and men athletes have poor functioning of their posterior pelvic floor. We can often see pudendal nerve entrapment in the pelvic floor in our cyclists, long distance runners, cross fit and weight lifters. This can lead to bowel, bladder and sexual dysfunction. 

What is the Posterior Floor

The posterior floor is responsible for posterior organ support, anal health and good bowel function.  The muscles there are striated  muscles like we have in our arms and legs. They respond as all muscles do,  when we use them in a coordinated fashion they work well, but if we overstrain them during training, then they will become dysfunctional. They are controlled by a set of sacral nerves that are highly sensitive and can become irritated and painful when the function of the floor muscles are not working well.   Neural “cross-talk” between pelvic organs shows an increase in sensitivity between the urinary, bowel and sexual organs function in the physiological system. This sensitivity appears to be related to the bodies need to have good daily regulation in these organs and often when one is affected they all become involved.

The pelvic floor muscles consist of layers of muscles and they have a complex integration system. There is a superficial layer which consists of the anal sphincter and deep muscle system that creates a sophisticated sling like set of muscles that integrates with the gluteal muscles, the hip adductors, rotators and  hamstrings. These pelvic floor muscles make up part of our “core” region. The “core” needs good functioning of the floor to remain healthy.  Any core muscles that are not functioning well will disrupt the system.

Physical therapy for pelvic floor health is a key integration as PT’s are movement specialists and their ability to coordinate the “core” and retrain the floor is needed. The signs and symptoms are key to knowing if posterior pelvic floor health is an issue for you. 

Signs and symptoms of Posterior Floor Dysfunction: 

  • Posterior pelvic pain and pressure 
  • Bloating, sense of non-complete evacuation of bowels 
  • Low back,sacroiliac joint and/or lower abdominal pain
  • Chronic prostatitis  
  • Pain with prolonged sitting 
  • Non-relaxing pelvic floor disorder with tight hip muscles 
  • Hemorrhoids 
  • Anal Fissures 
  • Burning and Irritation to the Pudendal nerve in floor, around base,shaft of penis 
  • Anal receptive intercourse 
  • Fecal incontinence 
  • Chronic constipation 
  • Pelvic floor dyssynergia-external anal sphincter dysfunction 
  • Type A personality -anxious mood 
  • Pelvic organ prolapse,Perineal Body decent due to obstetric trauma, multiple births vaginally 
  • Can begin in childhood 
  • Often have dysfunction bladder voiding as well 
  • Irritable bowel syndrome (IBS)
  • Interstitial cystitis (IC)

Daily Health Habits Needed:

  • Comfortable lightweight clothing ie cotton underwear for breathability. 
  • Sleep hygiene 7-8 hours a night for healing.
  • Increased water intake.
  • Healthy diet with fiber, dosing magnesium. 
  • Wean off use of laxatives. 
  • Relaxation training- Meditation, breathing ex’s. 
  • External and internal pelvic floor mobilization for increased blood flow. 
  • Physical therapy for education instruction on pelvic floor health mobilization, stretching 
  • and muscle coordination and integration of the floor 5-20 mins a day. 
  • Natural paraben free Lubricants -increased need for lubrication upon bowel mvts and anal intercourse.  
  • Education and instruction on health bowel habits- positions for improved function, decrease straining for bowel mvt and focus on relaxation and taking time for evacuation. 
  • Night time propping of hips and legs up on pillows for floor relaxation for 20-30 mins a day. 
  • Improved sitting postures to decrease floor pressure.

Physical therapy is an integral part of pelvic floor health. Please get a referral to a pelvic health PT for the restoration of the muscle function of the floor and to restore correct re-integration of the core. As much as we need our athletes to be strong, we also need them to have the coordination and balance to be able to relax the floor and have down time as well, for overall pelvic floor health.

Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her amazing  staff are here to help you during your athletic endeavors with good pelvic health. Please call for an appt. tomorrow Cda office (208)667-1988, Spokane Valley(509)891-2623, Hayden (208)762-2100, Post Falls (208) 457-3435.

Pelvic Floor Therapy for Constipation

Pelvic Floor Therapy for Constipation lake city pt

If you are suffering from constipation, you should consider pelvic floor therapy. This treatment can help ease the symptoms of this condition, as explained below. 

Constipation is far more common than most people realize. Indeed, one study has revealed that approximately 52 million people, or 16% of the American population suffer from some form of chronic constipation. As you age, this issue becomes far more prevalent and causes numerous people to visit the doctor to treat the problem. There are even over 700,000 visits to the emergency room each year related to constipation. If you are looking for relief from this condition, you could consider pelvic floor physical therapy. 

Get in touch now and we can book you in for an appointment immediately, helping you reduce issues with this condition.  

What Is Pelvic Floor Therapy For Constipation? 

Pelvic floor therapy focuses on issues with the pelvic floor. These muscles control various processes in the body including:

  • Urination
  • Defecation
  • Intercourse

Constipation can cause numerous issues including infrequent bowel movements as well as the sensation that the bowels are never fully empty. Many people who suffer from constipation do have issues with pelvic floor dysfunction. While there are numerous lifestyle causes of constipation, this is certainly a contributing factor. 

Pelvic floor therapy for constipation is used to manage any tightness that exists in the muscles or through the intestines and the diaphragm. Any constrictions here are going to make issues with constipation a lot worse. 

With pelvic floor therapy, therapists use internal treatment to help with the issue of muscular tension as well as breathing and relaxation exercises. In doing so, it’s possible to help key muscles relax more. 

Who Is Qualified To Perform Pelvic Floor Therapy For Constipation? 

Pelvic Floor Therapy for Constipation lake city pt 1

There are numerous people who will be qualified to complete pelvic floor therapy. For instance, a doctor may recommend a gynecologist, a urologist, or even a urogynecologist. It largely depends on the issues that a patient is suffering from. 

For constipation, it is best to contact a pelvic health physical therapist. Experts in the field, we are trained specifically to assess and treat a wide range of different pelvic floor problems. Be aware that constipation can impact men and women as well as children. 

If you are experiencing issues with constipation, we encourage you to contact us today. A friendly member of our team will book you in for an appointment so that we can work to resolve your issue. 

Does Pelvic Floor Therapy Work For Constipation? 

Many patients do experience new levels of relief when they start using pelvic floor therapy for constipation. Studies have shown that pelvic floor therapy can be highly beneficial for this issue because it helps ensure that muscles do relax which makes it easier for patients to complete a bowel movement. 

While there are other issues that often contribute to constipation such as diet and hydration, pelvic floor therapy can provide the level of relief that patients need. It can even ensure that they feel less pain and discomfort when dealing with a condition like this. 

Pelvic Floor Therapy Exercises For Constipation 

As well as providing internal treatments as well as expert advice, we also recommend pelvic floor therapy exercises for constipation. These exercises are based on helping you relax the vital muscles that will be causing you issues. 

While there are various exercises and stretches that can help, many are based on yoga poses such as child’s pose and happy baby. 

Happy baby involves lying down on your back with your legs in the air. You can then pull your knees towards your chest, holding your feet before pulling your legs apart. Alternatively, childs pose involves spreading your knees wide and allowing your belly to rest on the floor. You can then rest your forehead on the floor as well. 

Be aware that the exercise used will depend on which muscles are causing you problems and which ones feel tighter than they should. 

Furthermore, we can also teach you abdominal massages. These are beneficial for relieving tension and pain that can be caused by constipation. If you are struggling with painful issues, it can be helpful to try kneading and stroking the abdomen in a pattern that remains consistent. This is a popular method that is commonly used during therapy sessions. 

Do you need more support? If so, please contact us today. Our professional support and expert treatment methods have helped numerous patients gain relief from issues with constipation and we’re confident we can help you too. 

What is a postpartum sitz bath?

What Is A Postpartum Sitz Bath?

If you have just given birth then you may have heard about postpartum sitz baths. If you haven’t and want to know more about them, then this is the guide for you.

A postpartum sitz bath is essentially a special bath which is used during the postpartum period to try and help you to ease pain while promoting healing. It also helps you to maintain a high standard of hygiene for the perineal area. This is very useful if you have had an episiotomy, or a tear during birth. The great thing about a postpartum sitz bath is that it can help you to drastically reduce any perineum swelling you have, and if you have a swollen labia, it’s great for that as well. If you feel too sensitive for a postpartum sitz bath, then there are other options out there that can provide you with some relief, so don’t be afraid to check them out. Remember that everyone is different and what works for one person might not work for another. Take a look below to find out more about postpartum sitz baths and if they could benefit you.

How Often Should I Take a Sitz Bath After Delivery?

If you have never had a child before then the recovery time may be a little longer. You may need to take a sitz bath or two every day for the first week. If you have had a child before then you may find that one bath every couple of days is enough to soothe you.

Does the Hospital Give You A Sitz Bath?

What is a postpartum sitz bath lake city pt

In the hospital, there’s a chance that you will be given a portable sitz bath. This essentially sits over the toilet. You will fill the container with warm or cold water and then sit on the bath. The water will flow over your sensitive perineum and this will help you to heal and cleanse yourself. You can easily add medication or even herbal preparations as well if you want. If you need some help with preparing your sitz bath then your birthing doctor should be able to talk you through everything you need to know, while also helping you to get the right temperature. If you aren’t sure how warm your bath should be, or if you are worried about being too sensitive to the bath then take a look below.

How warm should a sitz bath be?

While you have the option of using warm and cold water, you should know that cold water will provide you with more relief. Studies have shown that cryotherapy or using ice to relieve perineal pain is very effective. Cold water might be quite a shock and it probably doesn’t seem like the best way to obtain comfort, but when you look at injuries to the body, you will soon see that cold packs tend to be the way to go. Cold water can reduce swelling much more effectively when compared to warm water.

How does a sitz bath work?

What is a postpartum sitz bath lake city pt 1

A sitz bath is a form of therapy that is done by sitting in shallow water. It’s ideal if you want to soothe itching, pain or any other symptoms that you may experience after childbirth. It’s also ideal if you want to keep your areas clean, but you are unable to take a bath or a shower. It’s more than possible for you to use either warm or cold water when you use your sitz bath, and you would be surprised at how easy it is for you to gain a level of relief without much effort. Sitz baths are very soothing and they are very popular with those who have just given birth.

How long should I stay in a sitz bath?

If you want to use your sitz bath, then you will be glad to know that you can sit in it for as long or as little as you’d like. If you want to get the best results, then you will want to use it for at least half an hour. When you do, you’ll soon find that you can easily reap the benefits. Remember that you can take as many baths as you need per day. So many people try and have one per day but if this is overwhelming for you, then don’t worry about it. You can easily have one every few days if you want, as this will still give some of the benefits so keep that in mind.

Moisturizer for the Pelvic Floor

Vaginal dryness is the blanket term used to describe skin dryness in the pelvic floor region — but this term isn’t descriptive enough. Women can experience vaginal dryness (internal) and pelvic floor dryness (external). External dryness in the vaginal region causes discomfort during activities, is a challenging to manage and creates tenderness during sex.

There are a lot of solutions for internal and external, but few solutions that tend both. That is why we created our Natural Feminine Cream — a two-in-one lubricant and moisturizer for your pelvic floor.

Natural Vaginal Moisturizer lake city physical therapy

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What is the difference between a vaginal moisturizer and vaginal lubricant?

It’s easy to get confused with so many products labeled feminine cream on the market. The two main options are lubricant and lotions. Lubricants are for internal use come in the form of creams, gels, moisturizers, and dissolving insertables. Moisturizers which are for external use come in the form of a salve or lotion. Each serve different purposes in your skin routine.

Vaginal Moisturizers

Vaginal moisturizers help women experiencing ongoing discomfort with external pelvic floor skin. Dryness, burning sensations, itching, pain, and sensitivity during intercourse can be helped by a vaginal moisturizer. When applied externally, it helps restore moisture to the area and assists in reducing irritation, swelling, and redness — which helps women have more enjoyable sex!

Like any topical lotion, a vaginal moisturizer can be applied to the area on a regular basis and is a healthier, hormone-free solution. It is recommended that your preferred vaginal moisturizer be applied at least 2 hours before intercourse to experience the best results.

Vaginal Lubricant

In contrast, a vaginal lubricant is applied internally before intercourse. A water based lubricant is most compatible with contraceptives and various sex toys.

Vaginal dryness from hormonal changes including those induced by pregnancy, menstrual disruptions, contraceptive pills, and certain cancer treatments can be helped by a vaginal moisturizer.

Can you put a lotion on your private area?

You should only apply certified vaginal lotion products to your vaginal region. The pelvic floor skin  is extremely sensitive and houses mucous membranes which keep the region naturally lubricated. Lotion that isn’t made for the pelvic region can cause further irritation and greater discomfort.

Choose a vaginal lubricant that is non-irritating, preservative-free and is compatible with your choice of contraceptive.

For vaginal moisturizers, find products that are naturally bio-adhesive. Bio-adhesive ingredients work better for longer lasting moisture as it attaches to the affected dry cells until they replenish with higher moisture content. Your vaginal moisturizer should be estrogen and fragrance-free so your vaginal regions natural temperament isn’t disrupted.

Natural Vaginal Moisturizer lake city physical therapy

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What do you moisturize your vagina with?

Using a vaginal moisturizer is your best bet to effectively and safely moisturize your vaginal region. Vaginal moisturizers can last up to 3 days but the recommended application for vaginal moisturizer is every second day during your first week of use, and then twice a week every week after that until symptoms are resolved.

Things Not to Use as Vaginal Moisturizer

When choosing products for vaginal moisturization avoid products that don’t have natural ingredients.

A short list that can help is to avoid products that have:

  • Deodorants
  • Perfumes
  • Parabens
  • Sulfates

You shouldn’t use deodorants because they often contain carcinogens that can negatively affect your genitals.  Deodorants which contain soap or alcohol mess with the naturally occurring pH balance of your vagina.

Perfumes disrupt the vagina’s natural pH, which helps regulate healthy bacteria. Water is enough to wash and clean the external parts of the vagina effectively, and natural soaps are also fine to use.

Parabens are a preservatives often used to prevent overgrowth of bacteria in personal care products and are also a common component of many commercial lubes. Parabens can penetrate the skin and act like a very weak estrogen in the body — potentially turning on the growth of hormone-receptor-positive.

Sulfates are most commonly the key ingredient in shampoos, body washes, intimate washes, toothpaste, facial cleansers and much more. Sulphates cause skin irritation to skin and are too aggressive for the delicate skin of the pelvic floor.

Telehealth Physical Therapy in Response to COVID-19

telehealth lake city pt

Due to the current nature of our national and international health care crisis, our physical therapy profession and businesses have been designated as “essential healthcare” for our communities. Therefore we need to have way to stay connected to our patients so they continue to have the highest quality of life.   

As evidenced to me today, we still need to be in a relationship with each other, even as you “shelter in place”. We know your healthcare challenges did not go away just because of this crisis. 

As a result of your needs we have trained our highly talented group of physical therapists to provide “Telehealth” to our community of patients. Our Physical Therapists can assist you with education to address your medical concerns with your musculoskeletal system, we can teach you self care modalities — such as how to use specific techniques to help ease your pain. 

We have free resources online, and can deliver exercises such as stretching and strengthening to you via our free app.  

We have the ability to progress your physical therapy program by using a HIPPA compliant medical portal where we will be able to video chat with you in real time, so you can ask questions and get answers, all within the safety and comfort of your home. 

We understand that having health issues during this time is stressful and it is easy to feel alone and unheard. 

We want our patients to know that we are here for them so that their fear and stress can be decreased and they can continue to thrive for their themselves, their families and this community. 

We can help through Telehealth! 

Use the form below to schedule an Telehealth appointment.

lake city physical therapy sheree dibiaseAuthor Bio:

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can help you with your telehealth physical therapy needs. Sheree has 35+ years of physical therapy experience — 30+ of those years spent in private practice. She owns and manages 4 clinics in the greater Spokane/CDA area. Schedule an appointment –

What is the Lymph System

The Lymph system is a major system in our body that probably is the least understood and one of the systems that is barely talked about in health care today. However, really it is of vital importance on a daily basis for our health and overall well-being. The lymph systems primary function is to protect the body from infection and disease via the immune response system according to the National Lymphedema Network. It does this by the production, maintenance and distribution of lymphocytes. The lymphocytes are the “infection fighting cells.”

The spleen and thymus gland produce the lymphocytes. These cells then fight the unhealthy cells and they are transported by little watersheds and vessels to the bloodstream and ultimately flushed out of the body. The Lymph system could be called the body’s own “garbage disposal system,” it gets rid of all the junk.

The lymph system is made up of more than 700-800 lymph nodes throughout the body.

There are chains of nodes and then clusters of nodes in strategic areas. The clusters are located in a specific area to protect that area from invasion. For example, when you get a sore throat often you will often have enlarged lymph nodes on either side of your neck. These nodes collect and filter the waste, and regulate the protein levels, so we know we are “fighting off something” when they are enlarged.

The lymph system has lymph fluid that is clear and colorless. It is made up of protein, water, cellular debris and fatty acids. Now imagine the lymph vessels as a stream, which runs in one direction. They have a one-way value only and this pushes the lymph in that direction. All streams run back toward the heart. So the bloodstream needs to be able to handle the load each day of the lymph cleaning system. The lymph fluid can be mobilized by massage, compression; the “muscle pump” which is why exercising is so important, external pressure, breathing patterns, etc.

If the lymph fluid builds up in the tissue and is not flushed each day, as it should be it could harden the surrounding tissue. It also loves to bind to the fatty tissue and then it is especially hard to mobilize. The skin integrity is then compromised due to too much fluid and breakdown of the tissues can occur and then the efficiency of the muscle pump decreases. The lymph vessels will dilate and the one-way values cease to function and the area becomes swollen. This can happen anytime there is any accumulation of swelling, whether from an injury, a bruise, a localized tendonitis or post-surgically. You do not want fluid that is ever stagnant, because that is where infection can brew.

When the body is functioning efficiently the lymph system will activate itself no problem. However, if nodes have been damaged or destroyed as with radiation or surgical lines that interrupt the lymph streams flow pattern, then the lymph system cannot handle the load and will shut down. We see fluid get backed up behind C-sections scar lines, and even edema from a total joint.

If this happens to you do not be dismayed. There are things you can do to mobilize the flow of protein rich fluid. The first thing to do some very basic things like drinking more water, up to eight glasses a day. Decreasing your sodium intake to below 1,800mg a day (the average American consumes 3,500mmg a day). Stop smoking because this slows the lymph system down and decreases tissue healing.

Make sure you are sleeping at least eight hours a night to ensure the body’s healing mechanisms. Then increase your leafy greens veggies, fruits and decrease all processed foods to a minimum.

Next seek the assistance of your physical therapist, which has been specifically educated in the care of the lymph system. Remember, the lymph system can be trained how to move fluid around areas of scarring. We also teach the system how to transport edema around an area that there is restriction with four specific steps.

The four steps include specific muscle pump strategies, compression techniques or kinsiotex taping, manual lymph drainage massage and meticulous skin care. The therapists who are trained in edema reduction know and use these steps to assist the lymph system in re-booting itself whether it is from an orthopedic, cancer or immune system related problem. Please know your therapists can get your lymph system back on track.

Sheree DiBiase is a licensed physical therapist and the owner of Lake City Orthopedic and Sports Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.

Anatomy of the Lymphatics

1) The initial lymphatics are endothelial vessels converging to form collecting lymphatics. The linings of the initial lymphatics have a high endothelial layer but no pericytes or smooth muscle media. They form a 3 dimensional plexus – like patterns within the connective tissue. The walls of these initial lymphatics have a one-way valve system. The valves prevent the reversal of the flow pattern. They are anchored by filaments to the connective tissues. The molecular structure of the vessels is similar to the anchoring filaments. The initial lymphatics collect interstitial fluid, proteins, lipids, colloids and cells. They feed into the contractile lymphatics, which has smooth muscle media. The unidirectional flow pattern happens here at this level. Since they have no smooth muscle media they depend on neighboring tissue structures for expansion and compression. This occurs by rhythmic deformation in 4 easy ways- skeletal muscle movements, arterial pulse and vasomotion, intestinal peristalsis and skin massage.


2) Collecting Lymphatics – The collectors have a sympathetic motor innervation. The values are bicuspid. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers. Collectors walls have 3 layers. Tunica intima, tunica media, tunica adventitia. In the tunica intima the endothelial cells have a cuboid/rhomboid shapes. There is a nuclear bulge in the lumen. In the cytoplasm there are vesicles, ribosomes and cytoplasmic filaments. Mitochondris Gogi app, centrioles and multivesicular bodies are in the cytocentrum. In the tunica media there are long smooth fusiform muscles cells that are essential to its function. Between the endothelium and the tunica media is an elastic membrane.


Open junctions are not present in the collectors. The adventitial layer has fibroblasts, collagen fibers and fiber bundles loosely arranged and parallel to the axis of the vessel. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers.


3) Lymphangions – In the collecting lympatics each vascular segment between 2 sets of valves represents the morphofunctional unit called a lymphangion. The contractions of smooth muscles of the lymphangion play a decisive role in lymph transport. It resembles small hearts.


4) Lymph nodes – They are peripheral and secondary lymph organs, along with the spleen, tonsils and lymphatic tissues of the mucous membranes. The nodes are present in groups or chains along the blood vessels. Their number size and form vary. The lymph node is encapsulated by an outer layer of collagen fibers. Blood vessels and efferent lymph vessels leave via the hilum. The internal framework is composed of trabeculae. Some trabeculae carry vessels from the capsule to the hilum. Between trabeculae there are reticular cells and reticular fibers. The space is filled with lymphatic tissue. The lymph traverses the nodes via the sinus system. The afferent collectors penetrate in the node through the capsule to peripheral sinus. Lymph runs from the peripheral sinus to the medullar sinus. At the hilum the medullar and peripheral sinuses combine to form a terminal sinus form the efferent lymph vessels originate.


Lymph node function: The lymph nodes are biological filtering stations. The phagocytic action of the macrophages cleanses the system of bacteria, cell debris, antigens and corpuscular elements. The lymph nodes produce lymphocytes. The lymph nodes regulate the protein content of the lymph, so that is the same as the intercellular fluid. The most significant changes in the lymph fluid occur there. They are like fluid exchange chambers where the protein concentration is established so there is equilibrium as Starlings law suggests.


Lymphatic pathways of UE-Lower arm to elbow – 4 primary-anterio-lateral and anterio-medial, posterio-lateral and posterior-medial.


4 secondary-bicepital, anterio-medial basilic, anterio-lateral cephalic and posterior triceptial Caplans pathway.


The cephalic pathway has 3 routes – to cephalic vein to nodes in axilla, across clavicle to C/S transverse nodes, to the clavicopecotoral group of the cephalic lymph nodes.


Lymphatic pathways of the LE – The superficial bundle: The ventromedial bundle – greater saphenous vein, the dorso-meidal bundle lesser saphenous vein.


The deep bundles: the anterior tibialis bundle, the posterior tibialis bundle.


(Lymph nodes of the LE. There are Superfical nodes there are upper and lower groups and Deep inguinal nodes that follow the femoral vein.)


Lymphedema is a collection of protein rich fluid caused by reduced transport capacity with insufficient tissue proteolytic activity in the face of a normal lymphatic load as defined by Foldi. It is an accumulation of water, proteins and in increase in cellular and ground matrix.


Unilateral Chronic Lymphedema clinical findings:


1) Pain is not constant


2) Positive stemmer sign


3) Fibrosis – development of fatty tissue


4) Papillomatosis


Lipedema: Edema that is caused by abnormal adipose deposits in the subcutaneous regions. It is usually bilateral in nature and affects mostly women. There is often a family history. There is no pitting signs, often associated with obesity and “orange peel ” at visual inspection and painful with pressure. Usually located between the pelvis and the ankle with sparing of the feet. Often it occurs 1-2 years after puberty.


Research for MLD-Leduc Method: The research method included using a Lymphoscintigraphy and a nanocolliod with TC 99 and a gamma camera to record activity. The call up maneuver enhanced the flow when applied proximally to the lymphedema. The reabsorption maneuver increased significantly the colloidial protein reabsorption. The call up maneuver will not enhance the flow if lymph nodes are in between the lymphatic site and the treated area. In 8/13 people a new pathway was established with MLD who underwent a min of 19 MLD RX’s. The study showed there is no contraindications in using MLD in people with heart failure or lower limb edema. It was shown that with the use of lymphoflouroscopy an increase in lymph flow was seen with the MLD and superficial mapping of the pathway could be seen as a result also. It is evident that MLD is a significant intervention for those with lymphedema and can be used alone as a source of treatment with good results.


Research for MCB-Leduc Method: They researched whether MCB with muscular contractions would effectively decrease lymphedema. They used a pressure transducer at the skin/bandage region to record the results and a hand held manometer to do the repeated contractions with. Then they were able to track the labeled colloids at the axilla and it was statistically significant. An increase in activity occurred at 6 min and 40 secs aft her the beginning of the exercise and this increased remained after the exercise was done. It was noted that when muscle contractions were done in the limb with the MCB in place an increase in colloid reabsorption and transport occurred. In those who only did a muscular contraction with no MCB in place no noted increase in transport occurred. It is recommended to limit the use of MCB with those suffering from lower limb lymphedema.


A study was also done on the types of bandages to use. The pressure was measured at he interface between the bandage and the limb. When the MLB was used the increase was significant at rhe interface and increased tension in the limb. In the elastic bandages it increased pressure at the interface and then plateaued.


Contraindications to MLB:


1) DLA, erysipelas


2) Cardiac condition


3) DVT


4) Arterial perfusions impairment


Contraindications to Pneumatic Pump:


1) DLA, erysipelas


2) Cardiac condition


3) DVT


4) Arterial perfusions impairment


Sheree DiBiase, PT, and her staff can be reached at (208) 667-1988 and they can help you with your physical health challenges. Never give up on your health. It’s your prized possession. Lake City Physical Therapy.


Lymphedema affects approximately two million people in the United States. Its incidence is on the rise because each year approximately 500,000 Americans will be treated for some type of cancer that will be treated for some removal or the destruction of their lymph nodes. One out of every five of those people will then develop lymphedema.


Lymphedema occurs when the normal drainage of fluid in our body is disrupted. As the fluid accumulates, the area will become red, hot, swollen and painful. Often the arm or leg will double in size. In a normal lymph system, the body utilizes a network of nodes and ducts. Those nodes and ducts maintain the balance of the body’s fluid, they filter our waste products and fight bacteria.


However, when lymph nodes have been removed or destroyed by radiation this lymphatic system loses its ability to maintain this delicate fluid balance. As a result, there is an accumulation of protein-rich fluid that becomes a breeding ground for bacteria. If this swelling in the tissue is left untreated, it can lead to permanent tissue damage, scarring and long-term disability.


Presently, it is seen most often in women who have had breast cancer surgery where lymph nodes have been removed and radiation therapy has been done. This swelling in their arms can occur weeks, months or even years later after surgery.


That is exactly what happened for Sarah Micheals. She had decided to take an airplane trip to New York City to visit her daughter. Five years earlier she had breast cancer surgery and had been doing just fine since then. However, the next morning after she woke up at her daughter’s home, something just didn’t seem right. She felt like she was getting the flu. Her body ached and her right arm had a strange red streak on it. Throughout the day the pain in her arm became worse and her arm started to swell. She got so swollen she could barely hold her coffee cup and she had to remove her rings. Finally her daughter took her to the ER, where it was discovered she was suffering from an infection in that arm resulting from lymphedema. She was given antibiotics, which cured the infection, however, the swelling in her arm remained. She then was referred to physical therapy for treatment of the swelling.


Physical therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM), Medical Compressions Bandaging (MCB), special exercises that milk the lymph system and supplement the massage, skin care and treatment of any infections.


The physical therapy care will help decongest the swollen body part, eliminate fiber tissue and improve the immune system function. Once the body part has reduced in size a protective garment needs to be worn on that extremity to avoid re-accumulation of that lymph fluid. This protective garment helps to maintain the natural fluid balance of the affected body part.


If you are a cancer patient who has had any lymph nodes removed or radiated here are some guidelines you should follow in order to prevent this chronic, progressive disease.


• Wear a protective garment for flying of when doing any new actives you are not accustomed to.


• Wear gloves during household chores or gardening to avoid minor cuts, animal scratches, bug bites and puncture wounds. Use antibacterial ointment right away if you do get a wound and consult your physician immediately.


• Avoid injections and blood pressure monitoring on the body part.


• Exercise at a moderate pace and keep “muscle pump” active. (Swimming in 75 to 85 degree F water is one of the best forms of exercise due to the natural pressure gradient in the water).


• Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun exposure.


• Avoid any deep tissue massage.


• Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your rings and watch on other extremity.


• Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and nicotine.


• Keep skin clean and well moisturized. Use electric razors only.


If you have further questions regarding Lymphedema or you are wondering whether you have this disease, you can go online to the National Lymphedema Network at or call them at (800) 541-3259.


Sheree DiBiase, PT, is a licensed physical therapist and the owner of Lake City Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.


October is Breast Cancer Month. Breast cancer continues to affect too many of our friends and family members and the women we are doing life with everyday. The whole reason we take this month is to prevent and eradicate breast cancer. It is so we can tell all the women we know and love that we need to be proactive in preventive measures and to be there for each other if we do get breast cancer.


I just had a lovely woman who would tell you that you being too busy for a breast exam should not be an excuse. She learned to not put off her mammogram because it can give the vital information we need quickly and accurately. In her case, they caught a very small tumor that was very aggressive during a routine mammogram and as a result she will have great outcomes.


As Physical Therapists we play a role in caring for breast cancer patients. We usually see our patients about 12-14 days after surgery or once their drains are removed. We focus on getting their arms moving again and on restoring their overall strength with everyday activities. We educate our patients on skin care and scar mobility so edema doesn’t build-up in that area. Then we screen all patients for possible lymphedema issues from a long-term perspective so that they can be active in understanding symptoms such as pressure and “feelings of fullness” around the breast, chest or arm.


The two main reasons that you would get Lymphedema following breast cancer is:


If you had Lymph nodes removed, whether sentinel node, three nodes or all nodes removed, and radiation.


Often our patients have never heard of lymphedema or the possibility of lymphedema. Prevention now is the key. The more you know about the likelihood of it the more you can prevent it. If they do have lymphedema issues then there are easy steps that can be followed to ensure the proper care of this problem.


Lymphedema can be taken care of with Four Simple Steps:


1) Massage every day – Learn how to re-direct the lymph fluid to a new area around the area where the nodes were removed. Keep the scar lines mobile so that no fluid gets backed up behind the scar region.


2) Exercise on a daily basis – Learn special exercises that pump the lymph system and keep it moving where it should go.


3) Good Skin care – Keeping the skin in the area of where the lymphedema is located soft and pliable.


4) Use of compression sleeves – Use of garments especially during high risk activities such as flying, going over the pass and repetitive workloads.


Sheree DiBiase, PT, is a breast cancer specialist and she is the owner of Lake City Physical Therapy

. She and her staff treat breast cancer patients everyday. Please call or come in if you have questions or you are just not sure what to do, we can help. On Oct. 17 we will have a free educational class for anyone with Breast Cancer at 6 p.m. in our Coeur d’Alene office. Please call (208) 667-1988 to attend.


Who doesn’t love a good story! Especially one with adventure, a hero and heroine and all that stuff. Well growing up in my big Italian family we would often sit around the dinner table after church and talk the afternoon away. We heard all the adventures of our family’s life. My aunts, uncles and family friends would share funny and often amazing tales of their life. As kids, we would hang on their every word, even if the story seemed to get embellished as the years went on.


Now that I am a physical therapist I hear peoples stories everyday. And just for the record, they always amaze me. This window into a person’s life shows me so many things. I see their character, and drive to live life fully. The most amazing stories I am told often happen when my patients are under great adversity. Like when one of my patients was on vacation here from Guatemala and she had some pain in her chest and went to Urgent Care. It wasn’t what she thought they would find, but it was a tumor 5 cms in size. She had gone to the doctor in her hometown numerous times about this pain, but they told her it was nothing to worry about. She is so thankful she came to the states for a visit.


Or another one of my patients who was at the courthouse taking care of some business when a woman she didn’t even know, who had recently had breast cancer said to her “How long it had been since you have had a mammogram? You should have one right away, don’t wait.” And sure enough this woman went and had a mammo and she had early stage breast cancer. I mean who would think that a woman you don’t even know could save your life.


So here I am asking you the same thing. This is Breast Cancer Awareness Month and it is the time to tell all these stories so that we can help save people’s lives. Do not become too busy for your health. A few weeks ago I met a woman who has family who has a history of breast cancer and she got so busy in her life she hadn’t had a mammo in three years. When she finally got around to it, they found a tumor the size of a walnut deep in her chest wall. She had never even noticed it.


The National Cancer Society recommends the following when it comes to Breast Cancer Awareness:


1) Know your risks – is there a family history?


2) Get screenings – mammograms and breast exams, talk with your doctor about any abnormalities.


3) Know your body – you will notice tissue changes or lumps in your breast.


4) Make healthy lifestyle choices – what you eat, drink and how much sleep and exercise you get everyday makes a difference.


A story in past generations was how we learned valuable lessons. A story today could help save other women’s lives. Please keep telling your stories. We would like to be able to eradicate breast cancer and you are part of that story.


Sheree DiBiase, PT, can be reached at Lake City Physical Therapy

, (208) 667-1988. She and her staff are breast cancer specialists and having been caring for cancer patients in Coeur d’Alene and the Spokane Valley for more than 15 years.