Congratulations to our PT aides on their acceptances into Physical Therapy School! Clare will attend Mount St. Mary's and Niko will attend SDSU, both starting Fall 2017. Alliena is currently attending PTA school at Concorde.

Have you or a loved one had a fall in the past year?

What about a near fall? When was the last time that you had your balance assessed by a healthcare professional? According to the San Diego Fall Prevention Task Force, one in 3 adults over the age of 65 falls each year, and according to the CDC, the cost of falls for Medicare patients alone in 2015 was more than $31 billion! And falls can cost us in more ways than one. Many previously active individuals who have had a past fall, especially one with an injury involved, become more fearful of falling again. As a result, they may stop participating in the activities that they used to enjoy, becoming less active, social, and spending more time at home. As result of decreased activity, one's muscles can become weak, leading to further impairment in one's balance and stability, which further increases one's fall risk. It becomes a vicious cycle.

We use 3 body systems to maintain upright balance:
  1. our vision
  2. the vestibular system (the inner ear)
  3. proprioception (what we feel through our joints)
As we age, our vision and mobility tend to decline, putting us at an increased risk of losing our balance and falling. Certain medications may also affect our mobility due to potential side effects such as lethargy or dizziness, and environmental factors including throw rugs, uneven terrain, and steps and stairways can place us at an increased risk of losing our balance and falling.

Fall risk, however, can be minimized by taking the correct actions. Staying active through regular exercise is important to maintain strength. It is also important to have your vision checked annually, and to talk with you physician regarding any medications that you are taking and the potential side effects. Also, clearing spaces in walkways around the home, not leaving clutter on the floor that could be tripped over, clearly marking steps down from one room to another, and having good lighting around the house can help to reduce the risk of falling. If you or a loved one are concerned about balance or have had a fall or a near fall in the past, talk to your doctor or physical therapist regarding exercises and strategies in order to improve your balance and safety.
Toni Flynn, DPT
I had the privilege of attending the first-ever Spinning Babies World Confluence last September in St. Paul, MN. I am a certified birth doula (as well as a women's health/pelvic floor PT), so I am keenly interested in how pelvic structure and function interact with the process of vaginal birth.

For those of you who may not have heard about Spinning Babies before, it is a series of techniques designed and gathered by midwife Gail Tully that promote optimal alignment of the baby within the mother's pelvis.

One focus of Spinning Babies is techniques to release restrictions in the soft tissue of the pelvis (muscles, tendons, ligaments, and fascia), which in turn improves pelvic mobility and balance.  As Gail puts it, "Babies get into the best position they can in the space they have available," so with more pelvic mobility and space, babies can get into better positions for birth, including often flipping from breech presentation (feet-first) to vertex presentation (head-first). The other focus of Spinning Babies is preserving and promoting the science and art of vaginal breech birth among midwives and obstetricians.
I attended a variety of excellent classes at the conference. I learned new pelvic release techniques from midwives and from massage therapists, which I have found are helpful not only for pregnant patients, but also for both male and female patients with pelvic pain. I learned to teach women to think of the vagina as a space instead of a structure, a space that has the potential to change. I heard Penny Simkin, PT, one of the founders of the doula movement, speak about the importance of parents singing to their babies in utero, so that the parents' singing can be used to reassure the baby in the event of a difficult birth.

I heard Anke Reitter, MD, a German obstetrician who specializes in vaginal breech birth in a hospital setting, speak about the importance of giving all women with breech babies the options of:
  1. external cephalic version (manually turning the baby)
  2. vaginal breech birth
  3. cesarean birth when labor starts
All three of these options are not commonly available to women, even in the US, and Dr. Reitter is passionate about educating obstetricians about this optimal standard of care for women, and about the effect of pelvic movement on fetal positioning, which has been demonstrated through MRI research.

The conference was exciting and energizing. I met nurses, doulas, midwives, obstetricians, and massage therapists from all over the world, who are all realizing the importance of good pelvic alignment and mobility during the birth process. I was the only PT in attendance (besides Penny Simkin), but I advocated for pelvic PT at every opportunity, and educated people about the relationship between pre-pregnancy musculoskeletal dysfunction and problems during the birth process, which is a connection that I have seen over and over again with my patients. I came away from the conference encouraged, by seeing this new paradigm being spread through such a variety of maternity health care providers and bodyworkers.

If you know any pregnant women, please let them know about the resources available through Spinning Babies ( spinningbabies.com) and the importance of good pelvic alignment and mobility to the birth process. And as always, any of the pelvic PTs at CTS are ready to help anyone (pregnant or not) improve their pelvic and musculoskeletal health and wellness!
Katherine Dahl, PT, MPT, CD(DONA)