Balance, Bladder Control and Chronic Pain
Published October 2021
When you think of physical therapy (PT), you likely think about recovery from a surgery or an injury. But, PT can offer much more.
Here are three surprising things PT can help you with.
1. Vertigo and Balance Issues
If you feel dizzy or off balance, have vertigo (feeling like the room is spinning) or fall often, a physical therapist who specializes in vestibular rehabilitation can help.
Balance issues can be caused by the:
- Visual system: Knowing where your body is in relation to the horizon.
- Somatosensory system: Special sensors in your brain that tell you where your body is in space.
- Vestibular system: Balance organs in the inner ear that tell the brain about the movements and positions of your head. The vestibular system keeps your eyes focused. It can also tell your brain if you are moving in a straight line, like when you are riding in a car or going up and down in an elevator.
Your physical therapist may give you exercises that address how one of these systems work. Or, they may give you exercises that help how your body uses the systems together.
"Falls and dizziness are common among people ages 65 and older, but falling should not be thought of as a normal thing that happens as we age," says Northwestern Medicine Physical Therapist Melissa Buckley, PT, MSPT, DPT, MHA. "Many patients in this age bracket feel that they just have to live with these symptoms and that is not true," she explains. "A physical therapist is trained to look at problems with walking and balance, and they can conduct fall risk assessments to improve quality of life."
2. Bladder Control
The pelvic floor is a hammock of muscular and connective tissue located in the lowest portion of the pelvis. It reaches from your tailbone to your pubic bone and between both of your hips. It helps support the organs in your pelvis, including your bladder, rectum and uterus (if present). Your pelvic floor is an important part of bowel and sexual function and bladder control. It is also part of your core and contributes to trunk and hip stabilization.
Pelvic floor physical therapy can help improve bladder control by:
- Retraining your bladder
- Addressing limitations in the muscles of your pelvic floor
- Improving the strength and flexibility of nearby muscle groups, including the hips and the core
- Adjusting the breathing and posture habits that might contribute to your bladder issues
- Treating bowel issues or pain that can impact bladder function
Pelvic floor therapy for bladder control may help people who have the following:
- Overactive bladder symptoms, including frequent urination or a strong and sudden urge to urinate
- Urge incontinence (urinary leakage while on the way to the bathroom)
- Stress incontinence (urinary leakage when coughing, sneezing, laughing or exercising)
- Straining to empty the bladder or feeling like you cannot fully empty the bladder
- Dripping or leakage after urination
- Needing to adjust fluid intake or bathroom trips around activity avoid to urinary symptoms
"A common misconception about PT and bladder control is that the pelvic muscles are weak and that strengthening the pelvic floor by squeezing the muscles (i.e., performing "Kegels") will improve symptoms," says Northwestern Medicine Physical Therapist Bridget McMillion, PT, DPT, WCS. "While deficits in pelvic muscle strength should be addressed, pelvic floor physical therapy goes far beyond teaching pelvic muscle exercises, and there is no 'one-size-fits-all' prescription."
3. Chronic Pain
Most people seek PT after an acute injury that causes pain. But, PT can also be a great tool for treating chronic pain. Chronic pain is pain you have had for more than three months. When you have had pain for this long, your nervous system starts to change to protect your body. It goes on high alert and becomes more sensitive to any sensation. Your brain starts to interpret any signal coming from the area causing you pain as pain, even if it is not. Activities of daily living, such as walking, performing household chores and even sitting at your desk can trigger pain, even though there is no new harm or damage occurring with these activities.
PT for chronic pain addresses the injury or area that is causing your pain. It also focuses on fixing the changes to the nervous system that continue to cause you more pain. It treats your whole body.
Your individualized PT plan for chronic pain may include:
- Stretching and strengthening the area causing you pain and the areas around it
- Manual treatment (hands-on therapy)
- Modalities like electrical stimulation, cupping, dry needling and cold laser therapy
- Physical exercises, such as walking, biking and swimming
- Breathing exercises and mindfulness strategies
- Desensitization and other techniques to retrain the nervous system
- Addressing sleep positioning and habits
- A consistent exercise plan
- At-home pain management techniques, such as doing exercises, using massagers and more
Anyone who has pain that does not resolve after more than a few weeks should seek medical attention, because studies have shown that early treatment and movement can help prevent chronic pain.
"The degree of injury does not always equal the degree of pain," says Northwestern Medicine Physical Therapist Lisa Schwarz, PT. "Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut)," Schwarz explains. "Diagnostic imaging results are not always an indication of pain and prognosis. Just because nothing shows up on the imaging, doesn't mean that PT can't help."
Are you interested in PT, but do not know where to start? Start with your primary care physician, who can refer you to a physical therapist for your unique needs.