Hot Topics in Physical Therapy: Caring for the Perimenopausal Patient

My journey towards becoming a pelvic health PT began with my own path towards motherhood.  I got pregnant and got curious about preventing injury in myself both during and after delivery.  Over time, I began to collect skills to serve pregnant and post-partum people at the clinic, and it became an area of specialty.  Those skills expanded to include persons without children with pelvic pain, constipation, erectile dysfunction, etc. but the vast majority of my patients in this space were under 40.  Then something interesting happened…I got older, and so did my clients.   One of the gifts of being a physical therapist is forming relationships with people in your community, and serving as a care provider for them intermittently throughout their lifetime.  I noticed that the people I once cared for in the early days of parenthood were now corralling teenagers.  There was a group of clients returning to the office in their 40s and 50s with new symptoms and new concerns.  They were people entering the phase of life described as perimenopause, and they had questions.  As it happens, so did I.   If menopause describes the phase of life when one no longer menstruates, perimenopause is the time that […]


Given what we now know of the role of the pelvic floor muscle network, it would make sense that dysfunction could vary widely in presentation and that the avenues for treatment equally as numerous. Direct dysfunction of these muscles can contribute to loss of bowel/bladder control, constipation, urinary and bowel urgency/frequency, pelvic pain, diminished sexual appreciation or pain with intercourse, pelvic organ prolapse, and lumbo-pelvic-hip control issues.


The genesis for this blog occurred after I attended a birthing preparation course taught by Ashley Brichter at Birth Smarter. This organization has virtual and in person childbirth education classes for expectant parents and professionals. Despite being 5 years removed from having children myself, I found the educational review helpful for my professional practice. It reminded me that understanding the anatomy of a vaginal childbirth can gift the expectant parent with tools to improve the birthing experience.


In a broad sense, I have been amazed at the continued support that the Thrive staff has provided and received since our physical closure. I find myself in regular communication with my patients, and am bolstered each time I hear from them. They have emailed me: recipes, educational websites for children, mindfulness apps, yoga flows to calm you down, yoga flows to pump you up, books for when you’re sad, books for when you’re happy, books for when you’re too tired to read hard books, podcasts, TED Talks, and no less than 50 assorted Netflix suggestions.


We at Thrive are so fortune to collaborate with many types of rehabilitation, exercise, and movement specialists in the New York City area.  Pilates has long been one of our staff’s preferred exercise tools, and we dearly love and appreciate the expertise of the staff at Mongoose Bodyworks, a Pilates studio that is neighbor to our clinic here in Soho. Over the years we have found our mutual clients achieve more success in movement, return to activity, and engagement in life when we collaborate, and the conversation below is an edited version of a dialogue between Mongoose Bodyworks owner Halle Clarke and Thrive PT staffer Elizabeth D’Annunzio Shah.   Halle: Hi!  When we decided to have a conversation, we talked about many areas of professional overlap.  There’s lots of crossover between what you and I do! Elizabeth: That’s right.  Ultimately, both PTs and Pilates instructors spend a fair amount of time doing movement analysis.  We’re both trying to enable multi-dimensional, pain free movement. Halle: In the spirit of that crossover, I have some questions for you that I thought might relate to both of our client populations.   Specifically, let’s talk about breathing.  How do you think about breathing as it […]


We at Thrive are ready to help meet the needs of pre and postpartum women and are launching a comprehensive rehabilitation and wellness program. We are looking forward to helping women stay strong and pain free during pregnancy, maintain safe exercise practices pre and post birth, and rehabilitate from injury. Our services will include a full musculoskeletal evaluation and examination for a wide variety of issues relevant to women.

Diastasis Recti Treatment: Emphasizing an Individualized Approach

There is no such thing as a one size fits all approach to diastasis recti (DRA) management. Just as no two persons are the same, no two DRAs are either. The separation of the linea alba often times reflects dysfunction, but what generates and perpetuates said dysfunction is different in all people. While this may seem obvious, many people come to me seeking a quick fix, or looking for the internet resource, book, or exercise DVD that will solve all their problems. While there are some wonderful resources out there, ultimately creating an individualized approach to DRA management based on the patient’s unique physical attributes, activity requirements, and goals is the best way to enable healing.

Lower Back Pain and the Case for Early PT Intervention

Hello friends.  It’s that time again…a new year!  With it comes the promise of new commitments, resolutions made for health and fitness, and renewed zeal and engagement in activity .  We at Thrive want to be part of your move towards greater activity, and are here as your musculoskeletal experts to answer questions, prepare you for sport, and help you heal aches and pains.   That said, I must warn you of a lurking impediment to your wellness.  You’ve guessed it, the NEW DEDUCTIBLE.  Spending time and money on your care is less appealing when it’s an out of pocket cost, and we are intimately familiar with financial stressors and the challenge to access care when it’s at your own expense. So, without further ado, I am going to make the case for coming to physical therapy (PT) early, and argue why it might save you money, lost time, and pain (both literal and figurative) on the back end.  For the purposes of discussion, we’ll focus on low back pain management. Anecdotally and empirically, back pain is one of the leading reasons persons come in to PT.  In addition to being difficult physically, emotionally, and financially on the individual, it’s can […]

What to Expect At Vestibular and Balance Physical Therapy

As a physical therapist that treats persons with dizziness and balance deficits, I’ve come to realize that people do not know what to expect when they attend physical therapy (PT) for these issues. Due to the lack of exposure to this treatment and unfamiliarity with how it works, people come to their first session with trepidation and fear. So, let’s see what I can do to clear up some of your queries and give a more clear vision of what will occur in PT. WHY DO PEOPLE GET DIZZY? There are so many reasons! As I’ve previously mentioned in an earlier blog post, some of the reasons are: • Inner ear dysfunction having to do with loose calcium deposits. This condition is called Benign Paroxysmal Positional Vertigo (BPPV) • Nerve changes in the inner ear, often but not always associated with aging • Fluid imbalance in the inner ear, called Meniere’s Disease • Strokes in the part of the brain called the cerebellum • On rare occasion, tumors • Concussions Each of these issues requires a different management strategy. Some are movements meant to shoo the calcium deposits out of the canals, and others are aimed at getting your brain […]

Who Are Physical Therapists, What Do We Do, and How Are We Unique in the Medical Landscape?

Hello out there, Thrive loyalists.  To those of you who spend much time inside our clinic, you might find this blog topic odd given your familiarity with physical therapy.  That said, I have many times been asked, by persons I’m in process of evaluating, what IS physical therapy?  I grew up with a physical therapist (PT) as a mom, so for me the idea that one doesn’t know what we do is foreign.  I suppose I’ve always had proximity to the profession.  It has come to my attention that, while I’ve been in and around PT gyms forever, that’s not true for many.  So, I’m writing this to give some clarity to those out there who wonder what exactly we are qualified to do and how we fit into the wellness and rehabilitation realm. WHO ARE PHYSICAL THERAPISTS? PTs are, by and large, persons with a passion for PEOPLE, science, movement theory, rehabilitation, and often times exercise.  All PTs graduated in the past 10 years have clinical doctorates (DPTs), making them Doctors of Physical Therapy.  This means that, including clinical internships, PTs go to school for roughly 7 years.  Prior to making the DPT the entry-level degree, persons graduated with […]