By Jandra Mueller, DPT, MS, PHRC Encinitas
I’m Jandra, and I am a pelvic floor physical therapist here at PHRC, and the Director of PHRC Encinitas. I am very excited to announce that I have just completed my Master of Science degree in Integrative Health and Nutrition from Maryland University of Integrative Health.
A little about me: a few years ago I was on the doctor train, seeing multiple people for various GI issues, acne, and some pelvic pain issues, for what I eventually found out was actually due to endometriosis. I underwent endometriosis excision surgery which made a world of a difference for me. However, working with functional and integrative health practitioners and implementing nutritional interventions helped treat the numerous other pain generators I was experiencing like irritable bowel syndrome (IBS), small intestine bacterial overgrowth (SIBO), and hormone imbalances. Changing my diet reduced the systemic inflammation that was key to feeling better both before and after surgery. My experience made me realize that many patients I currently treat are experiencing a lot of the same issues! My personal experience prompted me to spend the last two years studying these disease processes and gaining understanding of how to help people with symptoms related to chronic inflammation and pain at a deeper level, really at the root cause of these issues.
You can also see my recent video post here on PHRC’s Instagram.
What is functional/integrative nutrition? What is an integrative nutritionist?
Functional nutrition, also referred to as integrative nutrition or holistic nutrition, puts the emphasis on the individual. The belief is that there are many “right” ways to approach functional health. Every person has a different genetic makeup, is exposed to different environmental factors, and has different preferences that will play a role in what type of diet they may need, or what other factors in their life are playing a role in their symptoms. It is about finding the right way for each person and using food and lifestyle changes to maximize the potential for health and help reverse dysfunction and disease.
Below is one of my favorite images, the institute of functional medicine tree. I love this visual because it truly depicts what I do!
The roots of the tree show the foundational factors we need to be healthy and disease free – sleep and relaxation, exercise and movement, nutrition, stress, and relationships. There are numerous studies looking at how each of these factors aid in our health.
Next, at the base of the trunk is our genetic make-up and our environmental factors. As we all know, our genetic make-up does not determine what we will or will not develop, but depending on a number of factors, it can play a role in what diseases we may experience – nature vs. nurture. For example, with endometriosis, many women are symptom free and others are in debilitating pain. There is absolutely no correlation between the extent of disease and a woman’s symptoms, why? The answer is because of various environmental factors that can influence how our genes express themselves.
Based on these foundational concepts, we have what are called antecedents, triggers, and mediators. When I evaluate my patients during a PT session, I ask “what was going on around the time you developed symptoms?” Many people respond that there was some sort of stressful event around the same time. Some make the connection that it could have been the triggering factor, others do not. But under the right circumstances, like a stressor to our body or mind – which can be a perceived stressor, like worrying about something happening – can actually cause our system to essentially “break down” and now we have symptoms, which you can see is next up the tree. Then the branches and leaves are all the various systems that make up our physical body that may be impacted due to an imbalance in our foundation.
Our bodies are complex systems that cannot fully be separated. This is a core difference between integrative or functional medicine compared to western medicine approaches – where you go to a gastrointestinal doctor for GI issues, the urologist for urinary issues, the gynecologist for your lady problems, the cardiologist for your heart issues. Our systems are so intertwined it is not effective to treat them independently.
What is involved in a nutrition session?
The intake forms. Our intake paperwork asks for a detailed history, the symptoms which led you to seek help, lab work and test results, medications and/or supplements you are currently taking, your health history both as a child and an adult, and your goals. Additionally, it will request a sample three day food history as well as questions about your sleep patterns, stressors, and a questionnaire about various symptoms you are having.
This gives me time to do some preliminary work and look at any micronutrients you may be lacking and get an idea of what may be going on from a nutritional standpoint.
The Evaluation. The initial evaluation is 90 minutes, one-on-one, and can be done in the office or by a virtual appointment. This is where we will go over your intake forms in depth and will discuss what is going on and create a plan for recovery.
What is included in the initial session? A full review and analysis of what may be going on from a digestive or nutritional aspect and how that may be impacting your symptoms. The treatment plan will also include recommendations for further lab testing that may be helpful (we utilize various tests that may be different than your regular doctor) and a meal plan recommendation that includes a 1-week plan designed specifically for you to help get you started. A number of resources such as handouts, food diaries, and educational materials will also be given to you based upon your specific needs.
Follow-up sessions. Follow-up sessions are 45 minutes during which we will review your plan and make any changes necessary based upon how you are doing as well as include more individualized meal plans that will be tailored to meet your needs. The number of follow-up sessions will vary based upon your needs and wants. Some people may just want an evaluation to see what it is all about and some folks may require regular visits for months based upon the complexity of their symptoms.
Here are what some people have had to say about their experience:
S.N.:
“I was diagnosed with Endometriosis in August last year. Like most people I would’ve taken the usual route of surgery if I didn’t come across yhr option of treating endo with integrative medicine, acupuncture and pelvic floor physiotherapy.
My main symptoms were pelvic pain, heavy bleeding and pain with sex, however once I began working with my doctor who specializes in integrative medicine for endometriosis, I understood the reason for other symptoms such as dysbiosis, blood sugar disregulation, chronic fatigue, Small Intestine Bacterial Overgrowth (SIBO) and weight gain also related to endo. To help relieve pelvic pain and pain with intercourse, I was referred to Dr. Jandra for pelvic floor physiotherapy. Her physiotherapy sessions that concentrated on my pelvic region and facia have considerably improved my pelvic pain. In addition to the physiotherapy, Dr. Jandra in coordination with my integrative medicine specialist also recommends dietary supplements to treat SIBO and other gastrointestinal symptoms commonly associated with endo.
It has been a rough ride, but looking back at how I was in August and comparing it with how I am now, I can confidently say I’ve come a long way. Endo and the lifestyle changes that come with it are slowly making me look and feel the best I’ve ever been. Although I have still not reached that stage of pain free periods, I am certain that I’m quite close to getting there. I wouldn’t have been able to get here if not for the terrific team of professionals supporting me to treat endo effectively and naturally from a whole body perspective. Dr. Jandra has been a huge part of my treatment in more than one way and I highly recommend her for any woman who needs help with treating endometriosis.”
E.B.:
“I have suffered from Stage IV Endometriosis, Adenomyosis, and Frozen Pelvis for 10 years. I learned of Jandra through a well-respected Endometriosis Specialist, Dr. Iris Orbuch. Before my second surgery I was able to get in with Jandra and I noticed a difference immediately. Needless to say this can be an awkward appointment to have, but she explained everything thoroughly before we started treatment and this put me at ease. I have recently started a nutrition and supplement program with her and feel confident that addressing both areas will help me be the best person I can be with this disease.”
How do I sign up?
I am currently taking virtual visits and you can sign up on our website which will allow you to schedule it directly. You do not need to be an existing PHRC patient to see me for my nutritional services. You will receive an email and a link to a portal in which you can fill out all the intake forms online as well as a link to the virtual session.
In order to sign up visit our website or click on the link here! https://pelvicpainrehab.com/nutrition/
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
dear dr. jandra
my poor daughter has been in extreme pain vaginally for a couple years. she’s young and her gyn doesn’t know what it is. can we speak with you please about her symptoms??
we need some real advice and validation.
sincerely, allie’s mom chris
Hi Christine,
It sounds like your daughter could benefit from pelvic floor physical therapy. If you would like to see Jandra, she is available for booking through this link https://pelvicpainrehab.com/nutrition/
I am very interested it nutritional counseling as I am really frustrated trying to coordinate bone health issues with thyroid , pelvic floor weakness , IBS and dysbiosis,
Hi Gayle,
If you are interested in nutritional counseling, we recommend you booking an appointment with our Nutritionist, Jandra Mueller. She is one of our pelvic floor physical therapists, with a speciality in Integrative Health & Nutrition. To book an appointment with her, use the following link https://pelvicpainrehab.com/nutrition/
Congratulations!! I am finishing my Master of Science in Yoga Therapy at MUIH in August. I just found this page as I am working with prenatal YT and I was seeking information to share on pelvic floor health. Small world!