Piriformis stretch to help with back pain

The piriformis stretch is a classic way to help mobilize and stretch the hips.

However, you do not want it to "pick" at your low back and irritate it!

Here is our approach to exercise prescription so you know not only where to FEEL exercises, but just as importantly, where NOT to feel exercises!

Back Pain Relief in Wake Forest, NC
Back Pain Relief in Wake Forest, NC

If you are seeking out ways to help your back pain, then give this exercise a shot!

However, if it just “picks” at your back and you are not getting the job done, then reach out to us to see if we can help you!

Movement is Medicine and Exercises can be great to help back pain. Sometimes it takes finding the right “cocktail” of different exercises for your condition based on your strength / flexibility and joint restrictions.

Harrison and Danielle Vaughan are Physical Therapists who co-own PhysioFit of North Carolina in Wake Forest, NC. We operate our small business with you in mind based on treating you with 1:1 services. If you are seeking out exercises for pain relief and other treatments for your pain, contact us to see if we are a right fit for you.

Can Dry Needling Help Peripheral Neuropathy

Common associated symptoms of peripheral neuropathy include numbness, tingling, burning, or even total loss of sensory function. These sensory changes can lead to limitations within activities of daily living, balance, gait mechanics, as well as overall quality of life. If peripheral neuropathy is not from Diabetes Mellitus, then the solutions to treatment are less concise and usually are medications aimed at managing symptoms.


Symptoms in the legs can include:

  • Burning sensation

  • Increased Warming sensation

  • Balance disturbances

  • Numbness

  • Tingling

Idiopathic peripheral neuropathy is a complex disease process with many uncertainties, and as a result, conventional treatment approaches may not resolve patient symptoms and restore function.

Physical therapy management for peripheral neuropathy comprises patient education, manual therapy directed at improving joint mobility, neural mobilizations, Dry Needling, ergonomic assessment, strengthening, stretching and modalities.

If typical approaches in physical therapy do not improve, a dry needling approach addressing neural and fasical restrictions down the limb into the painful areas can be an option. Peri-neural dry needling into myofascial trigger points in combination of neurodynamic exercises have been shown to be an effective approach in a 2019 case report.

In addition to improve strength and balance, any neural and vascular impairments can improve with dry needling treatment to specific regions of the body, which could help with sensory and motor function.

The conclusion from this study and from our own clinical research shows that dry needling treatment in patients with idiopathic peripheral neuropathy helps to mitigate sensory impairments and to potentially improve upon neural and vascular function. This can then help with pain, strength losses, balance disturbances and overall improvement in quality of life.

Dry Needling for Abdominal Pain

Abdominal pain can be difficult to differentiate between actual visceral organ versus muscular (myofascial) etiology. There are some clinical tests that can assist in a clinician ruling in more of a myofascial condition, but depending on the history and presenting symptoms, we do recommend consulting with your physician for a thorough abdominal examination.


With that said, many patients have ongoing abdominal pain that has been examined by a physician with appropriate tests and no findings. This type of presentation usually gives us the green light to examine myofascial trigger points as a potential trigger of abdominal pain. As the abdominal wall comprises mainly of skeletal muscles, the pain could arise from the specific Myofascial Trigger points. Myofascial Trigger Points are hyperirritable points in the skeletal muscle that is exquisitely tender in a palpable taut band, which can cause local and referred pain.

  • The patient generally has a nagging pain and at times may experience intense and deep-seated pain in the abdominal region.

    • Often, the patient can pinpoint the exact site of the pain.

This is usually overlooked in the medical field but even though this type of pain can be challenging, there are some treatment options.

Dry Needling in Wake Forest, NC

Dry needling is performed by using mono filament needle through the skin without introduction of any drug to stimulate myofascial trigger points and connective tissue for the management of neuromusculoskeletal pain.

Usually, the clinician will determine if if someone is appropriate for dry needling if the following criteria are met:

1) palpation of a taut band in a muscle

2) identification of an exquisitely tender nodule (MTrP) in the taut band

3) reproduction of the patient's symptomatic pain with sustained pressure.

Dry Needling therapy in resolving the myofascial abdominal pain. Dry Needling is less utilized in abdominal muscles compared to any other region in the body.

If you are dealing with chronic pain and looking for relief, contact us to see if we can help you.

PhysioFit of North Carolina is a physical therapy office in Wake Forest, NC offering different types of services including dry needling for chronic pain.

Dry Needling for Tension Type Headaches

Tension type headaches are one of the most common type of headaches in the United States. It receives much less attention from healthcare professionals and researchers than migraine does.  In fact, with the increase in stress to the neck and head with our postures at computer and other handheld devices now, the tension through the muscles of the neck and head can be higher than ever before.

Myofascial pain may play an important role in how headaches begin with tension-type headaches. It has been claimed that pain from the pericranial head, neck, and shoulder muscles is associated with the head and experienced as headache. This means that input from myofascial structures in places other than the location of your headache may be the reason for your headache.

Several muscles through myofascial trigger points can refer pain to the head. This includes the sternocleidomastoid, the upper trapezius, the temporalis, the masseter, and the suboccipital muscles (ones just below the skull).

The treatment for tension type headaches in physical therapy can include relaxation exercises, mobilization of the joints, myofascial release of the soft tissues and muscles and education on how to reduce stress and anxiety. Dry Needling can also be used to treat tension type headaches.

In 2019, a randomized, double-blind, parallel-group trial, aimed to explore the effectiveness of trigger point dry needling in patients with chronic tension-type headache in reducing headache frequency, intensity and duration, and improvement of health-related quality of life.

In the dry needling group, intensity, frequency and duration of headache and were significantly improved after treatment.

The results of this clinical trial suggest that trigger point dry needling in patients with chronic tension-type headache is effective and safe in reducing headache intensity, frequency and duration, and increasing health-related quality of life.

If you are having headaches and consider stress, anxiety and referral pain to your head pushing on different muscles in your neck and shoulders, you may be a good candidate for skilled dry needling services.

Dr. Harrison Vaughan is a physical therapist and co-owner of PhysioFit of North Carolina who performs dry needling, alongside other services, to help those suffering from headaches. Feel free to reach out to the practice to determine if you are a candidate for these services.

Plantar Fasciitis Diagnosis and Treatment

Plantar fasciitis is a very common foot condition that is treated by physical therapists. The current evidence suggests that this condition is not mainly characterized by inflammation but rather by degenerative changes in the plantar fascia. This may be a reason why your anti-inflammatory medications and ice are not working for your pain!

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Daily pain in the morning is usually the major complaint.

The pain is most noticeable when patients begin walking.

Plantar pain during the initial steps after a period of inactivity (such as getting up after sitting at your desk).

Pain can be worse at the beginning of workout (or exercise).

Tender location


Patients usually report pain after palpation of the proximal insertion of the plantar fascia and plantar medial heel.

Most tenderness can be found at the calcaneal tuberosity. 


Clinician techniques for plantar fasciitis treatment include:

  1. Passive joint manipulation of the ankle and foot

  2. Myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia. This can include:

    • Tool assisted soft tissue mobilization

    • Dry Needling

    • Cupping

  3. Neural mobilization of the tibial nerve

  4. Stretching of the plantar fascia and triceps surae.

  5. Taping to support the foot during the rehabilitation process

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Trigger Points

Muscle trigger points may be involved in the development of plantar heel pain and one specific way we improve your pain. Clinically, a trigger point is considered active when the pain referral elicited during examination reproduces any symptom experienced by the patient and is recognized as a familiar pain. A trigger point is considered latent when the referred pain does not reproduce any symptom experienced by a subject.

As the stiffness of Trigger Point taut bands is 50% greater than that of the surrounding tissue, it is probable that they induce an excessive tension on the calcaneal insertion, thereby contributing to plantar heel pain.

Most trigger points can be in the calf (gastrocnemius), inside of foot (flexor hallucis brevis) and under the foot (quadratus plantae).

The pain referral elicited by active trigger points in the foot and leg muscles can reproduce the pain symptoms experienced by people with plantar heel pain. If this is the case, this is a good sign! This means we have concrete substance to perform techniques to address the trigger points and find strategies to minimize how sensitive they are to prevent future occurrences.

Patient techniques for plantar fasciitis include:

  1. Stretching of the plantar fascia and triceps surae

  2. Strengthening of the triceps surae

  3. Strengthening of the intrinsic muscles of the foot

  4. Strengthening of the hip muscles

We usually find that combining manual therapy with exercises (if you feel them where you should!) is the most effective treatment for plantar fasciitis. We look at both muscle strength and flexibility. Motor disturbances, that is, muscle fatigue and accelerated fatigability, can be a factor in the rehabilitation. Additionally, muscle stiffness and tightness can be a major factor in rehabilitation.

Frequency of treatments

Typically, patients receive treatment regimens of 3 weekly sessions over a period of 3 weeks or 4 weekly sessions over 4 weeks.

In our clinic, we usually see someone once a week for this period of time. Reason we have less frequency of visits is that we spend an ENTIRE hour with you personally (no technicians or other patients right next to you). We value your time and commitment away from life to visit us to help you.

We have the ability to offer different treatment options. This is important to suit different patient requirements and to fit around patients. Some patients respond better to different techniques. We strive hard to find your “cocktail” so you can get better faster!

Contact us to learn more or go ahead and book an appointment to get relief!

We offer specialized, personal treatment in our office in Wake Forest, North Carolina.

Is walking good for me if I have knee arthritis?

This video blog talks about how long you should walk without having adverse events if you are having severe knee arthritis and also if walking backwards is more effective than walking forward!

If you are having knee arthritis or knee osteoarthritis, you don’t have to live in complete pain! There are also other options for you instead of having injections, taking medications all of the time and the ultimate decision, to avoid a total knee replacement.

If you want to start an exercise program but afraid as you do not want your knee to hurt more, or as we call it, “picking at your knee” —- then contact us to see if we are a right fit for you either in our 1:1 physical therapy appointments or small group fitness studio.

During our physical therapy treatments, we offer various manual therapy options including dry needling, knee mobilizations, stretching and strengthening. Our ultimate goal is to maximize the function of your knee and surrounding muscles/joints and allow you to be more active with less pain.

References for video blog:

Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial)

Conclusion: The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee arthritis.

The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial.

Conclusion: There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.

Avoid these Yoga postures if you have Osteoporosis or Osteopenia

Most injuries in Yoga are mild and can be attributed to “over-doing” the muscles. Mild muscle strains from myofascial overuse , or from “pushing” it too far, can certainly heal if managed correctly. These risks are usually benign but there could be more serious risks depending on your medical history. A more severe injury that is noted in the literature is a bony fracture.

Spinal Flexion Yoga Poses that load the anterior cervical spine, midthoracic, thoracolumbar, and upper lumbar spine are recommended to avoid. Most vertebral compression fractures occur in those areas.

Some of the poses can be fine if no additional loading is pushed through the spine. But, the weight of the body is also added in a closed kinetic chain, multiplying the amount of pressure that the vertebral body must withstand.

Here are two Yoga poses that we recommend you avoiding if you have Osteoporosis or Osteopenia.

Plough Pose - Yoga in Wake Forest, NC.  Recommend avoiding this pose if you have Osteoporosis or Osteopenia

Plough Pose - Yoga in Wake Forest, NC. Recommend avoiding this pose if you have Osteoporosis or Osteopenia

Seated Forward Fold Pose. Yoga in Wake Forest, NC.  Recommend avoiding this pose if you have Osteoporosis or Osteopenia.

Seated Forward Fold Pose. Yoga in Wake Forest, NC. Recommend avoiding this pose if you have Osteoporosis or Osteopenia.

We do not recommend anyone avoid Yoga (or any other exercise!), but we do recommend modifications if you have pain or at risk medically, such as if you have Osteoporosis or Osteopenia. We want you to protect your spine, shoulders, hips, and other musculoskeletal structures so you can keep staying active!

Therefore, here are some pose modifications you can do instead of the Plough and Seated Forward Fold!

Yoga in Wake Forest, NC.  PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Yoga in Wake Forest, NC. PhysioFit of North Carolina

Our goal is to help keep you moving and living an active lifestyle!

If you are looking for Yoga in Wake Forest, NC; I hope we can have you join us at our studio!

Be cautious with certain Yoga postures if you have Osteoporosis or Osteopenia

As physical therapists who own a Yoga studio and recommend this ancient practice to the general population, it is important for us to be aware of any risks associated with Yoga. The benefits of this exercise program certainly outweigh not doing anything at all!

But, we want to be able to inform participants and potential referral sources to our studio on Yoga injuries and any medical conditions that may put you at risk.


There have been multiple reports of injuries from Yoga ranging from mild muscle strains. These are usually in the shoulders, knees, hips, backs and wrists. Mild muscle strains from myofascial overuse , or from “pushing” it too far, can certainly heal if managed correctly. These risks are usually benign but there could be more serious risks depending on your medical history.


A more severe injury that is noted in the literature is a bony fracture. We are more concerned of those who are at risk of bony fractures. The biggest risk for this type of injury is if you have Osteoporosis and/or Osteopenia.

Women are also more affected by osteoporosis and osteopenia than men because of the changes associated with hormonal differences

Exercise can be great intervention for bone health for individuals who have Osteoporosis and Osteopenia, but we recommend avoiding extreme flexion and extension exercises of the spine. We call this “hyperflexion” and “hyperextension”.

In fact, a recent study by Lee et al 2019 from the Mayo Clinic found the following Yoga poses caused injuries when individuals were referred to a musculoskeletal specialist from his/her family doctor.

Yoga poses that caused injuries. Courtesy: Mayo Clinic

Yoga poses that caused injuries. Courtesy: Mayo Clinic


Most of the injuries came from the spinal flexion maneuvers. Spinal flexion exercises in yoga encourage spine flexibility through muscles and ligaments in the back column. Although a healthy spine can tolerate such postures with ease, an osteoporotic or osteopenic spine may have difficulty translating the forces.

From the study above, 29 of the 89 patients had bony injuries, not just muscles! We can deal with muscles but definitely do not want bony injuries! This was the largest description of yoga-induced vertebral injuries to date.

Several key aspects we recommend if you want to try Yoga:

  1. Be sure to let the instructor help you improve your form to decrease injury risk.

  2. If your joints/muscles do not feel “right”, as if you are pushing it too much, please ask for modifications of the poses.

    • Guided support will be given to each and every student, all levels are welcome.

  3. Consult your physician if you are concerned over Osteoporosis or Osteopenia to get a Bone Mineral Density Test through a Dexa-Scan (dual-energy X-ray absorptiometry or DXA).

  4. Once you are cleared to perform Yoga from your physician if you have Osteoporosis or Osteopenia, you could also consult one of our Physical Therapists to help guide you to a proper Yoga routine with recommendations on poses to avoid or modify.

    • At PhysioFit of North Carolina, we specialize in our “Feel it to Heal it Physio” Approach so you know what muscles you are supposed to be exercises during Yoga and even more importantly, what muscles you are not supposed to be working!


Our goal is to help keep you moving and living an active lifestyle!

Be sure to read our other blog posts on what Yoga poses to avoid if concerned of extreme spinal flexion and extension moments!

If you are looking for Yoga in Wake Forest, NC; I hope we can have you join us at our studio!

Instead of taking Opiods, try Dry Needling for Pain Reliev

Opioid addiction and abuse has become an epidemic, perhaps doing more harm than good. The use of an alternative method of treatment, in some cases, can aid in dramatically reducing the use of opioids.


Due to the side effects of taking opiods (nausea, constipation, vomiting, itching, respiratory depression, addiction, tolerance, and opioid- induced hyperalgesia), there has been a significant reduction in prescription of these drugs for chronic pain.

Many patients tell me that the drugs work but they don’t want to get addicted to them and even upset at physicians for not prescribing them!

From a Physical Therapist perspective, I always tell them that there are many side effects and the medical community is continuing to learn the bad effects of these drugs and continuing to look for other options to help people in pain! It is not that your physician wants you to be in pain, but he/she is looking after you!

What other options are available?

Dry needling has been utilized to help pain and has mechanisms similar to what opiods can do! In fact, the chemical mechanisms behind how dry needling works makes it a considerable substitute for opioid use with the benefit of lessening opioid addiction

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Dry needling seems to be effective method that allow patients to return to activities rather than stay sidelined by chronic pain and adverse effects of opioids.

It can be cost-effective and less harmful to the patient in that they allow the body to provide its pain relief. Dry needling appears to be a safe and efficacious alternative to opioids.

Dr. Harrison Vaughan, a physical therapist, utilizes dry needling in Wake Forest, NC alongside other orthopaedic manual therapy and exercise to help those suffering from pain. He and his wife have developed the Feel it to Heal it Physio approach to exercise so when you stretch or strengthen your muscles, you know that you are doing the right thing and not aggravating your symptoms!

With dry needling, we can help:

  • Low Back Pain

  • Sciatica

  • Cervical Radiculopathy

  • Chronic Hip Pain

  • Chronic Neck Pain

  • Headaches

At PhysioFit of North Carolina, we take a whole-body approach to addressing your pain and not just treating a local area of discomfort. We strive in providing quality work while developing positive relationships with our patients to help them live more comfortably.

Contact us to Learn more about our practice and how we can help you!

Pilates can help Fibromyalgia

Fibromyalgia is a rheumatologic disease with a range of symptoms such as fatigue, sleep disorders, morning stiffness, headache, and paresthesias.


One of the main pathophysiological mechanisms of fibromyalgia is central sensitization, defined as increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.

As a physical therapist, this type of condition can be very challenging as exercise and movements typically hurt. It takes time, patience and an effective exercise routine to help calm down the body and then build it back up.


Besides medication, exercise is the first choice of treatment. Aerobic exercise, such as walking, can be very beneficial to help with pain relief and build muscle.

However, we find that unless someone has a focused plan to help with walking, this activity compliance normally does not “stick” without any motivation or progression!

Pilates can help with pain


Besides individual physical therapy sessions for manual therapy, specific exercise and education, Pilates can be indicated to help with the pain from Fibromyalgia.

Group exercise can be cost-effective and can be time efficient way to help with pain and function. Pilates has also been shown to lead to greater adherence of continuing with an exercise program.

If you are looking for an exercise program to help improve pain associated with Fibromyalgia, PhysioFit of North Carolina has individual Physical Therapy sessions and we also offer group classes in Pilates and Yoga. The classes are intended to be more “gentler” than typical gym classes so you can start with a perfect graded exposure program to build from nothing to help you gain muscle mass and improve pain!

Pilates to improve balance, flexibility and strength

We can’t deny it, we are all getting just a little older!

One of the biggest concerns we get from our clients and patients is how balance starts to suffer and weakness in the legs especially! Continuing to address balance and strength can be especially important in neurological conditions, such as Parkinson’s and Multiple Sclerosis.

Balance deficiencies, lower limb muscle weakness and slowed reaction time have been identified as independent risk factors and may have the potential to lead to dependency and an increased risk of falling. We DEFINITELY don’t want anyone falling!

Regular exercise participation, at this point, appears to be essential and is considered an appropriate, healthy and cost effective way of both improving and sustaining physical aspects of health. There are many ways to exercise, including:

  • simply walking around the block,

  • strength training at the gym or home

  • even going to group fitness classes.

At PhysioFit of North Carolina, we have 3 pillars within our Fitness department that is essential as you age! We utilize Yoga, Pilates and Tai Chi to help our community gain and maintain flexibility, core strength and balance. For this post, we will talk about Pilates.

Pilates is “a unique method of physical fitness that uses a combination of muscle strengthening, lengthening and breathing to develop trunk muscles and restore muscle balance”.

Pilates exercises require activation and coordination of several muscle groups at a time. The beauty behind this is that you are working several muscle groups in a well-rounded manner during your sessions!

Pilates exercises have been shown to reduce the risk of falling as a result of improvements in balance, muscle strength and coordination (Irez et al 2010).  Pilates exercises has also been shown to be a preventive intervention method in reducing the risk of falling in the elderly (Kloubec 2010).


In a recent study by Irez et al, the authors found an improvement in strength, reaction time, balance, and coordination in the elderly after a 12-week Pilates program. The interesting thing behind this study —- the program included group fitness using resistance bands and balls —- and no reformer was used! Therefore, you can still get the benefits of Pilates without the use of a reformer!


Pilates exercise may reduce the number of falls in the elderly by increasing these fitness parameters — dynamic balance, reaction time and muscle strength.

At PhysioFit of North Carolina, we offer Pilates through weekly classes and class series. We offer Pilates, Yoga and Tai Chi in Wake Forest, NC.

We even have specialized Pilates classes mixed with other exercise approaches for special populations, such as Parkinson’s & Multiple Sclerosis.

Contact us to learn more about our approach and program or sign up for our next class!

Are Migraines linked to Neck Movement?

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

Many of us suffer from migraines with the cause being from many reasons!


One of the aspects of Migraines that can be modified is the strength, flexibility and endurance of neck muscles. Additionally, posture of the neck and head can make a big difference on avoiding and treating Migraines!

A study in 2016 identified a relationship between Migraines and Active Trigger Points and Neck/Head Posture.

The authors found active TrPs are associated with reduced cervical lordosis and head extension in individuals with migraine.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, referred tenderness, motor dysfunction, and autonomic phenomena (Simons & Travel 1999).


The link between Neck/Head Posture and pain has been scrutinized in the last few years and the research is leaning against a strong relationship. With that being said, most of the research is on static (body at rest) posture vs dynamic (body in movement) posture.

Dynamic movements and range of motion of the neck may be linked more than just static posture.


In the 2016 study by Ferracini et al, the authors found a relationship between the number of active trigger points AND the higher number of active TrPs was positively associated with a reduction in cervical lordosis and head extension of the head on the neck.

Here are pictures with labels of the muscles that the authors examined:

If you are having tenderness or hypersensitivity in the above muscles, in combination of not having proper cervical (head) extension, then this could be a reason why you are having migraines!

It may not be the SOLE reason for Migraines, but what if it was 25-40% of your pain—- wouldn’t you want your intensity or frequency of headache pain to be less?!

Here is a video of myself performing cervical (neck) extension and how much range you should have! Remember that cervical (neck) extension is related to cervical lordosis (curvature of your neck)

Here is a video that you can do to improve cervical lordosis through a common exercise, “Cervical Retraction”. Remember to feel it where you should per our Feel it to Heal it Physio Approach!

The Post-Partum Female Athlete and Urinary Incontinence

What is the Post-Partum Female Athlete?

Many times when I suggest the word, ‘Post-Partum Female Athlete’, many of my ladies say they aren’t athletes! That is not true!

I use the word athlete to ANYONE who does some form of exercise throughout the day. This can be going to work, taking care of the kids at home, going for a walk/jog and if be, training at a high intensity workout facility such as CrossFit, Orange Theory or Burn Boot Camp.

Therefore, we are ALL athletes! We use this term as we like for everyone to compare their own injuries and recovery to a professional athlete.

How does the Post-Partum Female Athlete relate to the Pelvic Floor?

One alarming statistic concerning is how common symptoms of pelvic floor dysfunction are with the Post-Partum Female Athlete!

Pelvic floor dysfunction is a term used to describe a variety of disorders involving moderate to severe impairment of the pelvic floor muscles. The pelvic floor is a sheet of muscles designed to support the abdominal viscera as well as maintain urethral, anal, and vaginal continence. floor dysfunction.

pelvic floor.jpg

Pelvic floor dysfunction symptoms are common among all women. A study of almost 2,000 women in the United States revealed that around one in four had at least one symptom or physical finding including urinary incontinence, fecal incontinence, or organ prolapse.

A common symptom in the female athlete that we hear about ALL OF THE TIME is urinary incontinence., especially when being active and exercise.

Urinary incontinence is the involuntary leakage of urine. It means a person urinates when they do not want to. Control over the urinarys phincter is either lost or weakened. 

You should NOT just expect that since you have had children, then it is normal to have urinary leakage while exercising! The following exercises are ones in which most women describe their symptoms:

Jumping Jacks

Jumping Jacks





It has been found from Arau ́jo et al. that 62.2% of long-distance runners reported urinary incontinence. These high rates in athletes are thought to result from an imbalance of con- traction strength of the pelvic floor with increased intra- abdominal pressure during exercise. Additionally, Da Roza et al. found that women who exercised the most demonstrated the highest prevalence of symptoms.

From just these two studies, if you are a runner or exercise most days of the week (>3 days), then you may have more risk of urinary incontinence.

How is Urinary Incontinence Treated?

Comprehensive treatment of pelvic pain should include a multidisciplinary approach, including seeing a physical therapist. Early intervention including both medical and therapeutic management is recommended. We always recommend that you seek advice from your physician and from your Physio.

Physical therapy has been an important treatment for women’s health issues for almost 50 years and has proven effective in treating pelvic pain and urinary incontinence. Physical therapists are trained in soft tissue mobilization of myofascial trigger points and mobilization of the joints in the pelvis and lumbar spine, which can address pelvic pain symptoms, as well as bladder and bowel dysfunction.

Because urinary incontinence is associated with weakness in pelvic floor muscles, exercise involves increasing muscle strength of the pelvic floor specifically but also surrounding musculature. At times, it may involve relaxing muscles that may be hypertonic. Your therapist will be able to determine which is the best approach.

Dr. Danielle Vaughan, a women’s health specialist AND post-partum female athlete, also can address movement reeducation. She instructs patients with pelvic pain on exercises for lumbopelvic stabilization and core strengthening to address any deficits in the kinetic chain that may be caused by your knee or even ankle.

A multimodal approach of pelvic floor muscle exercise and manual therapy has a positive impact on pain, disability, and urinary incontinence in the Post-Partum Female Athlete.

If you are having urinary incontinence while you lift your children, exercise, or even just squat; this doesn’t have to happen! Schedule an evaluation and treatment today to start changing your life.

Treatment of Vulvodynia without drugs or surgery

Vulvodynia is chronic pain or discomfort of the vulva (the area surrounding the outside of the vagina) that lasts for three months or longer without any evidence of other skin or gynecological causes. Vulvodynia is usually characterized by burning, stinging, irritation or rawness of the area. The most common complaint is a burning sensation.

There are many options to treat this condition, including pharmacological (i.e. drugs), surgery and non-pharmacological methods (i.e. physical therapy). It is how for women to be persistent in seeking an accurate diagnosis so they can receive appropriate treatment. We highly recommend you determine if vulvodynia is the cause of your symptoms as there are some treatments available conservatively.

As Physical Therapists, we strive on treating many conditions associated with pain without the use of medications and strive on keeping the community out of surgery! There are obviously many people who need drugs and surgery, but, majority of the time, symptoms can improve with a detailed physical therapy assessment and treatment.

This is especially true for Pelvic Pain and Women’s Health issues. Just recently, Rosen et al in 2019 wrote an article in Drugs magazine with the following conclusion for treatment of vulvodynia:

There is strong evidence to support and recommend non-pharmacological interventions including psychological therapy, pelvic floor physical therapy, as well as surgery (i.e., vestibulectomy for provoked vestibulodynia) for the treatment of vulvodynia.

As you can tell, there are many options to treat this condition. If you are looking for a Women’s Health specialist in Wake Forest, NC, we hope we can be of service to help you with your pain and improve your life!

Dr. Danielle Vaughan is a Women’s Health Specialist focusing on Pelvic Physical Therapy in Wake Forest, NC. She is co-owner of PhysioFit of North Carolina, alongside her husband. They offer their 1:1 treatments with specialized care, as well as group studio classes of Yoga, Pilates & Tai Chi.

Can neck pain cause dizziness?

Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders.

Dizziness and imbalance may originate from altered proprioceptive signals from the cervical spine due to trauma, fatigue and pain. Considering there is an abundance of proprioceptive receptors in the neck, which are located in the joints, ligaments, and deep cervical neck muscles.

Dizziness has been shown to be prevalent in 50% of individuals with cervical spondylosis (arthritis) and with individuals who have suffered some type of neck trauma (such as concussion or whiplash), this percentage can be over 80%.

Cervical proprioception contributes to the perception of head motion and converges with vestibular and visual information for spatial orientation and balance. Therefore, if cervical proprioception is altered, it is feasible that unsteadiness, lightheadiness or dizziness can be from the neck.

It is pertinent that a differential diagnosis is performed by the treating clinician as there are many causes of dizziness, which could be from more dangerous reasons, such as instability, vascular and myelopathy.

If you are having dizziness with head movements or even change positions, the cause could be from the neck.

We recommend consulting with your physical therapist or physician to determine if an evaluation is right for you.

Dr. Harrison and Danielle Vaughan teach other professionals across the country on the Diagnosis and Treatment of Cervicogenic Dizziness. Our unique approach of combining manual therapy and vestibular rehabilitation helps patients who have dizziness and pain.

Do you get dizzy when you lie down in your bed?

Vertigo Treatment in Wake Forest

Have you ever experienced dizziness when laying down, rolling to the side, or looking up?

Check out this video below to see what happens with the eye that causes you to feel that spinning sensation 👇

Positional vertigo occurs when you have a blockage in the inner ear, causing a change in the signal sent to the brain which results in a "nystagmus", which is what you see below. No wonder you feel dizzy- check out that eye!!! 👁

PhysioFit has the equipment and experience to diagnosis and treat in the clinic, in most cases within 1-2 visits!

Dizziness, Vertigo, Physical Therapy, Wake Forest, NC

Repositioning treatment is the #1 way to treat this type of dizziness, so don't just live with it-- let us help you resolve it!

Schedule an evaluation with our vestibular specialist, Dr. Danielle Vaughan.

Is Tai Chi right for me?
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Tai Chi is a form of art that can be observed by its beautiful movements.  Most of these movements are slow, graceful and fluid. 

 Think of it as slow dancing vs fast dancing.  Which type of dancer are you?!

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A common misconception is that Tai Chi is only for old people. 

Granted, it is a great exercise program for the elderly due to the slow, gentle and low impact on the joints. 

However, Tai Chi can be for everyone and not just for seniors.


If you are looking for:

  • Better flexibility

  • Better proprioception

  • Better balance

  • Better lower limb strength


 I would also say Tai Chi can be great for you if:

You perform high impact exercises (such as high intensity exercise, running, etc) but looking for a low-impact, active recovery approach.

You have a fast paced job and live a fast paced lifestyle but looking for a slow and balanced exercise approach to clear the body and mind.


I always encourage my patients and clients that they should find an exercise routine, in itself or in combination with another program, that makes them feel good.

 Then, Tai Chi may also be for you. 


 Whatever you do, you need to feel good about yourself.  You cannot succeed if you don’t feel good about yourself.

 Contact us to find out more about our program and see if Tai Chi can be a right fit for your active lifestyle.

PhysioFit of North Carolina offers Tai Chi classes in our studio in Wake Forest, North Carolina. We hope it can be a great exercise program in itself for your lifestyle or in combination with other exercise routines.

Vertigo Treatment in Wake Forest, NC

Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief episodes of vertigo evoked by changes in the position of the head.

The diagnosis is established if there is a combination of typical symptoms with a positive Dix–Hallpike test, which is a maneuver that provokes both typical vertigo and torsional–vertical nystagmus and is diagnostic for the presence of canaliths in the posterior semicircular canal.

Physical Therapy Wake Forest, NC

These patients can be easily treated using the Epley maneuver, resolving vertigo complaints in 80%–90% of the patients.

However, in some cases, the Dix-Hallpike test is negative, meaning that during Dix-Hallpike positioning either vertigo or nystagmus does not recur. In that case, the diagnosis is based solely on the patient’s history of temporary, isolated episodes of positional vertigo with characteristic triggers (bending, turning, or rolling in bed). This type of BPPV is classified as probable BPPV .

Among patients with probable BPPV, more than half have been shown to have recurring complaints of positional vertigo within 8 weeks, which can be objectified as definite BPPV in 16%. (Zaag-Loonen et al 2018)

It is recommended that by advising patients to actively contact the clinic in case of recurring symptoms, BPPV could be confirmed and treated.

Physical Therapy Wake Forest, NC

Research guidelines advise professionals to adopt a policy of low-threshold access for patients with recurring symptoms when confronted with a patient with symptoms of BPPV but with a negative Dix-Hallpike test.

This is one reason we have direct access, so you can get for treatment fast for quick and effective results when you need to.

We also have a Physio Membership program that allows for monthly wellness visits to address deficits in strength, balance, pain and flexibility; as well as address any dizziness complaints that may be coming from your inner ear.

Feel free to contact us today to determine if your vertigo or dizziness symptoms are BPPV.

Dr. Danielle Vaughan is a Vestibular Specialist who treats balance, dizziness, and vertigo conditions in Wake Forest, North Carolina.

What does exercise do to help my knee arthritis?
Yoga in Wake Forest, NC

When it comes to having pain, the last thing someone wants to do is exercise!

However, exercise can have huge benefits and a now the healthcare profession is definitely pushing the concept of “Movement is Medicine”.

So, the question is, how will exercise improve my knee arthritis?

First, exercise can enhance cardiovascular benefits, muscular strength, balance, and coordination; all of these are thought to be able to reduce joint pain. 

As the severity of pain is directly correlated with the degree of muscle weakness, stronger muscles and better coordination improve the stability of the joints and lessen pain. Increased peri-articular muscle strength may also protect joints from traumatic impacts. 

Second, evidence suggests that the mind-body component may influence immune, endocrine, neurochemical and autonomic functioning. An improved restful state and mental tranquility may help break the arthritis “pain cycle”.

Why choose PhysioFit’s Knee Arthritis Yoga Class?

Our group environment with individuals who have similar condition as you can help build confidence, get support and overcome fears of pain. Together, these can lead to improved physical, psychological and psychosocial well-being and overall quality of life.

This is in addition to the science behind our approach of providing exercise that can build strength, balance and flexibility without “picking” at your knee, so you can be certain that we will not (or try not to!) flare up your symptoms!

How can I learn more?

Feel free to contact us to speak with us personally to see if our class is right fit for you!

Physio Membership
Physical Therapy Wake Forest, NC

Our Physio Membership is a subtype of concierge medicine.  We accept a small group of members into the practice.  Members make a small, monthly membership investment that allows them access to medically necessary Physio care.

There is no insurance involved.  No pre-authorizations or authorizations, co-payments or deductibles, denied treatments or benefit limits for the patient to worry about.  Likewise, the health care provider does not have to employ a small army of staff to contend with the insurance company's' red tape or wrestle reimbursement from them.  This produces better care at lower costs.

Without the “sting” of co-payments and deductibles which make people hesitate to seek medical care (and use their insurance), people can come in as soon as needed instead of trying to “wait and see” or “tough it out”.  The problem can be addressed quickly and effectively before it has snowballed into something that requires far more care!

Most people will save significantly by receiving care at our office. By having your personal Physio who knows what you need, when you need it — you ultimately get treatment faster and get back to doing what you love —- biking, walking, gym work or even just life! —- quicker!


Frequently Asked Questions

Physical Therapy Wake Forest, NC

How can I become a Physio Member?

After an initial evaluation and initial treatment plan with your injuries, your Physio will determine if a Membership Plan is right for you.

What is the best plan for me?

Your Physio will discuss with you the best option available to keep you healthy.

Is the initial evaluation covered in the cost of the Physio Membership?

No, an initial evaluation cost is a separate fee.

What if I am currently seeing you for neck pain but I hurt my knee. Can I have this body part examined and evaluated?

As long as you are an active PhysioFit Member, there is no charge or additional fees associated with evaluating a different body part. This is one of the best perks of the program!

I think this is a great idea and want my spouse to be a member too so we can both continue to be active as we age together! Any family discounts?

Contact us for this request and we can chat :)

What if I need further treatments for my condition other than the full, 60 minute 1:1 treatment with you under my membership plan?

Everyone’s conditions are different and frequency and duration of treatments vary. For the most part, more than one treatment per month is necessary for an ailment, especially if an acute injury!

We realize this and offer a percentage off any other Physio treatments for our members! How awesome is that!

Physical Therapy Wake Forest, NC

What if I am out of town and cannot make it in to treatment?

Our Physio Membership plans have a Tele-Health option! This can be perfect if you do not have the time to come into the clinic, but still would like advice on any painful issues or exercise questions. This works perfectly for our patients who travel for work!

What if I need to cancel my Physio Membership?

There is no charge or penalty to cancel. However, if you do cancel and want to return for treatment of a different condition at another time, an initial evaluation fee will be charged.

How can I pay?

The chosen membership package will be automatically charged to your account each month.

Can I submit my membership payment with a superbill to insurance?

Unfortunately, no. At this time, we cannot provide a superbill for the monthly fee.

Have any other questions?

Feel free to contact us!