INTRODUCTION
If you are reading this, chances are that you or someone you care about is suffering with pelvic pain. You may feel isolated, alone, and as if no one understands what you are going through. Perhaps, you have other health conditions and are feeling overwhelmed. Or maybe you appear quite healthy, and family or friends don’t understand when you tell them you don’t feel well. In addition, your previous experiences with healthcare providers may have left you feeling discouraged. You may have been told that there is nothing they can find that is wrong. On the other hand, you may have undergone extensive medical testing and treatment with little or no improvement.
No matter what your previous experiences have been, it is my sincere desire that this message will give you hope. No one can fully understand what another person is going through when it comes to pain, because it is a very subjective experience. No two individuals’ experience is the same, even if they have the same diagnosis. Let me reassure you, however, that we understand that what you are going through is very real, and we want to help. I also want to encourage you that the scientific understanding of chronic (also called persistent) pain has exploded in recent years, causing treatment to become much more comprehensive and holistic. One of the distinct advantages you will find at the Florida Center for Urogynecology is that you have more than just a doctor or physical therapist but a healthcare team. We want to combine the best of medical care with the best of physical therapy and perhaps other healthcare disciplines to optimize your path to better health and wellness.
WHAT IS PAIN?
That may seem like a silly question. Isn’t it obvious? Surprisingly not. Pain is a protective response of the nervous system in every person 100% of the time. For example, if you are in a car accident, your neck may be stiff and sore the next day. Why? The pain and muscle spasms you are experiencing are protective strategies to keep you from moving your neck. In acute situations (immediately following an injury or problem), this is a helpful response. It becomes an issue, however, when pain persists beyond the normal healing time of tissues.
Pain is also very complex. It is influenced by what is occurring in the pelvic area, but it is influenced by many other factors as well such as past experiences with pain, memories, other parts of your nervous system, your senses (vision, hearing, taste, smell, touch), thoughts, emotions, hormones, the immune system, etc. The brain is bombarded with information from many different areas. Also, when pain persists, some of our natural mechanisms that control pain become less active.
Why is this good news? It is good news, because the nervous system changes or adapts to learning and experiences. It can change in ways that cause pain to persist. More importantly, it also means that by providing new experiences that regulate the protective response of the nervous system, we can help you manage your pain and feel better.
WHERE DOES PHYSICAL THERAPY COME IN?
A physical therapist’s job is to improve mobility, to decrease pain, to improve function, and to prevent disability. In pelvic floor physical therapy, we accomplish these objectives through treating the muscles, the joints, the connective tissues, the nervous system, and providing education in self-care techniques.
Although there are different names for pelvic floor dysfunction and ways in which the conditions vary, there are also common features. For example, pelvic pain is nearly always accompanied by muscle overactivity. Other common findings include connective tissue restrictions, joint problems (i.e. back pain, hip pain), changes in breathing pattern, weak muscles, altered movement patterns, and changes in posture.
When you begin physical therapy, we will perform an assessment, to determined what your specific needs are and how we can help you the best. The treatment plan will be discussed with you, and you will be given work to do at home.
Some treatment examples include:
- Soft tissue mobilization – hands on treatment of the muscles and soft tissues surrounding the muscles
- Trigger point release – hands on treatment of irritable areas in the muscles
- Joint mobilization – hands on techniques to improve joint mobility
- Scar mobilization – hands on treatment of scar tissue
- Visceral mobilization – a hands on technique directed at the connective tissue surrounding the pelvic organs
- Myofascial release – hands on treatment directed at the muscles and connective tissue surrounding the muscles
- Relaxation techniques
- Movement and exercise, yoga
- Graded exposure and motor imagery – a method of regaining the ability to do an activity that is currently limited by pain
Benefits of these treatments include improved breathing patterns, decreased muscle tension, improved ease of movement, decreased sensitivity of the nervous system, decreased protective responses of the body, improved body awareness, an increased sense of control, and feeling stronger again. As this occurs, you will find that your ability to cope with the pain improves, your pain decreases, and you begin to feel better.
For further reading and educational videos, the International Pelvic Pain Society is a wonderful source of information. In addition, I highly recommend Neil Pearson’s videos (Part 1 & Part 2) on overcoming pain on You Tube.