By Maryssa Steffen, DPT, PHRC Berkeley
Have you ever noticed the relationship between your feelings and your bodily sensations? For example, have you ever noticed that gut-wrenching feeling you get in the pit of your stomach when you know something is wrong, or you just got bad news? Or your heart rate suddenly increases when you get scared or nervous? These are symptoms that are in direct correlation to how you are feeling. The tension in the body combined with the perceived threat activates the autonomic nervous system, or your fight, flight, freeze responses. If you are unable to address these cues and move away from the threat, then fear of pain may surface. This is also true in the case of persisting pelvic pain.
Often, the sensation of pelvic tension can lead to feelings of discomfort, restlessness, and danger. In today’s blog, you will learn how movement and feelings influence each other to create emotions. In other words, movement can change how you feel.
If you are familiar with pelvic pain, go back to a time when you were anticipating the onset of pain, what did this feel like to you? The symptoms that one often experiences with pelvic pain can be debilitating, it can interfere with social settings, limit your exercise routine, and prevent you from working. You may fear you are doomed forever. This fear is exacerbated when countless providers cannot give you answers and eventually throw up their hands to say, “it’s all in your head.” This fear of being stuck with persisting pelvic pain is traumatic for some people. “Emotion is the consciousness of the body.”
Did you know that movement can also elicit feelings?
Laban movement analysis describes, visualizes, interprets and documents human movement. In a 2017 study, participants experienced fear when they embodied retreating, condensing, enclosing, binding, or moving back movement qualities. So, if your tissues are healed, your MRI’s are unremarkable, and your test results are negative, consider how your movement qualities may be contributing to your bodily sensations, feelings, and strong emotions.
This idea that physical sensations and feelings are bidirectional is not commonly accepted in our Western and American cultures. That could be another blog topic, but the focus of this blog is to empower you with ways to move out of your pain.
First, pause during an emotion. Let your bodily sensations improve your awareness. This is called “listening to your body.”
What is the neuroscience that supports this?
- The medial prefrontal cortex of the brain receives input from bodily sensations.
- It is the only area of the mammalian cerebral cortex that alters the limbic system, and therefore, emotionality.
- This part of the brain connects our body to our emotions.
The somatosensory system is part of your sense of touch, pressure, vibration, movement, arising from the muscles, joints, skin, and fascia. If you have pelvic pain, the somatosensory system is part of pain processing.
There are three fundamental somatosensory divisions:
- visceral sensation
- vestibular and musculoskeletal
- fine touch
The brain is constantly receiving signals from your gut organs, what we call the viscera. The visceral division is in charge of sensing changes in the chemical environment of cells throughout the body. Chemicals flowing in the bloodstream are sensed by neurons in some regions of the brain stem, hypothalamus, and telencephalon. Eventually, the nerve pathways involved in this division includes the perception of pain.
What about emotional resiliency? How can you use embodied movement to support your emotions and regulate your nervous system? How can you move out of your pain?
- Posture and movement effects on your mood is supported by literature.
- You can change your emotional state by shifting your posture and movements.
- This concept originates in Darwin’s ideas from 1882.
- Autonomic nervous system activation contributes to internal sensations and may result in feelings.
- Sensory feedback from facial and postural movements contributes significantly to emotional experience and is also suggested in the evidence.
Consider your potential for embodying new responses when faced with difficult situations. Notice what feelings arise when you look at a chair that you anticipate will trigger a flare-up in pelvic floor symptoms. As you pause to notice these feelings, shift your focus to the sensations in your body — how is your breathing, your posture, your habitual holding patterns in your body? Are you gripping your pelvic floor muscles as you imagine sitting in that chair? Consider exploring new habits and notice how it affects your feelings and emotions.
If you experience pelvic pain, you may have difficulty associating your pelvic floor with sexuality or pleasure. You may feel symptoms with penetration, orgasm, or post-orgasm. During sexual appreciation, go slowly enough to track your sensations and feelings. For example, as tension develops, deliberately relax your muscles. Breathe with your diaphragm and let your belly and pelvic floor soften. Notice how surrendering to your breath and releasing tension changes how you feel.
Body, Emotion and Consciousness: How Your Body Can Regulate Your Mind
Antonio Damasio describes in his research that emotions are evoked by visceral sensations and by joint position senses. Your conscious feelings result from your perception of this somatic input. His theory implies that you can affect your feelings by moving deliberately through space and by sensing your movement from moment-to-moment with gravity. How powerful!
How do you feel after going for a leisure walk outside? How do you feel during a breathing practice with body scanning to check for and release unnecessary tension? These are just a couple of options to integrate mindful movement into your life and assess how it changes your mood and perception of pain.
Embodied/Somatic Movement Practice: Another Way to Practice Daily Mindfulness
- There are many established somatic movement techniques for mindful movement such as Body-Mind Centering, Bartenieff Fundamentals, the Feldenkrais Method, the Franklin Method, Yoga, Tai Chi, indigenous dances from anywhere in the world, and Alexander Technique, to name a few.
- https://pelvicpainrehab.com/uncategorized/815/can-yoga-help-my-pelvic-pain/ is an excellent resource about yoga for pelvic pain.
- These practices empower the expansion of one’s daily movement vocabulary. Use new movement patterns to replace habitual ones that tend to associate with pain.
- These new movement possibilities could be used to regulate emotional states.
- For example, the Alexander Technique teaches you how to avoid a slouched posture. Try a slouched posture and assess how you feel. Now, try a more erect posture and assess how you feel.
- “Good” posture is not just better for your vertebral discs — it can also elicit feelings of alertness, happiness and readiness. It is better for your pelvic floor because these muscles attach to your tailbone and pubic bones. You may notice how the position effects with different postures alter your pelvic floor sensations. How does it feel?
Embodied Movement = Felt Movement
Uncover your physical habits during felt movement. Embark upon an internal journey to expand beyond your preconceived limits and enter a fuller range of movement vocabulary and emotional awareness. The somatic practices listed above are some options that may support resiliency and attunement to your emotions.
To summarize, here are five things you can try when you are experiencing pelvic pain:
- Diaphragmatic breathing, chanting, singing in low tones. The vibrations in your belly will massage your organs and pelvic floor. Pain may change as you feel changes to abdominopelvic sensations.
- Go for a walk outside. Feel your feet on the floor as you walk. Go slowly enough so you can notice the sensations of temperature on your skin, the colors and sounds that surround you, and your heart rate increasing. This practice grounds you in the moment as you move.
- Somatic Movement: There are options listed above but Feldenkrais is one method that is supported in the literature to help with chronic pain. It can take several sessions before you understand how the process is deepening your sense of your body. It uncovers physical habits as you explore small, guided movements. These habits may be causing pain. Through practice, you will experiment with new movement possibilities that may offer pleasure and joy instead.
- See a pelvic floor physical therapist! Call us for an in-person or digital appointment! www.pelvicpainrehab.com
- If you are struggling to contain emotions that are stuck in your body, a trusted mental health provider may give you the support you need. Our physical and mental health are equally important. Hopefully this blog has made the connection between the body and the mind more clear for you.
This practice takes discipline, focus, and a commitment to learning about your body. You will embody your daily experiences more fully. As your movements are nurtured and strengthened, you will have a powerful coping strategy to regulate your mood, improve resilience and deepen self-awareness. As part of a multidisciplinary approach for your pelvic pain, notice how it helps manage your symptoms.
References
Damasio, A. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Harcourt College Publishers.
Levine, P.A. (2010). In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, Calif.: North Atlantic Books.
Tsachor, R.P. and Shafir, T. (2017). A Somatic Movement Approach to Fostering Emotional Resiliency through Laban Movement Analysis. Front. Hum. Neurosci. 11:410. doi: 10.3389/ fnhum.2017.00410
______________________________________________________________________________________________________________________________________
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
Like us on Facebook,
Subscribe to our YouTube Channel,
and follow us on Twitter, Instagram and Pinterest!
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.