By Maryssa Steffan, DPT, PHRC Berkeley
Pelvic pain can feel like you are stuck in an endless cycle of symptoms. It may feel like you are doomed forever. When your body is tense and your fear is feeding the pain response, moving your body may be the last thing you want to do. You may wonder how you can possibly move your legs or spine if it triggers persistent pelvic pain.
Mindful movement is medicine.
Scientific evidence supports many benefits of movement therapy, including reduction in pain, stress, physical limitations and weaknesses, improvements in range of motion, strength, balance, coordination, cardiovascular health, physical fitness, mood, and cognition.
One type of movement therapy is the Feldenkrais method. The guided mindful movement session in the video was inspired by the Feldenkrais method.
The Feldenkrais method, founded by a physicist and engineer, is a system that uses movement exploration for somatic learning through two major techniques: group and private. The video with Karah as the model was a guided somatic movement exploration inspired by the Feldenkrais lesson, “Differentiation of Pelvic Movements by Means of an Imaginary Clock.”
In Feldenkrais, a series of guided movements allow the participant to use body sensation and perceptual feedback to choose between favorable (easy, comfortable) and unfavorable (painful, straining) positions. With practice, discernment between favorable and unfavorable movements improves, and movement modifications develop and become ingrained. This practice takes focus and awakens a state of being rather than doing.
For example:
- You are lying on your back. If you move your pelvis to the right, you notice pain in the right inner thigh.
- Instead, imagine pouring your weight into your right hip.
- Let go of unnecessary force.
- “Easy does it.”
- You may find more ease with this cue and your right inner thigh relaxes.
- With practice, you will move your pelvis to the right with a more efficient movement strategy that does not recruit unnecessary tension and pain.
Moving with one strategy is habit. Moving with multiple strategies is freedom.
Mindfulness based movement including Feldenkrais, facilitates self evolving material. As you notice your habitual movement patterns that elicit pelvic pain, and as you explore new movement options that feel easy and smooth, you learn how to be more free in your body. You discover new movement strategies that feel good. Your function improves. Your body awareness enlivens and grows.
Persistent pelvic pain can feel traumatic.
Trauma that is stored in the body and perceived as pain tells your nervous system that you are in a fight/flight/freeze response. The physiological response to the sympathetic nervous system feels like “this pain will never end!” Cortisol levels rise. You may cope by moving less. Consider mindful movement! Studies show it decreases cortisol levels.
For a blog that explains how trauma is stored in the body, the fight/flight/freeze response, and how to regulate your nervous system, check out this.
Mindfulness is paying attention to what you do not ordinarily give a moment’s thoughts to. During mindfulness, you can feel your body on a moment to moment basis. This embodied nature of the mind helps regulate energy and information flow that is then processed in the brain. When you are embodied in the moment, you disrupt the sympathetic nervous system cycle and you may switch to feeling curious, safe, and more comfortable. Now you are ready to move and enforce new movement strategies away from pelvic pain!
We created a video for you to explore the practice we are discussing in this post. While doing the exercises in the video, keep the points below in mind and see how you feel.
You have many options to disrupt this stress and pain cycle with mindful movement:
- Play. When Karah demonstrates the mindful movement lesson, watch how her movement ripples into new movements and grows into variations that make her exploration different from what yours will be. Her playful nature creates various forms of movement. How fun!
- Listen to your body before you tell it what to do. The video encourages you to feel your feet, your contact points on the floor, your breathing, without changing anything. Simply feel. Do very little and feel so much!
- Go beyond your familiar limits. Have you ever tried to move your hips by feeling your feet first? Does initiating movement from your feet make it easier to move? It may feel odd at first but this curiosity changes the fight/flight/freeze cycle. You cannot be scared and curious simultaneously.
- Let go of perfection. Be free! Try not to compare yourself to how you think you should move. Instead, encourage yourself to be unapologetically joyful as you discover new movement patterns that feel pleasurable.
- Let go of thinking about your muscles and how to force movements. Rather, attend to your structure as you organize your movement. Imagine your bones, ligaments, tendons, blood vessels, and fascia. Feel your structure. This feeling tells your brain where your body is in space. The muscles will naturally know what to do when you initiate movement from your structure.
Notice if you get frustrated during these somatic movement practices. Frustrated means you want something, that there is a path before you you haven’t yet traveled. Breathe into it. You are recovering and releasing the restrictions of what you already know. Let the old, dysfunctional habits resurface, notice them, and soften into it. Trust that this is part of the process. Awareness is the first step to change.
Commonly, your sensations are only held in your awareness for brief periods, if at all, before your thoughts and emotions react to what you are feeling. These responses are rapid. They are often judgmental. “Is this good? Is that movement bad? Do I have bad posture? Is this stretch good for me?”
These thoughts are usually conditioned by past experiences. If you fell on your tailbone as a teenager and then fall again years later, the memory stored in your body may trigger a pain response. The response is probably different, and more intense, than the first time you fell, even though your tissues have healed since you were a teenager. The memory of pain makes the threat of falling intensify the feeling in your tailbone.
In the video, you are invited to get into a meditative state. Notice thoughts and emotions but let them wash over you. Take deeper breaths. Follow the guidance to explore how your feet relate to your pelvis. Approach the pelvic clock with curiosity. How does three o’clock compare to nine o’clock? Is one half of the clock smooth as you move along the hours and seconds, but the other seems to skip over some hours?
Acknowledge that you probably learned how to walk once. Nobody told you how to walk. You pushed with your feet, reached with your hands, and gleefully ventured into the sense of balancing while falling. Can you unleash new movement potential with a similar curiosity and tenacity?
You are now ready to try mindfulness in somatic movement for pelvic pain relief!
In summary:
- Movement based therapies, including somatic movement and Feldenkrais, decrease fear avoidance behavior and empower you to take a proactive role in your health and wellness.
- Make yourself comfortable. You are welcome to modify the lessons and movement sessions to what you can do comfortably. This practice is available for all abilities because it is customizable to the individual’s needs and health.
- Somatic movement is safe, cost-effective, and is a potent adjunct treatment used to supplement standard care.
- It is patient-centered and holistic. You are integrating your body, mind, and spirit.
- Evidence-based benefits of somatic movement include a reduction in pain, stress, and weakness and improvements in mood and physical health.
Enjoy the module!
References
Alexander R. Lucas, et al. Mindfulness-Based Movement: A Polyvagal Perspective. Integrative Cancer Therapies 17 (2018) 5-15.
Blessen C. Eapen, MD. Movement Based Therapies in Rehabilitation. Phys Med Rehabil Clin N Am 31 (2020) 577–591
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Are you unable to come see us in person? We offer virtual physical and occupational 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 and occupational 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 and occupational therapistss 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 and occupational therapistss via our video platform, Zoom, or via phone. The cost for this service is $85.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical and occupational therapistss, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical and occupational therapists 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 and occupational therapists 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
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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 and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.