As a physical and occupational therapists specializing in pelvic floor disorders, specifically pelvic pain, I have noticed a strong correlation between chronic pain, the thyroid, and the endocrine system. I wanted to explore what hormonal imbalances can do to chronic pain. I won’t go into too much detail about persistent pain here, instead please refer to the blog post Pain as the Ultimate Protector to get a quick refresher. Pain was once believed to be a signal of tissue damage, but now, the understanding is that pain is not so specific. Persisting pain is complex and signals are sent from the brain to the body and from the body to the brain. Pain can build in intensity varying on many factors including, fear, stress, systemic inflammation, hormonal and autoimmune issues, or history of a trauma.
The thyroid is a major player in the endocrine system and there is a link between elevated muscle enzymes and creatinine in the blood which can influence chronic muscle fatigue/pain. During an abnormal stress response, which is associated with chronic pain, dysregulation of the adrenals occurs resulting in chronic pain and fatigue. Chronic pain of the musculoskeletal system is a common symptom of autoimmune thyroid issues. As a result, it is important to look at the endocrine system, adrenals, nutrition, and the musculoskeletal system when dealing with chronic pain. When the body is under a significant amount of stress whether it be with chronic pain, emotional stress, physical stress, etc the thyroid becomes compromised and is unable to keep up with the adrenal insufficiency or stress response. In most cases, the thyroid shuts down or becomes overactive, disrupting the homeostasis of your body. Let’s delve into the complex world of the thyroid or endocrine system, shall we?
Quick Facts about the Thyroid:
An estimated 20 million Americans have some form of thyroid disease, and up to 60% of those with thyroid disease are unaware of their condition. The thyroid is a hormone-producing gland that regulates the body’s metabolism. The metabolism is responsible for producing energy and it affects body functions such as heart rate and energy levels. The thyroid gland is relatively small, located at the middle/lower neck, and it produces hormones that influences every single tissue, organ, and cell in the body. The two most common conditions are hypothyroidism and hyperthyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone. Common symptoms include: fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, muscle weakness, muscle aches, tenderness, stiffness, pain/swelling in the joints, heavy or irregular menstrual periods, thinning hair, depression, slowed heart rate and impaired memory. Hyperthyroidism is a condition causing the gland to produce too much thyroid hormone. Common symptoms include rapid heart rate (tachycardia), heart palpitations, increased appetite, nervousness/anxiety/irritability, tremor, sweating, changes in menstrual patterns, increased sensitivity to heat, changes in bowel patterns, difficulty sleeping and brittle hair.
Hashimoto’s Disease occurs when the body’s immune system attacks the thyroid and destroys the body’s ability to produce hormones. Common symptoms are similar to hypothyroidism.
Graves’ Disease occurs when the body’s immune system attacks the thyroid, causing overproduction of the hormone responsible for regulating the metabolism. Common symptoms are similar to hyperthyroidism.
Thyroid Hormones:
Here is a very brief overview about the thyroid hormones that are important in regulating the body. Thyroxine (T4) is the major hormone secreted by the thyroid. T4 is then converted in the liver to T3 by the removal of an iodine atom. The important thing to note is the amount of T4 produced by the thyroid gland is controlled by another hormone called your thyroid stimulating hormone (TSH). This is produced in the pituitary gland located at the base of the brain. TSH is the most common thyroid level tested, however, it is important to have your T4 levels checked as well because the amount of TSH that the pituitary sends to the bloodstream depends on the amount of T4 in the pituitary. If the pituitary sees lower levels of T4, then it produces increased TSH so that the thyroid gland will produce more T4. You can think of TSH and T4 as a thermostat. When the heat rises to a balanced level, the thermostat senses this and then turns off the heat. Finally, it is important to note that pregnancy, oral contraceptive use, chronic pain, and autoimmune conditions can change the thyroid levels in the blood.
Thyroid Function Tests:
Thyroid functioning is tested through a blood test. The two most important thyroid levels to address are the TSH and T4 tests. Initially, the TSH level is the best way to see if your thyroid is producing what it should be. Then, combining that TSH test with the free T4 accurately determines if the thyroid gland is functioning. I don’t want to go into too much detail. To find out more information please click here.
Normal TSH levels are between .5 and 5.0, which is a wide range. It is important that your levels are closer to a one or two, especially if trying to conceive or if you have an autoimmune condition or chronic pain condition. A recent study was conducted to assess thyroid dysfunction in women of reproductive age and to see if thyroid dysfunction is associated with menstrual irregularities, anovulation, and infertility. The study showed that women who had TSH of less than 3.0μIU/mL had significantly better functional ovarian reserve than the group that had a TSH of greater than 3.0, which is still considered within normal range. From experience with my clients, many thyroid specialists do not think outside of the box and do not take the time to tailor thyroid treatments. If you are within the wide range, they often say you are okay. If you are having the symptoms of thyroid dysfunction and are at a 5.0 of TSH, even though it is “within the range,” you more than likely need a supplement to help support your endocrine system.
Thyroid Deficiency and Iodine:
The American Thyroid Association states approximately 40% of the world’s population is at risk for iodine deficiency. Iodine is an element that is needed when producing thyroid hormone. Because the body does not make iodine, it must be an essential part of your diet. It is found in various foods including cheese, cow’s milk, eggs, yogurt, saltwater fish, seaweed, shellfish and iodine containing multivitamins. This is especially important in the great lakes northwest regions of the US and Canada, where there was a major iodine deficiency in the 1920’s and people were treated with iodized salt to help with “goiter” and thyroid deficiency. These places continue to have decreased iodine in food and often people must take an iodine supplement in order to regulate thyroid conditions.
Some alternative ways to boost your endocrine system and regulate your body:
- Replace processed foods with whole foods
- Exercise regularly and it should be more weight bearing exercise
- Establish regular bedtimes and sleep
- Practice relaxation techniques,a great app is Headspace or Calm
- Avoid alcohol and stop smoking
- Avoid/limit sugar consumption
- Identify food intolerances or sensitivities (we usually crave foods we are sensitive to)
Because of all these factors that affect intensity of pain, it is important to look at an integrative approach.
- It is important to recognize that your pain is a signal that something is out of balance.
- If you have chronic pelvic pain, seek a pelvic floor specialist to help guide you in the right direction to attack the musculoskeletal component.
- Adrenal fatigue/autoimmune thyroid conditions are common with chronic pain.
Finally, when finding a thyroid health care practitioner/endocrinologist/naturopath, it is important to find someone who looks at the “whole body” and is open to finding the right thyroid treatment for you.
Resources:
- http://www.thyroid.org/media-main/about-hypothyroidism/
- https://www.ncbi.nlm.nih.gov/pubmed/16382004
- http://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/dxc-20155382
- http://www.thyroid.org/iodine-deficiency/
- https://rbej.biomedcentral.com/articles/10.1186/s12958-016-0162-0
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.
Comments
Really interesting article.
I beat my hyperthyroidism about 8 years ago using a natural method (lemon balm tea). A few years ago my back and si joints started playing up, felt loose.
I then suffered a mystery back pain which crippled me for three days or unable to stand. Since then I’ve been doing physio to get my core and back stronger.
Still unable to run but slowly returning back.
Jon,
Glad to hear you enjoyed the article. Returning to exercise is important to a lot of people suffering from chronic pain or pain in general. How has your physio helped you get back into running since you started? If we can offer any other resources to you, we would be happy to do so.