By Karah Charette, DPT, PHRC San Francisco & Berkeley
Pain might be one of the most pesky forms of mindfulness. When you are in pain, it is usually all you can think about. It draws you into the present moment whether you want to be or not. In this moment, there also often comes the fear that you have no control over this pain or that it will last forever. Thus you begin to induce what is known as secondary suffering. You move beyond the physical sensation of pain to the psychologically induced perception of what the pain could mean. As you are human, you are a meaning-making creature. You evolved to protect yourself at all times, to assume the worst in order to achieve what natural selection wants for you- survival. However, as a human you are also very capable of changing that narrative. You have the power to step outside of the reptilian brain and observe those patterns. More so, you also have the power to learn from them.
One of the primary teachings in Buddhist philosophy is that life is suffering. This is not taught so that you now must perpetually suffer with no way out. This is taught as a form of acceptance, or even companionship. Suffering is inevitable and it comes in many forms. It is universal and it has the potential to either walk by your side as a teacher on the path of life, or drag you down as a weight of denial.
This is an important concept to work with when dealing with pain because pain is a form of suffering, and therefore will always be there in some form. Bargaining with the idea that it should not be there is what ultimately feeds the beast to continue to exist. You cannot control whether or not pain exists, but you can control your relationship with it.
Your challenge with pain (when you feel ready to accept it) is to try to look at pain as an opportunity. What can you learn from this experience? What does this pain tell you about how you are moving in your body? How can this pain be informing you about your attachments to comfort and control?
Unsure on how to do this? Start with a simple five minute meditation in which you ask yourself these three questions:
- How can I separate my feelings of pain from the sensations of pain?
- How can I observe my emotions towards this pain without judgement?
- How can I be curious about this pain and what it is teaching me?
In this journey of acceptance in your pain, it is important to acknowledge that you can still seek ways to alleviate it. That is what doctors and physical therapists, as well as healthy movement and emotional practices are for. However, it is important to be mindful of your relationship with your healing process. Learn to be a part of the process rather than outside of it. You can achieve a real sense of control when you are able to truly embody the idea that you are the driver of your experiences.
“The mind and how it is designed to work is not a reliable tool for perception and thought.” These words spoken by Robert Wright, an evolutionary biologist and writer of Buddhist philosophy, speak to the idea that evolutionary you were not designed to optimize for contentment and satisfaction. The satisfied mammal is not the one to continue to seek food, shelter, and reproduction- all things that ensure survival. The mammal that is able to predict something that can cause harm and avoid unsafe situations is theoretically the mammal to survive and get genes into the next generation. This is in part why humans have a negativity bias.
What natural selection does not optimize for is quality of life. You can have a negative thought or emotion and choose to not believe it. Your feelings govern your perception, and your feelings should not always be accepted as the unquestioned truth. You must look at your feelings to dis-empower them. If you are designed evolutionary to be unsatisfied, you must then rebel against natural selection in this mindful work. Accepting and exploring your pain requires a radical reorientation of your thoughts.
A key concept that can never be talked about enough in this work is mindfulness. Mindfulness is the gateway to the present moment, and a majority of suffering with pain comes from a projected future. When sitting with your pain, can you ask yourself:
- What sensation am I feeling right now that I am perceiving as pain?
- How does this sensation feel to me when I anticipate this lasting forever?
- How does this sensation feel to me when I acknowledge this is my experience in this moment?
Does the sensation differ between questions two and three? When doing this deep work you may notice that if you can accept your pain for what it is purely in the moment, you can still experience safety and control. In meditating on your pain, you may even find that it never truly feels the same. The nature of all things in life is impermanence- everything is in a constant state of change. One way to combat the fear of persistent pain is to acknowledge the powerful fact that it can, and already has been, dynamically changing.
Another challenging area of pain is the focus on the negative with little to no acknowledgment of the positive. As discussed earlier about the nature to focus on negative thoughts for survival, it is now well understood why this is our nature as humans. Knowing that you are set up to function this way makes for a more powerful argument to have a practice of gratitude. In any given moment, duality always exists. There will always be something that could be better, and there will always be something that is ok (or even good). You can hold space for both and both can be true at the same time. When you are in pain, it can be even harder to see what is good. Practicing the embodiment of a profound sense of gratitude for what you do have can create a sense of grounding into the idea that perception is truly malleable.
You can try asking yourself these three questions to focus on gratitude in meditation:
- What can I observe that does not feel good in my body at this moment?
- What can I observe that does feel good in my body at this moment?
- How can these two co-exist? How can one inform the other in my perception?
Throughout this work remember that there is no right or wrong answer. This work is about creating space to ask the question and being curious about what the response is. As you dive into the world of asking questions, you may begin to dance with the concept of having a more objective view of your experiences. In order to accept your pain, you must first get closer to it. Escaping into the discomfort rather than away from it is how you can more powerfully find a path that leads to acceptance and alleviation of suffering. You do not get to have the choice of whether or not pain exists. You do, however, get to have the choice of how it will either hinder you or serve you. What do you feel ready to learn from this teacher?
If you are interested in exploring more concepts in dealing with mindfulness, you can check out this great blog here.
Below, you can participate in this guided meditation I created for exploring and embodying these concepts.
If you are dealing with pain and are interested in working with one of our clinicians, please call one of our locations to set up an appointment here. If you have an interest in working with Karah on more embodied meditation, you can set up a virtual appointment with her by calling the Berkeley office.
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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 $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 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
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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 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.