Time to Talk About Healing, It’s a Process

In Pelvic Floor Physical Therapy by Emily Tran2 Comments

Earlier this month I had my wisdom teeth removed. Last thing I remember was talking about elephants in Thailand, and next thing I know I wake up looking like a chipmunk that got in a bar fight (and lost). After a few days, I couldn’t understand why I still felt bad. This was a “simple” procedure and all the pictures at the oral surgeon’s office showed happy smiling people! I was neither happy nor was I smiling and I felt like an adorable woodland creature, not a person.

I started to panic and called my doctor’s office. This can’t be normal! I said I have a lot of pain! I need to talk to the doctor! The lovely receptionist calmy reminded me that I had surgery four days ago and that what I was experiencing was totally normal. Before she could continue I suddenly realized that I was about to be given the same advice that I give my own patients: healing takes time.

Why? Well the human body is not like Amazon Prime. We (unfortunately) can’t get what we want in 48 hours. Why you may ask? Well it helps to understand the healing process. So prepare for a very brief breakdown in human physiology.

First, we have the inflammatory phase. Wait, isn’t inflammation bad?! Nope! Sadly, inflammation has gotten a bad reputation over the years. Inflammation is actually a normal and essential part of the healing process. It is when inflammation becomes chronic that things can become problematic. Yet, inflammation, which includes increased blood flow to the area, brings different immune responders and mediators to begin the healing process. The body senses a problem, calls 911 and a whole rapid response team are sent in to fix the situation. This response can lead to swelling and pain. This phase typically lasts anywhere from a few days to several weeks depending on the injury.

The next phase of healing is called the proliferative phase. This is when some of the rebuilding begins. Damaged cells continue to be removed and new tissue is laid down. Different cells synthesize materials to allow for collagen production and the formation of new blood vessels to bring oxygen and nutrients. This process typically starts after 48 hours but can last for several weeks.  

Finally, we enter the remodeling phase. The collagen fibers shorten and create scar tissue that continues to remodel to mimic the “original” tissue that it once was. In muscle, this fibrous scar maintains structural integrity but lacks the same functional ability as muscle tissue, which is one reason why soft tissue injuries commonly re-occur. It is important to note that this phase can last anywhere from a few weeks to a whole year.

That’s right, the whole healing process can take up to a year. So again, the body takes time to get better.

This is especially true for many patients dealing with pelvic pain. On a regular basis I get asked isn’t there a “pill/shot/surgery I can get to make this all go away?” That would be amazing, and perhaps someday modern medicine will develop one of those machines seen in sci-fi movies that can diagnose and treat you within 30 seconds. Unfortunately, as demonstrated already the body is a little more complex and as a result it often requires more than just one type of treatment to recover. This is where the multidisciplinary care team comes in. If you have read any of our blogs in the past, you have heard this term. Patients with pelvic pain often need more than one provider to address  their symptoms.

Why?

Well, the pelvis contains several different organs: bladder, bowel and depending the uterus or prostate. This means that one or more body systems may be involved and would warrant a specialist to address that specific area. So a person may need a urologist to address any issues related to the urinary system, a gastroenterologist to address any bowel dysfunction and an endocrinologist to address underlying hormonal dysfunction. That is just one example of course, some patients may have a team that consists of a pain management provider, a general practitioner, an acupuncturist and of course, a pelvic floor physical therapist.  

Basically, there is no one size fits all treatment plan for people with pelvic pain which is why the type of providers needed on their care team may differ from person to person.

It can be a frustrating process, but if you have read some of our success stories, things can get better and that is why we are here to help.

References:

H., T. A., N., T. L., Kääriäinen, M., Kalimo, H., & Järvinen, M. (2005). Muscle Injuries: Biology and Treatment. The American Journal of Sports Medicine, 33(5), 745–764. https://doi.org/10.1177/0363546505274714

Crisco, J. J., Jokl, P., Heinen, G. T., Connell, M. D., & Panjabi, M. M. (1994). A Muscle Contusion Injury Model: Biomechanics, Physiology, and Histology. The American Journal of Sports Medicine, 22(5), 702–710. https://doi.org/10.1177/036354659402200521

Goodman, C. C., & Fuller, K. S. (2009). Pathology: Implications for the physical therapist. St. Louis, Mo: Saunders/Elsevier.

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.

Comments

  1. Well done! This is a great reminder for the days when it feels like things are taking a step backward. Thanks!

  2. Very helpful article. I have had pelvic tightness problems for almost 7 years since prostate surgery. I probably had problems before that also. I have been trying to figure out why stretching causes so much discomfort (and, for some reason, high blood pressure). Nobody could answer that question. Now I understand. I kept quitting the stretching because of this. I often overdid the stretches and ended up with high blood pressure that was so volatile I ended up in the ER twice. It would also sometimes drop to dangerously low levels probably from the HBP medication. I think if I work up to full squats gradually I’ll be OK. Thanks.

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