By: Rachel Gelman
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.
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.
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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
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