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.
Melissa E. Phuphanich, MD, MS, Jonathan Droessler, MD , Lisa Altman, MD ,
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 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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