PHRC’s approach to treating pelvic pain. Exciting new treatment methods for overcoming central sensitization. And why kegels are no good for a tight pelvic floor. These are among the topics Liz weighs in on during an interview with PT TV, a series of video chats produced by Therapydia.com.
In the segment titled “Treating Chronic Pelvic Pain,” Liz chatted with Park City, Utah, PT Heather DeFord. Liz kicked off the discussion by driving home the importance of embracing a multidisciplinary approach to treating pelvic pain.
“That’s what we focus on here,” she said. “[PT] is a vital component of a treatment plan, but we have to be working with gynecologists, urologists, sex therapists, pain doctors, our orthopedic PT colleagues…because we all have a part to play in this.”
“Pelvic pain is a multimodal diagnosis, so you can’t just use one mode of treatment,” she added.
When asked to describe how the PTs at the Pelvic Health and Rehabilitation Center treat pelvic pain, Liz said: “We’re one hundred percent manually based here. We actually don’t use any kind of modalities or biofeedback, it’s all manual treatments.”
She added, “ And those [treatments] include connective tissue manipulation, trigger point therapy, and of course internal myofascial release techniques, and various external myofascial techniques as well as structure biomechanics and neuromobilizations.”
On the topic of pain and the brain, specifically the role central sensitization can play in pelvic pain, Liz brought up the fascinating research of Australian neuroscientist, Lorimer Moseley, who was the keynote speaker at the International Pelvic Pain Society’s Annual Meeting in Chicago last month.
“They’ve done enormous amounts of research on how to lessen central sensitization…no medications required. Their basis is educating the patient about what is pain and the fact that you don’t have to have a nociceptive input to have pain, that there are many types of input that can cause pain.”
Take urinary dysfunction, for instance, she added. Just thinking “I need to go to the bathroom,” or putting the bathroom key into the lock often leads to leakage or feelings of urinary urgency.
Liz goes on to describe the “change your brain, change your pain” techniques now being researched by Moseley and his team in Australia.
At the heart of the research is how educating patients about pain can change actually change how their brains perceive their pain. We’re not talking an “it’s all in your head” approach. We’re talking about actually changing neural pathways to turn down the volume on pain signals.
“It’s really cutting edge,” Liz said. “We’re starting to incorporate it in our practice, and it’s a really big shift because we may not touch our patients for the first few sessions.”
That’s because, according to the research, if a patient has a central sensitization issue, a PT could run the risk of increasing the patient’s pain if manual PT comes before the work of educating the patient, she added.
“It’s really fascinating stuff,” she said. “We’re super-excited to start to incorporate it into our practice. I think it will be one of the missing links that we’ve been looking for.”
The conversation ended with an eye-opening discussion of the ever-controversial kegel.
“Kegels are contraindicated for a high tone pelvic floor,” Liz stressed. “Until tone is normalized you can’t start doing any kind of uptraining because the hypertonic muscles are likely the source of pain and dysfunction. Plus, if there are trigger points in the muscle, doing kegels will cause further irritation.”
In the past, the theory was that doing kegels would fatigue the muscles causing them to relax.
Liz explained why this is faulty logic: “The pelvic floor muscles are not like your biceps or your hamstrings,” she said. “[The pelvic floor] muscles are working all the time so we can maintain continence, so you are never going to get a perfectly relaxed pelvic floor. So when you have a pelvic floor that’s hypertonic and you continue to do concentric contractions, that pelvic floor is just going to get tighter and tighter and tighter until it doesn’t know how to relax.”
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Comments
Hello
I did a course over here (uk) called the lightening process which is self help to change neural pathways regarding pain and associations, this has been a valuable addition to my PT work.
Hi Liz! I was trying to find an address for Heather DeFord and found this interview. I am so happy to hear from you. I work at the University of Utah Pain Management Center and came here with orthopedic experience in pelvic floor rehab. I have been astounded at how the two treatments have become one and the same. Treating chronic pain is all about changing the brain and nearly entirely education based (even our movement is education based). Lorimer Moesely’s work is integral of what we do be it pelvic pain, low back pain or CRPS.
I’m not surprised that it is pelvic health PT’s who are thinking along the lines of pain management. I would be very interested in any diologue with you. It’s nice to feel like I’m not working in a bubble; chronic pain PT’s have been labeled “on the fringe” for many years. In fact, it is critical for the treatment of so many common neuromuscular disorders.
Hi Tami,
Thank you so much for your kind words!
While education is certainly an important component in our treatment approach, we embrace a hands-on manual therapy technique. So during our hour-long sessions with patients our hands are on them the entire time. We’ve found that manual therapy techniques combined with education works best. If you’d like to read more about our specific methods, please read this post: https://pelvicpainrehab.com/blog/2012/05/what-is-a-good-pelvic-pain-pt-session-like/.
Do pelvic pain patients receive this type of hands on, manual therapy at your clinic?