Is there a role for yoga in pelvic pain healing?
“Absolutely!” says Dustienne Miller, a Northern California-based pelvic floor PT who also happens to be a certified yoga instructor.
I sat down with Dustienne to learn more about exactly how yoga and pelvic pain rehab go together, and in today’s post I’m going to share what I’ve uncovered.
How Yoga can Help Pelvic Pain
As a pelvic floor PT and a yoga instructor, it didn’t take long for Dustienne to recognize the potential of applying yoga to pelvic floor rehab.
The combination appealed to her for two reasons: For one thing, she realized that many yoga poses could serve as therapeutic movement, and for another, she saw the value in yoga as a self-treatment tool.
“I like the aspect that it’s something that the patient can do on his or her own,” Dustienne says. “It’s empowering because you have this tool to augment PT, and to self-treat if you are having flare ups.”
While a growing body of research shows that exercise in general is beneficial to those dealing with chronic pain, Dustienne saw in yoga major benefits that could be applied specifically to pelvic pain.
The first of those benefits involves the “pranayama” or deep breath work that is a fundamental tenant in any yoga practice. The umbrella term that Dustienne uses for the breath work practiced in yoga is “conscious breathing.”
So what role can conscious breathing play in pelvic floor rehab?
Generally, those in pain tend to breathe more shallowly; there is a decrease in rib cage excursion in both inhalation and exhalation, which deprives muscles and organs from getting enough oxygen.
More specific to chronic pelvic pain, most people with pelvic pain have pelvic floor muscles that are too tight. In addition, there is typically a component of “muscle guarding” involved in the pain cycle. Muscle guarding occurs when muscles contract rigidly around an injury to hold it in place to protect it from further damage. But when pain persists after the original injury has healed, that protection mechanism becomes maladaptive. The contracted muscles clamping down on nerves cause pain, and muscles atrophy from disuse and become another source of pain themselves.
The consequence of too tight muscles is less blood flow, i.e. oxygen and other nutrients, to muscles, organs, and tissue resulting in pain.
Enter conscious breathing. Conscious breathing helps to reverse this situation. How exactly? When you take a deep or conscious breath, the diaphragm works in coordination with the pelvic floor muscles, so when you inhale the pelvic floor muscles expand allowing for greater pelvic floor muscle release, relaxation and blood flow. Try it right now…I’ll wait.
Didn’t you feel that nice pelvic floor expansion while you were taking in that big deep breath?! Cumulatively, conscious breathing can have a therapeutic effect on pelvic pain.
There are two different conscious breathing techniques that Dustienne recommends. The “three part breath” and the “letting go breath.”
With the three-part breath you inhale into the belly, then expand the ribcage, allowing the collarbones to float up. Upon exhaling, you expel all the air out from the belly through your nose.
With the letting go breath, you simply inhale through the nose then exhale with an audible sigh through your mouth. (To watch a Dustienne’s video about the letting go breath, click here.”)
In addition to enabling better blood flow and increased relaxation, conscious breathing can also impact the sympathetic nervous system, which for some people plays a major role in their pelvic pain.
Let me explain: The sympathetic and parasympathetic nervous systems are the yin and yang of the “autonomic nervous system.” (The autonomic nervous system controls body functions that occur below the level of consciousness, like breathing, heart rate, sexual arousal, perspiration, and pupil dilation, just to name just a few.)
For its part, the sympathetic nervous system controls our flight-or-fight response releasing “excitatory chemicals” into the body, while the parasympathetic nervous system governs the rest-and-digest response releasing inhibitory “chill out” chemicals. These two systems are designed to work together to balance each other out.
However, when it comes to chronic pain, the sympathetic nervous system can overreact releasing too many excitatory chemicals for too long a period of time. One way to combat this is to activate the parasympathetic nervous system. That’s because when there are more “chill out” chemicals than there are “run from that bear” chemicals, there is less pain.
That’s where conscious breathing, as well as other tenants of yoga, like certain yoga poses, comes in. “We can use yoga practice, postures and breathing as a modality to increase parasympathetic activation in the body in order to normalize the balance between the sympathetic and parasympathetic nervous system,” Dustienne points out.
How to Incorporate Yoga into Pelvic Pain Rehab
So now that we’ve covered the whys of yoga and pelvic pain, it’s time to cover the hows. To figure that out, I asked Dustienne to share with us the advice she gives pelvic pain patients who want to incorporate yoga into their healing.
First off, she recommends either a “gentle” or “beginner” yoga class to those with pelvic pain, she says.
For instance, a gentle hatha yoga class would be a good choice. Typically, a hatha yoga class is a slow-paced stretching class with some simple breathing exercises and seated meditation.
Another good choice would be a “restorative yoga class.” In restorative yoga, props are used to support your body so you can “let go” and relax allowing for your nervous system to take a much-needed break. “Restorative yoga is a gorgeous way for us to get the rest we need,” Dustienne says.
Other kinds of yoga, such as ashtanga yoga, is sometimes too vigorous for those dealing with pelvic pain, she adds. “Classes where there are a lot of sun salutations and lunging are not a good fit for those with pelvic pain.”
In addition, these days, some yoga studios are advertising “pelvic floor yoga classes.” These classes are typically focused on pelvic floor strengthening. So those with pelvic pain will want to steer clear of them. However, if your problem is not pelvic pain, Dustienne points out, but weakness, these yoga classes might be able to help you.
A major consideration before adding yoga to your pelvic pain rehab is to talk to your PT about what your specific movement restrictions are. However, since many PTs will not know the yoga language, it’s best to just ask them to point out your specific physical restrictions, like “avoid hip openers or doing back bends” as opposed to asking them to give you a list of which yoga poses to avoid.
From there, it’s important to talk to the yoga teacher about the restrictions you have and ask him or her for modifications. “So coming to the class with a list of ‘do’s and don’t’s’ is really helpful,” Dustienne says.
“If you don’t have a PT,” she adds, “I would say think about what flares you up and be mindful of that as you go through class.”
Lastly, and this is perhaps the key to successfully incorporating yoga into your pelvic pain rehab, is to always practice “Ahimsa.” Ahimsa is the Sanskrit term for “nonviolence,” and it basically means to “do no harm.”
“If you feel like you’re pushing yourself towards the edge of discomfort,” Dustienne says, “don’t push past it, thinking ‘no pain, no gain.’ You gain most by listening to the boundaries your body is telling you about.”
If you find yourself experiencing discomfort in a yoga class or while using a yoga DVD, back off of the posture, and come into a position of ease.) “When I’m teaching a class,” she says, “and I see that someone comes down into child’s pose or lays down onto their back, I’m thrilled because I know they’re really taking care of themselves.”
Pelvic Yoga Rehab: At Dustienne’s Pace
For her part, Dustienne has developed a DVD, Your Pace Yoga: Relieving Pelvic Pain, especially for pelvic pain patients who want an alternative to venturing out to a brick and mortar yoga class. In addition, this month she has begun to offer yoga classes via Skype.
So what makes her yoga DVD a good fit for pelvic pain rehab?
Well, in developing her DVD, Dustienne says she decided that it was important to make it approachable to users, and toward that end, there is no chanting or Sanskrit in the DVD. Also, she decided to keep each class on the DVD short, unlike most yoga classes, which typically run from an hour to an hour and a half. Indeed, the first class on the DVD is 25 minutes and the second is 20 minutes.
In addition, she says when she was developing the classes on the DVD as well as her in- person classes; she was extremely cognizant of what movements would be the most beneficial to those with pelvic pain. “ I put my mat out and got some sticky notes, and said: ‘Now, if I had pain, which way do I want to move? Which way would I not want to move?’”
“So the DVD and my classes are really symbiotic of my PT background and my yoga background. I don’t always know how to separate them, and I think it’s a good thing.”
About Dustienne Miller: Dustienne is a board certified women’s clinical health specialist and owner of Flourish Physical Therapy in Santa Rosa, California. In addition, she is a certified Kripalu Yoga teacher and creator of the “Your Pace Yoga: Relieving Pelvic Pain” DVD. She offers private yoga sessions via Skype and invites you to visit her website at www.yourpaceyoga.com.