Tag: physiotherapy

Pelvic pain is a condition that affects 26% of the world’s female population, yet it remains cloaked in misunderstanding, often going misdiagnosed or untreated (Lamvu et al., 2021). While you may think this pain affects one exclusively in a physical sense, research long supports a strong relationship between pelvic pain and one’s psychological well-being. This relationship is complex, and one worth diving into to help explain not only how they are linked but what we can do to help decrease your pain and improve your quality of life. 

Before we continue…

We want to acknowledge that pelvic pain affects people of all genders, even though this post focuses on female pelvic pain.  Written from a physiotherapy perspective, this post aims to be valuable for both allied health professionals and individuals coping with persistent pelvic pain. Also note that while we use the term “chronic pelvic pain” during our discussion, we recognize that current literature supports the use of the term “persistent pelvic pain.”

Understanding Chronic Pelvic Pain

As Lamvu et al. (2021) explain, chronic pelvic pain (CPP) is a persistent pain in the lower abdomen or pelvis that lasts six months or longer, significantly impacting daily life and overall well-being.  It can negatively impact your:

• Thoughts
• Behaviours
• Sex life
• Emotional/psychological state

You may also experience symptoms indicating issues with your urinary tract, bowel, muscles or gynecological health.  Chronic pelvic pain can be non-cyclic, cyclic, or related to your menstrual cycle and intercourse (Lamvu et al., 2021).  As this condition can stem from a variety of sources, diagnosis and treatment are complex. Oftentimes, multiple pelvic pain conditions coexist (Lamvu et al., 2021).  Common pelvic pain conditions include:

• Endometriosis, where tissue similar to the lining of the uterus grows outside the uterus, causing severe menstrual cramps and pain during intercourse.

• Interstitial cystitis, a painful bladder syndrome, results in discomfort and pressure in the bladder and pelvis, often accompanied by frequent urination.

• Pelvic inflammatory disease (PID), an infection of the female reproductive organs, can cause chronic pain and is often associated with sexually transmitted infections.

• Irritable bowel syndrome (IBS) is another condition that can lead to pelvic pain, characterized by abdominal cramping, bloating, and changes in bowel habits.

• Musculoskeletal issues like pelvic floor dysfunction, where the muscles and connective tissues supporting the pelvic organs become tight or weak, can contribute to chronic pain.

The Physical and Psychological Intersection

The human body and mind are intricately linked, with each influencing the other in profound ways (Renoir & Gray, 2013). This is especially evident in chronic pain conditions, including pelvic pain. The central nervous system, which includes the brain and spinal cord, plays a crucial role in our perception of pain.

When someone experiences chronic pain, their brain’s pain processing centre can become hypersensitive, leading to an exaggerated pain response (Till et al., 2019). This phenomenon is known as central sensitization (Latremolier & Woolf, 2009). When someone is centrally sensitized, their nervous system goes on what could be called “high alert.”  When on “high alert,” any stimulation might be perceived by the central nervous system as dangerous or painful.  With repeated stimulation over time, the pain response continues to be amplified. 

Beyond the physical symptoms, chronic pelvic pain can often lead to psychological distress. The persistent nature of the pain can contribute to anxiety, depression, and a reduced quality of life (Till et al., 2019). The psychological impact is not simply a derivative of living with chronic pain; the psychological impact can also exacerbate the pain itself (Till et al., 2019). Increased levels of stress and anxiety can trigger or worsen pain through the body’s stress response, which activates the sympathetic nervous system. This system releases stress hormones like cortisol, which can increase inflammation and sensitivity to pain (Till et al., 2019).

Individuals living with persistent pain can get trapped in a negative reinforcing feedback loop where their physical symptoms impact their mental and emotional well-being or vice versa, often amplifying their symptoms. Regardless of which one comes first, the impacts can be similar: increased pain, discomfort, and a decreased quality of life. 

Breaking the Cycle: Integrated Treatment Approaches to Chronic Pelvic Pain

According to Till et al. (2019), a multidisciplinary approach to treating pelvic pain is often the most effective. This approach typically includes a combination of medical, psychological, and physical therapies aimed at addressing both the physical, emotional, and psychological aspects of pain (Lamvu et al., 2021). 

Medical Interventions

Various medical interventions are often used in treating individuals living with persistent pain. These interventions can include medications to manage pain and inflammation, as well as treatments for underlying conditions such as endometriosis or interstitial cystitis (Lamvu et al., 2021). In some cases, nerve blocks or other interventions may be necessary to provide relief, however, the evidence supporting their use is limited when compared to other treatment modalities (Lamvu et al., 2021).

Psychological Therapies

Psychotherapies, including working with a registered clinical counsellor, can help individuals manage the psychological impact of chronic pain (Lamvu et al., 2021). These therapies can teach coping strategies, reduce stress, and address any underlying trauma or mental health issues.

As a team, we strongly believe in co-treating chronic pain and pelvic pain with the help of a mental health professional for the best results. You can read more about our resident Bump registered clinical counsellor here. Alternatively, you can find a list of additional resources at the bottom of this blog post. 

Physiotherapy

Working with a registered physiotherapist who has taken additional training in the treatment of pelvic pain can be extremely beneficial for many individuals living with pelvic pain conditions.   Physiotherapy techniques that can help reduce pain and improve overall function (Lamvu et al., 2021) include:

• Internal vaginal and rectal release work
• Myofascial release
• Soft tissue release
• Biofeedback
• Breathwork
• Body scans
• Yoga
• Generalized movement and gentle exercise

From a physiotherapy management lens, it’s important to find ways to downtrain or calm the nervous system to prevent the body from perceiving any kind of touch, stimulation, or movement as painful. It’s also important for physiotherapists and other medical providers to choose positive or neutral language when working with clients with chronic pain to avoid further catastrophizing and reinforcing a negative treatment outcome. 

Lifestyle Modifications

Stress reduction techniques, such as mindfulness, meditation, yoga, and relaxation exercises, can also play a critical role in managing both chronic pain and mental health. Encouraging regular physical activity, a balanced diet, and adequate sleep are also essential components of a comprehensive treatment plan (Till et al., 2019).

The Value of a Holistic Approach

Understanding the connection between pelvic pain and mental well-being highlights the need for a holistic view of pain management. Those suffering from pelvic pain are encouraged to discuss their physical, emotional, and mental health openly with their healthcare providers and seek integrated treatment plans that address all of their needs. It’s important to know that each discipline and clinician might impart a different lens and treatment approach to your specific condition. Please know that what’s most valuable is that the treatment approach is best for you!

By acknowledging and addressing the psychological components of chronic pelvic pain, healthcare providers can offer more effective and compassionate care. This approach not only helps alleviate symptoms but also improves the overall well-being and quality of life for those living with pelvic pain (Till et al., 2019).

Final Thoughts

The relationship between pelvic pain and mental health is a testament to the complex, and wondrous, interplay between mind and body. Recognizing and addressing this connection is crucial for effective treatment and improved outcomes for those struggling with chronic pelvic pain.

If you are dealing with chronic pelvic pain, compassionate help is available.  Please book online to seek advice/treatment from one of our experienced pelvic floor physiotherapists or to work with our registered clinical counsellor as we believe their interdisciplinary care goes hand in hand. 

Bump Physio & Co is a community of health care providers dedicated to changing the way pelvic health and obstetrical services are delivered. Our two clinics locations are Port Moody and Langley BC, where we treat beyond the Bump and welcome clients from all stages and phases of life. Our team has advanced training in Pelvic Health, Orthopedics, Obstetrics, Clinical Pilates, and Active Rehabilitation.

Please follow us along on our socials @bumpphysio.co keep updated on all that is going on and for more information about how the Bump Community can help YOU!

Resources

Find a Counsellor in BC

Pain Care Aware

International Pelvic Pain Society

Citations

Lamvu, G., Carrillo, J., Ouyang, C., Rapkin A. (2021). Chronic pelvic pain in women. Journal of the American Medical Association, 325(23),2381-2391.Retrieved from:

https://academy.flexwebdiensten.nl/wp-content/uploads/2023/09/Lamvu-2021.pdf

Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The journal of pain, 10(9), 895–926. https://doi.org/10.1016/j.jpain.2009.06.012

Retrieved from:

Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity – PMC

Renoir, T., Hasebe, K., & Gray, L. (2013). Mind and body: how the health of the body impacts on neuropsychiatry. Frontiers in pharmacology, 4, 158.

Retrieved from: 

https://doi.org/10.3389/fphar.2013.00158

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866391

Till, S. R., As-Sanie, S., & Schrepf, A. (2019). Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clinical obstetrics and gynecology, 62(1), 22–36. https://doi.org/10.1097/GRF.0000000000000412

Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment – PMC

Sometimes there can be confusion in the world of rehabilitation when it comes to who does what with whom and the lines between various professionals including physiotherapists, kinesiologists, personal trainers and athletic therapists can be blurred. While there can often be overlap between professionals, today’s blog post, we are going to answer four common questions when working with a Kinesiologist. 

What is Kinesiology?

Kinesiology is the scientific study of human movement which focuses on using active techniques (i.e., movement and exercise) based on anatomy, exercise physiology, and biomechanics to help promote and optimize health and well-being (Weir & Vincent, 2020). 

Kinesiologists help prevent, manage, and rehabilitate a variety of acute and chronic injuries, illnesses, and conditions using a full body approach focused on improving movement and function. Kinesiologists are trained to treat clients of any age and all physical abilities. 

How can a Kinesiologist help?

There are a variety of different reasons and conditions that a kinesiologist can support in achieving your goals. The scope ranges from personal training services to specialized condition or injury rehab. At Bump, our Kinesiologists typically work with clients in the following areas: 

• Pregnancy 
• Postpartum Recovery 
• C-section rehab
• Diastasis Recti
• Pelvic Floor Muscle Training 
• Acute and Chronic Injury Rehabilitation 
• Chronic Disease Prevention and Management
• Post Motor Vehicle Collision (ICBC)
• General Strengthening/Stability/Mobility 
• Sport Specific Athletic Training 
• Personal Training 

Kinesiologists have a wide range of skills, experience and expertise so if you are seeking help with something specific, please don’t hesitate to reach out and ask. We will do our best to help you achieve your personal rehabilitation goals. 

What can I expect during my kinesiology session?

Your very first session with a kinesiologist will be your initial assessment with them. It’s typically the longest visit as your kinesiologist needs the time to get to know you and gives them the opportunity to better understand everything that is going on with your body! The initial assessment often times consists of your subjective assessment (the talking portion), your objective assessment (the movement portion) client centered education, exercises and movements to practice at home. 

The first thing your kinesiologist will want to do is go through your personal, medical and injury history. We want to know your WHY; how is this condition/injury etc… impacting you and your life? What is it stopping you from doing? Why does it matter to you? Often times shoulder pain isn’t enough of a reason to get help, but if that shoulder pain is limiting you from playing with or picking up your children, or getting your work done, that often is more impactful. Once we’ve done all the talking, you and your kinesiologist will work together to set some collaborative goals to identify what you would like to achieve during your sessions. 

Next, your kinesiologist will take you through a physical movement screen where they will look at a variety of different things including:

• Posture 
• Breathing 
• Gait Analysis
• Functional Movements 
• Muscle Strength and Range of Motion 
• Abdominal Function 

Some kinesiologists also have training in fascial release, taping and other hands on techniques. Based on your objective assessment, your kinesiologist will provide you with information and education to give insight into your symptoms and potential underlying causes. They will help you understand what needs to be addressed so you can see improvements in symptoms. This education is intended to help you better understand what you are experiencing, how your current function and movements patterns are helping or hindering you, and what you can do to start feeling better! 

Following the assessment, your kinesiologist will discuss your individualized treatment plan. This will usually include a discussion of:

• Recommended exercises to help you move and feel better.
• The frequency of sessions to help you achieve your individualized goals.
• How many sessions we anticipate you might need and the length of time to get you moving and feeling better.
• What you can do at home to help! This might include stretches, cardiovascular training, strength training, manual releases with a ball or band etc… 

Your follow up sessions are focused on helping you complete the exercises and/or movements you collaboratively chose alongside your kinesiologist as part of your active rehabilitation program. Your kinesiologist will work 1-1 alongside you to ensure your mechanics are good throughout your session, your breath is coordinated through movement, they will help you identify specific muscles to activate or lengthen and provide individualized tips, tricks and modifications throughout your session. This will ensure you are doing movements in a way that will benefit your recovery. They will be able to identify when to progress (or regress) certain movements depending on how your body is feeling. 

Kinesiology vs. Physiotherapy: What’s the difference?

One of the biggest questions we get asked as rehab professionals, is what’s the difference between kinesiologists and physiotherapists? 

Physiotherapists and kinesiologists share a love of exercise and movement. Both professions use active based movement techniques to treat and will often work together with the shared goal of improving function and quality of life (Fransen, 2004). The biggest difference between the two is that a physio can provide a diagnosis for your injury/disease – whereas a kinesiologist identifies dysfunction and imbalances within your body, after your injury/disease has been diagnosed. A physio will usually refer you to a kinesiologist after your initial symptoms have improved.  

Physios assess, diagnose, and treat clients with more passive/manual techniques such as massage, mobilization, and manipulation (Fransen, 2004), whereas a kinesiologist will focus on the active rehabilitation component of the rehab. This means that as a client, you will be moving your body under the guidance of a kinesiologist during your sessions. They say movement is medicine and kinesiologists continue to be a vital part of the rehab process. 

Curious to learn more about kinesiology? Here’s a few resources to help.

• https://bcak.bc.ca/for-the-public/
• https://www.cka.ca/en/kinesiology

Ally Ferronto, Bkin

Bump Physio & Co is a community of health care providers dedicated to changing the way pelvic health and obstetrical services are delivered. Our two clinics locations are Port Moody and Langley BC, where we treat beyond the Bump and welcome clients from all stages and phases of life. Our team has advanced training in Pelvic Health, Orthopedics, Obstetrics, Clinical Pilates, and Active Rehabilitation.

Please follow us along on our socials @bumpphysio.co keep updated on all that is going on and for more information about how the Bump Community can help YOU!

References

1. Fransen, M. (2004). When is physiotherapy appropriate?. Best Practice & Research Clinical Rheumatology, 18(4), 477-489.

2. Weir, J. P., & Vincent, W. J. (2020). Statistics in kinesiology. Human Kinetics Publishers.