Physical Therapy
1317 THIRD AVENUE (at 76th St.)
212-288-2242
Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.
I am fascinated by how the body and mind work together to heal from pain and injury. To learn more about healing and how physical therapists can help patients be committed to their healing process, I interviewed my good friend Rose Caiola, founder of Rewire Me, a company with a wealth of resources, writings and teachers in fields of physical, spiritual and emotional health, all thoroughly researched and curated by Rose and her team at Rewire Me.
Here are some of the gems I gleaned from our interview:
Evelyn: Why did you start Rewire Me?
Rose: Rewire Me evolved from life lessons I’ve learned from age 13 onward, meeting various teachers and mentors who helped me on my life’s healing journey. Connecting with these teachers proved more beneficial than trying to “fix things on my own.”
Many people feel alone when dealing with life’s challenges and don’t know how to ask for help or even where to look for guidance. One method or teacher may not resonate for every person, so I thought “Wouldn’t it be wonderful to have a site with a range of authentic experts, teachers, and healers?” People can seek and access these teachers’ wisdom through writings, books and classes to help them on their healing journey”.
Rewire Me’s website includes a range of experts on topics such as relationships, parenting, physical health, spiritual growth, dealing with illness and loss – incorporating all aspects of life.
E: How can people with physical pain start their healing process?
R: The first step is to acknowledge that there is something wrong. Many people don’t want to acknowledge that they are feeling pain, so they bury it or pretend it is not there. Once you acknowledge there is a problem, then you can reach out to a friend, call a medical professional, research on professional medical websites like WebMD and go on to Rewire Me to find teachers who may inspire them.
People may reject acknowledging pain or injury due to fear of the unknown. Others may feel that asking for help is a sign of weakness, especially if they are used to being in charge or control. Pain can make a person feel out of control. In essence what this really translates into is, ‘I don’t feel worthy enough to have somebody help me. I don’t love myself enough to get the help I need.’
E: How can one rewire fear-based thinking that stumps taking positive action?
R: Set a little time in the morning before you have to start your day. Sit up, feet on the floor to ground yourself and spend 5 minutes focusing on your breath, feeling and focusing your attention to the breath moving in and out, at whatever pace. This centers you to the present.
After the 5 minutes of quiet breath, ask “What do I want to happen today so I can achieve good health, or be successful as a parent or attain a work goal”
Envision your hero, or person of history who inspires you, for example, Amelia Earhart. What would it feel to be like her? Envision and embody the emotion of Amelia‘s courage, risk taking, forward thinking. How do you think she felt when she was flying solo in the starry night sky?
E: How can we help patients stay motivated and the course of treatment; to understand that their home program as physical therapy is not a “quick fix?”
R: Well, one I think is to have faith in the healing process. So that might become their mantra. ‘Today I’m going to do what I can to heal myself.’ ‘Today I’m going to take that first step.’ ‘Today I’m going to do my physical therapy exercises.’ Not worrying about tomorrow, not thinking about anything else, but having faith that they can overcome. When and if they come up to a crossroad or a flare up, don’t give up. Tell yourself “It’s okay.” Acknowledge that it’s painful and that you’ve hit a rock or a wall. Figure out how you can go around the wall instead of letting yourself get stuck. Avoid the “Oh poor me.’ ‘This always happens to me.’ ‘This is my life.’ If you keep repeating that story, you’re never going to get anywhere. Replace them with positive statements. The brain and body are listening!
The second thing to do is Practice. Practice your home exercises, self care techniques, say your positive affirmations out loud. With practice different parts of our brain light up and those neural networks become bonded over time, overriding faulty pain patterns. If you play a sport you have to practice to compete well. But, if you don’t practice, you won’t play as well. My kids are on sports teams and if they don’t practice, they get benched. They’ll say: “Why did the coach do that? I’m so angry…the coach hasn’t put me in play for the last 3 games!” Well, if you don’t practice, why would that coach put you in the game? It’s the same with committing and doing your home program, practice allows your body to change for the better.
Third, Schedule the 2-3 times a day in your calendar where you know you can do your physical therapy exercises. They don’t take long, right?
E: No. People wouldn’t do them otherwise, so we keep them short and manageable.
R: That’s great, so patients start to feel better, get stronger and over time they’ll see the many benefits of committing to their treatment.
E: Yes! You’ve used the term “healing journey.” What does that means to you?
R: A healing journey means learning to love myself. Learning to forgive myself, including what happened in my past. Incorporating growth and love from others and building this Rewire Me community is all about healing. Healing your heart. Healing your physical, emotional and spiritual well-being
Check out Rewireme.com to be inspired and continue on your healing journey!
(Image courtesy of Eva Margo Kant, LCSW-R)
The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today. As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.
The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.
Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.
Eva believes that “understanding how the body works is the key to understanding you”. Her job is to help people understand what their sexuality is to them and to own how they view and understand it. Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.
Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment. She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.
Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.
As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.
EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R
If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track. Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!
Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm
At EMH Physical Therapy, we support an interdisciplinary approach to treating our patients. We are in constant communication with primary care physicians, urologists, psychologists, gynecologists and other healthcare providers to make sure all our patients have a strong team working for them.
A team based approach to medical care has been shown to prevent medical errors (1), improve patient-centered outcomes and chronic disease management (2-4).
This week the EMH team are packing our bags and headed to Chicago to attend the International Pain Society’s annual fall meeting on chronic pelvic pain where we’ll hear practitioners of various disciplines discuss advances and techniques in treating pelvic pain. Some topics we’re excited about exploring include the “mind-body” connection, psychosocial aspects of pelvic pain, cancer and pelvic pain, cystitis, hormone treatments, vulvodynia and more.
The International Pelvic Pain Society (IPPS) was established in 1996 with the goals of educating health professionals on how to diagnose and manage chronic pelvic pain and to bring hope to men and women who suffer from this pain by raising public awareness (5).
Their website, pelvicpain.org, contains articles which can help to educate patients on a wide variety of conditions and find healthcare providers. We are excited to share the information we learn at IPPS conference with all of you when we return to New York City next week! Stay tuned.
P.S. We’ll be active on Instagram, @emhpysicaltherapy, and Twitter, @EMHPH, while we’re away, so keep up with us there!
Resources:
1. IOM (Institute of Medicine) To err is human. Washington, DC: National Academy Press; 1999.
2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association.2002;288(15):1909–
3. Ponte P, Conlin G, Conway J, et al. Making patient-centered care come alive: Achieving full integration of the patient’s perspective. Journal of Nursing Administration. 2003;33(2):82–
4. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs. 2001;20(6):64–78.
5. International Pelvic Pain Society. Pelvicpain.org
What’s your first reaction to this image? Laugh? Sigh and Roll your eyes at the tasteless joke? Did you think: “How can anyone REALLY have this?”
What if you were experiencing sexual arousal or multiple orgasms on a daily basis, for hours at a time, day or night, with no one medication or method to relieve symptoms on a consistent basis?
What if you had the guts to talk to your doctor about the embarrassing (or what may even feel like devastating) symptoms and find out that your doctor either never heard about PGAD, or worse was a medical professional that did not believe you?
This is the suffering that people with PGAD or PSAS, Persistent Genital Arousal Disorder or Persistent Sexual Arousal Syndrome, experience and continue to endure. Sadly, the condition has even led some patients end their own lives as recently as a few months ago in 2016.
Persistant Genital Arousal Disorder, a “monster sexual dysfunction”, as coined by Irwin Goldstein, MD (1) is a condition characterized by 6+ months symptoms of high levels of genital sexual arousal in the absence of desire (2). Genital arousal does not dissipate, with orgasm nor by medication alone.
PGAD sufferers describe their symptoms as intrusive, unwelcome, unpleasant and sometimes painful. Multiple, frequent disturbing orgasms (not pleasurable) occur spontaneously, at work, home, school and create tremendous embarrassment and anxiety, which eventually can lead to depression, frustration, and social withdrawal. It causes major stress for personal relationships. Seventy five percent (75%) of women with PGAD report moderate to high distress levels and report feelings of shame, isolation and suicidal thoughts (3).
PGAD has similar qualities, fluctuations, flares like and is starting to be viewed as a subset of chronic pelvic/abdominal pain.
Chronic pelvic/abdominal pain diagnosis is also made after 6 months of pain, burning, stabbing, cramping + other symptoms involving 1 or more “private “areas: bladder (urinary frequency and bladder pain) bowel, (IBS) reproductive organs (endometriosis, vulvodynia), groin, buttocks and pelvic floor muscle pain.
As chronic pain takes 6 months to develop, the tissues that were involved at the initial onset of insult or trauma may not be the main or only source currently producing chronic symptoms. Rather, a highly sensitive brain/nervous system that is persistently on High Alert, “Danger-Danger!” mode perpetuates the symptoms.
PGAD alone has not been researched extensively. We do not know the cause, the amount of women and men with symptoms, nor do we have effective, evidence based treatment – yet. With the push of some PGAD “warriors” and a relatively young organization, International Society of the Study of Women’s Sexual Health (ISSWSH), www.isswsh.org, research on PGAD is now being conducted. ISSWSH will have their annual conference in February 2017 where the PGAD Significant Interest Group will present state of the art research as well as testimonials from sufferers.
Chronic pain research has made amazing strides in the last 10 years due to the ability to incorporate MRI studies of the brain in all sorts of pain research. Our brain’s main job is to protect us. For example, we don’t keep our hand on the hot stove, or step down further onto the nail under our foot as the brain instantly weighs information coming from sensory nerves and makes a decision on how to react – i.e. PROTECT. Pain is the brain’s response to incoming nerve reports.
Research shows hundreds of areas in our brain “light up,” or simultaneously become active when experiencing pain, including areas in the brain that process Sensation, Movement, Emotions and Memory. This knowledge helps us understand how a certain movement, emotion or even noise & light can lead to a pain reaction, especially if the brain is persistently on the faulty “Danger-Danger!” mode.
“Neuroplascity” is the ability for the brain to make new neural connections throughout our whole lifetime, to adjust, to change.
How can we help our brain change from being on a highly sensitive “Danger Danger!” mode to a more functional mode?
Once medical diseases have been ruled out, the first step of effective treatment of PGAD is to change the brain from high alert to a healthy functional mode, by educating yourself on the science of pain (stay with me!) and to write down all of your possible triggers for symptoms. Lorimer Moseley’s and David Butler’s Explain Pain (www.noigroup.com) and pain educational website www.retrainpain.org are great resources for pain/PGAD sufferers and their loved ones.
Write down all the actions (riding in a car, walking up stairs, showing affection to partner, etc.) and write down what fears/thoughts (not knowing the “cause” of pain, not being able to work, loss of partner, inability to care for children etc.) that stimulates PGAD symptoms (4).
Describe each symptom related to the trigger and rate the intensity of symptom on scale of 0-10. This will give you and your medical team a baseline to measure and monitor progress. You have to be an active participant in your healing because each person’s cause of symptoms and how your brain reacts with pain/PGAD symptoms is unique.
Find your team of practitioners who understand PGAD and who will work with you. A Medical Doctor and a Pelvic Physical Therapist is a good start.
Physical therapy treatments are individualized as no patient is alike in their presentation – their symptoms of PGAD /pain may be similar, but the causes are different. Education about brain/nervous system and motivating patients to become active partners in their healing process has the best outcome.
There is no one “magic bullet,” no 1 medication or 1 technique for symptom relief. Receiving regular pelvic PT treatments plus doing a daily exercise/movement program (the brain loves movement!) is part of PGAD therapy. Treatments can include:
Manual Therapy – incorporating movement and awareness for both the external & internal muscles of the pelvis, abdominals, hips, fascia and skin; calming the “fight or flight” reaction allows for improved blood flow, oxygenation and balances the nervous system.
Biofeedback – to promote awareness of pelvic floor muscle tension and teach coordination training.
Breath and Meditation – deep diaphragmatic breath expands the front, sides, back of the ribs & abdominal cavity, relaxes the pelvic floor muscles, massages the internal organs and improves oxygenation to tissues. A simple 5 minute meditation where one focuses on the sensation of slow inhalation and exhalation calms the brain.
Desensitization Techniques: Strategies to lower the high alert nervous system as used in treating Complex Regional Pain Syndrome, is applied to our PGAD patients with promising results.
Stretching and Stabilization Exercises to lengthen and strengthen, stimulate the core stabilizers, soften the pelvic floor. Cardiovascular exercises to improve general blood flow are performed daily at home. Exercises are paced and applied gradually as the patient reports responses in their symptoms.
Modalities such as TENS, Low Level Laser and use of dilators can also be used as part of our treatment.
PGAD, like chronic pelvic pain is complex and requires patience by both the patient and the practitioner. Results are best if patient and practitioner work consistently together and the patient performs daily home/self care exercises, paying attention to responses and slowly increasing the pace and challenge of the new movement. Neuroplasticity takes persistence and develops over time.
Further research in measuring the efficacy of all the treatment techniques mentioned above and the importance of a concurrent multi-specialty approach to PGAD still needs to be done. My team and I at EMH Physical Therapy will continue to help patients heal from PGAD.
References
1 Goldstein I. Persistent genital arousal disorder- update on the monster sexual dysfunction. J Sex Med 2013;10:2357-2358
2 Jackowich R, Pink L,Gordon A, Pukall C. Persistent Genital Arousal Disorder: A Review of Its Conceptualizations, Potential Origins, Impact and Treatment. Sex Med Rev 2016;1-14
3 Leiblum SR, Brown C, Wan J, et al. Persistent sexual arousal syndrome: a descriptive study. J Sex Med 2005; 2:331-337
4 Butler D,Moseley L, Explain Pain, Noigroup Publications Adelaide, Australia 2013
Have you been working out for years, but neglecting a crucial muscle group??
At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.
Visualize this:
The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!
Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm? Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.
Come try out our discounted PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!
We offer 2 options:
“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50
“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130
To register call 212-288-2242
or
email info@emhphysicaltherapy.com
For more information click here
Were you watching the Olympics this summer wondering about those red circles on Michael Phelps’ shoulders? Those marks, called “sha,” are from an ancient Chinese healing technique known as “cupping.”
Cupping has been around for over 5,000 years. It’s practitioners stated it released toxins and helped correct imbalances in the flow of energy.
There were two cupping types: dry and wet. Dry cupping is performed when a glass bulb with a smooth rounded lip is suctioned onto the skin via heat. Either a cotton ball is lit on fire and used to generate heat inside the cup, or alcohol is rubbed around the rim and lit on fire before being placed on the skin.
The heat inside the bulb generates a vacuum like effect, producing a negative pressure on the connective tissue or fascia under the skin pulling the skin upwards (1).
The resulting “sha” are painless broken skin blood vessels which heal in 3-7 days.
Wet cupping was administered in the same way, except the skin is slit prior to application to allow blood to escape (2).
This method is rarely used today.
The modern application of cupping by physical therapists is known as “myofascial decompression.”
Instead of glass bulbs, hard plastic cups are used and instead of heat generating a vacuum, a hand pump suctions the skin. This allows for a more precise application of pressure.
The application of cupping is done with the “cup” device left in place for 5 – 10 minutes or slowly moved back and forth over the restricted area.
While more studies are needed the literature thus far shows some positive effects from myofascial decompression (3), including decreased neck (4) and low back pain (5).
Empirically, we at EMH Physical Therapy observe that the cupping technique combined with functional movements reduces pain and releases tight tissues quicker for patients with painful cesarean scars, plantar fasciitis, scoliosis and other conditions.
Keep in mind that cupping is an adjunct treatment, used alongside other types of manual therapy, therapeutic exercise and neuromuscular re-education at the discretion of your physical therapist.
References
1. Kravetz, R.E., 2004. Cupping glass. The American Journal of Gastroenterology 99, 1418.
2. Xue, C.C., O’Brien, K.A., 2003. Modalities of Chinese medicine. In: Leung, P.-C., Xue, C.C., Cheng, Y.-C. (Eds.), A Comprehensive Guide to Chinese Medicine. World Scientific, Singapore, pp. 19–46.
3. Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complementary & Alternative Medicine 2010;10:70.
4. R. Lauche, H. Cramer, K. -E. Choi et al., “The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study,” BMC Complementary and Alternative Medicine, vol. 11, article 63, 2011.
5. Y. D. Kwon and H. J. Cho, “Systematic review of cupping including bloodletting therapy for musculoskeletal diseases in Korea,” Korean Journal of Oriental Physiology & Pathology, vol. 21, pp. 789–793, 2007.
One of the things I love most about being in the healthcare field is learning from other practitioners. Through my years as a physical therapist treating chronic pain patients, I’ve found that a team approach works better than an isolated one. So, when Dr. Sharlene Bird, a clinical psychologist, came to talk to the EMH team I couldn’t wait to pick her brain!
Dr. Bird is a New York State Licensed Psychologist, Certified Sex Therapist and Certified EMDR (Eye Movement Desensitization and Reprocessing) Therapist who specializes in CBT and SE®. Say What? Let me translate the alphabet soup.
Dr. Bird has been in practice for over 20 years treating individuals and couples who experience sexual dysfunction and/or childhood trauma.
Initially, Dr. Bird mainly used a cognitive behavioral therapy (CBT) approach, aka “everything is in the head”. However, over the past seven years, she’s been integrating Somatic Experienci
SE®, developed by Dr. Peter Levine, focuses on the patient’s actual physical response in conjunction with the nervous system’s reaction to past traumatic experiences. There is a healthy range of responses to trauma which doesn’t wreack havoc on our physical and emotional stability.
In the graph below, you’ll see a normal range of responses: settling between being activated/heightened or relaxed/lowered.
image credit www.mindfulsomatictherapy.com/
Unhealthy levels are those responses that are outside of the “normal” range. If a patient is too elevated above the normal range they may be suffering with anxiety, panic, digestive issues, hypersensitivity to sounds (heightened startle reflex), sleep problems or chronic pain.
Too low under normal range and a patient may be suffering with depression, flat affect, lethargy, poor digestion or chronic fatigue.
image credit www.mindfulsomatictherapy.com/
SE® helps the body resolve physical and emotional trauma so one can reach a sense of being “settled.” By working with her patients on becoming present and mindful in a safe space, Sharlene helps her patients heal.
As a DPT I’m obviously focused more on the “body healing” side of things, but I understand that our mind plays a big role in how we process pain.
With the SE® approach, Dr. Bird asks a patient, “As you recall that trauma, what begins to happen inside your body?” this allows the patient to focus on the senses their body is feeling. The simple act of being mindful of how the body feels when remembering a traumatic experience plays a large role in freeing trauma. The patient will then be able to resolve the stalled ‘fight-or-flight’ resp
Dr. Bird works with patients for weeks or months to learn to read and help patients sense what is going on in their bodies in small manageable bits. She creates an environment that is moderately stressful, but still safe and controlled, to expand the capacity for creating new experiences and learning to “ride the wave.” The end goal is to re-establish a natural ability of the nervous system to shift smoothly between being activated and settled within the normal ranges.
Dr. Bird encourages mindfulness and sensory awareness and ended her presentation with a quote by Steve Goodier that is so fitting and helps us appreciate our bodies:
“You have a great body. It is an intricate piece of technology and a sophisticated super-computer. It runs on peanuts and even regenerates itself. Your relationship with your body is one of the most important relationships you’ll ever have. And since repairs are expensive and spare parts are hard to come by, it pays to make that relationship good.”
In today’s hectic world we can all use a reminder to be kind to ourselves and our bodies and keep that relationship “good.”
If you feel like Somatic Experiencing® will help you on your healing journey, see the resources below for more information. Happy feeling & happy healing!
resources:
http://www.drsbird.net/: for more about Dr. Sharlene Bird
http://somaticexperiencing.
Do you find that you have pain and difficulty inserting a tampon?
Is it a struggle to allow the Ob/GYN to use a speculum?
Have you experienced pain during intercourse?
Are you unable to have intercourse due to vaginal muscle spasms?
You may be experiencing vaginal muscle tightness, or a fairly common condition known as vaginismus.
Vaginismus is involuntary vaginal muscle tightness or spasming that occurs when attempting to insert something into the vaginal canal. It can be extremely painful with patients often describing symptoms as stabbing, burning, throbbing or “knife like” sensations.
Statistics show that 30% of women report pain with intercourse, however, it is difficult to determine the number of women suffering from vaginismus because women are reluctant to report the symptoms, or are unaware that this pain isn’t “NORMAL”. Many women experience vaginal pain beginning in adolescence and become so accustomed to living with discomfort, that it becomes their “normal”. They expect to have pain inserting a tampon, they expect pain with intercourse – so it never occurs to them that these actions should or could be pain-free.
At EMH, we want to make sure you are aware that inserting a tampon, getting a pap smear and engaging in intercourse should be absolutely pain-free! We have helped countless women of all ages tackle vaginismus. The key is to understand the muscles of the pelvic floor and to build a mind-body (neuromuscular) connection.
The muscle tightness you’ve been experiencing initially feels like it is completely out of your control, but luckily we know these vaginal muscles are voluntary just like most other muscles in the body. At EMH we will teach you how to identify, control, and relax the vaginal muscles using a combination of breathwork, meditation techniques, external stretching, internal vaginal stretching and dilators.
While the idea of using dilators (pictured below) may seem daunting at first, have no fear: an EMH Physical Therapist will slowly and gently guide you through the stretching process as well as initiating and progressing dilator use at a comfortable pace.
Seek treatment early and often for best results
A pelvic physical therapist can evaluate and identify if the source of your vaginal pain is due to muscle restrictions. Make an appointment for a pelvic floor evaluation at your earliest convenience. Begin physical therapy treatment to start the healing process. In many ways, the vaginal muscles are like all othe
r muscles that you would exercise and strengthen at the gym. Commitment and dedication are key. Plan on a minimum of 2-3 times a week.
Take 5:
Take 5 minutes out of your day to focus on breathing. Lying down on your back with your knees bent, take a slow breath in, allowing your belly to expand gently on the inhale and allowing the breath to escape slowly on the exhale. Mentally focus on “melting” the vaginal muscles and allow them to unclench.
Stretch, stretch, stretch:
If you have a tendency to clench your vaginal muscles, chances are you are holding tension in many other muscles groups in your body, especially the hip, thigh and butt muscles that attach directly to the pelvis. Taking 10 minutes out of your day for a quick and easy stretching routine will go a long way in teaching your body how to begin relaxing your vaginal muscles. Don’t forget to breathe!
Figure 4, Child’s Pose and Modified Happy Baby (all pictured below)
Cited source:
Herbenick, Debby, et al. “Pain Experienced During Vaginal and Anal Intercourse with Other‐Sex Partners: Findings from a Nationally Representative Probability Study in the United States.” The journal of sexual medicine 12.4 (2015): 1040-1051.
A staggering 100 million people in the USA suffer with chronic pain, a higher number than those diagnosed with cancer, diabetes and heart disease. Chronic pain patients suffer because they feel like they are not believed by medical professionals especially when many test results are negative, the medications don’t make a significant difference and their doctors don’t know what else to do.
Medications or even surgical procedures alone may fail in treating chronic pain as retraining pain requires a multifaceted approach to achieve results.
Recent research reveals that Pain is in the Brain. The faulty processing of danger signals by the brain and it’s decreased ability to modulate or manage the signals received from nerves is the reason for persistent pain. Having a variety of solutions that the patient implements concurrently may reap the best results.
( Visual infographic explaining chronic pain from behance.com)
Pain perception in a healthy body is good. It prevents us from fully burning our fingers on the stove, stepping on a nail, etc. The way pain perception works is that the receptors in our skin/body send danger signals through nerves to the spinal cord which then sends information to the brain where the pain is “perceived.” The brain instantaneously interprets the signals as either safe or dangerous depending on your past experiences.
The brain has areas that are dedicated to our awareness of pain and areas that determine our “experience” of pain. The healthy brain has flexible pathways and neurotransmitters that can “down modulate” or stop the danger signals. The neurotransmitters are the “happy chemicals” that our bodies naturally produce, (e.g. serotonin, endorphin & enkephalin). They actually BLOCK pain/danger signals to the brain. “We have a drug cabinet in the brain that’s 18 to 33 times stronger than morphine” says David Butler, PT, GDAMT, M.SPP.SC (1). There are a number of ways to increase production of neurotransmitters.
A recent study of chronic pain patients found 90% reported early childhood rejection by a primary caretaker, an unmet need for closeness and psychological interpersonal trauma (2). Feelings of rejection impairs the body’s ability to lower or “down modulate” and leads to hypersensitivity to pain.
These patients also reported difficulty in expressing emotion as they did not trust the people who took care of them. Science shows that interpersonal psychological distress and pain share the same neurotransmitters, genetic and immune markers. As babies, we are initially consumed by bodily distress then, as we grow, we feel safe and trusting and we develop a higher order of emotional expression and regulation. Over time, these pathways in the brain become like superhighways so when chronic pain patients experience negative interpersonal trauma, sensitivity to pain is heightened too.
Find your team of health professionals who can partner with you on your pain retraining program:
References
