One of my areas of specialization as a physical therapist is in pelvic pain. People come in to my clinic across the age span for treatment of this often debilitating condition. I see it in new moms, runners, people who sit in cubicles all day…. You name it. As a physical therapist, I evaluate the patient as a whole person to determine where the pain is coming from and why it is occurring. This involves assessing the posture of the spine both in standing and seated position, movement of the low back, pelvis, sacrum, and coccyx. A diagnosis of “Pelvic Pain” is used to describe pain in the lower abdomen, pelvis itself, or perineum, and is often described as burning, aching, or stabbing.
Causes of pelvic pain vary individually, and can include sacroiliac joint dysfunction, muscle imbalance or tightness in the pelvic floor muscles, trunk, or pelvis, or pressure on the nerves in the pelvis from tightness in overlying muscles. Scarring from surgery in the abdomen or pelvis or from delivery of babies can also be contributing factors.
Sometimes, something more serious is causing pelvic pain, and it is important to report your symptoms to your physician, so that it may be determined whether the pain is musculoskeletal, or pathological. If it is indeed musculoskeletal, ask your physician for a referral to a physical therapist who specializes in this treatment. If you live in Southern Oregon, come see me!
Here is a list of common behavioral traits in individuals with pelvic pain:
1. Runners who consistently run on the same side of the road: this contributes to mechanical strain on the pubic symphysis, leg bones, and pelvic floor muscles. Sometimes stress fracture in the pelvis occurs as a result of high mileage on a slanted road. Be sure to change up your route and run on both sides of the road to prevent this.
2. People who sit for prolonged periods. Mostly, the sitting is worsened by sitting with poor posture, commonly slumped. Be sure to have your office fitted to you by an ergonomic specialist if one is available at your company. If this is unavailable, try to fit your own desk to your size: computer terminal directly in front of you, hips and knees aligned at 90 degrees, head up tall.
3. Cyclists on improperly fitting bikes. Have a professional fit your bike to you, it is worth it in the long run! Nerve compression in the pelvic floor is common in this case.
4. New mothers who have recently delivered a baby. Babies compress important structures while in the uterus, especially during delivery. Complications during labor can lead to tearing and stretching of muscles, ligaments, tendons, and nerves. This is often fixable with physical therapy treatment, specific exercises, modalities, and bracing.
5. People who are under stress. Believe it or not, just as you can get “knots” called trigger points in your shoulders and neck from stress, you can get them in the muscles of your pelvic floor. There are manual techniques that can alleviate these trigger points. Folks that experience this are often jaw clenchers as well. Identifying stress triggers is important in the treatment of this one. If this sounds like you, I highly recommend the book:A Headache in the Pelvis, a New Expanded 6th Edition: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes. I have all of my chronic pelvic pain patients read this book because it is an empathetic and informative explanation of pelvic pain written by a doctor who experienced it himself. It discusses successful treatment programs and gives helpful insight on stress reduction techniques.
6. People who recently sustained a fall. This can lead to damage to the tail bone (coccyx) and the surrounding muscles. There are manual techniques to put the coccyx back into resting place, and to help heal the surrounding area.
This overview is brief, and there are many other factors to be considered. Be sure to discuss pain with your physician, and see a physical therapist for assistance- it is treatable!
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