Category: Anatomy

Dry Needling

3/9/2018

Dry Needling: An overview of benefits and risks for chronic pelvic pain patients

Pain 'Down There' | Though dry needling offers an avenue for pain management, several cautions should be noted if you are considering this line of treatment

Dry needling, also called Intramuscular Manual Therapy, is a treatment technique recognized by the state licensing board in 33 states to be within the scope of practice for physical therapists. It was first cited over 25 years ago but has picked up in popularity in just the last 5 years. It involves a solid needle similar in diameter to an acupuncture needle that is inserted into tissues for the purposes of managing pain and/or dysfunction. This is typically achieved through placing the needle in a muscle trigger point but could also include targeted areas of tendons, ligaments, scar tissue, and peripheral nerves.

Based on current research and clinical success, dry needling is generally thought to be effective in offering relief for a variety of neuromusculoskeletal conditions. There are several theories as to how exactly dry needling causes the relief of pain. It could be that several of these theories are interconnected and working together.

Though dry needling offers an avenue for pain management, several cautions should be noted if you are considering this line of treatment.

Research has documented adverse effects as a result of dry needling. Typically, these adverse effects are mild such as bleeding and pain, which do not require additional treatment. But there has been cited in the research rare cases of dry needling causing hematoma, peripheral nerve tissue damage, and impacts on the spinal cord.
Dry needling is an evidenced-based treatment modality when applied by a skilled professional. Inquire as to the professional’s training in this area. The clinician must have expert level knowledge in the understanding of the underlying anatomy. For instance, take the gluteus maximus, often used in entry level training programs because it is a large muscle and relatively safe for needle placement. Even as such, the clinician would need to know the course of the sciatic nerve underlying the muscle to avoid any potential risk of damage to this nerve.
The clinician (and you) should be aware of what’s called the vasovagal response. Certain stimulus that causes fear such as seeing the needle, seeing blood, or experiencing pain can cause on autonomic response leading to lightheadedness. The practitioner should be skilled in recognizing these symptoms and in patient positioning so that there isn’t a risk of falling and creating a harmful situation.
Keep in mind that dry needling is one among a variety of treatments available. It shouldn’t be seen as a cure-all or stand-alone treatment but rather a complimentary treatment inside a holistic treatment approach that seeks to address the underlying, root cause issues.

*References:
1. Halle S John Halle J Rob Pertinent Dry Needling Considerations for Minimizing Adverse Effects – Part One. Intl J Sports Phys Ther. (2016); 11(4): 651-662

2. Halle S John Halle J Rob Pertinent Dry Needling Considerations for Minimizing Adverse Effects – Part Two. Intl J Sports Phys Ther. (2016); 11(5): 810-819

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LIVE Event in FACEBOOK Group!

2/13/2018

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Reflexology Basics & CPP
"Going LIVE" Inside the Closed Facebook Group

If you're like me you're up for learning any new tools to add to your toolbox!

Join me LIVE on Monday March 5th at 12:30PM Central with certified reflexologist, Kate Haines.

Just click to join the group so you can attend the event!

Join the Group!

**Can't make the LIVE Event? The recording will be posted in the group**

EVENT DETAILS:

I'll be LIVE in the group talking with Certified Reflexologist, Kate Haines. Kate also has her degree in Physical Therapy and has a history of treating women with chronic pelvic pain conditions as a PT.

We'll be discussing the basic premiss for reflexology: how and why is it helpful for addressing any dysfunction in the body. As well as how it can be used specifically for chronic conditions in the pelvic area: pelvic organs, muscles, fascia, hips, back, etc.

We'll even be taking your questions live in the chat as long as we have time so show up and post your questions! Or if you can't make it live, don't worry - we'll post the recording. And you can ask your questions in the comments below and we'll try to get to it during our LIVE session.

I'll also be asking:
- Can we "DIY" reflexology?
- What are the areas we should most take note of (probably using my foot!)?
- Are any of those foot maps online even close or should we not pay attention to those?
- Would a Reflexologist without training in Chronic Pelvic Pain conditions still be helpful for me? If so, how do I find one?
- How often would I need to use reflexology before I notice a difference?
- Is reflexology really healing anything or is it pointing out the areas that need work (so I have to figure out that part on my own)?
- Any cautions or general "advise" for us as a group if we're interested in pursuing this tool for ourselves?

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WHY DO I HAVE VAGINAL PAIN? A SCIENTIFIC LOOK AT THE VULVAR VESTIBULE

11/30/2016

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If you were to take a mirror and take a look at the opening of your external genitalia, you would be looking at your vulvar vestibule. The vulvar vestibule (or “entrance way” to the vagina) includes from the clitoris to the urethral opening (for urinating) to the vaginal opening as well as portions of the inner lips on either side of the vaginal opening. Many incorrectly refer to the whole area as “the vagina”. Actually the skin of the vestibule lies between the vaginal lining and the outside hair bearing skin. If you need a little help on vocab and anatomy - check out this blog.

It is also really important to realize that the most common reason for entrance pain with intercourse, tampon use, vaginal speculum or just light touch from clothing is the common condition known as vulvar vestibulitis or better called vulvar vestibulodynia. (“itis” means inflammation and “dynia” means pain).

So back to looking in the mirror. You’ve probably never whispered “you’re special” to your vulvar vestibule. But it is. Not just for its role in the reproduction of life, but because the external tissues in that area are actually very different from other mucosal surfaces in the body. Mucosal surfaces are those bodily tissues that excrete mucus like the inside of your mouth and the inside of your nose. The difference is in the “profile” of the immune cells in that area, meaning the type and the amount of the cells of the immune system. Given how important the external genitalia is to the reproduction of life, we would suspect that it would indeed be a place that needs some extra immune system defense. This same observation holds true for other species as well, not just humans.

We also know that one of the methods the immune system uses to attack what it identifies as a threat to the system is inflammation. And as a result of inflammation we often feel pain. It makes sense then that pain brought on by inflammation at the vulvar vestibule would be different than the pain brought on by inflammation at other mucosal sites. Recent research seems to indicate that pain felt in this area is determined by 1) the amount (not simply the presence alone) of low grade inflammation, 2) altered vulvar nerve innervations, meaning an abnormality in the distribution of impulses of the nerves in that area, and 3) genetic susceptibilities that contribute to abnormal inflammatory cascades (chemical messengers that ramp up the immune system and cause a domino effect).

Vagina! (You are definitely more complicated than we thought!!!)

Just making sure you’re still with me here, this information is dense but it’s how we know persistent genital, sexual, and pelvic pain has a MEDICAL and SCIENTIFIC explanation.

Ok, back to the mirror. We know that the vulvar vestibule is derived (or made from) the endoderm. When we were just embryos in the womb, the inner-most layer of that embryo is called the endoderm. Do you know what else was derived from the endoderm? The bladder and urethra and also the gastrointestinal tract. It is possible that these other structures also have unique immune profiles, similar to that of the vulvar vestibule.

Let’s briefly recap: The vulvar vestibule has a unique immune profile compared with that of other mucosal sites. An immune/inflammation response at the vulvar vestibule isn’t enough to cause pain. Pain is determined by the magnitude of the immune response/inflammation. The vulvar vestibule, the bladder, and urethral linings are all derived from the endoderm and could share immune profiles.

One last piece of information that’s critical to note: the most recent research is finding that in the clinical setting, self-reported pain levels at the vulvar vestibule are closely connected with the release of an immune system messenger known as cytokine. That means when research study participants reported increased pain, the presence of cytokines in the examined vulvar tissue also increased.

What does all of this really mean? It means that we know that chronic genital, sexual, and pelvic pain is real in a clinical and biological sense. We of course recommend treatment modalities that work from the top-down to address the mind-body connection and help turn the central nervous system pain ‘volume dial’ down. But we also want to highlight the science behind the pain and the need for bottom-up approaches in line with current research and the desperate need for earlier diagnosis and appropriate treatment modalities and medications to counter these inflammatory and painful processes.

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Vocab Lessons in Vaginal Penetration Pain

12/2/2015

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Entrance Pain: Vestibulitis (Vulvar Vestibulodynia)

Vaginal penetration pain, or vaginal entrance pain. Pain in this region when "provoked" (trying to insert any object into the vagina) is most commonly due to a condition popularly known as vestibulitis. Vestibulitis is thought to be caused by highly sensitized nerve endings being contributed to by other pelvic pain triggers. This condition is frequently misdiagnosed as vaginal infections.

But let's back up. What do we call the vaginal opening anyway? If I had known more terms in my own research for answers, I may have gotten a bit farther a bit sooner.

Vocab Lesson 1: What is the vaginal opening? The vaginal opening is known as the vestibule. The vestibule contains large amounts of pain receptors.

Vocab Lesson 2: So then where is the vagina? The vagina is actually muscular tubing inside the female reproductive system that runs from the external genitalia to the cervix.

Vocab Lesson 3: If that's the vagina then what do we call the external genitalia? The entirety of the female external genitalia (including the vestibule) is called the vulva.

Vocab Lesson 4: So if I have pain at the vaginal opening... ahem.. I mean the vestibule... then what is that called? Pain in the vestibule is called Vulvar Vestibulodynia or Vulvar Vestibulitis (or you might hear it called just vestibulitis).

Vocab Lesson 5: What if my pain occurs in other areas "down there" or seems to be spontaneous instead of provoked? Chronic pain anywhere in the region of the vulva (as far back as the rectal opening and as far forward as the clitoris) is known as vulvodynia. Vulvodynia has two categories.
1: Vulvar Vestibulodynia (see Lesson 4) and
2: Generalized Vulvodynia
Generalized Vulvodynia is unprovoked pain. It is relatively constant and often described as burning or sore. It can occur in just one specific area or in multiple areas around the vulva. It is less common and more difficult to successfully treat. Pain emanating from the pudenal nerve may be a significant contributor to this condition in some cases (pudendal neuralgia).

So that's the vocab lesson for now in vaginal penetration pain, or vaginal entrance pain. Want to understand more pelvic and genital pain related vocab? Go to the Glossary.

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The Pelvic Floor: An OverView

10/27/2015

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Chapter 6: The Pelvic Floor: An Overview

Watch Chapter 6 of the Video Resource Series Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain.

This chapter introduces the physical therapy component of the DVD. Hear from Karen Liberi, a physical therapist specializing in women's health and pelvic pain for over 16 years. Learn how to view pelvic pain as a threshold of pain and how to affect and move this threshold through techniques we will teach you.

What feels like "there is no rhyme or reason for my pain" will start to have a rhyme and a reason. The feeling of "I don't know where the pain is coming from" becomes "this is the reason for my pain and I can do something about it". The global feeling of pain in the pelvis becomes an identifiable, local area of pain that can be addressed with the strategies given.

View More Chapter Previews

Purchase Now

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What's Psoas Got To Do With Sexual Pain?

8/27/2015

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The psoas (said like so-az) is an extremely important muscle. It plays an important role in postural and structural stability as well as in respiration. This muscle attaches from the front part of your lower spine to the front part of your hip allowing you to bring your knee to your chest.

Several interconnected factors going on in the psoas and surrounding areas can affect pelvic, genital and sexual pain. For instance, because there are nerves that run through the psoas, if the muscles are too tight they could be pressing on the nerves and contributing to pain. In another instance, if this hip musculature is too tight it forces the angle of the pelvis forward, causing excessive curvature of the lower back which affects our ability to regulate the tension of the pelvic floor.

Therefore, a properly functioning, released, and relaxed psoas muscle is crucial in the process of healing the pain "down there" and maintaining health and functionality in the pelvis.

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DVD Guide for Healing the Pain 'Down There' Available Now

8/12/2015

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BUY NOW

The long-awaited Video Guide Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain is now available for purchase.

Learn More:
A woman with chronic pelvic pain brought together a team of multidisciplinary professionals to create this instructional and educational DVD guide for those suffering with “pain down there”. The team represents over 50 years of experience in women’s health related fields including OB/GYN, physical therapy, mindfulness techniques, and human sexuality with their focus being on the treatment of pelvic pain. This educational video is intended for women of all ages who are experiencing pain during intercourse who want to learn why they have their symptoms and learn strategies to improve them. This video is also for teens and young women who may be at risk for developing these symptoms, and for clinicians who are practicing in the field of women’s health.

“Groundbreaking … “
Jill Osborne, MA
ICN Founder & CEO

“A well designed comprehensive view of pelvic pain from a multidisciplinary perspective and clear options for returning to health and well being.”
Sandra Hilton, PT, DPT, MS

“A very important resource for many women...”
Frank Tu, M.D., MPH

" Respected pelvic practitioners create a road map to navigate the challenging path of healing pelvic pain."
Dustienne Miller PT, MS, WCS

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Breath & Sexual Pain

8/4/2015

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An important way to promote or restore function and control of the pelvic floor is through the breath. Clenched abdomen and habitual breathing from the chest directly affects the pelvic floor, making it too tight/tense and "turned on" which can contribute to sexual pain. Shallow chest breathing also cues our bodies into the tensing, fight or flight mode of the nervous system (see previous blog).

Breathing is meant to come from the abdomen/diaphragm, not from the chest. If you've been taught by sports or cultural influences to suck in your abs and breathe from your chest you may need to re-train your body to breathe appropriately. Musculoskeletally, the respiratory diaphragm and the pelvic floor work together.

As you inhale .... the diaphragm lowers and the pelvic floor expands.

As you exhale... the diaphragm and pelvic floor return to their elevated positions.

Therefore, if you are constantly breathing from your chest, your pelvic floor never gets a chance to relax and expand. Mentally check into your breath pattern throughout the day to ensure proper breathing techniques. We go more in depth about how to do this in the DVD, Healing the Pain 'Down There': A Guide for Females with Persistent Genital and Sexual Pain.

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TYPICAL DEPICTION OF THE FEMALE PELVIS: INCOMPLETE

4/8/2015

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Take a look at the image in the blog post just below. This image of the female pelvis is incomplete because there is a great deal more to the anatomy of the female pelvis that is just not shown in this image. The pictures in this blog post show much more of the complete anatomy of the pelvic region.

The actual causes of chronic, persistent pain itself are in all of these neuro-myofascial components: Nerves, Muscles, and Ligaments. Bladder, bowel, and reproductive organs are commonly acting as "triggers" that set off painful, but protective responses in the region. Just as in any other area of the body, the muscles, nerves, and ligaments go into a protective bracing mode as a result of current tissue injury, protecting against further injury, and even when the system is reminded of past injury. These structures are trying to immobilize the region in order to control the pain.

Comprehensive assessment and treatment of chronic pelvic pain therefore will naturally include specialized pelvic floor physical therapy to rehab and release long term muscle spasming and trigger points, as well as a working knowledge of diagnosing and managing chronic nerve type pain in the pelvic and genital region.

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TYPICAL DEPICTION OF THE FEMALE PELVIS: MISLEADING

4/1/2015

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Recognize this imagery? You've probably seen it on your doctor's examining room walls and in your health books since middle school. However, there are 2 important misleading and incomplete aspects of this depiction of the female pelvis.

First, the uterus and ovary seen on this picture are deceivingly pictured way up near the umbilicus or “belly button” - that positioning of this anatomy does not actually happen until about 15 to 16 weeks of pregnancy and as can obviously be seen, the uterus in this picture is not pregnant. In this respect this picture is a “cartoon” type drawing that is not anatomically correct. It is simply meant to show that the 3 main organ systems in the pelvis are the lower urinary tract, the reproductive organs, and the lower bowel.

This may not seem important, but in actuality, it is terribly misleading in many circumstances such as when a young woman goes to her doctor or the emergency room doubled over in pain and everyone believes it must be her ovary or certainly a “female” issue, when in fact her ovaries are located considerably deeper or further down in her pelvic “core” than what this picture indicates. So when the ultrasound, the CT scan or any of the other tests don’t show anything abnormal, everyone is puzzled. When this happens repeatedly in young women, they begin to believe and are even told that the pain “must be in their heads”, that they are seeking attention, and/or they are just “drug seekers”.

The second and considerably more important reason this picture of the pelvic region is wrong or incomplete, and which begins to explain why all those tests patients may have undergone did not show anything obviously serious - is that there is indeed a great deal more to the anatomy in the pelvic region that is just not shown in this picture.

To be continued..

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Dry Needling

Dry Needling: An overview of benefits and risks for chronic pelvic pain patients

LIVE Event in FACEBOOK Group!

Reflexology Basics & CPP
"Going LIVE" Inside the Closed Facebook Group

WHY DO I HAVE VAGINAL PAIN? A SCIENTIFIC LOOK AT THE VULVAR VESTIBULE

Vocab Lessons in Vaginal Penetration Pain

Entrance Pain: Vestibulitis (Vulvar Vestibulodynia)

The Pelvic Floor: An OverView

Chapter 6: The Pelvic Floor: An Overview

What's Psoas Got To Do With Sexual Pain?

DVD Guide for Healing the Pain 'Down There' Available Now

Breath & Sexual Pain

TYPICAL DEPICTION OF THE FEMALE PELVIS: INCOMPLETE

TYPICAL DEPICTION OF THE FEMALE PELVIS: MISLEADING

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​Dry Needling: An overview of benefits and risks for chronic pelvic pain patients

Reflexology Basics & CPP "Going LIVE" Inside the Closed Facebook Group

Entrance Pain: Vestibulitis (Vulvar Vestibulodynia)

Chapter 6: The Pelvic Floor: An Overview

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Dry Needling: An overview of benefits and risks for chronic pelvic pain patients

Reflexology Basics & CPP
"Going LIVE" Inside the Closed Facebook Group