Flare Update, Part 2 of 3

For Part 1 of this mini-series, go here.

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I had a follow-up appointment with my PT last Thursday, which seemed kind of pointless. I was feeling much better, presumably from the estradiol cream, since amidst the holiday busy-ness I hadn't gotten around to doing the PT exercises she had suggested more than, oh, twice.

After my intake and update she asked (as she always does, because she's freakin' amazing) "How would you like to spend our session today?" A thought occurred to me. It seemed like a long shot, but lately I have been having knee pain that is aggravated, if not caused, by my chronically tight hip rotators.* I mentioned it to her - even though my pelvic floor looks good, any chance tight hip rotators could be causing distress?

As it turns out, yes they can. Our gluteus maximus and medius, and our tensor fascia latae, are supposed to do the heavy lifting when it comes to hip stabilization. If they're not doing their part, the deeper hip rotators may take on the job.

After her assessment, in which she confirmed her theory, she gave me four home exercises to do. The goal is to first train my brain to use my gluteus medius and maximus instead of my hip rotators to stabilize my hips, and then to build up strength. Once they are nice and strong, my hip rotators should chill out a bit.

Doing the exercises yesterday in the office and again this morning, I was struck by how challenging they are, even though I was making small movements. As soon as I engaged my glutes, my pelvic floor muscles tensed, which is exactly what we don't want them doing. It takes a lot of concentration to move them independently of each other. 

Hopefully doing these exercises (yes, I will actually do them this time) will retrain my brain to use my glutes without straining my pelvic floor muscles. And maybe I'll kill three birds with one stone - decrease the annoying hip rotator tension, reduce my chance of recurring pelvic floor pain, and get rid of my knee pain.

It would be pretty amazing to achieve those three goals.

The chronic hip tension has been with me my whole adolescent and adult life, and I notice it throughout the day and every morning in my yoga practice. It has that nasty aura of permanence.

It would also be a major victory to get rid of this new knee pain - which came on suddenly and without obvious provocation - without having to start the rigamarole of bouncing from doctor to doctor looking for an answer. These exercises may not be the only piece of the puzzle, but they are worth a try.

The Take-Away, Part One: Don't skip appointments with your health care practitioners even if they seem unnecessary!

The Take-Away, Part Two: Knowing your anatomy is a huge help. Understanding the pelvic structure** increases the level on which you can communicate and collaborate with your health care providers. 

Applied anatomical knowledge - that is, the anatomical knowledge that will help you in your role as a patient - has two parts. First there is the book learning: knowing the names and locations of various muscles and bones and what they do. Second is the personal awareness. Book learning becomes powerful when you are able to locate anatomical structures in your own body, know how they feel, and understand how everything affects each other - in your body, not theoretically.

For the book learning I don't actually recommend books per se. While they are necessary, it's difficult to learn anatomy from a 2-D source so I recommend taking a class. That said, the best books I know for applied knowledge are The Anatomy Coloring Book (which is exactly that) and Trail Guide to the Body, which gives you directions on how to find particular muscles and bones in your own body.

There are also some great tablet apps out there that give the added benefit of seeing a muscle in motion or rotating it's image, but I haven't tried them.

FYI I learned the bulk of my anatomy through massage and yoga trainings, but there are plenty of other ways, like through community colleges or extension schools.

* For the anatomy nerds in the audience: the "deep six" are piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris. Although all six are in the pelvic neighborhood, obturator internus attaches on the internal side of the pubis, making it the closest neighbor of the pelvic floor muscles. 

** Okay, not just the pelvic structure. As a centrally sensitized person I also had a lot to learn about how the central nervous system works and the biology of pain, but muscles and bones are a great place to start!

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Part 3 of the series, about last week's neurology appointment, is coming out on Wednesday. Cheerio!

Featured Post

Hey all,

Today I refer you to the Fangirl Interview with Rhonda Kotarinos, a pioneer in pelvic pain physical therapy. It was recently posted on Blog About Pelvic Pain, a website run and written by by Sara Sauder PT, DPT, a physical therapist in Austin. 

This particular interview is aimed more at physical therapists than patients, but sometimes it's useful to see life from the other side of the lab coat. In reminds me that health professionals are not all-knowing, and behind the scenes they are still figuring out what works and what doesn't in a world where limited information leads to controversy about treatment options.

That in turn means that pelvic pain patients need to be even more active in their own care than patients who have a well-researched medical condition (not that those people are off the hook by any means.)

Thus, there is a lot of relevant material for patients in this interview. 

Due to the lack of physician knowledge about the existence of physical therapy for pelvic pain, you may not have heard that physical therapy is a fit for you. I especially recommend this post if you are not aware of pelvic physical therapy, are currently in physical therapy, or have had limited success with it - who knows, you may learn something that you can pass on to your PT so they can treat you better.

While you're there, check out the rest of Sara's site - there's all kinds of good stuff there!

Resource Spotlight: Section on Women's Health

Did you know that physical therapists can help with pelvic pain?

If you didn't, you aren't alone. Most doctors, even gynecologists, are not aware that PTs can help with pelvic pain and dysfunction.

The Section on Women's Health is a sub-organization under the umbrella of the American Physical Therapy Association; it was founded in 1977. Originally focused on the needs of women before, during, and after pregnancy, the scope has expanded to include a variety of female health issues such as:

• incontinence
• pelvic pain
• vaginal pain
• fibromyalgia and chronic pain
• rehab following breast surgery

and more.

The site primarily serves physical therapists, but there are a few key pieces here for patients.

First, there is a page briefly explaining how these specialized PTs can help different medical conditions, what certifications they may have, and why this specific education is necessary in order to help you.

There is also the awesome PT Locator. You select your symptoms and poof!, get a list of local providers who specialize in your complaint. How handy-dandy, especially since your doc may not be a source of referrals. 

If you are all into science-y stuff, there are two things that may be of interest to you:

1. You can subscribe to the Journal of Women's Health Physical Therapy, or buy a specific article. The site doesn't seem to offer their entire catalog of articles, but it's a start.
2. You can find research projects in which to participate, a great no-cost way to

"Be the change you wish to see in the world."

(Thanks Gandhi.)

Pretty cool!

Even though the site is primarily aimed at physical therapists, it's worth a look-see, especially if you are curious about, or actively looking for, a PT. 

I hope this week's round-up of Resource Spotlights help you on your healing journey.

Be well, darlin'!