15 Aug Managing Pelvic Pain with Exercise
This article was contributed and written by Accredited Exercise Scientist, and Accredited Exercise Physiologist, Lyndal McCoy.
25% of women, and approximately 50% of postpartum women experience Chronic Pelvic Pain (CPP).
CPP, which is pain in the lower abdomen and pelvic region lasting for over 6 months with no medical reason, has a significant impact on quality of life. Pelvic pain can be caused by health conditions, including endometriosis, adenomyosis, fibroids and cysts as well as musculoskeletal pain and IBS.
Conditions affecting the nervous, musculoskeletal and urinary systems can also contribute to pelvic pain.
Managing pelvic pain can come with a significant cost to the individual. This cost is due to loss of income and increased cost of medical, allied health and therapy appointments to manage the condition. CPP can also cause pain or discomfort with sex (dyspareunia), difficulty using tampons, menstrual discs or cups and passing urine or stools. Reduction in work productivity and missing important family or social events can often happen due to CPP as well.
HOW CAN PELVIC PAIN BE MANAGED?
Pelvic pain can be managed with the use of analgesic (pain relieving) medication and medical and exercise interventions.
For women with chronic conditions like endometriosis, surgeries such as laparoscope, excision or ablation of tissue can be used to manage the condition and associated pain. Sometimes, a hysterectomy (which is the surgical removal of the uterus) may be required or requested to help with relieving pain.
As chronic pain also affects our nervous system, it’s important to remember that surgery may not completely relieve pelvic pain! That’s where exercise comes in…
Exercise can be a highly beneficial tool for managing pelvic pain. Accredited Exercise Physiologists (AEPs) are exercise experts who prescribe exercise to reduce pain and inflammation, increase flexibility, improve strength and manage chronic health conditions. AEPs can work with you to manage chronic conditions through the prescription of exercise and the improvement of lifestyle behaviours.
WHAT CAUSES PELVIC PAIN?
When we experience pain, our muscles respond by tightening up, aiming to limit movement to protect us. When this occurs to our pelvic muscles due to CPP, the muscles around our hips, lower back, pelvic floor and legs can become overactive, meaning they are always tense. This can lead to feelings of fatigue, stiffness and pain in this area.
This can also lead to overactivity of the nervous system which can further aggravate stiffness, nerve pain and can worsen chronic pain symptoms, including period pain. Overactive muscles can lead to poor muscle contraction patterns, which can place excessive strain on soft tissues around the pelvis.
CAN EXERCISE MAKE PELVIC PAIN WORSE?
When done without qualified advice, exercise can make pelvic pain worse, especially if the load or intensity is too high, or from lack of core or pelvic floor strength. This increases loading on structures around the pelvis that are already inflamed and irritated.
An AEP will provide an appropriately prescribed exercise program based on your medical history, screening assessments and goals to help you exercise without pelvic pain! Find your local AEP here.
EXERCISES TO RELIEVE PELVIC PAIN
The pelvic floor makes up part of our ‘core’. The pelvic floor muscles, the muscles around our abdomen and the diaphragm (strong band of muscle underneath the lungs) make up the core, and these structures work together to manage intra-abdominal pressure (IAP) which provides stiffness to our trunk to help with movement.
When there is dysfunction at one of these structures, additional pressure and loading is placed on the remaining structures. This can increase the severity of chronic pelvic pain.
A combination of mobility, strengthening and aerobic exercise can be used to reduce pain sensitivity and improve quality of life of people living with pelvic pain.
Downregulation of the pelvic muscles is usually the first step to improve movement, reduce tension of the muscles and reduce pain. This can be achieved with relaxation, mobility and stretching exercises such as:
1. Pelvic floor relaxation
While sitting or lying in a comfortable position, place one hand on your chest and one hand on your belly. Take in deep breaths, aiming to let the belly rise and fall with your breaths, rather than your chest. As you breathe in, imagine that your abdomen is filling like a balloon, and the muscles around your belly and pelvic floor are softening and lengthening. As you breathe out, very gently draw the belly button to the spine, and lift through the pelvic floor.
2. Cat-cow stretch
A common stretch in yoga and Pilates, this stretch helps to open though the chest and brings movement to the back. Resting in an all-fours position on your hands and knees, breathe out while looking forward, and arch your back so that the belly is relaxing towards the floor. Breathe in as you tuck your chin to your chest and round your back towards the ceiling. Gently move between these two positions.
3. 90/90 hip stretch
Sitting on the floor with your knees bent and feet on floor, wider than your hips, place your hands on the ground behind you to rest on. Rotate your legs to bring your knees towards the ground, then gently move side to side to rotate through the hip joints.
STRENGTHENING THE PELVIC FLOOR
Performing appropriate resistance (strength) exercises to strengthen the pelvic floor, hips and core will help with managing pelvic pain symptoms.
An AEP can discuss your symptoms and medical history with you, perform movement and strength assessments and prescribe exercises to help manage your condition. A combination of resistance and aerobic exercise provides you with the most benefits, and increased aerobic fitness is also associated with lower pain sensitivity.
MAKING A PLAN FOR PELVIC PAIN
Exercise gives you the best benefit when you are exercising consistently. With pain conditions, symptoms can vary greatly from one day to the next.
Discuss a plan with your AEP for an exercise program that you can perform on a high pain day. These exercises may look like some gentle stretches or a light walk, but it will help to keep in a routine of exercising.
WHO TO SEE FOR EXERCISE ADVICE WHEN LIVING WITH PELVIC PAIN
It is important to seek expertise from an Accredited Exercise Physiologist (AEP) to ensure your exercise routine supports you throughout your CPP journey.
Written by Lyndal McCoy, Accredited Exercise Scientist, and Accredited Exercise Physiologist.
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