Equilibria
Leave this field empty

Tag Search: myofascial

Page 1  

Ovulation Pain or Mittelschmerz

Posted: Thursday, December 19, 2013 at 8:00:22 AM EST by Alyssa Tait

 Can you feel when you're ovulating?

That niggling pain is back again, low down in the left of your lower abdomen. It’d be nice to just sit down and put your legs up, but you’ve got to keep working.  That time of month again – no, you’re not due for your period for another two weeks! This is mid-cycle pain. Not only do you get period pain, but you’re hassled in the middle of the month by more pain! Why?

That cyclic stabbing pain in one side of the lower abdomen that some women experience is known as ‘’Mittelschmerz’’ (meaning middle pain) or ovulation pain. It is typically described as occurring at mid-cycle. However, this is dependent on the length of the cycle. It would be more accurate to say it occurs approximately 2 weeks before the menstrual period – that is, at the time of ovulation.

Ovulation pain tends to switch sides from month to month (depending on which ovary you are ovulating from, obviously). For most women it lasts a few hours or less – just enough to let them know they are ovulating. For some women, it lasts for more days. And for some very unlucky women, it is severe and can be accompanied by other symptoms such as nausea or even vomiting.

The precise cause of Mittelschmerz is uncertain. It may be due to the enlargement of the follicle before the egg bursts forth in ovulation, or the rupture of the follicle itself, with the spilling of its contents into the surrounding tissue. Whatever it is, if it is anything more than a minor nuisance, you may want to have it looked into.

Severe Mittelschmerz is often due to endometriosis, a condition where the inner lining of the uterus (the endometrium) ends up implanted in places it shouldn’t be. Endometriosis can only be definitively diagnosed with a laparoscopy – a relatively invasive procedure. Women with endometriosis usually have painful and heavy periods as well, and sometimes pelvic or abdominal pain at other times of the month. This can imitate irritable bowel syndrome.

In my experience, cyclical abdominal or pelvic pain is more likely to occur when there are ‘’tissue restrictions’’ around the organs involved (in this case, the ovary, fallopian tube and uterus). For example, endometriosis causes adhesions (scarring) within the tissue which causes it to tighten up and be less flexible. As your pelvic organs contain smooth muscle and are designed to be very mobile, these restrictions can result in you feeling things you shouldn’t (such as pain) – or feeling sensations more strongly than necessary. Tissue restrictions that can be palpated by an experienced physiotherapist are certainly present where there is endometriosis, but many women I see with these problems do not have a diagnosis of endometriosis (yet, anyway).  In my experience, ovulation pain, period pain and other pelvic or abdominal pains can be successfully treated by gently easing these tissue restrictions. This involves a form of tissue release known as visceral manipulation, or visceral-specific myofascial release. Visceral manipulation is very gentle and performed through the abdomen by a physiotherapist who has trained specifically in this technique. It can provide relief within just a few sessions.

Contact us for an assessment using this approach and possible visceral manipulation treatment, or just to make an enquiry.

contact_us_button

 

 

photoforwebsitesmallest

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

A Pain Up the Backside: Proctalgia Fugax Explained

Posted: Saturday, August 16, 2014 at 5:25:34 PM EST by Alyssa Tait

‘’A knife-like pain in the rectum’’...

’’A red-hot poker up the bum’’…

’’A feeling of being stabbed in the anus, which takes my breath away’’…

These are just some of the descriptions that my patients suffering from proctalgia fugax give.

Somewhat surprisingly for something so unpleasant, proctalgia fugax has a pretty straightforward cause.

It’s simply a matter of the anal muscles (part of the pelvic floor muscles) going into sudden spasm. In that way it is very similar to a leg cramp, foot cramp or toe cramp that you might get in bed at night. Not so coincidentally, this is often when episodes of proctalgia fugax occur – at night. Sufferers are often sleeping soundly before they are suddenly woken by an intense pain in the rectum, where all they can do is lie completely still and attempt to breathe while they wait for it to subside. Pain relief rarely helps. It’s simply a matter of waiting until the spasm relaxes. This may take a few seconds or minutes, or up to two hours.

However, night is by no means the only time that proctalgia fugax episodes occur. It is very common to be suddenly gripped by a painful spasm while going about your daily business.

Proctalgia fugax occurs because the external anal sphincter muscle, which surrounds the anus like an elastic ring or short tube, is ‘’overactive’’. It may be that you pull in the muscle unknowingly during the day, such as when you are stressed or emotional, and the fibres of the muscle shorten. When magnesium levels drop, as they do at night, you become prone to any sort of muscle cramp or spasm – including proctalgia fugax. It is common for proctalgia fugax to occur in people who are also prone to anal fissures, constipation, tailbone pain, irritable bowel syndrome chronic pelvic pain and painful sex. (At Equilibria, we not only treat the proctalgia fugax, but explain the links with these other conditions and treat them as well.)

Many people experience a one-off episode of proctalgia fugax in their life. Because it is so distressing, if it happens more than once within the space of a few months, it should really be treated – especially because it is usually exceptionally easy to treat. Treatment involves gentle stretching of the muscles, either via the vagina or anus. Sometimes malalignment in the sacro-iliac joints is contributing and treatment dramatically reduces tendency for attacks to return.

Additionally, magnesium can not only help the muscles ‘’normalise their behaviour’’, but the right form of magnesium taken at the time of an attack can often get rid of the pain almost immediately. (interestingly, magnesium issues can also be related to bladder problems).

Recognise these symptoms? Get in touch with us today for rapid and successful treatment.

appointment_button

photoforwebsitesmallest

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Pudendal Neuralgia: Pain from the Nerve Downstairs

Posted: Saturday, August 16, 2014 at 7:01:12 PM EST by Alyssa Tait

A Little-Known Cause of Pelvic Pain

How well do you know the nerves of your pelvis? Chances are you don’t even think about the nerves of your pelvis – unless you have pain in the area. While most of us are vaguely aware that problems with the sciatic nerve can cause “sciatica”, it’s not so obvious that troubles with the pudendal nerve of the pelvis can cause a condition called “pudendal neuralgia”. In fact, this is so obscure that even your doctor may be somewhat foggy on it.

The pudendal nerve is a nerve that runs very close to the sciatic nerve in the pelvis. Instead of running down the back of the leg, however, it curls back around into the inside of the pelvis and runs close to the inside of your “sitting bones”. Like all nerves, it branches out into many parts. Specific branches of the pudendal nerve run to some highly important areas – the anus, the vagina and perineum, and the clitoris, or their equivalent areas in men. Not a nerve to be underestimated!

Issues with the pudendal nerve can create pain in the lower pelvic areas, anywhere from the clitoris to the anus. Sometimes the nerve is trapped, being “held” or “bound down”. This is known as Pudendal Nerve Entrapment, and is due to tightness in the ligaments or fascia (connective tissue, like “cling wrap” around your muscles) near the nerve.

However, the nerve can be irritated without actually being entrapped. This situation is known more generally as Pudendal Neuralgia. The most common causes of this are prolonged or repeated pressure on the nerve (e.g. from cycling) or prolonged or repeated stretch to the nerve (e.g. from giving birth vaginally). It can also occur due to damage during gynaecological surgery or due to pressure from a tumour. Commonly though, it is due to a myofascial syndrome. This basically means tightness or overactivity in the muscles that the nerve runs close to: the pelvic floor muscles and the obturator internus muscles.

It can be hard to diagnose pudendal neuralgia. While it tends to cause burning pain in the pathway of the nerve, worse in sitting than standing, it can only be clearly diagnosed by having a pudendal nerve block. Sometimes, it is labelled less precisely by your doctor as "generalised vulvodynia" because it causes vulval pain. All the confusion in diagnosis aside, the symptoms of pudendal neuralgia can often be helped enormously by specific physiotherapy treatment.

No, we’re not talking general back exercises or stretches here. The type of physiotherapy required for pudendal neuralgia usually involves internal muscle and connective tissue treatment – that is, via a vaginal exam or a rectal exam. This is done by a physiotherapist who not only has specific training in the pelvic floor area, but specialised expertise in manual therapy treatment in this area. Don’t see your knee physio about this one! Ask questions to make sure your physio has the exact skills required. Physios with experience in this area have the skills to make this as comfortable and dignified as possible for you, while providing effective treatment.

If you have had your pain for a while, it may also be important in pudendal neuralgia to work on retraining the circuits in your brain. Persistent pain is often  a sign that the brain has got into faulty patterns, which need to be retrained.

Pudendal neuralgia is a condition I’ve been treating for several years, and is a special interest area of mine. In fact, I am so interested in this area that in September 2013 I’m travelling to Canada in order to do further specialised training on the manual therapy treatment of this condition, where physiotherapists refine their skills on each other! I wouldn’t ask you as my patient to have anything done I haven’t experienced myself!

If you think you might need help with Pudendal Neuralgia, contact me and tell me your story.

photoforwebsitesmallest

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Adhesions: A Cry For Help From Your Episiotomy Scar

Posted: Saturday, August 16, 2014 at 5:27:31 PM EST by Alyssa Tait

I suspect we underrate the negative impact of episiotomy scars.

My last post was about scar tissue after surgery and how it can cause real problems, both in the short and long term. I used the examples of an orthopaedic surgery scar and a Caesarean scar. Both of these are considered major surgery, and when you really stop to think about it, it makes sense that they require some rehabilitation. (As an aside, nutrition has a big impact on healing of scars, and should be a major focus in the first three months after any surgery).

But what about perineal scars from childbirth injury? These include scars from episiotomy, OASIS (obstetric anal sphincter injuries), and all types of tears to the vagina and perineum, whether first-, second-, third- or fourth-degree. Won’t these types of scars benefit from rehabilitation too? Of course they will – in fact, I think we need to be much more proactive about this.

When the obstetrician gives you your six-week postnatal “clearance”, this is just the beginning. In fact, many women see their GP and have no perineal or vaginal examination at their six-week check-up. If they do have an examination, the aim is to ensure healing is adequate and there are no signs of infection. This quick check is not designed to confirm your tissue is back to its fighting best!

Many women I see, when they see their doctor for their six-week check, have not started having penetrative intercourse again yet. This is perfectly natural; not everyone feels ready by this point. However, when they are given the “all-clear” by the doctor, it comes as a rude shock when they first try to have intercourse two, four or six weeks later – to find that it’s horribly painful and not at all what they were expecting.

For some women, this initial pain with penetrative intercourse eases up quickly; for others it is mild or not significant in the first place. However, for a significant number of women, this pain is severe, persistent and very disruptive of their intimate relationships.

Pain with sex after childbirth is quite common, and in a way should come as no surprise. Think about this: you break your ankle and it is immobilised for six weeks in a cast or moonboot. Finally the day comes when it can be taken off. With joy and enthusiasm you throw your weight onto it – in fact, you don’t just try to walk, but jump off a high step and throw yourself into an exuberant set of dance moves. OUCH! It’s excruciatingly painful, isn’t it? Of course it is. Your body is not designed to go from zero to a hundred in the blink of an eye after a significant injury.

Well, an episiotomy or perineal tear is a significant injury to your vulva. While it might be mild and you get away with token, short-lived discomfort, you may be like many women I see for whom it is actually quite a hard road back to enjoyable, pain-free intercourse.  I often describe penetrative sex to women as being what a marathon run is to an ankle sprain. You wouldn’t jump straight into a marathon once your ankle sprain heals! But for some reason, women expect (or society expects us!) to be straight up for sex after the perineum heals postpartum. As I mentioned, some women have no ongoing problems. But if you find that the low-level discomfort (or strong pain) doesn’t get better and better each time you try, you need to get going with some perineal rehab!

The longer you leave this, the harder it is. A number of women I have seen with post-partum vulval pain and painful sex were so sensitive in the area of the scar they could barely stand light touch, let alone entry of their partner’s penis. This is more likely to occur the longer you leave it, and may involve sensitisation of the nervous system (where the brain, spinal cord and nerves become hypersensitive to touch and normal sensations become interpreted as pain: this is called central sensitisation).  The pelvic floor muscles become both tight/overactive and weak – not a good combination!

A good way to start to help this is some nice perineal massage daily with olive oil, apricot kernel oil or jojoba oil. You can do this yourself, and if you like, progress to allow your partner to do it. (You may need to have an agreement that nothing sexual proceeds from this, unless you yourself wish to initiate it.) If this does the trick, that’s fine. However, often more specific therapeutic input is required. A physiotherapist trained in connective tissue mobilisation and myofascial release can help your vulva and vagina restore its natural movement, flexibility and sensation. This requires specific training, and it’s worth enquiring of your physiotherapist whether they have this specific set of skills. With the right type of therapy, you can get back your good health in this area, get rid of pain, and restore the quality to your sexual experience. Contact me to get help for this.

contact_us_button

photoforwebsitesmallest

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Connective Tissue Dysfunction in Vulvodynia and Chronic Pelvic Pain Part 2: Evaluation and Treatment

Posted: Saturday, August 16, 2014 at 6:30:48 PM EST by Alyssa Tait

Connective tissue dysfunction in vulvodynia is often missed, and needs to be treated.

Confused about connective tissue? Picture a whole lot of fruit in a plastic bag, sitting in a bowl of jelly.

apricots, plums, grapes and so on. The fruit can be moved and jiggled around within the jelly, even within the plastic bag.

Now imagine a several layers of cling wrap around each piece of fruit. The wrinkles of the cling wrap stick to each other. The fruit doesn’t move so well. The jelly doesn’t get swished around so much, and hardens up.

Your muscles and organs are the fruit, and the connective tissue is the cling wrap.

If it gets tight and thick, it restricts movement. Any restriction of movement in your body, whether in muscles, skin, nerves or organs, can create dysfunction and pain. (The jelly is what is called the interstitial fluid of your body – the fluid you never noticed unless it increases, causing swelling and possibly pain and even abdominal bloating).

The connective tissue around the organs is called visceral connective tissue. Treatment of this connective tissue is known as visceral manipulation, and can be a very useful component of treatment of vulvodynia and chronic pelvic pain.

A specific type of connective tissue restriction will be very familiar to you:

The most common type of connective tissue restriction is a scar.

When scars are deeper in the body, they are often called adhesions (but they are the same thing by a fancier name). Connective tissue mobilisation is a brilliantly effective technique for tight scars and adhesions, which are sometimes playing a part in vulvodynia (especially when there has been surgery, such as an episiotomy or Caesarean scar, or endometriosis).

What does connective tissue mobilisation (CTM) feel like?

CTM feels like a skin-rolling type of massage. It can be very relaxing and soothing. It can also be quite uncomfortable, especially when there is dysfunction. In fact, if CTM doesn’t feel that comfortable, it’s probably a good sign you’ll benefit from it! Sometimes one side of your body will feel fine and the other uncomfortable – guess which one needs the treatment?

abdominalconnectivetissuemassage

However, slow and gentle is the key. Too much CTM too soon can stir you up – irritate local nerves, irritate the skin, even cause bruising. But the right kind and amount of CTM is wonderful for freeing up tight tissues and helping them move the way they should, improving circulation and skin condition and helping to desensitise your nervous system. The health professional treating your connective tissue should therefore be very familiar with your condition – and especially with central sensitisation – and plenty of experience in treating it.

Getting treatment for vulvodynia?

Make sure you ask whether your connective tissue has been checked, and if it would benefit from treatment. Treating your muscles, nervous system and connective tissue together and restoring their normal movement and function will get you the best results.

appointment_button

photoforwebsitesmallest

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

An Interview with Alyssa Tait - Adhesions, Chronic Pain, and the Nervous System

Posted: Tuesday, September 13, 2016 at 1:14:04 PM EST by Alyssa Tait

It's not often someone gives me the floor for 45 minutes to talk about the web of connections linking adhesions, pain, visceral manipulation, the gut and the nervous system...

Stephen Anderson's questions were so thought-provoking, I just kept talking!

Here's the interview: Alyssa Tait on Pelvic Pain, Adhesions, and SIBO

This interview will either be a great cure for insomnia, or a useful insight into how my brain sees this broad and fascinating field.

We traversed the physical, the emotional and even the metaphysical!

Listen here.

We covered all sorts of topics...

...the curious pathway of my career and how it led me to visceral manipulation

...the emotions and your organs

...chronic abdominal and pelvic pain and visceral manipulation

...adhesions, and how they are more than just structural, but neurological as well

...endometriosis and how these adhesions differ from surgical adhesions

...central sensitisation in chronic pain and its links to visceral hypersensitivity in irritable bowel syndrome

....the power of the words "let's see" in therapy

Have a listen now!

Stephen's highlights and insights include...

....the power of the nervous system to increase neurological tone as a means of self-protection, and how this might impact the function of the organs

...the importance of engaging in fun, nurturing and nervous-system relaxing activities to take care of ourselves

....the need as practitioners to be careful with our language with our patients and not be "part of the problem".

Please listen, and give your rating or review on itunes!

 

alyssa_may16_1868_highres_headshotcropped_1_resize

About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
Page 1