Endometriosis, the Pelvic Floor and Orthopedic Concerns

Dr. Amy Stein, DPT, BCB-PMD, IF, is a leading expert in pelvic floor dysfunction, pelvic pain, women’s health, and functional manual therapy for men, women, and children.  She is the founder of Beyond Basics Physical Therapy in NYC.  Amy is one of the founders of the Alliance for Pelvic Pain, a patient-oriented educational retreat, and she served as President of the International Pelvic Pain Society in 2017. Amy is incredibly passionate about helping people with endometriosis and it is an honor to have her join our Endometriosis Summit blog this week. She writes:
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The most common area for endometriosis sufferers to feel pain is the abdomino-pelvic region. Endometriosis can be very painful, lead to painful and heavy periods, bladder, bowel and sexual dysfunction, and infertility in some women. Endometriosis is a condition in which the lining similar to but not the same as the tissue of your uterus (endometrium) grows outside of your uterus. The result can be inflammation and pain. The inflammation caused by endometriosis can cause areas of restriction in your pelvic and abdominal cavity, which can decrease organ mobility and the mobility of the body as a whole. These areas of restriction can be a result of adhesions or of muscles that are tightening in response to the pain, which subsequently can cause more pain and other symptoms. In addition, the pain and inflammation can cause viscerosomatic reflexes. A viscerosomatic reflex occurs when inflammation or irritation of a pelvic organ causes spasm in the muscle due to its shared innervation at the spinal nerve level, and as a result causing more pain. Endometriosis can have a profound effect on your overall quality of life.
Due to these physiological changes, the body accommodates by moving around the area of tension, and over time this repeated movement leads to chronic irritation and more inflammation, which in turn cause dysfunction—in the muscles, in the nerves, in the surrounding joint, and in the organs themselves. Pelvic health physical therapists can ‘undo’ this tension and restrictions, and lessen the pain. These group of experts are skilled in a range of manual therapy and re-education techniques—from external and internal myofascial trigger point release, connective tissue and visceral mobilization to nerve decompression and neuromuscular re-education techniques, such as biofeedback.  
In my book, Heal Pelvic Pain, I address the elements of musculoskeletal structure that support and protect the crucial organs in the abdomino-pelvic cavity—the urinary, digestive, and reproductive organs. I explain how this area functions: the muscles, the nerves controlling the muscles, the tissues (AKA, the fascia) that connect everything together, plus 
‘the ligaments that link bone to bone and bone to organ that are attached to the front, back, and sides of the pelvis, from the pubic bone in the front of the body all the way back to the tailbone.” All these muscles, nerves, tissues, and ligaments form a kind of protective covering over the bottom of the pelvis and act as a sling supporting the organs and the essential functions they perform. This abdomino-pelvic area is a key part of the trunk of the body; along with some deep back muscles and the diaphragm. Some or all of this can get disrupted, irritated and can become painful and dysfunctional because of the disease process of endometriosis and the many years it takes for a proper diagnosis. 
Come and see Dr. Amy Stein present at The Endometriosis Summit. Our Town Meeting will feature many physical therapists, Dr. Sallie Sarrel, Dr. Holly Herman, Dr. Hannah Schoonover, and Niva Herzig, plus more than 30 physical therapists in the audience to participate in our open microphone format. Join us at www.theendometriosissummit.com
REFERENCES:
1.) Arung W, Meurisse M, Detry O. Pathology and prevention of postoperative peritoneal adhesions. World J Gastroenterol. 2011: 17(41) 4545-53
2.)Bonocher C, Montenegrow M, Rosa e Silva, et al. Endometriosis and physical exercises: a systematic review. Reproductive Biology and Endocrinology. 2014, 12:(4)
3.) Leong F. Complementary and alternative medications for chronic pelvic pain. Obstetrics and Gynecology Clinics of North America. 2014, 41:(3): 503-10
4.)Rakhshaee Z. Effect of three yoga poses (cobra, cat and fish) in women with primary dysmenorrhea: A randomized clinical trial. Journal of Pediatric Adolescent Gynecology. 2011;24(4):192-6
5.) Wurn B, Wurn L, Patterson K. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual therapy: results from two independent studies. 2011;3(4)

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