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I am treating a lovely client who has a history of sexual assault and PTSD. Her recent childbirth experience exacerbated the PTSD. I am seeing another incredible lady who survived a pretty crazy accident. They are two completely different women who have a very similar presentation, similar pelvic floors and persistent pain. In conversing with them, they wondered “could this pain I’m experiencing be related to that event so long ago?”
But how? How could something that happened so long ago be affecting pelvic floor muscles and be resulting in persistent pain today?
In considering this question I came to understand that their symptoms stem from what I will term “the protective pelvic floor”. It all explains how”this is related to that”.
I love this poem written by Elizabeth Noble, an obstetric physiotherapist who has been called the mother of pelvic floor physiotherapy in America. She describes the pelvis this way: (bold text mine)
Centre of pleasure. Centre of reproduction. Centre of creativity.A bony basin to cradle a baby.
Our first home, the primordial cave of bliss or terror? Wounds are stored here.
Survival, relationships, power and money.
Now back to our question “could this be related to that?”
Imagine with me for a moment that you live in a beautiful house. It is a place of safety, security, and relaxation where you feel at home and can be yourself. You allow in people that you trust and whose company you enjoy. You love your little place, and are connected to it, invested in its care, and generally thankful and happy for it.Now imagine that one day there is an terrible unexpected invasion. An unwanted armed intruder comes barging into your safe little home and makes threatening demands. You freeze in fear not knowing what to do or how to get away and you feel the panic rising as you go into flight or fright mode (heart pounding, barely breathing muscles flexing) . Thankfully your house has a fairly effective alarm system which alerts the authorities that something is amiss. They are able to come to your rescue in a timely way, apprehend the intruder, and re-assure you that you’re safe now.But just because someone insists that “you’re safe now” doesn’t mean you feel that way at all.
Fear is a primal and powerful force that can live on and on embedded deep in our psyches. When it comes to our neurophysiology, that threat you initially feel, can keep being replayed over and over. The experience is re-lived constantly even though the actual incident is over. You’re flight or fight mode of operation never really turns off.
Back to the analogy of a house. Following the home invasion, you don’t really feel safe at home anymore. You sleep with one eye open and a pistol under your pillow (and you’re so not a gun person!). You invest in the most sophisticated security system to replace the old one that you feel failed you. You organize a neighbourhood watch committee and ask your neighbours to be on constant guard for suspicious activity. You have your phone on you all the time with 911 and your dad’s number on voice dial. You take the utmost care to observe where everything is placed in case something (or someone hiding) may have moved it. You try not to jump at the rustling of an animal on your back porch at night, but you can’t help it. You have escape plans laid out and masterfully crafted hiding spots. You’re vigilant – hypervigilant – and far less relaxed in the space you formally were fully at home in. But you’re also fearful of venturing out and leaving your now highly controlled space just in case something happens to you while you’re unprepared. It is all about protecting yourself.
You see, your pelvis is a house.
A pelvis that has experienced trauma is that house I just described. A restless house. Given that our pelvis is, as Elizabeth Noble puts it “the centre”, it is no wonder that women who have survived past trauma will literally house that experience in the deepest and most intimate core of themselves. When it comes to the pelvic floor muscles of these women, we often discover that they are non-relaxing, high positioned, prone to spasm, tender or painful, weak and fatigued, have trouble moving through full range, and linked to other dysfunction and pain in close or distant body regions.
Muscles (whole bodies actually) that have undergone trauma, threat, unwanted experiences, adverse reactions or painful situations, will respond to those experiences in many ways – and it’s completely different for every body. The dynamic lies between the body and the brain, which is plastic. Our brains affects our physiology. Our physiology will in turn affect our brains. That means we can begin to bring healing and restoration to that highly guarded house by working on the body as well as the brain. And that is exactly what we do in physio. There are many gentle strategies we teach to essentially re-build the trust a client has in her own body. It’s about a woman learning to release the things holding her back from freedom and function and stepping out in faith that her body will still work if she begins to let go of the usual non optimal patterns. Of course, all this healing happens on a physical, emotional, psychological, and even spiritual level. It is not quick stuff but rather, it is a process – one that takes time to reset the internal and subconscious workings of the brain-body.
So that is how “this” (current physiological function) is related to “that” (past experiences physical and otherwise). We must treat knowing the whole picture and it is our privilege to work with women who are brave enough to embark on that healing journey from the inside out.