Reader note: This post deals with discussions of sexual trauma. Please take care while reading.
How Pelvic Floor Therapy Helped Heal My Trauma
Suddenly my vision got spotty and what felt like a beast deep inside me moved up through my body. It’s tendrils wiggled as it moved up into my stomach, chest, throat and burst up through my mouth in uncontrollable sobs.
“It’s okay. You are safe. This happens. Let it out.” she said.
I let it out. The sobs and screams arose from me frighteningly. An out of body experience that I could not quite understand. Where was this coming from? What was happening? With the sobs came memories and feelings so raw and fresh it felt as though I was back to that exact moment in time– anger, hatred, disgust, shame and sadness for the girl who was too young to understand what had been done to her and sort through these emotions on her own.
I opened my eyes and Amy offered me water, tissues and told me this was all part of the healing process. She asked if she could do a myofascial release to help complete the cycle of healing. With her one hand on my stomach and the other on my back, I focused on my breath as memories and feelings continued to cycle.
Sobs and screams came again. The strangeness of not understanding where these outbursts were coming from was startling and embarrassing, but Amy held a safe space for me. I let this second release settle over me– my body shaking, vision blurry and dizziness washing over me.
After giving me space to calm, Amy explained to me that the release I felt was the trauma I had experienced as a teenager.
My body was holding on to that for 15 years. She explained that my body found a place to hold this for my teenage self, as I was too young to process it properly. So here I was, as a 31 year old with 10+ years of chronic back and hip pain caused by the physical hold of this trauma. It was an incredible realization of awe and appreciation for my body, and the work it does for me each and everyday. I also felt my cheeks flush with anger and resentment at the physical and emotional pain one person caused me for 15 years, without any acknowledgement or remorse.
It has been almost 3 weeks now since this experience and I have felt relief for the first time in 10 years from my back pain.
About a week after seeing Amy, my pelvic floor physical therapist, I was sitting doing work when I realized I was not experiencing the dull, aching pain I am used to feeling all day. After standing all day at a party, I realized I didn’t have the dull, aching pain I had come to accept as part of my life.
At my next appointment with Amy, she rechecked internally and the release had relaxed the five internal tight trigger points like dominos. Healing is not linear and I have continued to see Amy when my pain returns. She has continued treatment to help my body release something it has held onto for a long time. There is still work to be done but the progress so far is so promising.
Amy Healy is a Pelvic Floor Physical Therapist at True North Pelvic PT LLC. She has been practicing PT for 30 years and began her work in Pelvic Floor Health because of her own experiences and discomfort. I sat down with Amy to ask her some questions about Pelvic Floor Health and why it is so important, especially now as reproductive rights are at risk.
What is your pelvic floor?
Amy: Your pelvic floor is a muscular sheet at the base of your pelvis. The muscles go from the pubic bone in the front, the sit bones on the sides, and tailbone in the back. When the muscles are tight, the muscular sheet can be rigid and flat. When the muscles are at an optimal length they look like a hammock. The hammock position is uniquely able to perform the functions of the pelvic floor; support for the organs, sphincters for the bladder and rectum closure, sexual appreciation, and a sump pump for lymphatic circulation.
Think of a bicep muscle, and how the muscle works through a full range of motion for lifting and carrying items. Imagine trying to live life with an elbow stuck in a mid-range position. The pelvic floor needs to lengthen/drop and to shorten/lift to perform its function. When you perform a task, like lifting a leg, a force goes through the pelvic floor. This force is called abdominal pressure and it is managed by the automatic contraction of the deep core.
The pelvic floor is a part of the deep core. The transverse abdominal muscle, the deep multifidi, the respiratory diaphragm, and the pelvic floor create a canister. The success of deep core muscle engagement relies on many things, coordinating the contraction with breath, having flexibility in the muscles so that they can work in a lengthening condition, and the ability of the muscles to work in an anticipatory mode.
The pelvic floor is heavily influenced by the autonomic nervous system, fight or flight/sympathetic and rest and digest/parasympathetic.
The pelvic floor and deep hip external rotators tend to “Grip” or stay tight without our awareness when we have experienced trauma or have fear. This is similar to the neck, shoulder muscles and jaw muscles which are also autonomically influenced. You can feel this as a tension in your jaw or shoulders. Training includes awareness and lengthening to allow the muscles to find an optimal resting state. This needs to happen before strengthening.
Strengthening is more than just doing kegals. Pelvic floor muscles muscles work in an anticipatory mode. If you don’t train the muscles to work with specific tasks the muscles won’t show up when you need them to, when you are running or jumping or managing a strong bladder urge. I talk about certain muscles needing to be invited to participate and other muscles being asked to step back. In the pelvic floor the coccygeus seems to work hard for other members of the pelvic floor that are not showing up. If you are having issues a pelvic floor assessment can help you to identify what members are showing up and which are not.
When the pelvic floor and core are not working in a coordinated fashion there can be dysfunction. If it is less tension I call this a leak in the canister. If it is more tension I call this a dent in the can. Pelvic floor PT can help you work on this.
What is pelvic floor health/physical therapy?
Amy: Pelvic floor physical therapy is getting your “story.” I read a questionnaire and medical records, but put aside 90 minutes for initial assessments so that we have plenty of time to talk about your story. Next, I start by assessing muscle function. I do a postural assessment, the pelvic floor does not work in isolation. I am looking for specific postural imbalances, at the rib cage, the femur, pelvis or even the foot! Next I check the hip and abdominal wall strength and range of motion. Looking for what happens when you perform specific movements more than specific manual muscle testing.
Oftentimes, muscles test strong, but don’t work the way that you want them to. I use rehabilitation ultrasound imaging to visualize the pelvic floor through the abdominal wall or the perineum (the space between the penis/vagina and rectum). This is a form of biofeedback so you can see the pelvic floor work in a lifting and lowering motion. It can also be used to visualize the multifidus and the transverse abdominal muscles. These muscles tend to be overshadowed by more dominant muscles, so visualizing them helps you to engaged them. Lastly, I assess the pelvic floor with an internal assessment. This involves using a gloved finger to palpate the muscles. There are three “layers” to the pelvic floor and I perform a muscle map to look for areas of tension or weakness.
We develop a plan to treat what we find. Usually this involves between 2-6 visits for education, manual therapy and exercise prescription. Every case is unique. Some come in for one visit and that is all that they need. There are others who I have been seeing monthly for a year.
What inspired you to get into the pelvic floor PT field of work?
Amy: Like so many of us I followed my passion with pelvic floor PT to treat my own symptoms. I am the owner of an overactive/tight pelvic floor. I was not able to have vaginal births with my two children and I have constipation. A deep delve into pelvic floor research was enlightening and discouraging. Enlightening because we know so much about pelvic floor disorders. Discouraged because other countries are much more advanced with pelvic floor awareness and treatment and a deep shame about discussing symptoms, even within families, is pervasive.
How can someone identify if their pain/discomfort is pelvic related?
Amy: There is a great screening tool: Screening Tool for Pelvic Health. Nicole Cozean is a PT who specializes in the treatment of interstitial cystitis. She has written The IC Solution, which I recommend for anyone who has bladder pain. It is important to get this questionnaire into mainstream healthcare. For those of us with pelvic floor issues, we do not know what normal is. All we know is what we have experienced.
What tips would you give someone dealing with pelvic related pain?
Amy: Self care! So many of us consider self care a luxury. It is not. Consider what you can add into your daily routine: A mindfulness app like Calm or Headspace. Taking time to perform yoga poses. Walk in the park. Hydrate. Set boundaries. Find what gives you joy. The autonomic or sympathetic (fight or flight) and parasympathetic (rest and digest), link with pelvic tension cannot be overstated.
What can people do to educate themselves and take care of their pelvic health?
Amy: There are Tik Tok videos and links on Instagram and Facebook trying to tell you the “best” type of pelvic floor PT. This is confusing for the consumer because everyone’s pelvic floor condition is unique and there is still so much about our bodies and the pelvic floor that we don’t know.
Some providers that I recommend learning from online are:
- Diane Lee PT: for suggestions on optimal core engagement.
- Nicole Cozean: DPT for Interstitial Cystitis.
- Sarah Duvall: for exercise during pregnancy and the postpartum period. I just completed her certification course and recommend that other health care providers and athletic trainers consider doing her trainings.
Is pelvic floor health just for women?
Amy: NO! Men can have urinary incontinence after prostate surgery. I find that the rehabilitation ultrasound device is especially helpful for men following a prostatectomy. Urinary continence for men is a bit more complicated in that the removal of the prostate removes the passive resistance that the prostate provided prior to surgery. In my experience men tend to have more difficulty managing abdominal pressures. They tend to contract the muscles involved in lifting, the rectus abdominal and diaphragm, and the lesser players, the bulbospongiosus, urethral sphincter and puborectalis are less active. Seeing the muscles “lift, squeeze and elevate” helps them learn to engage them while keeping the downward pressure from abdominal activation down. Men also have pelvic pain, oftentimes called chronic prostatitis or pudendal neuralgia. An overactive pelvic floor is usually contributory.
What are the signs/symptoms of someone who should see a pelvic floor physical therapist?
Amy: If you have a feeling of pelvic pain or heaviness. If you have any form of disordered urination or defecation. Of course talk to your primary care provider first. There are other drivers for pelvic pain and disordered elimination that are not helped by pelvic floor PT. It is always helpful to have a medical evaluation first.
Tell me about trigger point pelvic floor therapy and myofascial release.
Amy: I practice a form of myofascial release called The John Barnes approach. We consider fascia to be more than a packing material for organs, muscles and nerves. The fascia in the pelvis can become restricted. This can prevent bladder and rectal filling and can compress the nerves in the area. The stretching consists of long holds. When doing a stretch that lasts less than 2 minutes the structures that are stretched include elastin. To hold a stretch for 2-5 minutes, or longer, the collagenous barrier is reached and real tissue change occurs. I think that this is especially important in the pelvic floor, where there are narrow chambers for nerves between sheaths of tissues that are more difficult to stretch.
This myofascial release technique also considers the trauma that can be held in tissues. Treatment can involve feeling emotions from previous events. This is where having a team of providers is especially important. Our bodies can hold our histories. I recommend the book, The Body Keeps The Score by Bessel Van Der Kok M.D. for more on this.
How does pelvic floor health relate to physical/emotional trauma?
Amy: The pelvic floor has been shamed for centuries. The primary nerve for the pelvis is the pudendal nerve. Pudendal means shame in Latin. Consider the word hysteria. Hysteria was unique to women, and thought to be from dysfunction in the uterus, so hysterectomies were performed on hysterical women. I feel like this stigma persists in our society. Menstruation is also considered taboo. When the hormonal changes that our bodies go through are appreciated and understood we are empowered to work within the gifts that progesterone (restoring, resting and relaxing) and estrogen (muscle building) provide.
So many of us have lived through pelvic/emotional traumas including sexual assaults and birthing experiences that do not go as anticipated. What is missing is an acknowledgement of these traumas that we can heal from. When we are silenced and shamed we cannot heal. I think that the first step for healing is awareness. My mentor John Barnes states, “without awareness there is no choice.” That is why I am so grateful that you are doing this article. And why I am so happy that we are seeing more and more pelvic health providers in the Upper Valley. There are not enough of us.
Why is pelvic floor health more important now than ever?
Amy: Pelvic health is important in so many ways to so many populations. Lately, I have been working with those preparing for childbirth. I love being able to help prepare for the birthing experience and to help heal afterwards. Mother’s deserve to have someone help them with their healing. Too many of us accept that our bodies are forever changed and are not given the opportunity to rehabilitate following childbirth.
Our world is changing. The fear and insecurity from war, partisan politics and the pandemic creates an environment that is not conducive for us to become our best selves. I personally believe that reproductive health care is health care. Taking away our reproductive rights feels like a giant step backwards and another example of disempowerment for women.
If you are local to the Woodstock area– go see Amy Healy. Run, don’t walk. She is wonderful.
If you are not local, find a respected pelvic floor physical therapist in your area. I actually used to see Belinda J. Harrison when I went to URI, she is located in Narragansett, RI if you are a Rhode Islander. She was wonderful as well.
Open yourself up to a life without physical and emotional pain and discomfort. It is so liberating, I promise you won’t regret it.
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