Solving the Musculoskeletal Mystery
By Ingrid Harm-Ernandes
Author, PT (Board Certified Women’s Health & Pelvic Floor Biofeedback)
“I had no idea!” I have heard this from patients, doctors, nurses, physician assistants and others. Whenever a patient, medical practitioner or course attendee has spent an hour with me, they are amazed at how the pelvic musculoskeletal system is involved in pelvic conditions. In addition, they are astounded that there is actually something they can do to help reduce their symptoms and get back to life! It was very frustrating for me and my patients that they often had to wait 5, 10 and even 30 years before they were referred to me. Why should patients have to wait so long to get help? I believe the solution to this is education regarding the musculoskeletal system as well as pelvic physical therapy in a manner that is understandable to everyone.
Everyone needs to know that the pelvic anatomy and pelvic floor anatomy is intimately involved in the diagnosis and symptoms of pelvic floor conditions. Organs and hormones are not the only factors involved. Indeed, our pelvic floor is just one component of our true core and when it is not functioning well, can adversely impact our entire core. It is equally important to understand how our neurological system can impact pelvic conditions and how it in tandem with our musculoskeletal system. When our sympathetic system is on high alert pain, muscle tension and symptoms increase. Stress and other factors in life can all influence our symptoms.
Pelvic physical therapists treat a wide variety of pelvic conditions. These include pelvic pain (which can include pain with sex, pain with daily activities, pain from vulvodynia, functional limitations during and after pregnancy and more), urinary incontinence, fecal incontinence, constipation, prolapse, back and hip pain, prostatitis, and the list goes on.
“I am so embarrassed that I will wet myself or smell of urine, but that is part of growing older, right?”
“Why is sex so painful?” or
“My marriage is about to break apart.”
These are concerns that I hear from my patients all too often. It is important to understand that these conditions are common, but not normal. It saddens me that people are convinced they should live with these conditions when pelvic physical therapy can get them back to living and enjoying their lives.
The more knowledge people have about pelvic physical therapy, the less hesitant they will be about attending pelvic physical therapy. Asking your pelvic physical therapist what your examination and treatment will entail can help alleviate concerns, will help you build confidence, and communication between all members of your healthcare team will drastically improve. The more all health care providers understand the pelvic floor anatomy, pelvic anatomy, and pelvic physical therapy, the more everyone will benefit.
Self-care is an important part of good health and is what will start someone on the path to a better quality of life. For someone with pelvic floor conditions, knowing how to correctly perform a pelvic floor contraction and relaxation is vital. (It is also known as a Kegel but so many people perform this incorrectly, and even to the point of making their symptoms worse, that I use the phrase “pelvic floor contraction”). Notice I included relaxation in the discussion on pelvic floor exercises. Not everyone should do a contraction and some folks need to learn how to relax before they can effectively perform a contraction. A pelvic floor physical therapist can assess and instruct the patient and decide if contracting, relaxing or a little of both is needed.
My book, The Musculoskeletal Mystery: How to solve your pelvic floor symptoms discusses all the important topics mentioned above. The goal that I set for myself was education for everyone. This includes patients, their loved ones, and providers who treat patients with pelvic conditions. We all have a pelvic floor and pelvis! It has been so exciting to see people learning about their pelvic floor and pelvic anatomy and realizing that they can be helped. The book precisely explains the pelvic anatomy and pelvic floor anatomy, and how it is directly connected to symptoms and pelvic diagnoses. The illustrations throughout help you easily identify and understand the anatomy. There is an emphasis on stress, the neurological system, and other factors in life that can influence our symptoms. You will also learn exactly what you will encounter in a pelvic physical therapy assessment and treatment. The more knowledge you have, the more comfortable you will be with attending and understanding pelvic physical therapy. You can also find information on how to form a team of health care providers that can treat pelvic conditions. Supported with the knowledge from this book, you can help yourself or be empowered to help someone else.
Ingrid Harm-Ernandes has been a physical therapist for over 38 years and began specializing in Women’s Health over 26 years ago. Her experiences include treating a wide variety of pelvic patients in both a private practice and at Duke University Health System. She was the Co-Director and a mentor for the Women’s Health Physical Therapy Residency Program, mentor for new pelvic PTs, and played many different leadership roles in PFDN research projects. She is also board certified in Women’s Health (WCS) and Pelvic Bloor Biofeedback.