Tigers come up more than you might think when we think about pelvic pain….
The first time I came across the metaphor of tigers was in Peter Levine’s work ‘Waking The Tiger’. Levine writes and teaches about the multi-disciplinary study of trauma and stress disorders. He writes about the fight or flight or freeze response – he found that for prey that have completely lost the ability to move, “the sudden immobility of a highly charged nervous system compresses energy that is then ‘stored’ in the nervous system if not released” and when prey are able to avoid predators, prey will sprint away and “literally shake off the residual effects of the immobility response” while “their bodies convulse with paroxysmal spasms’’ – in other words, if someone has been in a traumatic situation they can’t escape from, our bodies can hold that tension, especially in the pelvic floor: ‘Trauma may begin as acute stress from a perceived life-threat or as the end product of cumulative stress. Both types of stress can seriously impair a person’s ability to function with resilience and ease. Trauma may result from a wide variety of stressors such as accidents, invasive medical procedures, sexual or physical assault, emotional abuse, neglect, war, natural disasters, loss, birth trauma, or the corrosive stressors of ongoing fear and conflict.’
Tigers also made an appearance in a recent paper ‘Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain’ by Bishop et al 2020. In this article, the authors discuss how manual therapy IS an effective strategy for pelvic pain…but it may not work the way we think it works. This is a head wrecker for many physios, massage therapists and other bodyworkers, who have been trained in the traditional biomedical model, that the issue is in the tissues…but all the evidence emerging over the past number of years supports the biopsychosocial framework, where yes, the body is still an important part of the equation…but just as important are the psychological and social influences – we know that stress, anxiety, loneliness and depression, along with sleep, nutrition and cultural reluctance to talk about female pelvic health issues are huge drivers of both pain and suffering, and that the therapeutic alliance, the power of being listened to and a kind touch may actually be where the healing begins.
This is a quote from Amelia Earhart, that I keep on the door of my fridge in the kitchen, to remind me daily about the ‘paper tigers’ that we all face that we can sometimes allow to hold us back. Sometimes, when we’ve worked in women’s health for a long time, we forget…that not everyone is as comfortable as we are, talking about vaginas, menstruation, bowel health, sex or pelvic pain…. We need to remember to hold space for the women that we work with, to ask the right questions…and to give time for uninterrupted answers!
All of these concepts were reflected in the recent interview I did with legendary pelvic physio Sue Croft – her books are essential reading of course but even more exciting is the news that we will have Sue as a presenter at Woman on Fire 2021, our virtual extravaganza! You can find out more about WoF here and book your tickets soon – although we’re going virtual, there is a limit to the number of tickets we can sell, so our platform can support this event! Here’s part one of the interview I did with Sue – I hope you enjoy, and stay tuned for part 2 coming soon….and speaking of coming soon….if you want to take a deep dive into Female Pelvic Pain Rehab…improving your confidence when working with women who have Interstitial Cystitis/ Bladder Pain Syndrome, Vulvodynia, Endometriosis, PCOS, Adenomyosis or Dysmennorhea…then this may be the course for you! A deep dive looking at the research as well as taking you on the journey from Assessment to Home Programme, whether you’re working in person or via telehealth. I was originally going to release this course in July bit as the Covid situation evolved, I realised I needed to make it telehealth friendly too – and to make up for the delay, you’ll be getting a free course on Female Pelvic Anatomy & assessment Strategies as a ‘thank you!’ for your patience. Not much longer to wait, I promise!
In the meantime, I hope you’ll enjoy this interview with Sue!
Until Next Time
Onwards & Upwards