Is Your Pelvic Floor Being a Real Pain in the Neck (and Jaw)?
We are so lucky to have a guest blog this week from the talented Dr. Brook Orvis, owner of Flora Physical Therapy in Durham, North Carolina! Brook and I were classmates at Northwestern University in Chicago, IL for our Doctorate in Physical Therapy program. She now owns a specialty Physical Therapy clinic, Flora Physical Therapy, that specializes in the treatment of a wide range of pelvic health conditions, as well as lymphedema
As a physical therapist who treats primarily orthopedic conditions, I often come across people who have pelvic floor dysfunction in addition to orthopedic pain. The neck and jaw are two areas that I treat very often at Wildflower Physical Therapy & Wellness, and I’ve found that more often than not, people will also have pelvic floor symptoms in addition to their head/neck pain! In this blog, Brook is going to review common patient presentations and evidence based treatment options for people with pelvic floor dysfunction!
What Conditions Does a Pelvic Floor Physical Therapist Treat?
As a Board-Certified Women’s Health (WCS) and Pelvic Floor (PRPC) Physical Therapist, I frequently work with clients that are struggling with pelvic pain. This can include pain during sex, painful menstruation (periods), pain with urination (peeing) and pooping, endometriosis, pain with tampon (or menstrual cup) insertion, pain with pelvic exams, abdominal pain, frequent UTI symptoms, low back pain, irritable bowel syndrome (IBS), painful bladder syndrome (also known as interstitial cystitis), and the list goes on and on.
Want to know something else my clients with pelvic pain and pelvic floor dysfunction are also commonly struggling with? Neck and jaw pain. Yes, you heard me correctly. You pretty much can’t get any further from your pelvic floor than your neck and jaw, but research shows that pelvic pain and neck and jaw pain are closely related.
What Does the Research Say About the Connection Between the Pelvic Floor and Other Orthopedic Conditions?
Chronic pain syndromes like pelvic pain, facial pain, and headaches are a dysfunction of the craniomandibular (head and jaw) system which can both cause and be a result of chronic pain. Evidence also shows that temporomandibular dysfunction (TMD or what people sometimes incorrectly call “TMJ”) is closely linked to increased pain during menstruation as well as pain conditions in other parts of the body, including the abdomen and low back. And guess what else research shows? Low back pain is closely linked to pelvic floor muscle dysfunction since your pelvic floor is a direct extension of your core (or abdominal) muscles and directly attaches at your tailbone. Your pelvic floor is also notorious for having pain referral patterns into the low back which can mimic low back pain, but is in fact originating from the pelvic floor due to similar nerve innervation.
Research also strongly supports the link between chronic pelvic pain, such as endometriosis, and migraine and menstrual headaches indicating that they could have similar causes. There is also research that links the neck and pelvic floor through the cartilage, muscles, and nerves of the spine and shows how changes in spinal stability can create a cascade effect triggering pain in both regions.
What does all of this mean? Well, there doesn’t appear to be any conclusive evidence so far regarding the whole “which came first, the chicken or the egg” debate regarding neck and jaw pain paired with pelvic pain. But the beauty of these forms of dysfunction is that there are treatment options available through physical therapy!
What Treatment Options Are Available Through Pelvic Floor PT?
As a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, there are many treatment options available to you for your pelvic pain. Depending on you and your symptoms, we can do:
Dilator therapy: We use a medical grade plastic or silicone dilator (your choice!) that starts at the size of around a small tampon or finger and gradually increase in size as your discomfort and tolerance to use improves. This helps to desensitize and lengthen the tissue if there are any restrictions or pain present.
Pelvic wand use: This is typically using a medical grade plastic or silicone wand internally (inside of the anal opening and/or vaginal opening) to access the deeper internal pelvic floor muscles that may have areas of tenderness and tension to help release the tissue. For clients not wanting to use a pelvic wand, I usually will talk them through the alternative of using a finger internally which can also access the deeper pelvic floor musculature.
Dry needling: I am certified in dry needling the entire body and have taken additional training to be skilled in pelvic floor dry needling. This is where a physical therapist will take a monofilament needle directly into the area of discomfort and can trigger the stereotypical “twitch response,” but not always, to help the muscle to lengthen and release which has been shown to improve pain in various regions of the body. Choosing to do dry needling is all dependent on you and your preferences, but I do find that sometimes it can help clients to see results quicker in terms of lengthening and releasing tense, painful muscles and scar tissue compared to manual therapy techniques using my hands.
Pelvic floor muscle down-training and coordination: This is where we work on the muscles in your pelvic floor and their ability to squeeze and release at the appropriate times, lengthen following contraction without a delayed response, and not sit at an overactive, contracted state when they are not in use. There are different ways we can do this, but I frequently use biofeedback using external and/or internal sensors or a gloved finger internally. For those that are uncomfortable doing an internal assessment, we are also able to do a visual assessment of the tissue from the outside to see what they’re doing.
Internal manual therapy: Similar to dilator or pelvic wand release techniques you perform on your own at home, we can work during our in-clinic sessions on working over any areas of tension in the pelvic floor muscles using a gloved finger and lubricant. I usually complete this with clients after completing a reassessment of your pelvic floor muscles and tissue each appointment to see how things are progressing and changing.
Strengthening exercises: Based off the available research, and what I have found anecdotally with many of my clients, is that strengthening the hip, back, and abdominal musculature can frequently improve existing pelvic pain without ever needing to do an internal pelvic floor muscle assessment (but not always!). Your pelvic floor muscles attach onto the bones of the pelvis where your hip, back, and abdominal muscles attach and I like to tell people that the pelvic floor is “just along for the ride.” These types of exercises tend to be more functional for most people and will naturally overflow into your pelvic floor and how it is functioning.
Education: I spend a large chunk of time with clients every appointment reviewing pain neuroscience and how chronic pain can impact what is going on at the body and contributing to ongoing symptoms (this is never me telling you that your pain is all in your head, but research shows that just by providing pain neuroscience education to clients that we can help to improve pain!), body mechanics, and healthy habits for your pelvic floor and skin.
All of these treatment interventions together (or in part) can make a huge difference in your ongoing pelvic pain! Just know that there are treatment options available to you if you are struggling…you don’t have to “just live with it.”
If you found this article helpful and have an interest in pursuing pelvic floor PT, Brook offers virtual consultations and digital products as well as in-person evaluation and treatment options for those of you located in Durham, NC.
Resources:
Plato G, Kopp S. The jaw and chronic pain syndromes. Manuelle Medizin. 1999;37:143-151.
Lim PF, Smith S, Bhalang K, Slade GD, Maixner W. Development of Temporomandibular Disorders Is Associated With Greater Bodily Pain Experience. The Clinical journal of pain. 2010;26:116-120.
Karp BI, M.D, Sinaii N, Ph.D, Nieman LK, M.D, Silberstein SD, M.D, Stratton P, M.D. Migraine in women with chronic pelvic pain with and without endometriosis. Fertility and sterility. 2011;95:895-899.
Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Australian journal of physiotherapy. 2006;52:79.
Written By: Dr. Brook Orvis, PT, DPT, WCS, PRPC, CLT
Owner, Flora Physical Therapy
Board Certified Clinical Specialist in Women’s Health Physical Therapy
Certified Pelvic Rehabilitation Provider
Certified Lymphedema Therapist
Certified in Dry Needling