The following is an excerpt from “A Headache in the Pelvis“

We have identified a group of chronic pelvic pain syndromes that we believe is caused by the overuse of the human instinct to protect the genitals, rectum, and contents of the pelvis from injury or pain by contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals and over time results in chronic pelvic pain and dysfunction. The state of chronic constriction creates pain-referring trigger points, reduced blood flow, and an inhospitable environment for the nerves, blood vessels, and structures throughout the pelvic basin. This results in a cycle of tension, anxiety, and pain, which has previously been unrecognized and untreated.

Understanding this tension, anxiety, and pain cycle has allowed us to create an effective treatment. Our program breaks the cycle by rehabilitating the shortened pelvic muscles and connective tissue supporting the pelvic organs while simultaneously using a specific methodology to modify the tendency to tighten the muscles of the pelvic floor under stress.

The reason that chronic pain and dysfunction resist a simple mechanical fix is that they tend to come out of a background of a life-long habit of focusing tension in the pelvic muscles. It is necessary to rehabilitate the pelvic muscles in conjunction with changing the predisposition to pelvic tensing under conditions of stress.

An Allegory

It came to pass that the world went through a period of strife, and the citizens of the pelvic floor were required to work more and more. Night shifts became common place. In some parts of the land, citizens were required to work twenty four hours a day, seven days a week, with no rest.

Painful protests from the pelvic floor were made with demands for a return to the balance between rest and work. The world, however, did not seem to understand what the pelvic floor was trying to say.

The world became desperate and decided to hire a new consultant who saw the problem differently. The new consultant said, “If you want to solve this problem, you must go to the land of the pelvic floor and listen to its complaints.” The world replied: “We don’t know how to talk to or understand the pelvic floor. We have never had a conversation with it.” The consultant answered: “I know the language of the pelvic floor and will teach you how to understand what it is trying to tell you.”

After a while, the world said to the consultant: “Your method seems to be working much of the time but why is everything not completely back to normal?” The consultant replied: “Both you and the land of the pelvic floor are used to the unhappy state of affairs that has existed for many years. If you are not reminded, you will continue to force the citizens of the pelvic floor to work without rest.”

Therefore, a curriculum was set up for the pelvic floor as well. The people of the pelvic floor went to special clinics where they learned to stretch the contracted posture that they developed due to their constant work. This stretching and their lessons in learning not to fall back into the old habits enabled them to relearn how to relax and rest.

Pelvic pain and dysfunction result from overused and chronically tensed pelvic musculature.

The pelvic floor is your pelvis and the contents of your pelvis, including your genitals, rectum, and the muscles that hold up the contents of your abdomen. It also includes the structures that are involved in urination, defecation, sexual activity, and physical movement. These functions and their myriad of biochemical, nervous, and mechanical processes go on often without requiring your awareness, will, conscious effort, or attention.

The pelvic floor muscles are not meant to be chronically contracted. When muscles are chronically tensed, they tend to shorten and eventually accommodate so that the posture of a shortened state of the muscles feels normal. This chronic shortening impedes the ability of the tissues to have proper oxygenation, nutrition, management of wastes and rejuvenation of tissue.

The tendency to focus tension in the pelvic muscles is not an accident. Some have suggested that a person’s inclination to focus tension in the pelvic muscles begins with toilet training. The child is able to stop his parent’s reaction to soiling by tightening his pelvic muscles. Over time, tightening the pelvis becomes a conditioned reaction to any situation in which anxiety arises. Let us be clear that this idea of focusing tension in the pelvic muscles as a result of early toilet training is simply an idea and we do not propose that it should be taken as fact. It is however, a compelling explanation of how pelvic tension may well begin early in life.

In our allegory, we see that the constant demand made upon the pelvic floor leads to a disruption in its ability to function. It is our view that, over time, a constant demand on the pelvic floor to tense results in an environment that is inhospitable to the nerves, blood vessels, and structures within it. The pelvic floor is not made of steel and in certain individuals is quite disturbed by chronic tension.

The painful pelvis is like a continually contracted fist.

Now imagine you maintain this clenched fist for a day. Now imagine you maintain this fist for a week. Now imagine a month of tightening your fist constantly twenty-four hours a day. Now imagine doing it for a year. Now imagine doing it for several years. This is one way to understand the state of the pelvic floor in people with pelvic pain.

Imagine continually tensing your pelvis.

People who have never had pelvic pain are incredulous at being asked to contract their pelvic muscles for 30 minutes. The prospect of continual tightening of the pelvic muscles for a week, month, or year would be unthinkable and yet the research shows increased tone in the pelvic floor for people with pelvic pain. Dealing with such a condition is the focus of our protocol.

In our allegory, we make the point that ‘the world’ has lost communication with the pelvis. Most of our patients tend to be out of touch with what is going on in their pelvis. We offer a method to open communication with the pelvis to help bring about a healing of the sore.