Everything You Need To Know About Persistent Back and Pelvic Pain

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Catherine Ryan, a FitRight Physiotherapist shares some information on chronic or persistent low back and pelvic pain, and some useful things to consider when trying to cope with persistent pain.

Written by Catherine Ryan, from FitRight HQ.

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    What is pelvic pain and how many people does it impact?

    Pelvic pain affects 1 in 4 women of childbearing age worldwide. It includes the lower abdominal region below the belly button including the pelvic, pelvic organs, genitals and surrounding tissues. Pelvic pain may occur for most days for six months or longer, and can be either a specific diagnosed issues or “non-specific,” where there may not be one factor pinpointed as a diagnosis. There is a high rate of health care seeking in females for pelvic pain, yet many of these medical visits will remain inconclusive.

    How many people are impacted by persistent back pain?

    When it comes to my other passion, managing persistent back pain…84% of people will have lower back pain at some point in their lifetime and 23% of people may experience a chronic or persistent low back pain. Similarly, these can also present with specific diagnoses, but more commonly are associated with a “non-specific” classification. Although it can seem frustrating to not be able to pinpoint a structure, it is important to know that this is more often a process of ruling things OUT.

    How could this be linked to the Pelvic Floor?

    Since there are so many different organs, body systems and sensory messages that interconnect around the low back and pelvic region, this can lead to organ “cross-talk” where irritation in one area can impact the sensitivity of another. We sometimes see increased sensitivity in other neighbouring body areas- like when the pelvic floor becomes tight or overactive as a pain guarding mechanism relating to back or hip pain, or even as a result of recurrent urinary tract infections. Our body can be really effective in protecting us from perceived threats, but sometimes it can become overly protective or suboptimal as we try to move beyond these issues.

    Difficulties faced in the healthcare system with management of persistent pain

    Having persistent pain can be frustrating and very bothersome for the individual, leading to reduced emotional well-being, social engagement and work participation. And it can have a big impact on society with increased costs associated with medical care and treatments.

    Often people can find themselves having to re-explain their story to multiple health professionals and management strategies can feel disconnected or “siloed.” Our current pain management strategies are proving costly, time consuming and don’t always seem to be effective for a proportion of the population. Many investigations may be carried out, but can be inconclusive, so the individual can be left wondering what to do next.

    That’s where evidence based, integrative, collaborative and multidisciplinary health care can be so effective. I feel very lucky to work with an amazing team at FitRightHQ and we have a database of other professionals that we may collaborate with or refer to, in order to best help our clients.

    What does research tell us about pain management?

    Research shows that getting to understand our bodies and our nervous system can help people better understand their pain and lead to better management outcomes.

    Pain is a message from our body to warn us of a threat or danger. It is a normal and adaptive experience in our lives to protect us from harm. Our nervous system acts as a communication system with our brain and body so that when we feel pain or can sense potential harm, it will coordinate a response. Much like we move our hand away from a hot surface.

    Each person will experience pain differently, which means that there is no recipe when it comes to dealing with pain. Pain is both a physical and an emotional experience. Pain can be influenced by other factors such as our environment, our background, previous experiences as well as our thoughts and emotions.

    Interestingly our body doesn’t need a physical injury for pain to exist, it may only need the potential for threat or danger, for the nervous system to react. Like when your heart races when you watch a scary movie. You may not have seen anything scary yet, but your body is preparing itself in anticipation in case you need to get yourself to safety.

    I like to compare the nervous system as like our body’s sensor light. Like the one we might have on our front porch at home. Generally your sensor light may go off when someone walks up the footpath or driveway and fades when they leave. However this sensor may become overly sensitive at times- and start to flicker on when someone is across the road or up the street. Or may stay on, despite there being no-one there anymore.

    So if we look at this when thinking about pain. The body is sending us messages to protect and be aware, so we may stop or avoid the activity that we are doing to avoid further injury. 1 in 4 people, the “sensor light” of our nervous system may not turn off to our base level and can start to flicker more frequently, with more intensity or even spontaneously. This can become more sensitive over time, especially with increased stress, suboptimal sleep and inadequate movement.

    How physiotherapists can help with persistent pain?

    What does a consult look like with a patient presenting with persistent pain? First of all, as an integrative Physiotherapist, I would get a full history to find out how the pain started, what might have been going on around that time and what sort of modalities or therapies that may have been tried. I like to listen out for the beliefs that the person may have around their pain and how it is impacting their everyday life and what thoughts and feelings could be surrounding that.

    I would then explain the physical assessment that may involve looking at difficult movements and watching for any maladaptive compensatory patterns and on movement quality with breathing, be it a musculoskeletal injury or pelvic health condition.

    My pelvic health clients may have a pelvic floor assessment with real time ultrasound or internal examination, and this can display movement or breath patterns that may be perpetuating tension in the body. This is all discussed in a trauma aware way.

    There is no recipe as each person will have their own personal experience and context with pain. I endeavour to help each person to better understand the processes behind their pain and how they can manage it moving forward. I like to work collaboratively and refer to other practitioners for a more integrated and holistic approach, and hopefully this can guide each person to feel supported in their journey ahead.

    Cat's top tips for management of persistent back or pelvic pain

    It’s the little things that can make a big difference, especially when it comes to recalibrating the nervous system.

    • Optimise your sleep

    Aim for a similar sleep/wake cycle each day, aiming towards 7-9hours per night (when you can around little ones!) Try to do a little wind down ritual for yourself before bed. Like a big toddler, have a warm bath or shower, dim lighting, book and white noise...! And no screens 60mins before bed…that’s the tough one!

    • Move often

    Find little opportunities for movement breaks in the day. Try walking for school pickups, play on the monkey bars or trampoline, take a phone call outside and stand barefoot on the grass. Movement is a great way to regulate our nervous system, and you get bonus points if you are able to get some fresh air or sunshine too.

    And if you are finding it hard to move because of pain or fear of movement, come and see us at FitRightHQ and we can help you find something.

    We are meant to be moving beings, but our lifestyle does not lend easily to this with cars/computers and Netflix.

    • Get the right team behind you, to help you move, help your mood and find your people.

    Having persistent pain can be really frustrating and impact our mood, emotions and well-being. See your doctor when you have had pain for a long time and help you rule out a medical condition.

    Having a holistic approach with a Physiotherapist to help with managing the physical symptoms and getting you moving, but also recognising that talking through the thoughts and feelings around and injury or stressful situation is also very beneficial. Our body and mind are closely interconnected, so it’s useful to address both when it comes to optimising our overall health.

    Each person will have a different multidisciplinary team to help them through a pain flare or guide them to the next step.

    You can book an appointment with Catherine Ryan, or one of the other FitRight physios here.


    Perth’s Leading Centre for Women’s Health and Exercise

    Physiotherapy, GP services and physio-led exercise classes specifically for women

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