Issue link: https://www.massageandbodyworkdigital.com/i/1315831
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 61 Pregnancy and childbirth-related changes in my body left me with a weak core that resulted in pelvic instability and back pain. I turned to Pilates to build my core, and the large positive changes I experienced in my body subsequently compelled me to pursue certification as a Pilates instructor. Although I am convinced that my cystocele condition might have been far worse had I not worked on strengthening my core through Pilates, the fact remains that in my case it was insufficient. Soon after becoming an LMT, I began to study the pelvic muscular structure and research alternative therapies, such as internal pelvic massage, that might help with my PFD. Just two sessions of internal fascial release, by a specialist certified in Holistic Pelvic Care, improved my pelvic balance to the point where I could begin to strengthen my pelvic floor with regular Kegels. A follow- up appointment with a urogynecologist, two months later, confirmed that my cystocele had improved. My doctor mentioned her experience has led her to routinely prescribe a combination of core strengthening through Pilates and pelvic physical therapy to her PFD patients. Having been recently certified in prenatal/postnatal massage, and being within my scope as an LMT practicing in Oregon (which, with proof of specialized training, allows for internal cavity massage), I subsequently enrolled in pelvic floor massage training so I could serve my postpartum clients in a more holistic way. My personal experience and research have led me to believe that pelvic floor massage, coupled with postpartum massage, are essential preventive measures to reduce childbirth-related PFD in women. LOOKING FORWARD The feelings of shame that often accompany the effects of PFD can cause women to suffer in isolation for many years before seeking medical assistance. Depending on the severity of the pelvic dysfunction, doctors may recommend a range of remedies for pelvic care, including, in severe cases, surgical intervention. In the US, pelvic care is generally not prescribed until a woman develops clear symptoms of PFD and seeks medical advice. In stark contrast to the American system of postpartum care, French women are encouraged to meet with a physiotherapist or midwife twice a week for six weeks after childbirth to reduce muscular tensions and scar tissue. The women are then prescribed a minimum of 10 supervised sessions of THE ROLE OF FASCIA We know that fascia surrounds every structure in the body, including organs, blood vessels, bones, nerve fibers, and muscles, literally holding them in place and providing both "form and function to every tissue and organ. Think of fascia as being like a nylon that surrounds and holds each muscle fiber, organ, nerve fiber, bone, and blood vessel in its place while maintaining its own nervous system, thereby making it almost as sensitive as skin that can tighten up when stressed." 16 When we get injured, tense, or sit with bad posture over long periods, our fascia can snag, twist, and adhere to itself, which results in a constriction of blood, lymph, and nerves, and creates an imbalance in muscle contractions. If we perform Kegels (repetitive contraction and release of the pelvic floor muscles) 17 with fascial imbalance, we only exacerbate the condition by strengthening the stronger areas while the portion of pelvic floor that has undergone trauma, such as scarring or adhesions (also referred to as tender or trigger points), will continue to remain weak. When a trigger point is formed, it is not always an indicator of muscle damage. Fascial adhesions can form a blockage causing a "disruption of the cell membrane, damage to the sarcoplasmic reticulum with a subsequent release of high amounts of calcium-ions, and disruption of cytoskeletal proteins, such as desmin, titin, and dystrophin." 18 When a trigger point forms and causes a clinical complaint, it is referred to as an active trigger point, which always feels tender to the touch and painful upon compression and/or causes radiation of pain toward a zone of reference. The effects of an active trigger point are muscle weakening, prevention of full lengthening of the muscle, and localized spasm response when muscle fibers are sufficiently stimulated. 19 A latent trigger point may share all the clinical characteristics of an active trigger point, but its presence is not always recognized because it does not cause spontaneous pain (defined as pain at rest), 20 but only registers as pain when compression is applied directly to the tender point. A latent trigger point always has a taut band that increases muscle tension and restricts range of motion. Another key factor is local ischemia, which leads to a lowered pH and a subsequent release of several inflammatory mediators in muscle tissue. 21 Pelvic Floor Massage as Routine Postpartum Care Twenty years after the birth of my first child, I joined the ranks of women with PFD and developed a cystocele (herniated bladder). As a classically trained dancer, exercise and fitness have always been a part of my life.