The Burdens of a Blessing

This post was written by H&W instructor Peter Philip, PT, ScD, COMT, PRPC. Peter will be instructing the course that he wrote on "Differential Diagnostics of Chronic Pelvic Pain" in Connecticut this October.

We have ourselves a wonderful profession, one in which we have the education that allows us to directly and often immediately impact our patients' well-being. Very often, patients come to us with the most intimate and consuming injuries. Often, our patients have been to several other clinicians seeking assistance. Many have been told that their ailment is psychosomatic, and that they should ‘get over it’, or medicate themselves through their pain.

Many patients have lost their ability to live the life that they had enjoyed for so many years prior because of this gnawing pain that involves a region of their body that they’d rather not discuss, let alone have poked and prodded. Many of our patients suffer so greatly that they’ve lost their relationships, employment and enjoyment of life. Many clinicians have had the experience of losing a patient, one that had suffered for too long and decided that death was the only reasonable means to eliminate their pain. Yes, those of us that have chosen to help those suffering with pelvic pains and dysfunctions have knowingly or unknowingly accepted the responsibility to address those ailments and individuals that suffer greatly; our responsibility is enormous.

This comes to mind after a recent phone call that I received from a woman that lives in California. She reports that she’s been suffering for years with dyspareunia, and that the treatment she’s received to date has done minimal to alleviate her pain. She states that she’s been the recipient of deep vaginal massage for months, attempted and forced dilation, all without true success or carryover from visit to visit. She is becoming despondent and losing hope. She feels as if this is to be her life from here going forward.

Upon questioning, she was unable to explain the reason “why” her pelvic musculature developed “spasms”, and why an otherwise healthy woman could fall from a state of “normal health” to that of a “chronic pain patient” without hope. She reported that her “fascia” was being “stretched”, and when questioned, she explained that she’d not been told how or why her fascia has become taut, or why the musculature had spasmed! This, to me, is unconscionable. Current research indicates that fascia actually tightens with stretching, and muscles do not spasm of their own accord. Local swelling and inflammatory mediators tighten fascia. The underlying cause of the local swelling must be addressed in order to release the fascial tension. In order to heal, the patient must understand this so as to best prevent the activities or positions that account for local swelling in the first place. As for a muscle spasm, there are many reasons this may occur, and it is our duty as professionals to deduce the cause of our patient’s muscle spasm, and then to apply a tissue, or joint specific treatment that properly addresses the lesion in order to eliminate these for our patients. To do so, the clinician must know which structures may be responsible in the formation of a spasm, and must understand the hierarchy of which is to be addressed and how to specifically address each in order to best offer appropriate treatment for each patient. That way, the clinician can offer a direct and patient-specific treatment to effectively eradicate our patients suffering.

It is my goalm whether working with a patient or lecturing nationally, to provide patients and the medical community alike with the means to accurately and efficiently deduce the origin of fascial restrictions, muscle spasms and pain. Providing patients and clinicians the knowledge and means of eliminating pain and dysfunction is the most wonderful blessing, and beautiful burden to bear.

It is my intention to provide the medical community the means to which they, too, can deduce the specific tissue at fault for each patient in order to provide the most patient specific care required to attain immediate and last wellness. This information and more is discussed during both courses I teach: Differential Diagnostics of Chronic Pelvic Pain, and Evaluation and Treatment of the Sacroilliac Joint and Pelvic Ring.

Our beautiful burden is our wonderful blessing. We, as professionals, have been given the gift of knowledge and expertise and our burden is to ensure that our patients receive the benefit of that knowledge.