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The Role of the Pelvic Therapist in Treating Endometriosis

This post was written by H&W instructor Michelle Lyons, PT, MISCP, who authored and instructs the course, Special Topics in Women’s Health: Endometriosis, Infertility & Hysterectomy. She will be presenting this course this February!

 

Michelle Lyons

Endometriosis is a common gynaecological disorder, affecting up to 15% of women of reproductive age. Because endometriosis can only be diagnosed surgically, and also because some women with the disease experience relatively minor discomfort or symptoms, there is some controversy regarding the estimates of prevalence, with some authorities stating that as many as one and three women may have endometriosis (Eskenazi & Warner 1997)

 

There is a wide spectrum of symptoms of endometriosis, with little or no correlation between the acuteness of the disease and the severity of the symptoms (Oliver & Overton 2014). The most commonly reported symptoms are severe dysmenorrhoea and pelvic pain between periods. Dyspareunia, dyschezia and dysuria are also commonly seen. These pain symptoms can be severe and have been reported to lead to work absences by 82% of women, with an estimated cost in Europe of €30 billion per year (EST 2005). Secondary musculoskeletal impairments caused by may include: lumbar, sacroiliac, abdominal and pelvic floor pain, muscle spasms/ myofascial trigger points, connective tissue dysfunction, urinary urgency, scar tissue adhesion and sexual dysfunction (Troyer 2007) – all of which may be responsive to skilled pelvic rehab intervention.

 

Endometriosis can lead to inflammation, scar tissue and adhesion formation and myofascial dysfunction throughout the abdominal and pelvic regions. This can set up a painful cycle in the pelvic floor muscles secondary to the decrease in pelvic and abdominal organ/muscle/fascia mobility which can subsequently lead to decreased circulation, tight muscles, myofascial trigger points, connective tissue dysfunction and pain and possible neural irritation.

 

Abdominal trigger points and pain can be commonly seen after laparascopic surgery for diagnosis or treatment. We know that fascially, the abdominal muscles are closely connected with the pelvic floor muscles and dysfunction in one group may trigger dysfunction in the other, as well as causing associated stability, postural and dynamic stability issues.

 

The pain created by muscle tension and dysfunction, may lead to further pain and increasing central sensitisation and further disability. Unfortunately for the endometriosis patient, as well as dealing with the problems already associated with endometriosis, she may also develop a spectrum of secondary musculo-skeletal problems, including pelvic floor dysfunction – and for some patients this may actually be responsible for the majority of their pain (Troyer 2007).

 

The skilled pelvic rehab therapist has much to offer this under-served patient population in terms of reducing pain and dysfunction, educating regarding self-care and exercise and helping to restore quality of life. Interested in learning more? Join me for my new course: ‘Special Topics in Women’s Health: Endometriosis, Infertility & Hysterectomy’ in San Diego this February or Chicago in June.

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The Role of the Pelvic Therapist in Treating Endometriosis

This post was written by H&W instructor Michelle Lyons, PT, MISCP, who authored and instructs the course, Special Topics in Women’s Health: Endometriosis, Infertility & Hysterectomy. She will be presenting this course this February!

Michelle Lyons

Endometriosis is a common gynaecological disorder, affecting up to 15% of women of reproductive age. Because endometriosis can only be diagnosed surgically, and also because some women with the disease experience relatively minor discomfort or symptoms, there is some controversy regarding the estimates of prevalence, with some authorities stating that as many as one and three women may have endometriosis (Eskenazi & Warner 1997)

There is a wide spectrum of symptoms of endometriosis, with little or no correlation between the acuteness of the disease and the severity of the symptoms (Oliver & Overton 2014). The most commonly reported symptoms are severe dysmenorrhoea and pelvic pain between periods. Dyspareunia, dyschezia and dysuria are also commonly seen. These pain symptoms can be severe and have been reported to lead to work absences by 82% of women, with an estimated cost in Europe of €30 billion per year (EST 2005). Secondary musculoskeletal impairments caused by may include: lumbar, sacroiliac, abdominal and pelvic floor pain, muscle spasms/ myofascial trigger points, connective tissue dysfunction, urinary urgency, scar tissue adhesion and sexual dysfunction (Troyer 2007) – all of which may be responsive to skilled pelvic rehab intervention.

Endometriosis can lead to inflammation, scar tissue and adhesion formation and myofascial dysfunction throughout the abdominal and pelvic regions. This can set up a painful cycle in the pelvic floor muscles secondary to the decrease in pelvic and abdominal organ/muscle/fascia mobility which can subsequently lead to decreased circulation, tight muscles, myofascial trigger points, connective tissue dysfunction and pain and possible neural irritation.

Abdominal trigger points and pain can be commonly seen after laparascopic surgery for diagnosis or treatment. We know that fascially, the abdominal muscles are closely connected with the pelvic floor muscles and dysfunction in one group may trigger dysfunction in the other, as well as causing associated stability, postural and dynamic stability issues.

The pain created by muscle tension and dysfunction, may lead to further pain and increasing central sensitisation and further disability. Unfortunately for the endometriosis patient, as well as dealing with the problems already associated with endometriosis, she may also develop a spectrum of secondary musculo-skeletal problems, including pelvic floor dysfunction – and for some patients this may actually be responsible for the majority of their pain (Troyer 2007).

The skilled pelvic rehab therapist has much to offer this under-served patient population in terms of reducing pain and dysfunction, educating regarding self-care and exercise and helping to restore quality of life. Interested in learning more? Join me for my new course: ‘Special Topics in Women’s Health: Endometriosis, Infertility & Hysterectomy’ in San Diego this February or Chicago in June.

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Meet the Instructor of the Male Oncology course!

Michelle Lyons

This March, H&W is launching a brand new course on Oncology and the Male Pelvic Floor. This course was developed by H&W faculty member Michelle Lyons, PT, MISCP.

Pelvic Rehab Report sat down with Michelle to learn more about her course.

PRR: What inspired you to create this course?

ML: I am very passionate about oncology rehab and pelvic physical therapy. While it has been great to see the huge advancements being made in the provision and recognition of pelvic physical therapy, I often feel that cancer survivors don’t always get the treatment they deserve – they don’t fall exclusively into the domain of the pelvic therapist or the oncology therapist. Add to this the lack of awareness in the medical community about the benefits of physical therapy generally (and pelvic physical therapy especially) and it becomes obvious that a lot of pelvic oncology patients, both men and women, have many issues that we can help address. The first step is creating awareness, both with our medical colleagues and with cancer survivors, about the benefits of physical therapy

What resources and research were used when writing this course?

I like to use a wide range of resources when creating a course. My main priority was to determine if there was a need for this service – I visited cancer survivorship websites and forums and asked on various social media sites, as well as talking to medical and therapy colleagues, about their opinions on the topic. The answer was a resounding ‘We need this!’

I read hundreds of journal articles, interviewed healthcare professionals and patients as well as drawing on my own professional experience. I want this course to be based on the best evidence based medical practice out there, but more importantly, I want to make the information immediately clinically applicable, so there will be a generous allotment of time to discussing and practising manual therapy techniques and exploring different ideas for exercise prescription. I believe we are all students and we are all teachers; I know I learn something new every time I teach, so I am really hoping these classes will be a forum to get therapists brainstorming and planning how best to serve this community

Can you describe the clinical/treatment approach/techniques covered in this continuing education course?

We will be looking at how to apply the skills we have to help problem solve pelvic issues such as bladder, bowel and sexual dysfunction, but also thinking about the sequelae and complications of cancer treatments such as osteoporosis, fatigue and cognitive changes. I want to discuss the necessary precautions and contraindications we need to be aware of but also to look at how to develop the skillset we already have to really enhance cancer survivors’ quality of life

Why should a therapist take this course? How can these skill sets benefit his/ her practice?

Fortunately, we are seeing more people living longer lives as cancer survivors – there have been huge advances in the treatment of many pelvic cancers. But these treatments do have side effects that impact on the pelvic health of the many men and women who battle pelvic cancers. We are the experts in pelvic rehabilitation and I think we need to expand our skillsets to offer cancer survivors access to our expertise. The many exciting changes we are seeing in cancer care means that therapists need to be able to not only assess, treat and educate cancer survivors but also to be able to show that the work we do has a body of research to demonstrate the value of what we do. I think developing an expertise in pelvic oncology will be of huge value to a therapist’s repertoire of marketable skills, but I can also tell you that working with pelvic cancer survivors will be one of the most rewarding aspects of your career. You will literally be changing people’s lives.

The course will be offered January 25-26 in San Diego, CA. Don't miss this brand new offering - Register today!

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