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Pelvic Pain And Physical Therapy

It’s common for people to experience pelvic pain when they exercise regularly. For example, those who do CrossFit or have a weightlifting regimen might have the following issues: pain in the perineum when sitting, abdominal pain when engaging in an intense activity, testicular pain which radiates upwards toward the abdomen, and abdominal pain which radiates toward the testicles. Women participating in CrossFit or other high-intensity weightlifting and sports training regimens might develop abdominal pains. Postpartum mothers may also experience pelvic pain when they try to pick up their physical fitness regimen again.

Experts have observed pelvic pain in patients who participate in heavy weightlifting workouts or CrossFit regimens, but this doesn’t have to be the case. By focusing on postural cueing, breathing, and bracing, the pelvic dysfunction experienced during exercise might greatly diminish or vanish altogether. Women often find that heavy lifting regimens can cause stress-related incontinence, especially if they haven’t received proper training. Men might experience pelvic dysfunction when they use an improper form while lifting. So how can physical therapists help mitigate these forms of distress? The first important thing to consider is core stability. When you see a physical therapist about pelvic pain, the first thing they’ll do is examine the wall of your abdomen. Many male patients who experience exercise-related pelvic pain present with diastasis recti.

What is Diastasis Recti?

Diastasis recti occurs when the rectus abdominal muscles have become separated from each other. This same separation can occur in postpartum women, regardless of their exercise levels, due to the immense pressure against the abdominal wall caused by the internal organs. When the separation is greater than the width of two fingers, a deep cavern is created between the sides of the abdomen.

Beneath the rectus abdominis muscles is the cavity known as the peritoneal cavity. Also located there is the sheath which contains and protects a person’s digestive organs. Diastasis recti (DR) might be caused by a lack of stabilization and support for a person’s core during their exercise regimens.

When the fitness and medical communities discuss diastasis recti, they’re usually referring to the experiences of postpartum women. But men can be affected as well, especially men who participate in heavy-lifting fitness regimens. Right now, there is limited research regarding how prevalent diastasis recti is in males. There has also been limited research done into the causes of diastasis recti outside of postpartum causes.

Since a link has been established between DR and increased pressure on the abdominal wall, most physical therapists advise against participating in the following common exercises while recovering from abdominal injury: sit-ups, roll-ups, planking, downward dog positions, double leg lowers, and any other exercises where the weight of the legs is supported through the abdominal wall.

DR affects core stability, leaves the spine more vulnerable to potential injury, and mars the stability of the pelvis in general. For this reason, physical therapists will usually focus on the rehabilitation of core stability in patients who present with DR. Rehabilitating core stability helps to reduce symptoms, lower pelvic dysfunction, and treat pain in the lower back.

Common Causes of Diastasis Recti

Physical therapists have observed problems with bracing and breathing techniques in people who participate in CrossFit regimens. In these cases, the proper techniques must be taught, and improper techniques must be corrected. Oftentimes, the breathing problem is reduced coordination regarding diaphragmatic breathing processes.

When you lift weights, you’ve probably heard of bracing your spine. It’s common for trainers to instruct people to use an arching motion when squatting or performing deadlifts. This is a way to brace your body for the exertion. Even when people brace themselves properly, it’s common for people to hold their breaths while in the middle of an intense exercise and not to pay attention to their breathing for the entire duration of their exercise.

The correct breathing techniques are one of the most difficult aspects of fitness to explain. Even though breathing is an automatic action, it’s important to control the manner and timing of breath when exercising. The most primarily used respiratory muscle is the diaphragm, which controls the rate at which you inhale and exhale. Meanwhile, your respiration is also assisted by accessory muscles and intercostal muscles.

The diaphragm is a structure shaped like a dome. It’s located underneath the rib cage. When a person inhales, the diaphragm contracts and moves downward, allowing the lungs to expand. Meanwhile, exhalation is accompanied by the diaphragm moving upward to expel as much air as possible.

One technique physical therapists use to rehabilitate the diaphragmatic breathing of their patients is called “balloon breathing.” This allows people to control their intake and output of oxygen. It also allows them to breathe more firmly into their diaphragms.

When a person breathes, their abdominal muscles and pelvic cavity are constantly being shifted. When a breath is taken in, the pelvic floor lengthens very slightly. During the exhale, the pelvic floor then relaxes reflexively. This means that improper breathing — long, shallow inhales during a weightlifting movement — puts pressure on the pelvic cavity when it’s lengthened, in response to stress. Conversely, completing exercises on exhales greatly reduces pressure on the pelvic muscles.

Phases of Physical Therapy

Physical therapists have outlined different phases of rehabilitation for their patients with DR. These phases depend on how acute the symptoms are, as well as how long it has been since the patient began presenting with the symptoms. These phases are:

  • Acute Phase

    Between one and seven days after the injury is sustained. The main therapy goal is to control and prevent further inflammation.

  • Subacute Phase

    Between five days and three weeks after the injury is sustained. The therapist will begin therapeutic movements. This is the best time period for physical therapy to occur.

  • Remodelling Phase

    Between one and six weeks after the injury. The therapist will work with a goal of achieving a normal range of motion and flexibility, and will begin to prescribe light exercise to challenge the healing tissue.

  • Functional Phase

    Between six weeks and six months after the injury. The goal is to be able to return to exercise regimens and sports without causing a recurrence of the injury.

If you’d like to learn more about the services Dynamic Therapy provides, or to schedule a consultation, contact us online today.


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