Osteopathy and Pelvic Pain
Osteopathy and Pelvic Pain: Looking Beyond Where It Hurts
Written by Dr. Fiona Callender, ND and Pelvic Therapist, in collaboration with Yasmine Khalaj, Osteopathic Manual Practitioner
Treating pain isn't always about treating where it hurts
You have pain in your pelvis, so in theory it would make sense to focus treatment in the pelvis, right? Osteopathy asks, “what if there’s more to this pattern of pain than injury = pain?”
Persistent pain may have started through one factor - an injury, damage, illness - but it may be persisting due to our body’s attempts at protecting us. We might see this as muscle guarding, changes in movement, compensation, sensitivity of the nervous system and tension in surrounding areas. Pain can be protective and provide us with information about what is happening in our body. The problem is we don’t necessarily want or need all of that information.
Chronic pain can become a bit like a spinning wheel: something may have initiated the pain (or gotten the wheel spinning), but over time, multiple factors can contribute to keeping that wheel moving.
The good news is that if multiple factors can be contributing, we have multiple opportunities to intervene. Manual therapy can be a great support for reducing sensitivity and adjusting pain thresholds in the system. Osteopathy is a gentle manual therapy approach that can be an added support for our pelvic pain patients.
What is osteopathy?
Osteopathy involves gentle hands-on treatment that works to unload tissues that are under pressure - either tension or compression - to help restore pain-free and easy motion through the body. As we’ve discussed, pain - especially when it is chronic - can cause us to adapt our posture (whether consciously or unconsciously) and our movements to protect us. Over time, the initial pain trigger or event may be gone or healed, but we might still be holding these protective patterns. Part of our plan can be releasing these old patterns and teaching our nervous system that there is safety in this release.
If you’ve ever had an osteopathy appointment, you might notice that you leave feeling better but your treatment may not have focused directly on where it hurts. Osteopathy looks to “unload” the tissues through gentle touch and movement rather than manipulate or adjust the joints like you might see in other forms of manual therapy.
When we think about pelvic pain, this is rarely just about one muscle
For someone with chronic pelvic pain, including those with endometriosis, persistent pain may have developed over time as a protective response.
A common response to pain - whether conscious or not - is often to have guarding of our muscles. This changes our movement patterns and we might notice other tissues and muscle groups adapt to compensate. The more pain we experience, the stronger this nervous system signal of alarm and “we aren’t safe” can get.
For a condition like Endometriosis, Osteopathy isn't treating the lesions themselves, or even the muscles directly in the pelvis. Instead, it may be one part of addressing the musculoskeletal tension, guarding and compensatory changes that can develop alongside persistent pelvic pain as well as down-regulating some nervous signals involved in keeping pain chronic. If you want to understand more about why pain can persist and how the nervous system can become increasingly protective, read our blog about Pain, the Nervous System and the Pelvic Floor.
What does “unloading” mean in osteopathy?
Unloading means reducing pressure on the area - whether the area is being pulled or compressed - in order to support alignment and healthy movement in the system. This is in contrast to a quick fix/manipulation mindset that tells us, something is out of place and needs to be corrected.
In osteopathy, instead we ask, “Can we reduce some of the tension/load this system is managing so that it has more options for movement?”
Osteopathy, pain and the nervous system
Manual therapy is one way of providing comfortable sensory and movement experiences that teach our body that touch and movement are safe. We unload tissues and send information to the nervous system that our alarm signals can be turned down. When a body has spent a long time protecting itself, our goal isn't necessarily to force tense muscles to relax. We're trying to create conditions where the body doesn't feel like it needs to protect itself quite so strongly. Gentle manual therapy may be one piece of that process. Other supports might include movement, pelvic floor therapy, medications/supplements, nutritional support, sleep, pain education, psychological support and other individualized care.
Why osteopathy and naturopathic medicine can work well together
When it comes to pain, we might both ask similar questions: Why might this be happening? What else might contributing? What is this person's body adapting to or protecting from?
We approach through different lenses but with a similar understanding of pain and how it can become chronic. Our tactics might be different, but often with the same goal in mind - decreasing nervous system sensitivity.
Pelvic pain often requires an approach that looks at the whole picture of you and your life. We need to look at all the factors that might keep that chronic pain “wheel” spinning. Where we start might be different for everyone.
We can investigate and support conditions like endometriosis. We can address movement, guarding and musculoskeletal tension. We can consider the nervous system, sleep, stress, bowel function and other factors influencing pain. Bringing together different practitioners can sometimes give us a much better picture than looking at any one piece in isolation.
Ready to explore your options?