When my physiotherapist (Aka Mrs physio friend) confirmed my suspicions that the pelvic pain I had been experiencing was another episode of chronic pain, at first I felt relieved. After five months of not knowing why I was in pain, I was pleased to finally know what the issue was.
However later that evening, and for a good few days afterwards, I felt really upset. Almost embarrassed that it had happened to me again, why me?! So many people have babies or have minor car accidents and don’t experience pain for months or years afterwards, so why me?
When I mentioned this at my next appointment, Mrs physio friend explained that in some people there are so many issues and stressors surrounding the pain experience, that the brain decides it’s best to keep the alarm system elevated.
These issues and stressors can take form in different ways;
- Failed treatment – all of the treatments the doctors had prescribed, had failed to work. They couldn’t tell me what the problem was so my brain still had questions and concerns, leaving my alarm system elevated.
- Family concerns and job issues – the concerns over Pete’s job loss and the security of my job due to COVID, meant money and security issues were providing little incentive for my brain to turn down my alarm system and in fact made things worse, by turning it up some more.
- Fear and anxiety – the last few months had been filled with uncertainty; the failed treatment and explanations of my pain. I was unsure if the exercises I was doing were correct or if I should be walking or putting my feet up. Jobs and money. All this uncertainty brought with it fear and anxiety, keeping my alarm system turned on.
- Ongoing pain – even though pain is a normal protective mechanism, the pain experience is stressful, it elevates the body’s alarm system as the brain tries to protect you. Ongoing pain is a stressor and keeps the alarm system elevated.
- Different explanations of pain – every doctor gave me a different opinion of what the issue was, add in other opinions from other professionals, family, friends, research on the internet and my mind was swimming with what could be wrong. All of which was keeping my alarm system sensitised.
If you are a chronic pain sufferer, perhaps some of these stressors are familiar to you?
The measuring jug scenario
Mrs physio friend explained a good way to think about your pelvic pain is to think about a measuring jug, where your pelvis is the jug. If water is continually poured into an empty jug it will overflow. Nerves in the body constantly send information to the spinal cord, which if needed, sends the message on to the brain for interpretation, some information stops at the spinal cord. The feeding of the spinal cord with information can be likened to filling a measuring jug with water.
The nervous system around the pelvis, constantly receives information from tissues, muscles, organs and other parts of the body and sends the information to the spinal cord. All of this information fills the jug with water, plus environmental information like stress, anxiety and fear can influence the nervous system and add even more water to the cup.
If the cup doesn’t overflow then everything is fine. However if it does overflow due to being too overwhelmed with information, then the spinal cord sends a message to the brain, which then decides if it needs to protect the pelvis by creating pain.
All the emotional and stress factors bulleted above affects how quickly the jug overflows. These factors act like a flame under the filling jug of water, heating it up and eventually causing the jug to boil over more quickly, accelerating the pain. My nervous system had been over-sensitised by pregnancy, birth, being a first time mum and many life stressors.
I needed to calm the f**k down! Literally, I needed to calm my nervous system down (desensitise it) by developing strategies to turn down the flame so my cup would stop overflowing. Eventually this would help put the flame out to stop the pain.
This doesn’t just apply to people with pelvic pain. The over-sensitised nervous system applies to chronic pain sufferers, whatever part of the body the pain is in. Your sensitised brain and nervous system puts greater emphasis upon your stressors, emotions, experiences or memories, seeing them as threats and therefore triggers a pain response to protect your body.
The first step to my recovery from pelvic pain
Although this was another episode of chronic pain it felt very different to my first episode in my neck and back. It’s very hard to explain pelvic pain, you cannot readily see or feel it, when it’s internal and it’s a bit embarrassing to talk about it (although I’m well and truly over that by now). It’s a very strange area of your body to experience pain.
So how do you calm down something that you can’t see and is very hard to feel?
I’d had a year and a half of not experiencing chronic pain. Despite the six years prior, of living with it day in, day out, I had to remind myself of the basic principles of how chronic pain operates. The pain was in a different area of my body this time, yet the same principles applied. I had to remind myself, even though I was experiencing pain, it didn’t mean there was any physical damage. There were other reasons as to why this pain was present.
Mrs Physio friend gave me the book ‘Why Pelvic Pain Hurts’ written by therapists Adriaan Louw, Sandra Hilton and Carolyn Vandyken. It explains in a comprehensible way, how the brain and nervous system collaborate to create pain, and provides coping strategies to aid relief and recovery.
I would highly recommend this book. It acted as such a useful reminder about why and how chronic pain occurs and really helped me to apply that knowledge to my pelvis rather than my past experience of the pain being in my back, neck and shoulders.
Acknowledging the stressors
My first homework from Mrs physio friend was for me to take some quiet time to write down all the things during my pregnancy and since giving birth to Isaac, that had been stressful or impacted upon me. This would enable me to understand what had contributed to my jug of water boiling over and therefore what had triggered my pain. If you can read my awful handwriting you’ll be able to see what these factors were.
Writing down all of these things was quite a therapeutic process in itself. I was told to break it down into primary contributors, which in my case was my pregnancy and childbirth and secondary contributors, which was everything that had happened after giving birth, which was when the pain started. I have talked about how many of these stressors came about, in my previous blog.
This exercise was really useful at reminding me of everything I had been through and enabled me to reflect upon the volume of different factors, which were all feeding into my measuring jug and contributing to the overall stress I had been under. If you are experiencing chronic pain, I would recommend this exercise to help you reflect on the many factors that could be contributing to your condition.
It also acted as a useful reference point for when I had a flare up of pain. If I couldn’t work out why I had more pain than usual, I would refer back to my brain dump to see if one of the stressors was more present than normal at that point.
Time to relax
Alongside this, my physio told me to back off all the hours of stretching exercises and leg rolling, which I had been running myself ragged trying to fit in (detailed in my previous blog), as they clearly hadn’t had any benefit. Instead I was to relax and use the time I had been using for exercise, to do something for myself that I enjoy, which is where this blog came in.
Yes I could have just baked some cakes, which I would have enjoyed. Yet I felt I wanted to do more. I felt like I had lost my identity when I became a mum. I was on maternity leave so I wasn’t working and due to lockdown I couldn’t even get out and about to see friends and family.
I also couldn’t exercise so I felt like I had a lot of time on my hands, apart from the small point of having a baby to looking after! I wanted a project which was just for me. As chronic pain was unfortunately back in my life, I wanted to do something which would aid my recovery by doing something I enjoy (baking) and that would also hopefully help other people who are chronic pain sufferers. Hence the creation of this website.
Mrs physio friend recommended that I regularly listened to a mindfulness meditation track to help me relax. I haven’t really ever tried to meditate or use mindfulness before so I was slightly skeptical. I had listened to the hypnobirthing tracks when I was pregnant which were extremely relaxing. I figured it was similar to meditating so I was more than happy to give the mindfulness a crack.
A big part of listening to the track was to help me focus on my breathing which would therefore help me relax my muscles and my mind. I never fully realised how much breathing can help you relax. Sure I’d heard people talk about it but I hadn’t really given it a go.
The track I listened to mentioned the pelvic floor so it was perfect to help me with my specific problem but there are tons of great tracks out there.
I also discovered that diaphragmatic breathing is incredibly powerful at helping both my mind and body to relax. Getting it right isn’t easy, you really need to be in the zone and focus, well at least I do. When I get it right, I can feel my pelvic floor relaxing. My physio told me to practice this breathing when I had time to relax. I made it part of my daily routine. If I am having a particularly painful day, I may practice it several times a day.
The diaphragm is a dome-shaped muscle, separating the chest and abdomen. When you breathe in the diaphragm tightens, flattens and moves down, drawing air into the lungs. As the diaphragm moves down, it pushes the abdominal contents down, forcing the abdominal wall outwards/the stomach to rise. Then as you breathe out the diaphragm relaxes, air passes out of the lungs and the abdominal wall/stomach flattens.
A few tips that I was given, which helped me to establish this breathing properly were:
- Lay or sit down comfortably in a quiet place where you feel relaxed. Closing your eyes can help.
- Place one hand on your rib cage and the other just below your ribs on the abdomen.
- Relax your neck and shoulders. Breathe in through your nose and let the breath fill your lungs so you feel your hand move as your rib cage naturally expands outwards, followed by your other hand rising as your abdomen rises.
- Hold the breathe for 4-5 seconds then slowly breathe out through your mouth, you will feel the abdomen flatten and your ribs relax.
- If you struggle to get the breathing correct, a great tip I was told by my physio was to use a scarf to breath into. Put the scarf around your back, resting it on your ribs, holding the ends of the scarf with each hand. Hold it relatively tightly so as you breathe in, you should feel the ribs push into the scarf. As you breathe out you will feel them contract away from the scarf which should then loosen slightly.
On top of the meditation and breathing, Mrs physio went through a very simple and short series of stretches for me to do when I had time to relax. She told me not to treat them as a ‘must do activity’, that I tick of my to do list for the day, which is how I had been approaching the hours of stretches I had been doing.
Instead she said to do them when I have time. I was to enjoy them and approach them as more of a continuous expressional dance, rather than approaching them as an exercise that I had to get done in a very particular, structured way. This was designed to aid my relaxation and to get me moving without me over-thinking about if the movement would trigger my pain.
If you are a chronic pain sufferer, over-time you are likely to have avoided moving your body in certain ways or stopped doing certain things, in fear that the activity will trigger your pain. This is a vicious circle, as it makes you do less and less, which makes it more likely that your pain will flare up when you do move.
Gently pushing you boundaries with safe movement, is one of many steps towards overcoming your pain. However I would strongly advise doing this under the advice of a physiotherapist who is trained in pain management.
Pacing your activity is essential for chronic pain sufferers
Mrs physio told me to pace my activity. I knew all about pacing from my first episode of pain and therefore I realised what a massive difference it can make to pain levels and your chances of ever recovering from chronic pain.
Instead of keep pushing myself to get things done and making my body tired and therefore triggering my pain. I was to behave myself. I had to pace my activity by stopping before I started to fatigue, to avoid triggering it.
I absolutely hated being back in this situation. Plus it’s even tougher to do when you have a baby to look after. They really don’t understand why you may need to sit down when they just want to be rocked to sleep!
For the next six weeks…
All I had to do was practice the things I have just described. I felt like I was on holiday. Instead of spending every spare minute cramming in the numerous exercises I had been doing, I simply did my new short series of stretches and then meditated and that was it. I didn’t even have to do it every day, just when I felt like it. Yet me being me, a stickler for routine and not being good at doing nothing, I did the exercise and meditation every day. I was trying to get better at relaxing, honestly!
In the following couple of weeks, things felt fairly similar in terms of the level of pelvic pain I was experiencing. However I felt much more relaxed, the meditation and diaphragmatic breathing really helped me to focus on being in the moment and relaxing my muscles down.
I would normally do my stretches and listen to the mindfulness track at lunch time, as this is when I would normally start to fatigue. Also Isaac would normally be napping so it gave me some time to catch some peace and quiet. This little routine really helped to reset me and lower my pain to get me through the rest of the day.
The mindfulness track was so relaxing I had to try my hardest not to drift off to sleep in the middle of the day. Not easy when you are severely sleep deprived from having a young baby. The track helped me to zone into different areas of my body, making me aware of how they felt, rather just focusing on my pelvic pain. It really helped my body to relax and let go of the tension. Even now, if I can’t sleep I will pop this meditation track on to help me drift off.
The stretches really helped when my hips and legs felt stiff, which was most days when I woke. Sometimes it would disappear after I had been up for a while and sometimes it would last most of the day. When you develop pain in and round your pelvis, the nerves in that area ‘wake up’. Due to the nervous system being connected, it works like an alarm system which then wakes up other neighbouring nerves.
If your house alarm goes off, it is likely to wake or disturb your neighbours as they are curious as to why your alarm is going off. If your alarm goes off for a long period of time, more neighbours further down the street will also become curious or wake up.
As I had been experiencing pain in my pelvis for a while, my alarm system had been going off all of that time. The neighbouring nerves in my hips, lower back, thighs and knees had also been woken up and were aching as a result. The stretches helped to relieve the tightness and aching and kept me mobile without putting too much stress on my body.
Pacing my activity had made a real difference. It had helped to keep my pain to a more even level of discomfort. I was more aware of the factors that had contributed to my jug overflowing and I had tried to eliminate some of the stress and activity that triggered my pain.
As the weeks progressed I started to feel a change in the type of pain I was experiencing. The swollen, throbbing feeling I had been experiencing around where my episiotomy stitches had been, had stopped and the stabbing pains were getting less frequent.
I’d started to do a very short walk of 10-15 minutes each day which was slowly getting less painful. After a few weeks Mrs physio had suggested increasing my short walks to twice a day, to help build the activity very slowly so I didn’t overdo it.
I would always feel some pain when I exercised but in comparison to how I had felt six weeks previously, the level of pain was much lower and my capacity to do things was increasing ever so slightly.
After a few more weeks I got on the spinning bike. My first ride was for less than ten minutes which seemed pointless. Yet I didn’t get a flare up of pain, which was the whole point of only doing a short stint. Every time thereafter I increased my time by an extra minute and very slowly got up to twenty minutes.
Once I hit twenty minutes I felt like I had really accomplished something. It was the longest I had managed to spin for since I’d started doing exercise again and it didn’t cause my pain to flare up afterwards. It felt like I had reached a milestone.
Although I was in no way pain free, I felt I was managing my pain much better on a day-to-day basis and my capacity had increased. I was achieving more without the pain increasing. I had reached the right point to speak to Mrs Physio friend about moving onto the next stage of rehabilitation.
I’ll cover the next steps of my rehab progress over my next few blogs. I just wanted to add that although I describe these steps as the first part of the rehabilitation programme, they continue to be intrinsic all the way along my recovery journey.
I started these first steps in May 2020. Yet, even now as I write this blog as we approach the end of October 2020, I still constantly revisit these first steps to avoid my nervous system becoming too sensitised. Although I have made big strides of progress and I am able to do more, if I do too much in a day my pain becomes worse.
I have days when I try to get away with doing that bit too much and I’ll exceed my capacity as we have a lot on, or Isaac is particularly demanding, which results in a bad pain day. However if I reign myself back in and focus on the steps above, the pain normally starts to settle down again, which highlights what an important foundation these principles are to recovering from chronic pain.