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Physical Therapy Helps with Endometriosis

Physical Therapy is an efficient and successful treatment for Endometriosis

What is Endometriosis?

Endometriosis is a disease in which the endometrial tissue that normally lines up the uterus can be found outside the uterus, where it does not belong. This tissue, although not found in the uterus, responds to hormonal changes, breaks down during a menstrual cycle and bleeds.  When endometrial tissue grows where it does not belong, the results from endometriosis may be internal bleeding, inflammation, and scarring.  If left untreated, the organs inside the pelvic cavity may be affected, including the bladder, the bowel, and the intestines.

Endometriosis is a painful disease affecting over 7 million women  and teens in the USA alone. This disease is the leading cause of female infertility, chronic pelvic pain, and gynecological surgery. It accounts for more then 120,000 hysterectomies annually. Without the proper treatments, the cost of  ongoing endometriosis care in the USA alone is estimated to be 119 billion! It has been estimated that 89 million of women and girls in the world and 5.5 million women in the USA and Canada suffer from this condition. It is also estimated that 6-10% of reproductive age women, 20-50% of infertile women and 71-87% of women with pelvic pain have endometriosis.  Endometriosis diminishes a woman’s physical, sexual, reproductive and emotional health.

Symptoms of endometriosis, among others, include pelvic pain, severe menstrual cramps, low back pain, infertility, muscle tightness, pelvic floor dysfunction, painful bowel movement, rectal pain, nausea, bloating, distention, painful bowel movement during menstruation, pain with interpose and spotting, and abnormal bleeding. Abnormal bleeding may include the presence of blood in urine or stool; light to moderate vaginal bleeding before the start of a menstrual period (premenstrual spotting); 
vaginal bleeding after intercourse. Although there are many symptoms to endometriosis, infertility could be the only sign that indicates endometriosis. Between 20% and 40% of women who are infertile have endometriosis.

Where did Endometriosis come from?

There are different theories to the origin of this disease. The most common ones are reflux menstruation and metaplasia. In the past, many scientists accepted the theory of reflux menstruation because the backward flow of menstrual blood into abdomenal cavities was believed to have caused this disease. However, in recent years,  many scientists have refuted the former theory and instead considered metaplasia as the most plausible explanation due to the occurrences of endometrial cells outside of the abdomen (brain, lung) and the genetic make up of those cells.  In addition to this, endometrial cells were also identified in infants and female fetuses, which makes reflux mensturation impossible.

Diagnosis and Treatment

Currently, the gold standard to treat a positive diagnosis of endometriosis is by surgery, either by laparoscopy or the more invasive laparotomy. The disease itself cannot be diagnosed by sonogram, CT scan, MRI or other diagnostic procedures alone. The use of high-power color sonograms are currently being investigated, but their detection rates seem rather limited at this time in confirming the recurrence of this disease in previously diagnosed patients.The best approach for endometriosis treatment is multidisciplinary treatments. Surgical excision followed by OCP (Oral Contraceptive Pills) use seems to prove the best results and a low 24-month recurrence rate. According to research data, 96 percent of excision surgery patients are pain free after 24 moths and 69 percent in the cases of coagulation surgery patients.  Furthermore, Surgical excision combined with OCP are reported to decrease incidence of recurrence to a very low 6%, when compared to 49% in non OCP, according to a research done by Vercellini et al.

How can Physical Therapy help ?  Women with endometriosis commonly have trigger points in the abdominal wall, the pelvic floor, as well as in the back and gluteal (buttock) muscles. According to Travell and Simons, a Myofascial Trigger Point (MTrP) is defined as “a hyper-irritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.”  In other words, this trigger point, when touched, causes pain. When pressure is applied onto a MTrP, the referred pain and/or tenderness may occur.  Trigger points found in the abdominal wall are thought to be the result of menstrual cramps, chronic pain and/or surgery.

How Can Physical Therapy Help?

The endometrial tissue implants are thought to swell during each cycle, causing endometriosis pain. The interrelated adhesions may pull on internal structures when walking, moving, or even breathing. The pull of these adhesions on pain-sensitive structures may be one main cause to severe endometriosis pain. By addressing the adhesions that appear to cause endometriosis pain, manual physical therapy treatment has shown success in decreasing pain from endometriosis while increasing reproductive and digestive functions in many women. The focus of physical therapy is to decrease endometriosis pain and the adhesions that form at the endometrial tissues, as well as to promote good posture and movement strategies for the successful management of pain.

Physical therapy helps most or all of the symptoms previously described through techniques such as myofascial trigger point release and deep tissue, scar tissue and connective tissue manipulations of the internal and external pelvic, abdominal, hip and back structures. Women with endometriosis commonly have trigger points (tight nodules or bands of connective tissue) in the abdominal wall as well as the pelvic floor, back and gluteal (buttock) muscles. When pressure is applied onto a MTrP, referred pain and/or tenderness may occur.  Trigger points found in the abdominal wall are probably a result of menstrual cramps, chronic pain and/or surgery. Connective tissue manipulation (such as skin rolling) used in improving circulation to areas described can decrease blood flow and pelvic congestion. This also allows for a better mobility for the surrounding structures. Other similar manual techniques are used to reduce pain, increase mobility of soft tissues and ultimately, to reduce adhesions.  During these processes, the muscles are re-educated to return to their “normal” position. These techniques can help decrease and release adhesions, which can later result in less pain and an improved quality of life.  Female patients reported at least 75% improvement in symptoms with these techniques. The reported improvements include being able to sit for longer periods of time, increased participation in work and/or home activities, and improved bladder and/or bowel symptoms.

Physical therapists will also work with the patient using neuromuscular re-education techniques such as contract-relax (stretching) and reciprocal inhibition (muscle therapy).  These techniques can be used along with or as a replacement for passive stretching.  They are used as inhibition techniques to help relax the muscles. Through such techniques, the physical therapist is able to help the patient re-training the muscles to return to their normal position and function properly. Normally, all of the muscles in the body function optimally and have a normal resting tone when at resthowever, with chronic pain such as is seen with endometriosis, the muscles of the body may tighten.

Patients with endometriosis and pelvic floor disfunction tend to have tightened muscles in areas such as the abdominal, the pelvic floor, gluteal and thigh muscles due to the pain and discomfort that they are feeling at the time.  As a result, the contracted muscles become hypertonic and accelerate the resting tone.  Simply put, this means that the muscles have an increased muscle tone, which may happen outside of conscious control, and with time, the normal resting tone is lost..  This muscular tension may result from protecting against pain, which can in turn lead patients to experience more pain.  The physical therapist usually notes decreased movement and circulation in the areas involved. The decrease in blood flow to those areas will also increase the chance of MTrP to develop.  As previously stated, trigger points may lead to localized and radiating pain.  In patients with ongoing endometriosis, this obviously can trigger a vicious pain cycle. It is thus vitally important for women with endometriosis to see a properly trained physical therapist to determine whether or not they would benefit from physical therapy. Nevertheless, patients should be aware that not all physical therapists are trained in treating pelvic floor dysfunction and symptoms related to endometriosis.

Lilly Physical Therapy, LLC and Endometriosis

If you have been diagnosed with endometriosis, Lilly Physical Therapy, LLC  can help.  We utilize cutting edge technology and advanced manual techniques in treatments for pelvic floor dysfunction, pelvic scarring, and muscle tightness caused by endometriosis. Doctor Lilly is skillful and experienced in manual therapy, helping patients to first identify the hypertonic (tightened) muscles and re-educate them through proprioceptive neuromuscular facilitation, verbal cuing and biofeedback. Our goal is to guide our patient in learning how to relax (or, down train) the muscles, which in turn helps break the pain cycle. This, in conjunction with the manual therapies described above, will help the agitated muscles to return to their normal resting tone and release adhesions and scarring. Our clinic also provides Transcutaneous Electrical Nerve Stimulation (TENS) that can assist patients in pain reduction, including chronic pain.  Lilly Physical Therapy, LLC uses a combination of computerized biofeedback technology, laser treatment and the latest manual techniques to help you heal faster and feel better.

Please contact us at (425) 224-2476 to schedule a consultation.