Infertility and dysmenorrhea.
Do know somebody, or are you yourself, having difficulty conceiving? Do you, or someone you know, suffer from painful periods? If you responded yes to either or both of these questions, have you ever thought that either of these issues could be helped with physical therapy?
Most likely not.
Often when we think of physical therapy, we conjure up the image of a clinic full of gym equipment, where you are being instructed in exercises to strengthen or stretch the area of injury. This seems to be completely unrelated to addressing impairments related to period pain or infertility.
Functional Manual Therapy is a unique hands-on approach to soft tissue and joints, we approach the body as a whole, looking at the body three dimensionally, assessing for all potential mechanical issues that may contribute to increased pain or decreased function. In regards to women’s health issues, we often need to normalize the alignment and mobility of the pelvic girdle, as well as address fascial adherences, that can be related to the ovaries, fallopian tubes and uterus. Restrictions in any of these areas can contribute to pain, as well as dysfunction in this region.
The female reproductive organs are complex in nature because of the constant flux they are under during the menstrual cycle. It is necessary for organs to move, and they do for healthy function, we are just not always aware of it. Our lungs are constantly filling and emptying with air, our heart is beating many times a minute and our intestines are pushing food along for digestion and absorption. The female reproductive organs are in constant motion as well. The uterus must expand and contract for menses (and during pregnancy and delivery), the ovaries move closer to the Fallopian tubes during ovulation, and the Fallopian tubes must be flexible and pliable to allow the egg to travel down it towards the uterus to implant. If one or all of these restrictions are present, than fertilization and implantation may not be optimal, or there can be pain at different times of the menstrual cycle (like during ovulation or menses).
Restrictions can occur from trauma (falls, blows to the low back or abdomen), endometriosis, prior surgeries, infection, inflammation, just to name a few. Infertility is defined in the United States, as the inability to conceive after 12 consecutive months of unprotected sexual intercourse (Wurn et al. 2004). The estimates are that 10-15% of heterosexual couples are affected, and that 40% is related to problems attributed to the female, 40% to the male, and 20% to unknown causes (Wurn et al, 2004). Wurn et al., 2004, also estimates that out of the approximately 5 million women who suffer with infertility, 40% have medical or hormonal infertility; 20% have idiopathic infertility and about 40% have mechanical infertility. Mechanical infertility is where PT can be helpful, because it usually refers to pelvic adhesions as the primary cause (Wurn et al). Adhesions are taut bands of tissue that form from the result of a trauma or inflammatory process. Our body needs adhesions in some form to heal, because it allows the injured areas to approximate and to rebuild, unfortunately, which is often the case, these adhesions never get the mobilization needed to accommodate and allow healthy function and movement. These adhesions can adhere organs or muscles, distorting the anatomy and causing decreased mobility and function (Wurn et al, 2004). When we have an injury in our knee, or shoulder, we are very familiar with the symptom of stiffness, or restricted motion that can occur as the tissues heal. This is a normal process and is needed to repair injuries to our tissues. In the case of a knee or shoulder, however, we are also familiar with the role of a physical therapist and how their manual techniques and skills can help to stretch and mobilize these tight tissues to allow the joint to regain full motion. Appropriate and specific stress through healing tissue is required to allow the collagen fibers to remodel and meet the demands required for appropriate, pain-free function. In the case of the abdominal and the pelvic organs, we forget that the same things need to happen. Healing needs to occur, but then it is imperative for function to return that remodeling and appropriate stress be applied to the tissues to reinstate healthy, normal, motion.
Wurn et al. has found that specific adhesions or restrictions in specific locations can lead to infertility through adhesions on:
“Uterine walls and ligaments, increases the possibility for uterine spasm, implantation problems, and miscarriage. On the tissues of the cervix, creating stenosis, affecting midline position, possibly causing uterine spasms, and sperm transfer to the uterus. On the ovaries, preventing exposure of ovum and making transfer to Fallopian tube difficult. At the distal end of the Fallopian tube, restricting the ability for the fimbriae to grasp the egg. Anywhere on or in the Fallopian tube causing partial or total tubal occlusion, decreasing probability of conception and increasing risk of ectopic pregnancy.”
The skilled visceral FMT practitioner is able to feel these minute restrictions and then utilize specificity and localization to mobilize these regions with observable and measurable gains in function and range of motion. There are many techniques utilized today to “mobilize viscera”, but FMT is based on having efficiency throughout the entire system, and not just the viscera alone. FMT also emphasizes the importance of addressing the mechanical restrictions in the hard frame (or pelvis) through mobilization and hands on techniques, to improve the environment for the pelvic organs, that when mobile as well, will have the best chance for optimum function.
-Dean Hazama MPT, FMTF, FAAOMPT