Conditions:

Pelvic Pain Dysfunction in Young Athletes

What is Pelvic Pain Dysfunction (PPD) and what can we do generally to help:

Pelvic pain affects nearly 25% globally and 15% of that tend to be very active. This is because exercise provokes the pelvis through certain movements and patterns of activity, specifically in physical activity. There are a variety of sub conditions caused by pelvic pain namely:

Causes:

• Disease of the tissue lining of the Uterus (Endometriosis)
• Muscle and bone dysfunction and irregularity
• Chronic pelvic inflammatory disease
• Ovarian remnant
• Fibroids
• Irritable bowel syndrome
• Painful bladder syndrome
• Pelvic congestion syndrome
• Paniculosis(microscopic Oedema)
• Urgency
• Stress incontinence

Symptoms:

• Sharp stabbing
• Burning
• Dull ache
• Twisting and Knotting
• Cramping or throbbing
• Urgency
• Bladder leakage

All these ailment can occur when sitting, lying – as well as during exercise which is our main focus when it comes to athletic bodies.

Here at CiONE, we have a treated a large number of athletes across ALL sports and at all levels from “fun’ runners to ‘Olympic’/ professional athletes.

When trawling through our patient archives, we find many that have suffered some form of “Pelvic Pain syndrome” and are renowned for our “results driven” rehabilitation and management of these conditions

History:

Most of our knowledge of Pelvic pain comes from the original study of inflammatory and infective conditions (which up until the last decade, has been the only link to pelvic research) alongside the continuous ‘positive’ results that we have been blessed with since specialising in this unique area of internal discomfort and pain for both male and female athletes.

However, due to the higher amounts of pain experienced by many women during ‘menstruation’, further studies were commissioned and a plethron of pelvic ‘flaws’ were revealed.

Despite the improvement of the NHS in Women’s health and Pelvic pain care; the Private sector still remains the leading treaters and healthcare body in this field and therefore obtain the most updated knowledge in research of this condition specifically on individuals with particularly high levels of physical activity.

Our involvement:

We offer our main biomechanics programme with specific focus on the pelvis during treatment sessions aiming to relieve one of the brains “guarding” mechanism re; perceived internal trauma – being the build-up of excess “microscopic oedema” (Paniculosis) in the bodies Fascia.

The biomechanical realignment of the pelvic position is ‘KEY’ in managing Pelvic pain, complimented by the use of our specialised ‘eastern’ holistic methodology ie; treatment programmes of the ancient Japanese therapy of AMATSU.

The CiONE therapy is therefore a combination of both “East and West” disciplines, which empowers each patient to be able to gain control of their own body dynamically, ensuring pain relief through removing and draining – via the Lymphatic system – the build-up of ‘Paniculosis’, which at times is the main driver of the inflammation and discomfort.

This process has had a remarkable effect on Athletes who have been suffering internal pain and incontinent discomfort, allowing for full recovery mostly and/or Maintenance of “pain relief” – whether that be a personal ‘Rehab’ continuation following the treatment – involving exercises – homing into the pelvic region or follow up consultations every 6 weeks or so.

Testimonials:

There are a variety of “Athlete” pelvic pain testimonials you can find on our website at Cionewellnesscentre.com/testimonials on the “home” page, with two specific examples under titles of male and female pelvic pain, these videos demonstrate the hardship endured before acquiring treatment from us and how we efficiently executed individualised plans to eradicate their pain within a programmed timeframe, with them often finding their pain reducing dramatically after just a few sessions, while others take a little longer due to their individual DNA and their treatment being tailored to their physical strengths and weaknesses.

Within theses testimonials you will find in depth details on different programme experiences and treatments performed, personalised to the patient, as well as an understanding of the environment, dedication and time given to each patient.

Case study: (If applicable to you – please call us on our landline or email us at the above given address)

Our female pelvic pain example discussed living in fear of conducting everyday actions such as sitting, walking, laying or bending. Describing the pain as a sensation of “broken glass” in the pubic/vaginal area and how the National Health Service could not work out the correct treatment through ir assessment and their diagnosis of the issue.

It led to problems with her family relationships and with her own social life; as anxiety and depression formulated more and more over time.

She became desperate and went on line to purchase anything that had been reported to help…such as pillows, medication and massage “trinkets”, which in our 20+ year experience of this condition, does not help reduce or eradicate “internal Pelvic pain”.

With the help of the CiONE Wellness centre, this patient is now completely “pain free” through the treatment methodology; which focuses on a 30 minute holistic treatment utilising some ‘ancient’ Eastern techniques (complimented with the Western Biomechanical intervention) every few weeks; resulting in improvements within a short space of time and a complete release from pain, once the brain had come out of its defence mechanism of “Guarding”.

Studies in to the condition of “Stress Incontinence” and “Pelvic Pain” in athletes:

There have been many studies over the years in this debilitating condition:

Below are a few “summaries” of study papers published on the internet for you to peruse – that we have found exceptionally useful in the development of our protocols at CiONE.

No 1:  Running into the Realm of Pelvic Rehabilitation

Posted Author information by Cindy Washeck, PT, BA, MSPT, DPT, FAAOMPT Creation date on Tuesday, 04 August 2015
Over the past 28 years, my pelvic floor has endured at least 20,000 miles of running, including racing on the collegiate level and then completing 10 marathons. Add to the high-impact sport two 8.1 pound natural childbirth deliveries 26 months apart, and you can imagine why I accepted the invitation to blog for this well-respected institute. One of my elderly patients once told me my uterus was going to drop out from so much running (which, thankfully, has NOT happened); however, I have to admit, urinary stress incontinence and frequent urination were unwelcome enough consequences! On the positive side, it all initiated my journey to understanding the pelvic floor.

In 2014, Poswiata et al used the Urogenital Distress Inventory (UDI-6) to assess how prevalent stress urinary incontinence may be among elite female skiers and runners. Of the 112 female athletes in the study, 50% reported leaking a small amount of urine. Coughing and sneezing provoked leakage for 45.54% of those women, indicating stress incontinence, and 58.04% of the women in the study reported frequent urination. Are those acceptable statistics? I would have to say no.

Research results can be comforting so athletes can be told they are not alone regarding a quite personal aspect of their lives. When I could supposedly empty my bladder, stand to wash my hands and have to go again, walk down the hall to put on my sneakers and go once again before heading out the door for a run, it was nice to know someone else was probably experiencing the same issue that morning. Just because it is common, though, does not make it “normal.” We are not meant to leak just because we stress our bodies beyond normal ADLs.

A very recent study by Luginbuehl et al (2015 July 21), just published online, attempted to explore the electromyography (EMG) activity of pelvic floor muscles with variable running speeds (7, 9, and 11km/h) over 10 steps. The highest pelvic floor muscle activity was recorded at 11km/h, which would sensibly suggest the muscles produce a greater contraction the faster someone runs. If a runner has developed a decreased ability to activate the pelvic floor muscles, stress urinary incontinence will likely become a highly irritating problem with fast running speeds over time. But how do they know, and where do they go?

Without health practitioners trained in rehabilitation of pelvic floor dysfunctions, consider how chronic an issue urinary stress incontinence would be for a large athletic population. So many women (and men) do not even recognize their leakage or frequent urination as treatable “issues” and never mention them to anyone. Often times, we are treating an athlete for a hip or lumbar injury and purposefully yet discretely have to ask the right questions and then educate the patient how some of their symptoms are secondary to pelvic floor deficits. Someone has to explain what is normal, and, better yet, someone HAS to make an effort to fix what is “broken” and restore the pelvic floor to a higher level of function. With the proper training, perhaps that someone can be you.

References:

1. Poświata, A., Socha, T., & Opara, J. (2014). Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes. Journal of Human Kinetics,44, 91–96. doi:10.2478/hukin-2014-0114.
2. Helena Luginbuehl, Rebecca Naeff, Anna Zahnd, Jean-Pierre Baeyens, Annette Kuhn, Lorenz Radlinger (2015 July 21). Pelvic floor muscle electromyography during different running speeds: an exploratory and reliability study. Archives of Gynecology and Obstetrics. doi: 10.1007/s00404-015-3816-9.

No:2   Clin Exp Obstet Gynecol. 2014;41(6):671-6.

Risk of pelvic floor dysfunctions in young athletes.

Schettino MT1, Mainini G, Ercolano S, Vascone C, Scalzone G, D’Assisi D, Tormettino B, Gimigliano F, Esposito E, Di Donna MC, Colacurci N, Torella M.

PURPOSE OF INVESTIGATION:

Numerous epidemiological studies have shown a correlation between sport and the development of pelvic floor dysfunction. Therefore, the aim of the present study was to evaluate the prevalence of urinary incontinence in female young athletes.

MATERIALS AND METHODS:

The epidemiological study was conducted on 105 female volleyball players, who were given a questionnaire, self-compiled, consisting of four main domains (personal data and medical history, urinary incontinence, urinary disorders, and judgment on the questionnaire).

RESULTS:

In a total of 105 athletes, the present authors observed that 65.7% had reported at least one symptom of stress urinary incontinence (SUI) and/or urgency, during sport or in daily life situations. In particular, the 49.52% reported urge urinary incontinence, 20% urine loss for urgency, and 29.52% SUI. In addition, the present authors observed that nocturia was reported in 70.48% of cases, incomplete bladder emptying in 55.24%, urinary hesitancy in the 36.19%, and pelvic pain in 52.38%. In all cases, the symptoms were occasional and low. In relation to the coexistence of symptoms, the present authors observed that 22.85% of athletes had only symptoms of urge urinary incontinence, 6.66% mixed incontinence, and 6.66% symptoms of urge urinary incontinence associated to urine loss for SUI.

CONCLUSION:

The present authors observed a relationship between the sport and the pelvic floor dysfunction, in particular urinary incontinence.

No: 3   PM R. 2013 Mar;5(3):189-93. doi: 10.1016/j.pmrj.2012.09.001. Epub 2012 Nov 2.

Assessment of pelvic floor muscle pressure in female athletes.

Borin LC1, Nunes FR, Guirro EC.

OBJECTIVE:

To evaluate the pressure of the pelvic floor muscles in female athletes and the associated signs and symptoms of stress urinary incontinence.

DESIGN:

A prospective observational study.

SETTING:

An academic institution, primary level of clinical care.

PARTICIPANTS:

Forty women between 18 and 30 years of age divided into 4 groups: 10 volleyball players, 10 handball players, 10 basketball players, and 10 nonathletes.

METHODS:

The measurement of intracavity pressure was performed with use of a perineometer. The volunteers were instructed to perform 3 maximum isometric contractions of the perineum, held for 4 seconds. Data regarding specific training and urinary symptoms were collected through a questionnaire.

MAIN OUTCOME MEASUREMENTS:

Statistical analysis was performed by analysis of variance, with a significance level of 5%. The Spearman correlation was used to verify the degree of association between variables related to training, urinary symptoms, and perineal pressure.

RESULTS:

The average (standard deviation) perineal pressure for nonathletes was 6.73 ± 1.91 mm Hg. The average perineal pressure for handball players was 5.55 ± 1.43 mm Hg; for volleyball players, 4.36 ± 1.43 mm Hg; and for basketball players, 3.65 ± 1.35 mm Hg. Statistically significant differences were found in the perineal pressure of volleyball (P = .009) and basketball players (P = .039) compared with nonathletes. The number of games per year, strength training, and on-court workout correlated significantly with perineal pressure (Spearman correlation coefficient [Rs] of -0.512 for the 3 variables). Urine leakage through effort and nocturia correlated moderately with perineal pressure (Rs of -0.51 and -0.54, respectively). A strong correlation was found between urinary frequency and perineal pressure (Rs of -0.85).

CONCLUSIONS:

Analysis of these data suggests that perineal pressure is decreased in female athletes compared with nonathlete women. A lower perineal pressure correlates with increased symptoms of urinary incontinence and pelvic floor dysfunction.

Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

No 4: BJU Int. 2012 Nov;110(9):1338-43. doi: 10.1111/j.1464-410X.2012.11029.x. Epub 2012 Mar 15.

Simultaneous perineal ultrasound and vaginal pressure measurement prove the action of electrical pudendal nerve stimulation in treating female stress incontinence.

Wang S1, Zhang S.

Abstract

Study Type – Diagnostic (case series) Level of Evidence 4. What’s known on the subject? and What does the study add? Pelvic floor muscle training (PFMT) and transvaginal electrical stimulation (TES) are two commonly used forms of conservative treatment for stress urinary incontinence (SUI). PFMT may build up the structural support of the pelvis, but many SUI patients are unable to perform PFMT effectively and its primary disadvantage is lack of long-term patient compliance. TES is a passive treatment that produces PFM contraction and patient compliance with it is good; however, its effect is not as good as that of PFMT when performed correctly. Electrical pudendal nerve stimulation (EPNS) combines the advantages of PFMT and TES and incorporates the technique of deep insertion of long needles. In this study, simultaneous perineal ultrasound and vaginal pressure measurement prove that EPNS can contract the PFM and simulate PFMT. It is shown that EPNS is an alternative therapy for female SUI patients who fail PFMT and TES and the therapy can also be used for severe SUI.

OBJECTIVES:
To prove that electrical pudendal nerve stimulation (EPNS) can contract the pelvic floor muscles (PFM) and simulate pelvic floor muscle training (PFMT). • To show that EPNS is an alternative therapy for female stress urinary incontinence (SUI) that does not respond effectively to PFMT and transvaginal electrical stimulation (TES).

PATIENTS AND METHODS:

Thirty-five female patients with SUI who did not respond effectively to PFMT and TES (group I) were enrolled and 60 other female patients with SUI were allocated to group II (30 patients) and group III (30 patients). • Long needles were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. Group I and group II were treated by a doctor skilled in performing EPNS and group III, by a doctor unskilled in performing EPNS. • When EPNS was performed in group I, perineal ultrasonographic PFM movements, vaginal pressure (VP) and PFM electromyography were recorded simultaneously. • The therapeutic effects were evaluated according to objective and subjective criteria.

RESULTS:

When EPNS was performed correctly, the patient felt strong PFM contractions. Simultaneous recordings in group I showed: B-mode cranio-caudal PFM movements; M-mode PFM movement curves (amplitude: about 1 mm, n= 31); a sawtooth curve of VP changes (2.61 ± 1.29 cmH(2) O, n= 34); and PFM myoelectric waves (amplitude: 23.9 ± 25.3 µV). • If during the EPNS process the electric current was stopped or its intensity was reduced to about 7-12 mA or the two lower needles were drawn back, then the above ultrasonographic PFM movements and VP changes disappeared. • In group I, the incontinence severity and quality of life score was 16.5 ± 4.0 before treatment and decreased to 4.2 ± 4.0 after 27.5 ± 11.9 sessions of treatment (P < 0.01). At the end of treatment, 100% improvement occurred in 16 cases (45.7%). A 2-year follow-up showed that 100% improvement occurred in 14 of cases (40.0%). • In group II, the incontinence severity and quality of life score was 17.1 ± 6.3 before treatment and decreased to 3.5 ± 3.7 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in 12 cases (40.0%). In group III, the incontinence severity and quality of life score was 17.6 ± 6.3 before treatment and decreased to 10.8 ± 8.2 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in one case (3.3%). • The post-treatment score was lower and the therapeutic effect was better in group II than in group III (both P < 0.01).

CONCLUSIONS:
EPNS can contract the PFM and simulate PFMT. • EPNS is an alternative therapy for female SUI patients who fail

Summary:

With all these “abstract” papers in mind – CiONE offers the patient a comprehensive and  detailed understanding of their Pelvic pain dysfunction; educating them in “practical application” on what they can and cannot do regarding the condition.

In other words taking out the “mysticism” of the condition and breaking down ALL the “dogma’s” relating to the debilitating pain.

This approach over the last 20+ years has but the CiONE Mehtodology at the forefront of “managing” and “rehabbing” the condition; as we continue to  ‘pioneer” unique approaches to regain and maintain “Pelvic Health”.

Email CiONE at “contactus@cionewellnesscentre.com” or call our head office on 01509263044 for further clarity on how we can commence your journey of recovery