There is a huge disagreement in the pelvic pain world. Some people say that you should cause no pain to patients who come to you for treatment of pelvic pain. The others believe that you should address what is causing the root of pelvic pain in as efficient a manner as possible. These two viewpoints don’t have to be at odds, except the latter might involve pain. And that, for the first camp, is a “no-no”.
You know how when you rip the skin off of raw chicken, you see that iridescent, thin layer over the meat of the chicken? That’s called fascia. That thin layer runs all throughout the chicken. It also runs all throughout…us. There are four layers of fascia and the most superficial of our layers – the one you see on the chicken – is the pannicular layer. This layer is so impactful in treating body pain, not just pelvic pain. This is like a full body suit from head to toe and everything in between. When one part of this pannicular layer of fascia isn’t sliding and gliding with ease and abandon, then you start to feel weird, ambiguous, though…sometimes extremely specific pain. The ambiguous pain can feel like “I just feel a spreading ache” or the specific pain can feel like “I am so aware of the opening of my urethra, I cannot stand it!”. This layer of fascia that we are talking about is found under skin, under fat and on top of muscle. As physical therapists, we can access this and affect it. We can make parts of it that are “stuck”, get “unstuck”. We can make it glide and slide without abandon. We can make it loosey and goosey and everything in between. And this, for many people, eliminates their pain.
So, what’s the problem?
The problem is this: This treatment hurts. It feels like I am ripping your skin off. But, that’s kind of because…I am ripping your skin off.
I’m doing something unique. I’m trying to create space between skin and fat and fascia and muscle. I’m picking skin and fat up and away from the body. Most everything else we do to try to treat body discomfort does the opposite. If you are a foam roller, then you are smashing everything together. If you like massage, then you are enjoying a compression of skin, fat and fascia – though it does provide some gliding. If you like trigger point releases, then you are pushing things together. This idea of “ripping the skin off”, is completely opposite, and hurts in a different way. I’m not taking pride in the pain. I’m not showing off about the pain. I just think that this discomfort is a necessary and efficient way to treat so much that stems from fascia, but talks like an organ. Fascia knows the language of the bladder, the rectum, the penis, the prostate, the urethra. The fascia knows a lot of languages and it is a capricious, arrogant party guest. It just keeps showing off.
This work, this connective tissue manipulation, it’s also called “skin rolling”. Doesn’t that sound pleasant – maybe even…bucolic? Well, it’s just not. It hurts. It hurts so much that I give every patient a “safe” word. And it’s not pineapple. It’s a four letter word: S-T-O-P. It hurts so much that I’ve seen many a tear escape from a man’s eye. They’re not crying – no…this is involuntary. This is a visceral reaction to a pannicular treatment. It may cause bruising the first few times it’s done. You might have fingerprints all over your body. It might look like tiger stripes. It leaves you sore. You will feel your clothes touching your body for a few days. But then, it doesn’t bruise. And it doesn’t leave you sore. Eventually, it energizes you with an influx of adrenaline and a burst of joy. Truly. Connective tissue work affects the nervous system – that’s how it changes how you perceive calls from the bladder, bowel, genitals, etc.. And finally, this “skin rolling”…it starts to feel good. And then you start to feel good. And then you are just that – good. Good to go. Good to get out of here without worry and without pain.
This right here, it’s a massive source of contention. Some therapists refuse to allow their patients any discomfort. It’s sweet. It’s kind. I. Am. Not. That. But, I do all things with informed consent, intention to serve you well and get results quickly. We are as varied as the stars in the sky. Not really – but it sounds good. So, you might have had a pelvic floor therapist that talked to you a lot, or one that only corrected your posture, or one that only did internal work, or one that never did internal work, one that always made you hurt, one that never made you hurt, one that really, really helped, one that didn’t touch your symptoms…this is all possible.
But, one thing that is true across the board is that you should not have to live with dissatisfaction with bowel, bladder, sexual function or pelvic pain.
Got a question? Cool. Hate what I wrote? Cool.
This blog was written by Sara Sauder, PT, DPT
Contact me at sara.sauder@urologyaustin.com
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