Urology Austin

Sometimes I Know Why You Hurt


It’s true.  People have issues in their back, hips, pelvis, bladder, urethra, genitals, vagina and rectum for a handful of reasons.  It doesn’t get that wild.  What is actually wild is the depths some patients have to go through to get referred to the appropriate care. I’ve listed super common reasons why people have pelvic issues… including pain.

Muscle Tightness

The word “tightness” is frowned upon in academic circles, but I don’t know if it’s for good reason. The only reason I’d frown upon that word is because I don’t think it is actually a word. But, if we write to communicate, then I’m going to use communicate by using a non-word that communicates what I need to communicate! Despite it’s lack of existence, everyone knows what I’m saying when I say muscle “tightness”.  When the pelvic floor muscles are tight, this causes pain.  It might not cause pain with fleeting tightness, but it will, inevitably, cause pain with muscles that stay tight. This is true for any muscle in the body, but it is especially true for pelvic floor muscles.

Tight muscles have reduced blood flow and oxygen. Blood flow and oxygen are necessary for muscle and nerve health. When any muscle is tight, it cannot perform it’s job because it is weak.  A tight muscle is not strong.  A tight muscle is weak.  This is a fact.  A muscle that never rests at a normal length is not going to be able to contract powerfully. When a muscle isn’t strong enough to do it’s own job, then other muscles have to step in and take over.  This compensation creates a slew of new problems and new pains.  So, tight muscles cause pain because they are not healthy.  And, tight muscles cause pain because they force other muscles to do too much and move other body parts in a weird, unintentioned way. Yet another non-word from a girl that likes to write. If Shakespeare did it, Sara Sauder can do it too.

Back Problems

The spine is like a generator that helps everything else in the body light up. The brain creates a signal to the spine and the spine has all these wires that light up different muscles and then the body appears to respond to the brain’s command. The spine has all these levels. It’s like a high rise with a ton of floors. Imagine that each floor has a window that has a zip line connecting it to one body part.  For example, the first floor zip line connects to the toes. The 10th floor zip line connects to the pelvis. The 22nd floor zip line connects to the fingers. The occupant of each floor glides down their own zip line and tells their corresponding body part what to do. The first floor occupant, her name is Betty, glides to the toes and says “give me a wiggle”.  Wilma glides from the 10th floor to the abdomen and says “give me a jiggle” and Herb glides down from the 22nd floor super slowly and carefully (he is actually afraid of heights) and tells the fingers to “give me a sniggle” – it rhymed. But, when these windows don’t open correctly, the occupants get frustrated. They push and they pull and they shell out money for a cocky and overpriced maintenance guy to come in, charge a $95 service fee to apply a little 50 cent grease and watch the window slide open on command. The occupant, now frustrated, humiliated and desperate for fresh air now buck and cuss their way down the zip line. The zip line frays a bit under the jolted movement of the unhappy campers. The high rise occupants are now so annoyed and disoriented that they no longer ask for a “wiggle” a “jiggle” or a “sniggle”. Now they give a garbled mutter of a command. And this, my friends, is confusing. It’s not the clear, energetic signal that the toes, pelvis and fingers are used to getting and this confusion equates to pain.

Was that the worst analogy of all time? Possibly.

Nerves come out of your spine and if your spine isn’t moving nicely in all directions, it can cause a pinched nerve. If that pinched nerve goes to your pelvis, this can cause pelvic pain. Boom.

Pain and Connective Tissue Restriction

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 could feel like “I just feel a spreading ache” or the specific pain could 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.

Pain and Trigger Points

In all honestly, I don’t know what a trigger point is. Sometimes I feel these little bundles on my patient’s skin and it’s tender when I push on it. Then I kind of hold my pressure and the tenderness goes away. That’s a trigger point. But, what is it? Some say it is a small area of bundled muscle fibers, bundled fascia fibers, bundled something…. Others say that trigger points are nothing. All I know is that sometimes I can feel these spots, but most of the time I cannot. I also think that trigger points are given way too much attention. I feel uneasy talking about trigger points. I feel like I’m talking about something mystical, some soft science. But, I use the term “trigger point”, because there are many times I don’t have another phrase to use to describe a tender spot on a person that becomes untender once I hold pressure on it. Is something wrong with me? Likely. Does this haziness stop me from treating “trigger points”? Not really. I can’t explain everything. I can explain some things. But, I’m really comfortable explaining that I can’t explain things. Understand?

Trigger points are weird. Sometimes I hit a spot on someone’s thigh and they feel it in their tailbone. Sometimes I hit a trigger point in the rectum and they feel it in their stomach. If it works, I do it. If it doesn’t, I don’t.

Got a question?  Cool.  Hate what I wrote?  Cool.

Contact me at sara.sauder@urologyaustin.com

Written by Sara Sauder, PT, DPT

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