Amy Stein - Heal Pelvic Pain

Heal Pelvic Pain

Heal Pelvic Pain

A Proven Stretching, Strengthening,
and Nutrition Program for Relieving
Pain, Incontinence, IBS, and Other
Symptoms Without Surgery

AMY STEIN, M.P.T.

FOREWORD BY ANDREW GOLDSTEIN, M.D.

Copyright 2009 by Amy Stein. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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DOI: 10.1036/0071546561

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When I was in medical school back in the 1990s, physical therapy (PT) was regarded as something of an afterthought. Since physical therapists rarely published studies in journals read by physicians, the PT practice lacked scientific cloutat least as far as doctors were concerned. When physical therapy was considered, it was seen as useful mostly for damaged muscles and joints after injury or surgery. In other words, after doctors had done the real work, you might prescribe physical therapy for the mop-up.

Despite completing nearly 20,000 hours of internship and residency in obstetrics and gynecology, I heard only one hour-long lecture on vulvar pain and sexual dysfunction. I was taught that pain during sex was the result of "vaginismus," an involuntary contraction of the vaginal muscles during attempted penetration. I was further taught that vaginismus was a psychological issue resulting from trauma or abuse, and that it was to be treated through psychotherapy and sex therapy. Physical therapy was never mentioned. Other types of vulvar pain were thought to be caused by nerve injury and were treatedas much as possiblewith drugs. Again, physical therapy was never discussed as a treatment for women suffering this pain, nor was I ever taught anything about pelvic floor disorders in men!

After completing my residency, I joined the faculty of Johns Hopkins and became the director for the Center for Vulvovaginal Disorders. A great many of the patients with whom I dealt had suffered pain for a decade or more. Prescription drugs controlled the pain, but they did not cure it and often produced significant side effectsincluding heart palpitations, extreme lethargy, weight gain, dry mouth, and constipation. If it was a steep price for these women to pay for the relief of their pain, few people in the medical profession questioned the situation or challenged the assumptions on which this standard therapy was basednamely, that the chronic pain was solely due to nerve injuryneuropathy, in medical lingo.

The only problem with this "wisdom" was that it wasn't true. It took some forward-looking physical therapists like Amy Stein, the very folks we doctors had typically paid little attention to, to enlighten us on what was really at issue.

It's not too far-fetched to say that Amy and her colleagues had to beat down the doors of the medical establishmentfiguratively, anywayto be heard. They made their case with compelling logic, arguing that the cause of much of the pain we were treating with medication was not, in fact, neuropathic, but instead myofascialthat is, in the muscles and tissue. The pain, they explained, was a result of the muscles having tightened and shortened. The tightening had decreased the blood flow and therefore the supply of oxygen to the affected muscles; as a result, lactic acid built up, irritating the nerves that pass through the muscles. As the brain perceives pain as being located in the end organ reached by the affected nerve, the person felt vulvar pain. In addition, the irritation of the nerve typically gives rise to an inflammation that produces redness and swelling, and the redness and swelling, like the pain, show up in the "endpoint" organ reached by the irritated nervenamely, the vulva.