Physiotherapy options for treating endometriosis

Learn about 10 directions of physiotherapy in the treatment of endometriosis

Women with endometriosis face numerous challenges affecting their bodies and, consequently, their minds. They live with chronic pain, which limits their normal functioning, often for half their menstrual cycle, or even every day. Pain, which intensifies during menstruation or ovulation, robs them of the ability to live spontaneously, requiring them to plan every event according to a "pain calendar."

The development of the disease often causes limited mobility and stiffness of tissues, creates further tension patterns, vicious circles leading to pathological tensions of the whole body, breathing pattern disorders, incorrect posture, closed silhouette - which secondarily intensifies the existing ones. symptoms.

It is very difficult to create one universal scheme of physiotherapeutic treatment due to the different symptoms, places where pain appears, location of adhesions and other symptoms coexisting with the disease, being its consequence or existing in parallel, such as painful intercourse, urinary urgency, incontinence, pain radiating into the oral cavity. belly, to the rib area, back, legs, or excessively tense areas of the temporomandibular joints, and even bruxism.

However, there are common denominators, areas of activity that, when tailored to individual needs, give us great opportunities to improve the quality of life of patients, because it is important to remember that the primary goal of any rehabilitation is not "treatment" but rather "improving the patient's quality of life."

Based on my experience in working with patients suffering from endometriosis, I have identified 10 basic goals and areas of physiotherapy in which we take effective action:

Pain reduction, normalization of tissue tension.

Pain reduction is a key goal of therapy for every patient. In principle, all of the areas mentioned will strive to achieve this, but in this first step, I'm referring to direct work with tissue tension. This manual work encompasses various techniques and therapeutic methods aimed at reducing myofascial tension. Most often, this will involve releasing the pelvic area, including the pelvic floor muscles, working on the abdominal tissue, the entire torso, the diaphragm, the shoulder girdle, the muscles of the head and neck, and any area requiring release.

Physiotherapy for pelvic floor dysfunction.

While it covers most of the remaining subsections, I'll focus here on the basics of pelvic floor muscle physiotherapy (PFM), the primary goals of which include reducing tension pain, learning how to independently activate and, above all, relax the pelvic floor muscles, educating the patient, and introducing pain-relieving techniques as part of self-therapy. It also includes prescribing appropriate exercises to restore muscle flexibility, strength, endurance, and contraction control. These interventions will result not only in reduced pain but also in reduced sexual dysfunction, urgency, and urinary incontinence.

Respiratory physiotherapy, diaphragm work.

This is a fascinating and very broad topic. There are many methods for retraining breathing or working with the diaphragm. I advocate those that are closest to natural, functional patterns. Functional breathing is primarily nasal breathing, gentle, calm, and deep, meaning "into the diaphragm," not "expansive," as is often misinterpreted. The diaphragm is called the "queen of muscles" and serves a multitude of functions. Its movement indirectly influences the functioning of all body systems. Impaired breathing patterns lead to poor posture, tension in the neck and back, imbalances, lack of spinal stabilization, poor movement patterns, and poor flexibility of the pelvic floor muscles. It's important to understand that it is the respiratory diaphragm that causes stretching or contraction of the pelvic floor muscles without our awareness. Its movements and the changing pressure in the body's chambers cause slippage and movement of other tissues and organs in the abdominal, pelvic, and thoracic cavities. Therefore, the ability to work with the diaphragm directly affects the mobility of these structures and the adhesions between them, allowing us to reach the source of pain. Furthermore, breathing techniques influence our nervous system, allowing us to tone down its arousal and, consequently, the psychosomatic tension that accompanies life under stress and with chronic pain.

Perioperative rehabilitation.

It's worth knowing that it's worth preparing for a planned surgical procedure, so that recovery will be faster from the first day. Before the surgery, we normalize tissue tension, educate the patient on breathing and pelvic floor muscle function, and improve the body so that after the procedure, endometriosis could focus on the fastest possible healing and return to pain-free function. We teach the patient how to proceed from the first day after surgery to reduce pain and swelling, reduce the risk of complications, and how to maintain an upright position, support the wound, mobilize the body, and protect the forming scar. Postoperative physiotherapy after the hospitalization phase is designed to support further recovery and address scar tissue, as well as mobilize the entire body to reduce the risk of adhesions, ensure tissue elasticity, and maintain a healthy working environment.

Visceral, osteopathic techniques.

These types of activities deserve a very important place in endometriosis physiotherapy. They help tone tension, normalize organ function, affect scars and adhesions, stimulate blood and lymph flow, and reduce deep tissue tension.

Education.

For me, this is one of the most important points. At the first visit, in addition to the interview and the first basic survey Above all, I educate the patient so they understand why we will act the way we do, how their body looks and works, proper toileting habits, pelvic floor prevention, functional breathing, and self-therapy techniques for pain relief. The more the patient knows and understands, the better they build awareness and connection with their body. They become self-sufficient in managing current tensions and reducing symptoms.

Posture correction.

Poor posture causes stress and strain in the musculoskeletal system, but it also disrupts the functioning of internal organs, breathing patterns, and the diaphragm, which in turn increases tension and impairs the functioning of other muscles, including the pelvic floor. Therefore, without proper posture and ergonomic postures during work and rest, we will not change the pathological tension system, which—as we already know—significantly exacerbates pain and disease symptoms.

Physical activity.

The body needs movement, both spontaneous (NEAT), like walking the dog or taking the stairs instead of the elevator, and specific—in the case of endometriosis—targeting flexibility and mobility. Without movement, our bodies weaken and become even more rigid, not to mention the accumulated stress. A physiotherapist will suggest appropriate exercises, but it's worth finding a form of exercise that will benefit you and be enjoyable at the same time. If you lack motivation and don't enjoy exercising, simply make a habit. Don't analyze it; make a conscious decision to exercise for at least 20 minutes a day. It's worth knowing that physical activity also has a huge impact on our mental health and significantly reduces the occurrence of low mood and depression.

Self-therapy and relaxation.

There are many options, techniques, and user-friendly tools that can aid in self-therapy. It's worth supporting yourself with those that will help neutralize everyday stress and tension on an ongoing basis. In addition to the pain-relieving techniques your physiotherapist will teach you, it's worth considering things like simple massage for relaxation, using breathing techniques for relaxation, using acupressure mats (accumulators), foam rollers, hot water bottles, relaxing baths, aromatherapy, and other alternative techniques to support therapy. This doesn't mean you have to use all of them—it's worth trying to find the ones that work best for you.

Contact with nature.

In contemporary physiotherapy, especially in its psychosomatic approach, a strong emphasis is placed on contact with nature. In its simplest form, this can include simple walks in the park or forest, contact with animals, Nordic walking in the fresh air, or more advanced therapies that utilize fauna and flora to work on oneself. Contact with nature stimulates all our senses and has a multifaceted, positive impact on our body, attitude, and the therapeutic process.

The activities described may seem overwhelming. However, I'd like to emphasize that many of them overlap and are implemented simultaneously during the same rehabilitation sessions or prescribed exercises. Others, however, should be adopted slowly, step by step, and treated like friends who, week by week, will help you come to terms with your illness and significantly improve your well-being and quality of life.