Chronic Pelvic Pain: How to Transform and Heal
Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Pelvic Health Specialist
“Work with the dissociation, it does not need to be excised.” - Resmaa Menakem, Therapist, Healer, Author
How can somatic practices help those living in pain?
Playing with the somatic principles of interoception, exteroception, and proprioception not only develops awareness and can enhance pleasure, but they can also modulate the sensations, emotions, and responses to environments associated with pain.
Somatic practices connect you to your senses and can support the self-management of your symptoms through changing behavior and exploring options.
For example, you can “self-dose” your exercise program depending on how energized you feel, if you need to stretch, and if you need to meditate first to settle your nervous system and to help organize your movements.
Somatic practices facilitate curiosity. Creative material may emerge in the process. For example, if your knee is sensitive during a squat, you can tune into the movement of your breath and focus on the senses that inform you of breathing. You can also attend to another body part, such as your collar bones, and visualize the upper lobes of your lungs that lighten the load on your knee as you breathe and imagine lightness.
Repeatedly practicing somatic approaches to movement improves the awareness of body signals, improves the self-management of symptoms, and offers resources to explore fear and pleasure of movement. Also, you will understand how social environments impact the pain response.
What is pain?
The International Association for the Study of Pain, IASP, has a core definition that states that pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons. (In other words, pain can be perceived without “tissue damage.”)
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience of pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being. (It once served a protective purpose, but may now be a dominant and unconscious response to stimuli.)
“Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a non-human animal experiences pain.”
The IASP definition of chronic pain states that it is pain that persists or recurs for longer than 3 months. If your back initially hurt 10 years ago, and it hurts again in pregnancy, you may be experiencing chronic pain.
So, what is the good news???
The science of neuroplasticity explains how our brain changes throughout our life. Pain is the “loyal soldier” of neuroplasticity because when the experience of symptoms lasts for longer than three months, our nervous system, immune system, and endocrine systems all adapt to respond to pain faster and with more sensitivity. Your brain is trying to solve a problem for you!
From a somatic perspective, people with chronic pain can be seen as “active producers of meaning rather than bundles of recalcitrant symptoms or medical mysteries.” Your body is telling you something. It may be holding layers to a story you have yet to attune to.
Somatics are based in attention to the lived, dynamic, and subjective experience of the individual. It is a container that holds the creative process of engaging with symptoms, and may offer validation to your experiences which may be otherwise challenging to describe.
Rather than simply saying, “I am in pain,” what is it like for you to try explaining it, or expressing it, with other words? Are there other qualities such as textures, weights, speeds, emotions, images, meanings, contexts, sensations, urges, etc. that are present?
Pause. Notice what shifts in you when you inquire about your body in this way.
You have somatic authority.
This is the beginning of process oriented healing.
What is an example of a somatic movement practice that has a curriculum and has been researched?
Body-Mind Centering® is “an integrated and embodied approach to movement, the body and consciousness,” developed by Bonnie Bainbridge Cohen.
In this practice, you can play with the sensations within muscles such as their movement, their mobility, tension patterns, and how they release.
You can linger in the weightedness and fullness of your organs as you roll out of bed in the morning.
You can inquire about the discomfort of pain, and play with other movement options that may be inspired by your own anatomical research and the embodiment of your early movement development and embryology.
There are many ways to source movement, and practicing different sources can train your mind to interrupt the pain loop.
If you refer to the last somatics blog, interoception is described as our internal sense during movement. Noticing body cues with improved accuracy can help to decrease the hyper-alertness to overwhelming pain signals. Interoception “seems to provide the basis for the subjective image of the material self as a feeling entity, that is, emotional awareness.”
Also recall that the IASP defines pain as influenced by psychological factors, is shaped by our experiences and meaning making, and can be perceived without actual tissue damage.
Therefore, chronic pain must be treated holistically. Interoception may be a potent resource for treatment, as it plays a major role in health and well-being, by linking bodily awareness with “self-image and emotional experience.”
How is interoception connected to self-regulation?
Interoception increases your capacity for self-regulation by connecting you to the moment, and by increasing the flexibility and resilience of your nervous system’s response to stress.
“Interoception is bound up with awareness of and modulating chronic pain experiences on multiple levels, often providing prompts for action such as discomfort or tiredness as cues for changing activity.”
How do somatic practices modulate pain?
Fundamentally, these practices bring your attention to the internal movement of breath. When you breathe, how do you know you are breathing? What sensations inform you of the quality of your breath? How deeply can you perceive this? What is this like for you?
Breath promotes relaxation. Your breathing controls the effects of your fight/flight responses in times of stress. Somatic approaches can enrich your breathing practice by moving your focus to different parts of your anatomy, such as your skin, bones, and visceral organs. Somatics invites personal movement research in response to this awareness.
Your nervous system, and your perception of pain, will benefit from moving in new ways. It may be soothing to liberate a pain-pattern-response-cycle.
For example, interoceptive consciousness may show you a tense stomach or held breath, both associated with the physical and emotional experiences of pain. How is your internal movement of breath when you notice this?
The Committee on Pain, Disability, and Chronic Illness Behavior note that “stress and anxiety increase muscle contraction and would thus be expected to exacerbate any pain problem…Conversely, any treatment that induces relaxation will reduce muscle contraction and perhaps lessen pain.”
Interoception can fundamentally support how you track the ongoing effects of pain, including your emotional states or social situations associated with your symptoms. Further, it offers the possibility of playing with different ways to respond to these parts and layers of your experience.
What is an example?
Interoceptive awareness as a resource for modulating pain may be practiced through exploring subtle physical shifts to adjust a release of pain and associated emotions. Another option is to engage with parts of your body that feel pleasant to move.
Thus, movement habits, and inquiring about the tense, habitual responses to pain, can be changed through “somatic re-education.”
What are habitual responses to pain?
The “sensory-motor system” is always responding to your daily stresses and traumas with specific, unconscious muscular contractions. When you slow down and examine these tension patterns in the body, you open up space to explore alternatives.
Please note, this is NOT about “correcting” you. Rather, view it as a way to be free and to open access to more options.
Because the definition of habit is unconscious action, these options are likely unfamiliar to the person in pain. Somatics is a “toy box,” whereby you may play with different material from your sensations, your positions, your rhythms, and patterns. As you play, you become more familiar with what is available to you.
You are working with the pain in a way that wakes you up to yourself, like a portal to consciousness.
What if interoceptive attention aggravates your symptoms?
Yes, it is possible that interoception may heighten focus on painful experiences. Perhaps consider how to “understand how to skillfully relate to interoceptive sensations, and under what circumstances they should be attended to.”
You can start by asking yourself your capacity to play with interoception. Are you rested? Are you curious? Do you have privacy to explore emerging, felt, self evolving material? What is your relationship to emotional resourcing and mental health support?
If you have capacity, you are more likely to have the internal resources to play with interoceptive sensations. More spacious capacity better prepares you for your session, without the activation and tension that could otherwise restrict your play and inquiry.
With spaciousness, your consciousness can track your shifting sensations and feelings.
What happens to body awareness for folks living with chronic pain?
People with chronic pain express an “altered sensitivity to exteroceptive stimuli.” For example, studies show that they may be unable to discern where in their body they are being touched, or they may experience a changed perception of the size of their body.
It is hypothesized that the brain is attending so much to the pain intensity, thus causing hypervigilance to pain. The increased focusing on the pain becomes more important than touch discrimination and body schema.
The hypervigilance may also lead to other central nervous system sensitization symptoms such as less tolerance to sounds, smells, or tastes.
People with chronic pain may also be less aware of their proprioceptive sense. In other words, they may have challenges with muscular effort, balance, and perception of where they are in space.
People with fibromyalgia have “described feeling a larger body over the course of a pain crisis which led them to underestimating their capacity to move through tight spaces.” When your exteroception and proprioception is altered, you are vulnerable to a “guarding-type” response to protect from the threat of moving.
Therefore, somatic and other embodied approaches to movement may support people living with pain to move with more ease and freedom.
How can embodied practices invite a resource to play with when experiencing pain?
Undoubtedly, the discomfort and fatigue resulting from persistent pain or symptoms will affect your perceptions and motivations for movement in space.
Somatic movement practices offer safe and comfortable ways to explore habits and fears associated with movement.
“Slowing down, connecting gently to the rhythm of breath, and visualizing slow movement can be a powerful tool in restoring a sense of ease and capacity to self-manage.”
Along with breath, bringing curiosity to exteroception and proprioception can also safely guide your attention to your fear of movement and how to play with it in a different way.
Avoiding movement because of fear may limit your ability to test out other possibilities. Over time, you may have less lived experience with disconfirming information, thus perpetuating the pain cycle and avoidance of movement in space.
How can you apply somatics to fear avoidance behavior?
Notice and sense your environment.
What is it like for you to notice how you navigate the structures of your environment?
How do you position yourself in standing, sitting, walking, lying down?
Explore triggers for fear.
Is there a story?
Is there an expectation that narrows your senses and drives your movements?
Develop resources for moving with confidence.
Where in your body do you feel strong?
Is there a position with gravity that is pleasurable?
Is there an environment in which you feel so comfortable that you can linger there and breathe for as long as you desire?
Micromovements are always welcome.
Imagine the movement.
Make it small.
Hold space for breath support as you play with gentle movement patterns.
Slowly increase your confidence with moving in space.
You are the expert of your body.
You have agency and power.
You have the capacity to ask your body what it is telling you.
How do you identify what is supportive to your values and needs?
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References:
Meehan E and Carter B (2021) Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain. Front. Psychol. 11:620381. Doi: 10.3389/fpsyg.2020.620381
Black Octopus Society and My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending our Hearts and Bodies, by Resmaa Menakem
