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The Climbing Doctor: Having Pelvic Problems?

Author: Jared Vagy

June 16, 2014

It happens to the best of us, but we don’t like to talk about it much. Surprisingly common among rock climbers, myofascial pelvic floor dysfunction is the pain and urinary symptoms that come from irritated myofascial tissues—muscle, connective tissue and nerves in the pelvic floor. Luckily, the symptoms are manageable with a little education, physical therapy and minor adjustments to your climbing harness.

Trigger points can cause pain
Trigger points are hyperirritable knots found in taut bands within a muscle. For example, “knots” in your neck muscles are common trigger points. When touched, they’re painful and often cause you to wince and pull away. They sometimes create pain in an area distant to the trigger point, known as referred pain. Trigger points develop when muscles are overloaded or overworked.

The strenuous nature of rock climbing may be a cause for trigger points to develop in various muscles of the upper and lower body, as well as the abdomen and pelvis. The pelvic floor muscles are a hammock like structure within the bony pelvis. They have three functions: controlling urinary and bowel systems, providing support to your internal organs and controlling sexual functions. Trigger points in the stomach muscles and the pelvic floor have been linked to genital pain, urinary and bowel complaints and sexual dysfunction. (1,2)

To determine if you have trigger points that are causing groin symptoms, it’s best to consult with a pelvic floor physical therapist. Physical therapists treat trigger points using a variety of manual techniques and therapeutic exercises. The therapist will provide a home exercise program to help decrease your pain. Ice and a specific backbend stretch for the abdominal muscles can help alleviate symptoms by deactivating the trigger points. Additional information can be found in The Trigger Point Therapy Workbook by Clair Davies (3), available at most retail book stores and online.

Connective tissue restrictions have bad effects
The human body has a unique communication system between its various components—organ, muscle, skin and connective tissue. This is a two-way street, meaning both muscles and skin can impact organs, and conversely, the organs can impact the muscles and skin.

Unhealthy muscles, skin and connective tissue in the pelvic region can refer to an organ such as the vagina, penis, testicles or bladder. (4,5,6,7)  This can lead to urinary and bowel dysfunction, pain or both. Manual therapy techniques including connective tissue manipulation can be performed to improve the health of the involved tissues thereby reducing your symptoms. (8,9)

Your harness may be cutting off your circulation
The position of the rock climbing harness is located in the referral zones for the urinary/bowel and reproductive systems. Prolonged compression of these tissues by the harness decreases the blood flow to the area. Passing through this location in the superficial connective tissue is a sensory nerve known as the Posterior Femoral Cutaneous Nerve (PFCN). When the harness compresses the tissues and decreases blood supply, it causes pain in the area that the PFCN supplies.

What are some solutions? First, try tightening your waist strap and loosening the leg straps on your harness.  This will shift the location of pressure away from the blood supply and nerves and into your pelvic bone.  If you’re still having pain in the genital area, try some aerobic activity to increase your heart rate, which will increase blood flow. Shake your legs side to side for a full minute. This will help restore some blood supply to the area, thereby reducing symptoms. You can also try switching to underwear that doesn/t have an elastic band around the leg, which can help minimize compression.

Persistent holding of your urine can over tighten the muscles that control urination
Have you ever been in the middle of a climb and wished there was some way you could urinate but there was no relief in sight? You then hold it until your stomach starts to ache or you finish your climb. Did you know that’s damaging to your body? Constantly postponing a trip to the restroom results in short, tight pelvic floor muscles. These are the muscles that you learned to control during potty training. The bladder fills to a certain level then contracts producing first urge. Most people do not use the restroom at first urge because the pelvic floor muscles respond to tell the bladder, ‘Not now, wait until it is socially acceptable.’  Ignoring repeated urges results in active contraction of the pelvic floor muscles, which causes the muscles to get stuck in a short position. Short muscles have a difficult time communicating with the bladder, giving you unnecessary signals of urge.

This exercise can help lengthen the tight, short pelvic floor muscles: Dropping your pelvic floor as if you were initiating urination will reverse the shortening. Doing this activity in a flat-foot squat facilitates the lengthening.

Take Home Message
Pelvic pain and urinary symptoms are no joke. Climbers are some of the most susceptible athletes to myofascial pelvic floor dysfunction because of the nature of the sport and the constrictive nature of the harness. Listen to your body and make the necessary adjustments to your gear and habits. If you begin feeling symptoms, try a few exercises to release your trigger points and lengthen your pelvic floor muscles. This will decrease your risk of developing these symptoms and ensure optimum health.

To learn more climbing tips to prevent injuries, visit: www.theclimbingdoctor.com.

 


Authors:  
Dr. Elizabeth Kotarinos, PT, DPT: Is a graduate of the University of Southern California where she earned her Bachelor of Arts in Psychology degree in 2003 and her Doctor of Physical Therapy in 2009.  She has served as a Junior Research Assistant for Loyola University Medical Center and RML Specialty Hospital as well as a Lab Assistant for the American Urogynecologic Society and the International Pelvic Pain Society. She has also met the requirements through Andrews University to include trigger point dry needling in her practice. Currently, Elizabeth serves as a Board Director for the Chicagoland Pelvic Floor Research Consortium and is a member of the Fundraising and Membership Committees of the International Pelvic Pain Society.  You can contact her at:

Email:  [email protected]
Webpage:  www.rhondakotarinos.com

Dr. Jared Vagy PT, DPT, OCS, CSCS: Is a Physical Therapist and an authority on climbing related injuries.  His articles are published in DPM magazine and he is a lecturer on the topic.  He received his Doctorate in Physical Therapy from the University of Southern California.  He is board certified as an Orthopedic Specialist by the American Physical Therapy Association and is board certified as a Strength and Conditioning Specialist by the National Strength and Conditioning Association.  He is an avid climber with over 10 years of experience climbing around the world.  Climbing and injury prevention are his passions and he is committed to combing the two. You can contact him at:

Email:  [email protected]
Webpage:  www.theclimbingdoctor.com
Citations
1. Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction The Trigger Point Manual Volume 1. Upper Half of Body. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
2. Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction The Trigger Point Manual Volume 2. The Lower Extremities. Philadelphia, PA: Lippincott Williams & Wilkins; 1993.
3. Davies C, Davies A. The Trigger Point Therapy Workbook. 2nd ed. City: MJF Books, 1997.
4. Head, Sir Henry. On disturbancy of sensation with especial reference to the pain of visceral disease. In: Brain. London, England; Oxford:1893:1-133.
5. Giamberardino MA, Affaitati G, Iezzi S, Vecchiet L. Referred muscle pain and hyperalgesia from viscera. J Musculoskeletal Pain. 1999;1/2(7):61-9.
6. Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309-17.
7. Mackenzie J. Some points bearing on the association of sensory disorders and visceral disease. Brain. 1893;16(3):321-354.
8. FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009; 182(2):570-80.
9. FitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012; 187(6):2113-8.

Jared Vagy

Dr. Jared Vagy is an authority on climbing related injuries. He has published numerous articles on injury prevention and delivers lectures and seminars on the topic. He received his Doctorate in Physical Therapy (DPT) from the University of Southern California, ranked the number one DPT Program in the nation for the last decade by US News and World Report. As a Doctor of Physical Therapy in clinical practice, he went on to complete a one year residency program in orthopedics and a one year fellowship program in movement science. He is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. Dr. Vagy is on Clinical Faculty as a mentor for a Physical Therapy residency program and is on Academy Faculty for the TheraBand Academy. He is a selected member of the Specialization Academy of Content Experts for the American Physical Therapy Association and is on the Editorial Board for ADVANCE Physical Therapy magazine.