After many years of dealing with chronic hip pain and pelvic floor discomfort, Karen Garcia embarked on a physical therapy journey that she says changed her life.
For many people, physical therapy treatment centers around increasing strength, stability, balance, flexibility and mobility. While those aspects of her overall wellness were an important part of her PT plan of care, for Karen, the greatest benefit came in learning how to relax her muscles.
“My body didn’t know how to relax,” she explained. “It was always in that state of half-flexed.”
Despite sometimes debilitating pain in her hips that had plagued her for much of her adult life, Karen’s drive to stay active and her competitive nature had always kept her from slowing down.
“I’ve always been very active. I played sports in high school and college and then just continued whether it was running marathons, getting into cycling, or playing volleyball, it’s always been a part of my life and at 46 it’s still really important to me.”
That’s why, when the pain that Karen says was with her throughout her days and not just while participating in sports, began to floor her, the ambitious mother of three resolved to find help.
“Sometimes I’d just be walking, and the hip pain would hit, and it would just take me down, like, my leg would totally give out.”
Meanwhile, a different, seemingly unrelated pain was also causing Karen excessive distress and had been for years as well.
“I would be going about my day and then suddenly feel like I had a UTI [urinary tract infection]. So, you know, you rush to the OB and they give you a prescription before you even have a test because you’ve described a burning, uncomfortable or painful feeling,” Karen reflected. “Then the test would come back negative. It was so weird to me, but I didn’t think a whole lot about it because it was not super frequent.”
The pain also impacted her during sex.
“My husband is sweet and kind, and our experience together when we were connecting intimately, sometimes it would hurt, sometimes it would shoot me through the roof,” Karen shared. “It was never intentional, and he would feel terrible.”
Karen’s obstetrician referred her to a urologist, who surprised her by suggesting physical therapy.
“Honestly, I didn’t get it – in my head, I simply did not understand,” Karen shared.
But, the urologist felt certain that Karen’s hip pain and the pain in her pelvic floor were related and encouraged her to try PT before medication.
Physical Therapy: A Pathway to Healing
Karen set her uncertainty aside and committed to trying pelvic floor physical therapy. She scheduled her first appointment with Mindy English, physical therapist and practice manager at Therapeutic Associates Physical Therapy – Eagle.
“From the very first appointment I appreciated being able to relate to Mindy,” Karen said. “She plays volleyball – I play volleyball! She has kids, so we both have families. And, I just really enjoyed her as a person.”
Additionally, Karen said she valued Mindy’s approach to each appointment.
“Every time Mindy and I met, she asked a lot of really great questions – she did not come to our appointments already knowing what we were going to do, because she didn’t know what had happened in that past week. So, she would ask how I was doing and what it had been like walking around, about my interaction with sports, and about intimacy with my husband – was it comfortable or uncomfortable – and was making those connections.”
Like Karen’s urologist, Mindy said she recognized that there was likely a correlation between her pelvic floor pain and her hip pain.
“Even though Karen’s primary complaint that she came to see me about was the pelvic floor, the hip issues kept coming up as we talked. So, I wanted to see how her hips might be contributing to her overall pain experience,” Mindy reflected. “Especially with as athletic and active as she is and knowing the relationship between the hip muscles and the pelvic floor muscles.”
During her initial assessment, as Mindy watched Karen move, she confirmed that there were limitations and dysfunction to her movement. Though Karen did daily workouts including squats, from her perspective as a musculoskeletal expert, Mindy could see that how she was moving was simply not efficient.
Next, in looking at Karen’s pelvic floor health, Mindy identified problem points that needed to be addressed.
“I’m a big picture person when it comes to the pelvic floor, so I really like to ask a lot of questions that help me understand how the pelvic floor is functioning in each of its different roles,” Mindy said. “Then I start to wonder, ‘Why is it not functioning in this role, but it functions okay in this role?’”
The pelvic floor serves five different roles, Mindy explained. It has a sphincter function to keep the pee and poop in, a support function to keep our organs lifted, a stability function to help support our pelvis, hips and low back while we move, a sump pump function to move blood and lymphatic fluid back toward the heart and a sexual function.
“That’s when my orthopedic side comes out,” Mindy said. She begins to question strength, and to analyze what movement looks like during high-level activities. “I look for compensations that might be causing the pelvic floor to be overly tightened and not relaxing as well as it needs to and consider how those movement patterns might be contributing to the pain and dysfunction.”
As Mindy worked with Karen to get to the root of her problem, she continued to ask questions.
“I asked digging questions that really made her think about some things she might not have been considering otherwise,” Mindy said. “That process helped give me more answers to put all the pieces of the puzzle together.”
As she figured things out, Mindy made sure to explain everything to Karen, equipping her with the education and tools to be successful on her physical therapy journey. She worked to ensure Karen understood that while she had previously had a bladder sling placed to solve her urinary incontinence, that surgery addressed the bladder issue but not the pelvic floor muscle issue.
“The way Mindy described it really resonated with me,” Karen reflected. “It’s like if you were to pick up a 5- or 10-pound weight and you’re kind of in a half-flex. When you’re working out or cycling, it’s necessary, but when you’re trying to use the restroom or you’re being intimate with your husband, those are times to relax. Often, as women, our bodies are stuck in that tight, half-flexed place. Then at some point, our bodies are tired but have forgotten how to relax, and that’s when they start to do weird things.”
Utilizing both tactile feedback during internal exams and visual feedback from real-time ultrasound, Mindy was able to help Karen learn how to relax her pelvic floor. Like many women, Karen would think she was relaxing, but as Mindy gave her cues and feedback, she came to understand what it felt like to truly relax those muscles.
“It’s pretty fun to be a part of that ‘ah-ha!’ moment with patients,” Mindy said.
“And Karen has almost been screaming it from the rooftops about how much pelvic floor physical therapy has helped her and changed her. It’s really cool to have been a small piece of that, to have helped guide her through that.”
In addition to that moment when she learned how to control the muscles in her pelvic floor, Karen said she celebrated another “ah-ha!” moment, and it’s one Mindy said she often quotes.
“That big moment for me,” Karen shared, “was when I realized physical therapy is not punishment for doing something wrong, it’s a chance to reset my body.”
Physical Therapy: A New Beginning
Karen’s enthusiasm is palpable when she talks about the life-changing impact pelvic floor physical therapy has had on her.
“My hips and legs … I don’t have that chronic pain anymore and that is huge to me. Then there’s the post-workout soreness — knowing now that this was not just age, but that things were not quite right and now, having the option to work out like that and not be so intensely tight at the end because I have the tools and can solve it instead of just enduring it, that’s huge!
“I don’t have that burning, that fire, that used to hurt so badly,” Karen continued. “It was so interesting to me, and my brain never would have made the connection because it felt like bacteria, like a UTI, but it was my muscles!
“And learning about the internal muscles – how to tighten, how to relax – now intimacy with my husband is so much more pleasurable. It’s amazing to have a solution, where husband and wife can connect and it doesn’t have to cause any pain or discomfort, it can be wonderful.
“My kids,” she added, “they’re very active and so much fun … and now I can run after them. My hips don’t hurt. I don’t leak.
“I was on a mission to not have constant pain and discomfort. After years, I finally feel normal again thanks to physical therapy.”
As a physical therapist, Mindy stands behind the value of PT, but also gives credit to the hard work that patients put in. Part of that, she said, includes being willing to share a lot of details.
“That’s one of the biggest things for us as PTs is that sometimes people come in and they think they’re talking too much or sharing too much, but you can’t tell us too many things – that’s what helps us figure out the problem and come up with an answer,” she said. “Something I really appreciated about Karen was how open and willing she was to talk to me about really intimate things and was able to give me really important details.
“It’s never too much information because we just might hear something that is the very piece of the puzzle we were missing, the one thing we had not thought about.”