The Masterclasses have been of immense value for my clinical reasoning. They have challenged me to think more deeply about different topics along with practical applications which have improved my patient outcomes.
Pelvic pain is a global problem that presents acutely after infection or injury, and in chronic conditions that are often slow to respond to treatment.
There is little consistency in how pelvic pain conditions are treated, and some of the older techniques are pain provoking to the point where patients will avoid care rather than endure the tears.
This Masterclass aims to provide a rationale for updating treatment practices and principles to follow based on current understanding of pain management. The lecture series covers a progression of treatment from desensitization to restoring tolerance to normal pressures.
There is more to recovery than “just not hurting” and in this Masterclass we go through the progression back to pleasure as a conscious pursuit.
Pelvic Pain is Pain +++
This introductory module established the foundation of the understanding of pain. The module begins the discussion of how to change pain based on self-efficacy.
This module discusses how to take advantage of techniques to calm a sensitized system down and why that is helpful for progression back to normal activities. These concepts are not well studied in the pelvic pain population. We draw on CRPS and other musculoskeletal conditions.
Sensorimotor Re-education and Strength & Conditioning for the Pelvis
After working to normalize sensation and tolerance to touch, pressure and movement as we discussed in Module 2, it is time to increase the challenge. In this module we address options for advancing input and adapting these techniques for pelvic function. We discuss the challenges of developing pelvic programs that can be carried out in home programs or in the community/workplace. This module will also cover options for return to regular exercise or sport program. Return to sufficient effort to build aerobic conditioning and strength training tolerance is covered for general pain conditions. The myths of frailty about pelvic pain and strengthening are addressed.
Individualized care is a catch phrase among rehabilitation plans, and rightly so. People experiencing pelvic pain are no less in need of a program that takes into account their social determinants of health as well as their access to time/equipment/safety for exercise and for work. We also discuss the importance of meaningful goals where the emphasis is on the meaning to the person in pain.
The path to independence is not straight and it is unreasonable to expect that people work out modifications and adaptations on their own. This module sets parameters to address transition to independence and establish the confidence that care is available to update programs and support self-efficacy. As part of a healthy lifestyle, the pursuit of pleasure is also discussed.