Most of us know how debilitating pain can be; whether caused by a broken limb, surgery, sickness, trauma, mental illness or a broken heart. We can become irritable, despairing, angry and inundated with a sense of hopelessness. Luckily, for most of us, we heal. The bone mends, the scars fade, new love flowers and we receive the help we need. For those whose pain is ongoing, life can become unbearable and devoid of hope.
Chronic pain is an issue often shrouded in silence. Sufferers live among us – working in our shops and health clinics and schools and governments, shouldering their conditions in secrecy. For many, a life in pain is a reality, representing a serious health issue in this country. One in six New Zealanders report suffering from chronic pain – which is defined as ongoing pain, generally lasting longer than three-months. It’s an issue that Lisa Carnie, founder of Pelvic Solutions, sees again and again. Sufferers stumble upon the clinic, often at the end of their tether, having tried every type of therapy under the sun, with no joy. Many have never heard of pelvic physiotherapy, and are floored with the results. This is life-changing work; lifting the burden of chronic pain and shining a light on days crippled by debilitating conditions.
Pelvic physiotherapists are often able to treat pain that has beens been deemed untreatable in the past, thanks to the speciality of their training and their holistic approach. “We look at the whole body and how it relates to each other, and that includes the pelvic floor,” Lisa says.
“The pelvic floor has a huge correlation in low back pain problems, more so than weight for example! General therapists are not able to assess and treat the pelvic floor like we can. Without a thorough assessment of the pelvic floor, and how it is working with the rest of the system, then it is largely a guess.”
Pelvic physiotherapists are trained and experienced musculoskeletal therapists first, who then take advanced training in pelvic health physio. They are often able to find the missing link in chronic pain issues – the deep core stabilising component; the pelvic floor. “We create a safe space for our clients to be heard, and we ask questions that have not been asked before. Clients feel safe to express their thoughts, and this allows us to get a deep understanding of the real cause of the pain,” Lisa says. “To treat pelvic pain effectively I need to understand exactly what can be contributing to it. Things like diet, sleep, stress, hydration, types of exercise, relationships, thoughts, beliefs, movements, shoes, foot position, alignment, position of the head, bowels, pee habits, strength, occupation, mood, alcohol intake – literally everything matters. Each thing that comes up in the history gives me something to change to help improve health, wellbeing and pain. The impact of stress on pelvic pain or chronic pain patients is profound, and giving strategies in stress management is hugely valuable for this patient group.”
Many of the common conditions the Pelvic Solutions team treat include painful sex (pain on penetration, or on deep thrusting), chronic painful hips, backs and coccyx, pain from endometriosis, and the problems in other parts of the body that can develop when someone is in pain for a long time, interstitial cystitis / painful bladder syndrome, pain from scarring after childbirth or surgery, as well as vaginal, rectal and scrotal pain. Lisa’s training journey has been nuanced and lengthy, as she comes to grips with the enormity of the field. “I used to be wary about treating pelvic pain because of the level of complexity of pelvic pain issues. The pelvis has a complex anatomy, and internal systems. I now fully understand the relationship between the somatic and the visceral systems, and the nerves that innervate them, and their relationship to the rest of the body,” she says. “As my understanding deepened, it became easier to treat.
“The more I realised that this group of patients were not getting the help they desperately needed, the more it inspired me to learn everything there is to know about pelvic pain.”
“I took advanced courses abroad, studied under the gurus, read truckloads of articles and books, co-collaborated with specialists and doctors. Now I can treat these patients who fall between the gaps of specialist assistance and generalist clinicians.”
The difference made to many of Pelvic Solutions’ clients is utterly profound. “I had a client who confided in me that she was going to end her life had she not got some relief from her pain with treatment with me,” Lisa says. “I was her last hope. Literally. To be able to help these people is why I do it, and why I strive to be a leader in this field of pelvic pain.”
Carnie believes there is a distinct lack of focus on preventative care – and simply not enough awareness about the existence of her profession. “The focus seems to be on fixing up at the other end once things go wrong. I believe there is a general attitude that so many pelvic problems are just a normal part of getting older or consequence of having children – and that ladies should just put up with it, and that nothing can be done. Changing deep embedded belief systems will help people realise that help is available. There is a difference between common and normal and something can be done,” she says.
There is a difference between common and normal and something can be done,” she says.
“Pelvic health does not get much air time at all during undergraduate training of medical professionals, including physiotherapists, so the young professionals don’t know they can refer on. It’s generally up to a dedicated bunch of pelvic physios to promote their profession in their local areas, and explain to anyone who will listen as to what we do. If I had a dollar for every client who said to me, ‘I wish I had known this information earlier’ then I would be a very rich lady!”
After six years specialising in her field, the list of Lisa’s inspiring stories is endless and incredibly hope-provoking. “I had a client who had very severe pelvic and back pain. She wasn’t able to have sex because of the pain she was in – she was married, but never had sex with her husband, despite wanting to start a family. The thought terrified her,” Lisa says. “I worked with her to help her understand her anatomy and how we can change the muscles to relax more. We added strategies to manage her life stress including diet changes and worked with her to calm the nerves suppling the painful area. We changed her lifestyle and the way she was moving and sitting. We adapted her environment and strengthened her body, adding to her flexibility. WE used technical equipment to facilitate her rehabilitation. Eventually she felt ready to try. It went well! Needless to say, when I met her first baby, it was truly inspiring!”
