Understanding the Whole Body Effects of IC
The following column is from my talk at the IC Fall Forum in Boston. Although I have covered this subject in previous columns, I am offering some new information and suggestions.
When Andy and I started our group in 1992, we had no idea that so many other IC patients also suffered with overlapping conditions. We watched as newcomers, to our group, would begin to experience new symptoms. There were doctors and researchers who believed that IC was a systemic disease, and there was a published study on the overlapping conditions of IC, however most doctors did not have this information.
Today, most doctors know that IC is often overlapped with fibromyalgia, irritable bowel syndrome, vulvodynia, allergies and so on. But, what they do not know is how to treat other conditions without interfering with our bladder maintenance. A good example is physical therapy. When a patient is prescribed physical therapy for muscle and joint pain, the prescription is usually for sports medicine. Although physical therapy can be helpful, the strengthening exercises may worsen symptoms in IC patients. Even rheumatologists who specialize in fibromyalgia often don't realize that the FIBROMYALGIA PATIENT is not the same as the IC PATIENT with FIBROMYALGIA.
There are good physical therapists who work with the individual. One IC friend of mine, who is sitting in the audience, had a very creative and understanding therapist. When she could not lift weights, he had her strengthen with a hand full of pennies. When he left the clinic, my friend saw another therapist who did not work with her, or listen. She had to quit therapy. There needs to be more awareness, more education about the whole body effects of IC.
I believe that there is a specific posture to IC. The on-going inflammation in the bladder not only affects the surrounding muscles, but also affects the larger muscle groups in the body, especially the postural muscles.
Many IC patients have tight hip flexors, the muscles in the front of the hips. The psoas muscle (the largest hip flexor), which connects the front of the hips to the lower back ribs, can shorten and pull. The psoas muscle helps to balance the upper body while sitting, and helps the body from falling backwards while standing.
Many patients also experience tight hamstring muscles, the large muscles in the back of the legs. These muscles can pull and shift the sitz bones (the tuberosities we sit on). As a result, the body weight falls into the heels. When this happens, the rib cage can collapse and leave little support for the head. What compounds this problem is the shortening of the rectus abdominus, which basically runs from the pubic bone (in front of the bladder) to the upper ribs near the diaphram (in the center).
When these areas, or muscles are tight and short, standing, walking, lifting, climbing stairs and sitting can be very difficult. The bladder may cause this compromise, but the bladder is also affected by this compromise. When we cannot use our muscles properly, we compensate and often injure ourselves.
Stretching, strengthening, good body mechanics and proper support are necessary to treat the pain pattern of IC. Stretching and strengthening are equally important. Stretching encourages length in the muscles. Strengthening helps to keep the length, and helps to avoid injury while performing everyday activities.
So often, IC patients become discouraged after trying to exercise, therefore, it's best for patients to use a conservative approach. Performing too many repetitions of a movement, or holding a stretch or a posture for too long can be detrimental. Muscles may not be able to find a resting place after over using them.
Aerobic activity, except for gentle swimming, can cause a jarring motion to the bladder. This is especially the case when the body weight falls into the heels, therefore, stretching and strengthening should always accompany aerobics or walking. Stretching and strengthening help to unravel the tight muscles that cause uneven weight distribution, and a lack of cooperation in body parts.
Aside from swimming, some country line dancing and 50's dancing seem to offer the smoothest aerobic movements. Latin, club and belly dancing should probably be avoided because they are very hard on the low back, hips and pelvis. Also, the pace is often too fast for most patients. Marching in place can always be substituted for difficult movements in easier videos, as long as the knees aren't raised high and the amount of marching is limited.
Most IC patients should also limit exercise routines to 20, or 30 minutes maximum. Patients should always practice new routines slowly and cautiously. Five minutes of gentle exercise (that does not hurt you) is better than no exercise at all. Exercise and dance videos are available through www.CollageVideo.com.
Practicing good body mechanics and ergonomics can also help to fight the IC pain pattern. For example, get the pet food off the floor. Avoid twisting your body to watch TV. Carry objects close to your body. Never pick up anything heavy. Make wide turns. The hips are the steering wheels for your knees. Making sharp turns can stress your knees. Instead, when turning around, make several wide steps and shift your body weight from foot to foot.
Proper support is always necessary. Sitting can be a challenge. Most patients must sit with their hips slightly rolled back and under to avoid pressure on the bladder. In this position the upper body collapses, because of the lack of pelvic support.
I have designed a back cushion, which gives the upper and lower body the needed support when sitting. I have also designed a seat cushion that supports the pelvic floor, and can be used for forward tasks (such as desk work), as well as for comfort (while resting back in a chair).
The seat cushion works well in deep chairs, such as wingback chairs, dining room and kitchen chairs, etc. The back cushion will be available in both a thick size, for sofas and deep chairs, and a thin size, for cars and some office chairs.
We hope to start production soon. This is a big and very expensive undertaking, and has literally taken us several years to get the right design, the right foam, and the correct support.
I also want to talk about the benefits of hands-on bodywork. Hands-on work can help to lengthen muscles and free up the tension pattern of IC. However, like exercise, too many repetitions of a stroke, or too much stretching can worsen symptoms. Therefore, deep tissue work should be limited to tight areas around the joints (avoid direct pressure to the joints). Surrounding muscles should be blended with firm and smooth strokes.
Patients should usually avoid work that realigns the pelvis, or encourages a lot of change in the posture. Too much change can cause problems. Although I believe that the work I am trained in, Aston-Patterning, is the best technique around, I still have to be cautious.
When I recently had a few sessions I had a central nervous system response, because I had too much work. My body read the work as an injury, and my muscles constricted all over. The same thing has happened to me with myofascial release. Muscles often cannot find a resting place after too much release, or too deep of work.
Questions and answers
After the lecture I was supposed to answer questions from the audience, but "public speaking shy," as I am, I ran back to my seat. When I noticed people signaling me to get back to the podium, I immediately did.
The first question from the audience was truly heartbreaking. A teary eyed mother, sitting with her young daughter, asked if all of these physical problems would affect her daughter too. I felt her fear and despair, and I apologized for frightening her.
I told her that not all IC patients have overlapping symptoms, or conditions. I let her know that IC can be mild, moderate or severe. IC can go into remission, can improve with proper treatment, and sometimes improve with hormonal changes. I stressed that the pain pattern in each patient is unique, and that I am speaking in general terms today in order to help those who experience the whole body effects of IC.
I hope I gave her some relief. It can be very difficult to speak about the compromises of IC to patients, and most especially to new patients, who are understandably overwhelmed by their new condition.
The next question, I believe, was very important too. A Craniosacrel therapist wanted to know if Craniosacrel treatment (a hands-on technique used by physical therapists, myo-fascial and massage therapist) helped IC patients. I safely responded "it depends. Therapists may add other techniques and styles to the work, which may, or may not help IC patients. However, I do feel that therapists should avoid lifting IC patients' heads too far forward while cradling their heads. And, traction should be as gentle and brief as possible. Also, most IC patients should probably avoid the deeper work."
It is questions like this therapist's that help both patients and therapists understand, and become more aware of the needs of IC patients.
I believe the next question was about chemical sensitivity. Since there seem to be a number of IC patients with sensitivity to chemicals, I was pleased when someone asked if other patients had this problem. My answer was yes, and I elaborated.
There were other
good questions and then other speakers. After the lecturing we all
circulated. I got to feel a patient's InterStim implant, which she
said had helped her IC quite a bit. A very nice husband also showed
me a seating cushion that he designed for his wife. I was very impressed
with the patients and family members who attended the forum. There
are some remarkable and very creative people in our population.
Exercise of the Month:
8. Quad & PSOAS Stretch
Avoid - Lunging forward or holding breath.
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