The Marathon and the Urine Shoes

Catchy title isn't it? Sadly it is an accurate description of myself and my shoes following my first marathon a few years ago. I ran my first marathon on January 10, 2016 at Walt Disney World. My twins were two and my son was four. Our parents kept them for us so my husband and I could head down just the two of us. It was a great getaway despite 26.2 miles of heat and humidity. And the urine shoes. Cause I mean, urine shoes aren't the most romantic addition to a weekend without the kids.

Stopping for a photo in front of the castle! 

Training for a marathon with three children aged 4 and under is easy. I truthfully couldn't dedicate the time that I now know is essential. Not only that, but eating well is hit or miss as a mom of young kids and my diet was not the least bit appropriate for marathon training. However, I needed to do something to show myself how far I had come since the days of having twin infants. I needed a goal that didn't involve feeding children or kissing boo boos. I hated running at the time but I also knew it was something I could do easily without spending much money and without having to drive anywhere for a class. Plus, my husband and brother in law had started running marathons and since I am a competitive Type A woman, I couldn't accept being outdone by two boys who had never grown a human in their bodies. No offense men, I'm just sayin. So off I went on my crusade to become a runner.

If you know me at all you'll know that one of my biggest soapbox topics is postpartum care in the US. It's totally unacceptable in many cases. I am a Pelvic Health PT, so I know better, but most women get NO instruction on their postpartum bodies. Because I'm a PT I am also the worst kind of patient. I'm non-compliant and totally lazy, unlike most of my patients who actually do their homework. I didn't do much of anything to prepare for running besides, well, running. I had some pain in my buttocks here and there and some incontinence during my training but honestly, I just didn't care.  I think I had struggled so much with stress and postpartum depression over the past few years that peeing on myself didn't seem like a big deal compared to taking care of kids.

On race day at Disney it was muggy and hot and we had been up for hours in order to get the starting line on time. We had walked a long way from the shuttle to the corral and adrenaline had been flooding through me all morning - not really ideal for my body which is typically already full of stress chemicals. By mile 7 I was losing control of my bladder. Whenever I would slow down to walk (which was VERY often) I would leak urine. By mile 9 or 10  I was already uncontrollably peeing on myself. The benefit there is no porta john lines, but still.

I struggled to get through the race. I was SO hot and had 11 blisters on my feet. I was soaking wet from sweat and pee. The high of crossing the finish line was unreal, despite my urine shoes. But the fact is that I should never have been at the point where I was just peeing on myself for miles and miles. It's not the least bit normal or okay.

For my second marathon, the Outer Banks Marathon, I trained smarter and ran solo. I ate better and made time for Yoga. I tried working on my abdominal, hip, and back strength. I PR'ed this race and felt amazing through it. Then came my third.

Outer Banks!

I don't know why I wanted to do another one. I suppose many runners can attest to that need to prove yourself faster. I ran the Wrightsville Beach Marathon this past March because it's close to home and we have a beach house nearby. I stuck to my training schedule, ate well, but even so my body just wasn't feeling it. I had major pain in my buttocks and down my legs every time I ran. My back ached literally all the time. I couldn't walk in the mornings when I first got up so I sort of threw myself forward into the bathroom holding onto the walls until a hot shower helped me stand up straight. I ran the race in pain. Major pain. Annoyingly enough, at first it wasn't even my "normal pain." I had put a tampon in that morning (because nothing is more awesome when you are trying to run 26.2 miles than menstruating at the same time) and within the first two miles I was having rectal pain. Yes, literally pain in my butt. I knew why - I'm a Pelvic Health PT and all - so I knew my pelvic floor muscles were tightening because they didn't like the tampon in there at that moment. Nevertheless, I persisted. At mile 7 I stopped at a toilet and yanked it out, texting Ashley (my PT Best Friend) cuss words and whines about my pelvic floor woes. The good news is that the rectal pain went away when I took out my tampon. The bad news is that my back and leg pain presented itself immediately because now my brain could feel it since my bum was happier. Hurray.

I almost quit this race. My daughter had started vomiting at 3am the night before, our car broke down, and there was a chance my family wasn't going to make it to the finish line. I was over it, but I had a college friend who was biking to various points along the route cheering for me which pulled me through. The pain was excruciating and basically debilitating and I cried a few times toward mile 20 because it was awful, even with me popping Tylenol during the run. I crossed the finish line only 15 minutes behind my PR which was super surprising to me. Even so, I could hardly move for three full days, something that isn't normal even after a marathon, at least not if your body is working well. My brother in law pointed out after the race that I actually ran it injured, and that was the first ever time I had ever thought of it that way. I was injured.

Wrightsville Beach Marathon

I have run maybe a couple of miles a handful of times since that race but there is pain. I am 5 years postpartum from my youngest babies and the lack of care of my body has finally caught up to me. It took some time for my diastasis to cause me problems (for more about my Diastasis read this blog post), for my pelvic floor weakness to cause pain, but now here I am - fairly broken because of some of my postpartum issues even though I am years past my delivery. My Cesarean scar still needs some TLC, my abdominals need retraining, my pelvic floor is still very weak. Had I done something for myself after my twins were born I can almost guarantee I would not have peed for an entire marathon all the way down into my shoes. I can pretty much assume I would be running my fourth marathon soon. Instead I am feeling more dysfunctional with every week that passes. I am on my friend Ashley's schedule at the end of the month to get some PT of my own. I am going to spend some time diligently trying to get my body back into a functional place. It's going to take some time, but I love the idea of running a few more marathons. I want to run a big city one like Chicago or NYC. I want to run one when I turn 40. I want to show my girls that our bodies do incredible things and that hard work pays off.

Me and my father in law at the finish line of the Ft. Bragg 10-Miler last year. 

If PT were the standard of care following childbirth (which let's be honest, is MUCH HARDER on our bodies than running a marathon), I would be in a better place. I am so excited when new moms take it upon themselves to come in for PT in the early postpartum time frame. They are so much ahead of the game. They understand how to move well, how to work out safely, how to keep themselves healthy. They prevent this gradual breaking down of the body that I am dealing with at the moment. I knew better, but I didn't take the time. It's easier not to. I'm paying for it now, but I'll be okay. I am going to take it slow and figure some things out. I am going to take some time to allow my body to move well again. My body is very different than it was before I had children, and I am totally okay with that. However, I need to learn to use this new and beautiful body well. I am excited to see what Ashley helps me find that needs work and to see if I can get things working better. It's definitely nice having a best friend who also does what I do and can get me back to running. I can't wait to hit the pavement again for something more than a short painful jaunt around the block. Ladies, mothers: we don't have to live this way. We can change how postpartum care is delivered in our country if we would just talk about this. Share this with your girlfriends, your daughters. Tell them there is help and hope and something so much cheaper than having to buy new shoes every time you run. Don't go squishing around in urine shoes like me. Find a PT and give your body the gift of moving well.

Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Why You Should Be Discussing Your Vagina Tears With All Your Friends Right Now.

I'm stepping up onto my soapbox because, y'all, I'm so sick of this crap. I only work a couple of days a week but nearly every week I see a woman who is postpartum and is shocked that her pain or her leaking isn't normal. IT'S NOT NORMAL. I'm not mad at you guys, I'm just mad at the state of our postpartum care. I will say that I read through the new guidelines put out by the American College of Obstetricians and Gynecologists and they sound great, in theory. But I'll also say that just last week I had a patient come in to see me in the morning before heading to her OB's office for her last follow up after childbirth. She sent me a message that afternoon saying that her OB told her that her pain and leaking were normal because "oh, of course, you just had a baby." Then sent her on her way.

Eye roll, mad face, eye roll, heavy sigh, irritated growl. If you know me you know exactly what those faces look like. I have no poker face and I don't hide my emotions well.

When I gave birth to my son, my first baby, I tore. Down below is a graphic illustration of perineal tearing with childbirth. I'm putting this in your face because we need to be aware of this and open to discussion with our loved ones. Or strangers. I have more discussions than you'd think with strangers about this thanks to the power of social media and it makes me so happy. I love meeting a stranger and immediately discussing their vagina. It means that we are breaking down some walls, at least here in Fayetteville.

Day 2 after our son was born, feeling rougher than I looked.

So anyway, at the time my son was born I was only dabbling in pelvic health physical therapy and I had only taken one of the three main courses, so I was very green. I was also exceptionally exhausted. I didn't know enough at the time to ask my physician about the degree of my tear. I remember her saying a few times that I was going to be sore because it was a "pretty good tear." In addition to being exhausted I am almost positive I had postpartum depression the entire year after his birth, so again, I didn't think twice about any of it. The tear had to be cauterized three times over the next few months before it fully healed but I was too tired to care. My MD asked me how sex was and I never told her that there was no way in hell either of us were remotely alert enough to even begin the process of that. She just assumed and I let her, I was probably embarrassed to tell her we hadn't done that since the baby but I can't remember. I knew nothing back then y'all. Not about pelvic health, or motherhood.


Years later I went back to work and devoted by time at work to pelvic health patients. Around that time that my friend gave birth to her son. I was accidentally present for his birth, something we hadn't discussed, but she was induced with pitocin and honestly I thought it would take forever, so I went to the hospital to sit for a couple of hours and no joke it was suddenly 8am and he was on his way any second. So I hid in this little closet with the sink in it in the delivery room because I was pretty sure I wasn't supposed to be there for the birth. Oops. I stayed long enough to snap some photos and ask her doc how badly she had torn.

Me (as a Pelvic Health PT): "Did she tear?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health PT): "How bad was it?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health Doctor of Physical Therapy): .....

Eye roll, mad face, eye roll, heavy sigh, irritated growl to myself. Look, when your friend has a baby and is enjoying the moment, you don't make a scene. I kept my mouth shut and just sat there updating her family with photos, then drove her husband's truck into a concrete post in the parking deck on my way to get her other car with the baby's car seat in it. Once again, oops. In my defense, that parking deck is a bear and also his truck is like a flipping tank. Also they knew I am not a great driver when they gave me the keys so...

Image from the University of Sydney: http://sydney.edu.au/medicine/nepean/research/obstetrics/pelvic-floor-assessment/English/sydney%20pelvic%20floor%20body/After%20Birth/Anal%20Sphincter%20Muscle/Anal%20Sphincter%20Muscle%20html.html

Anyway, at her follow up appointments with the physician he didn't once mention her tear, her recovery, her emotional status, her continence, her pain, sex, NOTHING. I wasn't surprised because this physician had made me cry ugly tears during a difficulty period in my nursing of my TWIN BABIES. Which, umm, may sound totally easy to a man who doesn't lactate or birth babies, but nursing two babies is the opposite of easy thankyouverymuch. Anyway, thankfully a couple of years later she was ready for us to work on her incontinence issues because that's what friends are for after all. She's good now, but if she didn't have me going into my tiny fits of rage and explaining what is normal, what's right, what's good care, what's going to happen after birth, she'd have been like the majority of women out there who have NO idea what is normal.

9 years at APTS where I have been able to develop
a Pelvic Health practice over the past 4 years. 

Now thankfully, many women do have doulas or PTs or friends or midwives/physicians who understand that we need to do better in our country when it comes to the postpartum period. Many of them get great care. I do realize that, but I also see first hand that most women aren't getting that. And it's just not okay. In France, Pelvic Health PT is the STANDARD OF CARE. As in, you have a baby, you go to your pelvic PT for a few visits (or more depending), but you always go. It's like the norm there. In the US, most women don't have a clue about what we are, what we do, or how to get to us and frankly don't end up begging for a referral until years later when they have suffered for years. That's unacceptable. It makes me super mad and frustrated. My patients who have come in to see me soon after birth tell me all the time that they are the only ones out of their girlfriends who don't have issues. Guess why. Because we teach them how to re-learn the right way to use their body, their muscles, their pelvic floor right away before things get worse. We start using the correct abdominal muscles, get the pelvic floor working well, take care of scar tissue early so it doesn't become a problem, we nip the painful intercourse in the bud right away before things progress to marital distress. It's the right thing to do after birth. Birth isn't easy and no matter vaginal birth or Cesarean birth, it's hard on the body. It creates changes in the body that aren't necessarily bad, but warrant a couple of visits with someone who knows what your body needs and deserves after birth.

In my last Facebook video I begged people to spread the word. I'll say it again. Please, please, pretty please talk about this with your friends, family, colleagues, strangers you meet at the next wedding you go to. It's too important to keep it all taboo. There is someone in your world who is suffering right now from leaking so much they can't work out and they feel depressed over what their body has become. Someone whose marriage is suffering because she can't have sex with her partner because it hurts too much. Someone who can't play outside with her kids because her back or pelvis hurts too much. You could change someone's life by talking about what's normal and what's not normal. I'm not being dramatic. This is what I do, I see it all the time. It can be life changing. Please help me make this stuff okay to talk about it at book club. Or at girl's night. Or even your next dinner party. I don't care when you discuss it, but discuss it. We all have pelvic floors. We all have some issues going on down there at one time or another. So let's help each other. Tell your people that LEAKING IS NEVER NORMAL, SEX SHOULD NEVER HURT, and there is help for it. Here's my latest video if you haven't seen it on Facebook yet. 

End rant. Happy face, clapping hands, little dance. Thanks y'all.

Here are the updated guidelines for postpartum care:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

What's with the plant? Are you moving in?

Over the past year, I have arrived at my clinic hauling arm loads of home decor, books, and artificial houseplants into the back room. At first, the joke around the clinic was that I was "moving in" and my little back room in the clinic quickly became known as "Lacy's apartment." I tried to transform the perfectly lovely little PT treatment room into my own space, almost obsessively. I am the first to admit that I crave my space to feel peaceful, put together, even a little fancy by some standards because that's just how I am. However, that was never my goal in my clinic room. I just didn't want it to feel, well, "clinical."

Back circa 2009 when my name went up on the sign of the clinic! The start of my eventually becoming a Pelvic Health PT!

When you go to a medical practice complaining of a problem "down low" as I like to put it, you already feel insanely on edge. A lot of the time you have been to numerous medical offices and had to wear the dreaded paper gown while sitting naked in a cold room with shiny instruments closing in on you. I have been fortunate - I've had only one provider who has ever made me feel small and "less than" in one of these rooms, and thankfully it was unrelated to my pelvic pain issues because that would have been worse, but even with the kind physicians making you feel comfortable, you never feel comfortable, amiright? So I want my practice to be one of the places where you do feel comfortable. Or at least as comfortable as you can be when you are dealing with an issue down low.

For starters, when you come into my room, I don't want to it to remind you of all the other experiences you've had in your journey. I don't love thinking back on the room where I was told about my pelvic pain diagnosis, even though it was a pretty defining moment in my life (in a good way). It just takes me back to the other places where they kept telling me there was nothing wrong, all the poking and prodding, all the self doubt and fear. That's not what physical therapy is about.

In the back room of our beautiful clinic is my little oasis. Admittedly the paint color is a little too bright for me though it's a great color, but otherwise, it's a little place of peace for me. I have some of my favorite books there -  some about pelvic health, some about sex, even a couple of parenting books that I've accumulated. I have some succulents, some gold accents, and some art on the walls. I even begged for a purple chair so people didn't feel like they were sitting in the traditional medical office chairs. It's not perfect, but it's a reflection of me. And that's my goal. I want my patients to sit down and know ME. If they don't know me, they can't trust me. I am typically an open book when it comes to my body, my experiences in my own health journey or my pregnancy experiences. I want people who are sitting in front of me to know that there's nothing they could ask me or share with me that would make me judge them or shock me. In that room, we talk about everything from sex to menstruation, from erections to pregnancies, from motherhood or fatherhood to marriage. Pelvic health is not an island unto itself isolated from the rest of the PT world, but it's definitely a little different from "normal" outpatient orthopedics in that it's a vehicle for some pretty deep and in depth conversations that years ago I couldn't imaging having with people who were basically strangers at the time.

Of course, by the time patients are done with therapy they are no longer strangers. Often we have not only had intimate discussions but also intimate treatment sessions that involve internal work (like vaginal or rectal). Not always, but sometimes. However, I almost never start with these intimate treatments, because sometimes these are a trigger for anxiety or fear. And I get it. Because I've been there. Unless I can read that someone is eager to get moving in that direction, I typically take a few visits to work on lots of other things that are much less intimate. Internal work should NEVER be forced. It should ALWAYS be 100% okay with my patient. Period. (It's not my body that I'm working on, it's YOUR body, so YOU get the control.) There is always plenty else to do outside of that work, so we take our time. We build a relationship first, I earn their trust, and together we get to the bottom (ha, pun intended) of their issue. Always together.

Always together in the "pretty" room. Not that pelvic health is always pretty, nor is the journey through pelvic pain or incontinence, but things don't have to feel cold and sterile. It can feel softer, kinder, more relaxed, more comfortable. Treatment can be slow, it can encompass everything from the actual physical problem to the emotional implications that come with it. We talk about the guilt, the shame, the heaviness that some of these issues can bring. We talk and we make changes and we treat the person as a whole, not just pointing fingers at various organs or places and expecting things to miraculously heal by this time next week. There's no body shaming or blaming here. There's no guilt over taking two steps back or needed to shed some tears on day. That's not pelvic health. That's not good PT in itself no matter what you are doing there.

Corinne, Lacy, and Colleen renovating my kitchen soon after moving home and starting my career. These girls were my mentors first year out and came to visit me when I got home from UNC after my vagina surgery. They still mock my "waddle" that I was instructed to do when I got out of bed to use the bathroom.

We don't look so pretty here but we are genuinely enjoying each other's company. The road is sometimes full of dust and oil-based paint (that may or may not have made Colleen sick that day) but in the end, it's worth the time and effort.
Also - I took them for Exxon yogurt after this so they did get something out of it. :) 

Look, I've been in that purple chair before. I have been the patient with the tears feeling ashamed that I can't have sex with my spouse because there's something "wrong" with me. I get it. I've been the new mom, the not so new mom, the one with the crazy tear in the vagina after a vaginal birth and the one with the healing C-section scar nursing twin infants. I have been the student on the treatment table half naked while two other students who know nothing about what they are doing poke around in my vagina or rectum as they learn the new techniques to treat actual patients. I've been the one in yoga scared to do three legged dog because I don't trust my pelvic floor to keep everything in and the one at the end of the marathon with urine soaked running pants because my pelvic floor was dysfunctional. There's nothing we do in my little room that I haven't experienced on myself before. I say this not to make people uncomfortable, but to assure you that on some level, I get it. No matter what you are going through, I do get it, even if it's just a little portion of what you are going through. Every story is different. Every journey is different. Every person is different. But my goal is to make sure everyone walks out of the room feeling like they are not alone. That on some level, there's someone who gets it. Feeling confident that there are other people out there dealing with whatever it is they are dealing with, even if they may not have found them yet. Because y'all, I can assure you that whatever embarrassing physical issue you have "down low" is also being experienced by someone else right now. Probably someone you know, maybe even someone you know well. Because as I've said before NO ONE TALKS ABOUT IT.

Duke graduation, getting hooded. I was deep in my pelvic pain journey here but had the courage at the time (not realizing then that it DID take some courage) to take the Women's Health elective and start learning about how to help other women. 

But I talk about it, WE talk about it. We talk about it together with honesty, open mindedness, kindness, and grace. In the pretty room. Because when you talk about these things it should feel safe and unlike a hospital or procedure room. It's clean, it's professional, but it's different, because my hope is that you finish physical therapy and feel empowered, educated, emboldened, and that you know a place for healing that you can come back to should you need it again - this time without fear. Maybe even with a little eagerness, because Pelvic Health is just SO AWESOME y'all. I promise.


Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

On Grief and the Pelvis

Grief. While it's not something new to me having been on this earth from 35 years, at the moment I feel like I am heavily influenced by it. To be honest, I have been luckier than many people in that I haven't lost too many loved ones or been through nearly as much as many have at this point in life. Right now though, at this moment in my life grief has dragged me down in a very real way. Years ago when we lost my grandfather I was terribly sad, but a part of my brain put the grief tightly in another space and locked it away. My attention was focused on trying to make sure my Nana was okay and then, within two months of Granddaddy passing, I was pregnant with our first child. It was the gift that we all needed and I threw all of myself into growing a human, then becoming a mother. A couple of years later our other first "baby," our little spaniel mix Charlotte passed. I had literally just given birth to our twins. They were two weeks old. I didn't have the emotional capacity to grieve her at that time. I loved that doggie, but at the time my grief was filed away somewhere deep because I couldn't face it. I was so tired, overwhelmed, beaten down by delivering the babies via C-section, nursing twins, and keeping up with a 2 year old. It was too much to handle so my brain kept it somewhere far from my consciousness.

In my little room in the corner of the clinic, I hear about and see so much grief. So much devastation and heartache. So much resilience and inspiration too, but a lot of sadness and sometimes trauma. Grief over the loss of a loved one, the loss of a baby, the loss of innocence. Grief over the inability to get pregnant or over a birth going very differently from the original birth plan. Grief over a hysterectomy or not being able to be intimate with a partner because of pain. So often, this grief has brought them here to see me. Because grief becomes pain. Like, literally, it can become pain in your body. It's almost, in a non scientific way of looking at it, like your heart can't take it all so it becomes physical pain because it has to go somewhere. Not for everyone of course, but very much for some.

I am a Pelvic Health PT. I deal with pain in places that people don't want to talk about, don't want to hear about, don't want to think about. I ask the questions that sometimes people don't want to answer because inside they know it'll bring more pain to talk about it. But honestly, to heal the pelvis, sometimes you have to heal the grief too. Not me I mean, because it takes a village, and most of the time they have many other people fighting for their healing as well - therapists, psychologists, psychiatrists, counselors, priests. But it is part of my job to explain to people how these feelings - these traumas and struggles, fears and emotional distress - contribute to their pain. It's a long story all about brain chemistry and chemicals circulating all through your body and leading to dysfunction, pain, then more dysfunction, then even more pain. Pain science is for real, and it's incredibly interesting. Typically we talk about stress and how this leads to pain, but often it's the grief that causes the stress. Because grief is no joke, and when your brain perceives that, it very often begins a vicious cycle that leads to pain. Sometimes just for a short term, but sometimes for years. Then, the pain makes you even more tired, more discouraged, more desperate and often depressed.

I tend to see people at their worst. They've often spent years in pain being passed from one practitioner to another and then as a last resort, they end up in this corner room with all the windows and sunlight flooding in, sitting there gripping the purple chair in either fear or desperation or just annoyance at yet another appointment to sit through. But my job is to try and bring hope, and we start by talking. We progress through ups and downs, setbacks and triumphs, laughter and tears. And so often, when we get to the bottom of the inevitable question of "why" it comes back to grief. What are you grieving? What happened, who is lost, what is lost, what is buried deep inside of you that brought you here? It's heavy stuff sometimes.

When my Nana died I was there, in the hallway, just then texting my husband an update and waiting for an NG tube to be placed, and then in the next moment the door flew open and the blue light flashed over the door and she was gone. This loss was the one that I couldn't tuck away, that wouldn't just shut itself in some little place in my brain again. This year I have grieved the enormous loss of one of the most special people in my whole world as well as the losses of my Granddaddy, my sweet little Charlotte dog, the growing up of my children, times lost with loved ones who couldn't be present for one reason or another, and friends who have moved on. Sometimes the weight of all of it makes me feel like I can hardly walk forward. And sometimes it's literally painful. My neck is full of trigger points and my back is aching more than usual. For others, it's pelvic pain. Painful intercourse, pain with sitting or with exercise.  It's a physical manifestation of deep pain that doesn't seem to know where else to go.

Lacy and Nana before a high school Christmas dance, c. 2000

Treating pelvic pain is a lot different than what I expected. Not because it's harder than other PT or because the pain is worse, but because many times people have no idea how the pain came about. It's not a sports injury or a slip on the ice. It's often a mystery. But so often, when we get deeper, there is something inside, in the past, that needed a place to go. In a way, experiencing this grief for nearly a year has been good for me, it's helped me to empathize in a different way with my patients, to understand the hurt in a way that I didn't before thanks to my brain's protective mechanisms. I had buried that away, but now it's always right here. So I get to relate to their pain in a way that I couldn't before. Yes, I too have had pelvic pain and yes, it was hard living with that for those years, but now I understand on a deeper level. Now I see not just how pain can cause grief, but how grief can cause pain.

*For more information on pain science, chronic pain, and more check the link in the blog above.

Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Yoga and Pelvic Health - A Guest Post by Ashley Chandler PT, DPT

Today I am excited to feature a guest post by Dr. Ashley Chandler PT, DPT on Yoga and Pelvic Health PT. Ashley works at Advanced Physical Therapy Solutions with me and has begun to work in the pelvic health field more and more over the past few years. I am very thankful to have her help in writing about why yoga is an important part of pelvic health PT as well as jumping on the pelvic bandwagon with me! 

Pelvic floor dysfunction and yoga. They have such a great relationship with each other, the more I learn about both the more I think this.

Let's rewind.

I first met Lacy Kells at Duke University in 2006 when we both started our journey towards our doctorate in physical therapy. We became immediate friends and helped pull each other through the rigorous process that is PT school.

Lacy Kells, Ashley Chandler, and our dear friends from Duke
enjoying our reunion weekend in Charleston in 2017. 

  As we were winding down the academic portion of our schooling, we had to choose what elective we wanted to take. Lacy, without hesitation, knew that she would take the women's health elective. I wanted NOTHING to do with vaginas and decided to take the prosthetics and orthotics elective, about as far away from women's health as I could get. I felt no need to know what the pelvic floor was or did, thank-you-very-much.

Fast forward to 2015. Pregnant with my first baby and still mostly uninterested in working with pelvic floor patients. I gave birth in January 2016 with a lovely tear of my perineum. I had sensations of something "extra" in my vagina in the first few weeks following delivery, leading to a panicked text message in which Lacy told me to let myself heal and we'll figure it out when and if we need to. Luckily I have a pelvic health PT as my best friend, because my 6 week check with my delivering MD included a cursory look and a leading question of "everything is going well, right?" Yup, super fantastic (dripping with sarcasm). I'm still weak as can be but thank goodness the prolapse sensations had resolved for the most part.

This lit a fire under my butt to be able to offer other women better care than what I had received. It is ridiculous that my physician didn't complete a more careful examination. It wouldn't have taken long to ask me about leaking or tell me things to watch for and what to do about them (like go visit your friendly, local pelvic health PT for example). So I took matters into my own hands and decided to attend Hermann and Wallace's Level 1 course. Here we go, a weekend filled with giving and receiving internal exams. I don't think many professionals get this level of intimate encounters in their continuing education.

Around this time, Lacy came back into the clinic for more patient care and began seeing almost all pelvic health patients. I became her "assistant" or maybe apprentice is a better way to put it.

I have a background in chronic pain and happen to be a yoga instructor and had found a great relationship between the two, and I soon found that the same can be said of pelvic health and yoga.

To waaaaay oversimplify, the patients Lacy sent to me seemed to be either people who needed to relax the pelvic floor (usually those who are more pain driving and have pain with intercourse, pain with sitting, sometimes accompanied by leaking) and those who needed strengthening because of incontinence. Again, I way oversimplifying the many things that can be going on with a woman but it helped me make sense of things as I eased myself into the specialty.

I did a lot of research, began following a ton of people more experienced than me on social medial and began to find the connection between breathing and the pelvic floor. There is this beautiful dance that happens between the anterior abdominal wall, diaphragm and the pelvic floor. It happens with every breath we take and with pelvic patients I almost always found this to be altered. Luckily, I have been teaching yoga for years and yoga is very much about the breath.

Most fitness or functional cues I use have a yoga twist to them and I already started almost all my treatment sessions or plans of care by watching my patient or client breathe, so I was already very comfortable with this. Combining this with new knowledge of how the pelvic floor and the breathe work together and you get a naturally amazing relationship between pelvic floor dysfunction and yoga. Everything in yoga is tied to the breath and all movement in yoga uses your own body weight as resistance; both things we need to master for our body to work at its greatest potential. There is a component of relaxation, utilization of the parasympathetic nervous system (our relax and digest side) in every class taught which is paramount to happy pelvic floors. Yoga also builds strength, stability, and power. I have always used it in my PT practice, but now that I am becoming more and more involved in pelvic health, I am finding it even more essential. Yoga and pelvic PT definitely go hand in hand, in my totally biased opinion!

Ashley on her wedding day in 2008 in the midst of PT school with our three best friends from Duke, back
when she was totally sure she would NEVER treat vaginas.
#neversaynever 

Ashley Chandler is a certified lymphedema therapist in Fayetteville, NC who leads the oncology rehabilitation program at Advanced Physical Therapy Solutions.  She is also manual therapy certified and uses hands on care every day as she makes movement better for her patients. She has practiced yoga since 2002 and has been a yoga teacher for nearly 9 years and uses this daily in her clinical practice.  In her free time she enjoys the outdoors, traveling with her family, and baking the most delicious treats you've ever tasted. 

You can follow her on instagram @ashleychandleryoga, facebook at Ashley Chandler PT, DPT, CLT. Best of all she has a youtube channel with lots of short yoga flows that you know are safe since she's a Doctor of Physical Therapy AND a yoga instructor. 



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Book Club, Sand Dollars, and What They Have To Do With Pelvic Pain

My book club recently read a book called Present Over Perfect. The gist of it is about allowing yourself to be present in whatever season of life you are in rather than constantly striving for perfection in all things. I have actually finished the entire book but did appreciate the overall point. It has definitely helped me pause to enjoy more moments with my kids instead of obsessing over the cleanliness of my house and overflowing laundry hampers. I definitely need those reminders on a regular basis thanks to my type A personality and my anxiety (see my blog post on what anxiety does to your body here).

Present Over Perfect 
by Shauna Niequist with a glass
of wine and some chocolate

When I treat patients with pain, be it pelvic or pain elsewhere, they often have perfection in their heads. I get it, I have been there. If you need proof that I actually do get it, check out my blogs about my own pelvic pain journey HERE and HERE. It's easy to assume that your body is supposed to be perfect to work correctly. When you experience years of painful intercourse, it often takes an eternity to get it diagnosed. Over time, you start to fear that you'll never be fixed and that your body is getting worse and worse. I mean, let's be real, oftentimes it IS getting worse. When one area hurts your entire body can start to move differently. With chronic pain you get actual changes in your brain chemistry that makes you hurt even worse. It's a pretty awful cycle. Pelvic pain gets into your head and makes you question everything from your health to your marriage to your fertility. There is a big component of shame and embarrassment to pelvic pain with a desperate need to hide it. It's a different beast than when you hurt your ankle running. Again, I know this, I run marathons and I've had pelvic pain, and trust me when I say that for most people, pelvic pain is something entirely worse.

My husband and my imperfect self
 on a family road trip, almost
9 years since my pelvic pain
was healed! 

But here is what I tell people: Your body does not have to be perfect to work well. Let's repeat that one more time. You don't have to be perfect to work well, to be whole. In fact, our bodies were not meant to be perfect. If you look closely at your face in the mirror you'll notice asymmetries, little things that aren't quite perfect from one side of your face to the other. Guess what, that is NORMAL. It's what makes us beautiful and unique. Your body isn't made to be perfect symmetrical. Still, we get people in the clinic all the time who have been told that their "hips are off" or that "one shoulder is lower" and that that is what is causing their problems. Here's the thing though - that's how your body was made. It's meant to be a bit like that in most cases. Look at any elite athlete and watch them move. They are always going to have a side with more arm swing when they run, a dominant arm for shooting free throws, a leg that lets them do a few more pirouettes because they can balance better on it. It's normal. The problem is that in their heads "being off" means that they aren't working correctly. Look, sometimes that may be true. Sometimes the little things that are "off" are causing some problems, but most of us that's just how the body is made. You are not meant to be perfect.

Even so, when people come in to see me, they are terrified of their own bodies because they think their body has failed them in some way. They feel broken. I have felt that, it's so true. You end up feeling like even if the pain gets better your body still won't do what it is supposed to do and that you're doomed to a sexless marriage. Or if you think that maybe one day you'll get to have sex you but won't be able to run or exercise because your body is a failure. Or maybe you'll be able to exercise but definitely never ride a bike or sit through your kids' ballgame on the hard bleachers. There are lots of "buts" involved. (No pun intended there.) These thoughts and feelings are completely legitimate, pelvic pain is so scary because no one talks about it. However, there is so much hope.  Before you had pain your body functioned just fine. What needs to happen is not getting everything magically perfect, but instead re-teaching your body how it worked before. How to function well in all its imperfection. And you WILL function well again. It takes a lot of attention, specific training, tweaking of how you move, but it'll get better. It also helps once the ideal of perfection is officially out of your head. Because guess what, your body is going to work well without perfection.

With my friend Tracey after finishing my third marathon with
a ton of imperfections, my weak abs for one because of my
pregnancies.

Imperfect but whole and beautiful. 

On the beach this weekend I found some sand dollars. For me, sand dollars have a special meaning. Last summer I was in a very dark place and I was desperate for a sign of comfort. I had lost someone beloved to me and I was devastated. My blog isn't about religion, but I'll share that I believe in God and while running down the beach alone I started praying for a sign. I asked specifically a sand dollar because I had never in 35 years found one on the beach, ever. I knew it was wrong to pray for that but I did, like I said I was desperate. As I reached the end of the beach a perfectly formed sand dollar was lying in my direct path. For me, I knew it was my reminder that my loved one was okay. I know some people wouldn't agree, but it's my blog so I get the last word. Kidding. But technically I do. Anyway, this past weekend, 7 months after I found that first ever sand dollar I was running again on the same beach and found five sand dollars. It's that time of year for them to wash up I guess. But I chose to think of it as a sign of peace. However, this time, they weren't perfect. Not one of them was. But they were all whole. Let's read this once more - they were imperfect but whole. (Another but y'all.) Like me, like you. Like those of us suffering from pain. We will never be perfect, but our bodies are whole and our bodies will work well. Perfection is not attainable. Our hips aren't going to be perfectly symmetrical, our pelvic floor muscles aren't going to work the exact same on both sides. There may always be certain positions during intercourse that aren't the best for our bodies. But there will be others that are. There are ways to use our bodies that allow them to work well. Without being perfect.


My job is so amazing. I get to teach people how to be present in their imperfect bodies and accomplish the goals that are important to them. I get to take life lessons that I have learned from books, pain, and loss and use them for good. My past has had times of difficult, but those times get to be beautiful now because I have learned from them. All of these lessons translate into healing pelvic pain. Healing pelvic pain is complicated, it's challenging, it's lots of imperfection. BUT, it's not impossible. Every person deserves to learn how amazing their body is and learn to use it without pain. To see how beautiful it is in all its imperfection. To learn to be present over perfect.

Dr. Lacy Kells PT, DPT

The Physio Down Low

lacykells@gmail.com
Find me on Facebook at Lacy Kells PT, DPT or on instagram at lacykellspt

Kegel Confusion: Reasons to Kegel and when it's not right for you

One month ago I ran my third marathon. It was my first one completed without leaking urine during the race. Woohoo!! That was no small feat considering how my first two marathons went. I will be honest and say that I am a terrible patient when it comes to fixing my own incontinence because I am so good at coming up with excuses not to do my homework. However, with the strength training I did this time around (core strengthening with some Kegels thrown in there when I wasn't lazy) I had enough endurance built up down there to hold things in. Thanks levator ani muscles! I'm so proud. Here's the thing though - Kegels aren't for everyone. There's a right time to do them and there are many times that you should not be "Kegeling."

Kegel exercises are named for Dr. Arnold Kegel, a gynecologist who had his patients doing pelvic floor contractions after childbirth to try and decrease incontinence. He did not "invent" the pelvic floor contraction, but in the US his name is the one we refer back to when we talk about strengthening the pelvic floor since we have named this exercise after him. I have found that there are many people who are well aware of these Kegel exercises (either from their physicians, friends, or just their own online research) and there are just as many who are not. Often I hear the whole "I've heard of that but have no idea what it is" response. Just as often I hear the "Yeah, I know I'm supposed to be doing those but have no idea how." I always reassure my patients that all of these answers are okay because honestly, we don't know yet if you need to be Kegeling until we sit and chat and go through an examination. So stop beating yourself up over not doing your Kegels. You may not even be ready for them and if you are, chances are you aren't doing them in the best way anyway.

Here's how your it works: If you come in to see me for urine leaking, there are generally (by generally I mean no one fits into a perfect mold) two overall reasons. Either your pelvic floor is (1) weak because it's just weak or your pelvic floor is (2) weak because it's actually tight. Now, admittedly these aren't super scientific explanations, but that's the gist of it. You can have that typical weakness that sometimes comes with pregnancy, childbirth, aging, high impact activities, lack of physical activity, etc. but you can also have weakness that is actually a result of a tight pelvic floor. See, your muscles have a "happy place." The little fibers that make up a muscle like to rest at just the right spot. They overlap each other in a way that lets them contract with strength but also stretch a bit when they need to. If the muscle fibers are resting in such a way that they overlap too much, then the entire muscle won't work well. So when you go to use the muscle, it won't have nearly as much strength as it needs to work right. Weak muscles can't compress the urethra (where your urine comes out) so when you go do sneeze, stand, cough, laugh, jump, shop, try and hold your pee as your key turns the lock, they can't work enough to keep you from leaking.

If your muscles are "just" weak, meaning they aren't tight but are just lacking enough strength to keep you from leaking, then you could definitely benefit from Kegel exercises. As Pelvic PT's we are trained to develop a personalized program just for you to get your pelvic muscles working well again. We are, after all, experts in exercise and movement science. Your home program is tailored to where you are starting now, so we work on exactly what you need. The best way to work on the pelvic floor is through long holds (which strengthen what I call the marathon muscle fibers) and also on the quick flicks (which work on the sprinter muscle fibers). For my marathon, I needed both. I needed the endurance fibers to be able to stay turned on for 5.5 hours but I also needed my sprinter fibers to turn on when I sneezed (#allergies) or "jumped down from a curb while crossing a street" (#gracefullystumble). We need both to get the most benefit. These are things I go over in a session and always write down on a sheet for homework. We then progress things as your body gets stronger over time and move from lying down to sitting to standing to even jumping or running depending on your desires.

The other side of the story are the patients who come in with leaking but also seem to have other problems as well. These often include constipation, pain with intercourse, trouble or pain with tampon use, history of trauma, history of abuse, or general pain in the pelvic region. These are usually signs that Kegels are going to take a backseat to pelvic relaxation. If you have tightened muscles in the pelvis, strengthening them won't be effective until we get the muscle fibers to their "happy place." You could Kegel all day long everyday and not see improvement. In fact, you could make things worse. So, we have to teach the muscles to relax, get them to their neutral starting point where they prefer to be before we can build up their strength. Sometimes, once the pelvic floor learns to relax again patients will notice less urgency to pee through the day or that they are better able to keep themselves from leaking when they sneeze. That's because the muscles are finally happier and can automatically work better even without training them to be stronger. Over time, once the muscles have found their happy spot, we begin the Kegels and can take care of the leaking. This tends to be a longer process than "just plain weakness" but more often than not, while fixing your incontinence you'll also fix some of the other issues like pain with sex or excessive straining to poop. So you are almost getting more bang for your buck! You can tell your levator ani muscles thank you for that little bonus.

Don't forget that peeing on yourself is NEVER NORMAL. It's not. It's not something that happens "because you are pregnant" or "because you've had babies" or "because you are getting older." Nope. Don't let anyone tell you that. It's not true. We don't have to live this way. We can go without Depends or extra large pads just so you can do your Christmas shopping. There's a better way, and that is retraining your pelvic floor muscles. Retraining can be a few sessions where you learn how to activate your pelvic floor and learn how to progress yourself through a home program or it can be weeks of pelvic relaxation and learning to get to the bottom of your tightness so you can start strengthening, but either way there is help and hope. You too can be like me, a three time marathoner with a goal of not peeing on yourself! Yippee!! Doesn't that sound awesome?? No? You're probably right. I should find a better hobby. But this last time I got pajama pants just for running 26.2 miles and it seemed like a great deal.

Anyway, back to the point here. It's time for us to DEMAND BETTER. Let's demand better from our physicians or healthcare providers. Tell them you will not accept leaking as part of your life and insist a referral to a Pelvic PT. PT's are experts in exercise prescription. Pelvic PT's get to take it to another level and teach you how to be an expert in your own pelvic floor so you can put the pads behind you. We can do better y'all. Spread the word and get the help you deserve. Your body is amazing and with some education and special attention it can work beautifully - even when you are pregnant, postpartum, a high intensity athlete, struggling to get back into exercise, or aging. (And for the men out there the same goes for you - even post prostatectomy). With all the money you'll save on pads or laundry detergent you could register for your first marathon... Or at least buy yourself a cute pair of "running shoes." You know, just in case. It won't hurt if they look cute with your yoga pants.

Dr Lacy Kells PT, DPT

The Physio Down Low

lacykells@gmail.com
Find me on Facebook at Lacy Kells PT, DPT or on instagram at lacykellspt

Year 4 of Diastasis Rectus Abdominis

When I started practicing pelvic health, I didn't realize how terrified women were of the dreaded "diastasis." Diastasis rectus abdominis is something that is most commonly seen after pregnancy and is the separation of the abdominal muscles in the middle of the belly, along that line that sometimes turns dark during pregnancy. After a few women came in to the clinic to be evaluated "just in case" with looks of terror in their eyes I realized that this was a big deal to new moms (and some not-so-new moms as well). Much of the time these women didn't even have a separation, but the horror stories on the internet freaked them out enough to want confirmation from an actual human rather than WebMD. They were scared of the idea of a hernia, a surgery, or "making it worse" while they exercised. Seems like a legitimate worry of course. After all it can be scary to feel your belly and feel like there's a big hole.

My non-pregnant belly four years after my last pregnancy. 

For me, it was something that hadn't ever really crossed my mind. I was a healthy person when I got pregnant with my son and while I carried him full term I didn't stop to think about my core for a while. The postpartum depression, nursing, and sleeplessness took precedence over my abs at that time. When I got pregnant with my twins I was too overwhelmed about, well, twins, that again I wasn't worried about it. They were born via Cesarean birth at 38 weeks and I didn't have two seconds to even think about my body. I nursed and pumped for a full year with them, so it wasn't until about 3 years ago when my body became my own again. I have my own body image issues like most women out there, but because I didn't have any pain or problems I just sort of moved past my post-baby belly. I tried to just be grateful for what my body had done for me and stop focusing on how different I looked. 

Mile 7ish of my last marathon -
March 2018

It's only been the past few months that I am experiencing the issues that an abdominal separation can create in the body. The thing is, when I check my separation, it's only 1 fingertip that can fit down in there. (There are about a million videos that "teach" you how to check for it, some are right, some are "eh").  In the world of PT, 1-2 centimeters (about 1-2 finger widths) is considered normal. It's the 3-4 finger separations that are typically more concerning. My problem is actually not the width of the separation, but the depth. It's deep y'all. And the longer I practice Pelvic Health, the more classes I take and books I read the more I realize that it's so complicated. I don't look that bad from the outside but my body is screaming otherwise. The tissues that hold muscles together, that run between muscles and connect things, my fascia, is stretched. And it's not going to just tighten back up. Over the past three years, my body has slowly started to suffer from the fact that my abdominal muscles can't work effectively and my poor pelvis isn't very stable. Up until this year it's done pretty well trying to fake it. Your body does NOT have to be perfect to work well, and up until this year my body was working just fine for the most part. I trained for two marathons (both of them after my babies were born) without any problems. But this time it was different. My body couldn't work overtime just to keep me stable anymore and I had pain every time I ran for months while training for this most recent race, my third marathon. It was a beast. I had pelvic pain and butt pain and back pain and then hamstring pain by the end. Rough. It took me three days to recover. 

Retired marathon shoes

My point here is that now I sort of understand the fear. I didn't before, partly because I felt like "but I'm a pelvic health PT, I will never have that!" I had read articles about it and books about it and learned in classes about it. I figured that since research can't find a big connection between separation and major dysfunction and since I only had about a finger width between the muscles that I was good. However, for me, I am beginning to feel the effects of my abdominal weakness. My body is done trying to compensate for it. I couldn't run another marathon like this. Marathons aren't necessarily my main fitness goal, but I know I'll want do do another one in the future and currently my body isn't going to let me. I am taking things back to basics, trying to teach my body to be strong despite the weakened fascia so that I can safely do things like run. I'll get there, and if I don't I'll look to the next step. I am lucky that I know enough to retrain myself, but probably dumb for not paying more attention to things a couple of years ago. 

Belly taped up to bring the fascia closer to the middle so my abdominals can work better. Sadly this tape doesn't stay on for 26.2 miles. 

Regardless of whether you have a really large separation or just a small little valley, if you are having pain, trouble lifting, urine leaking (no, even when you exercise it's not normal), find a PT to check you out and get you back to functioning correctly. Don't be like me and ignore it and hope for the best, at least not if you have high hopes for staying active in the years to come.  I'm starting over and showing my body the love it deserves after growing three amazing people inside of it. It's frustrating to me that I wasn't more careful and respectful with my body after my babies, but I am fortunate to be an exercise specialist, it's what we PT's do, we make movement better. So I will work on my back, my buttocks, my core, and my pelvic floor carefully, thoughtfully, and with love. If you need help with this, find a PT to help you. You owe it to your amazing body! 

Dr Lacy Kells PT, DPT

Fayetteville's "Physio Down Low"

lacykells@gmail.com
Find me on Facebook at Lacy Kells PT, DPT or on instagram at lacykellspt

For more info about our clinic please visit Advanced Physical Therapy Solutions at aptsnc.com 

Anxiety, pain, and that time I drove around with only one lens in my sunglasses

The past few weeks have been exceptionally stressful around our house. My husband has had work deadlines, I have been busy with work both in the clinic and at home, I was gone for four days to Boston for a continuing education class last weekend, the kids have had a cold, we had a random showing for our house pop up, and I have a marathon coming up this weekend. We thankfully have a lot of help from our parents and a great friend group for support, but still, it's felt like a lot this month. Anxiety is NOT new to me by any means, just check out my other blogs for a little insight here and here, but even so, it continues to be something that I struggle with during particularly stressful times. I have come a long way over the years and now I am rarely disabled from it, but it is something that I have learned can be a big contributor to physical pain.

This is anxiety y'all- being so worked up in your own brain that you DO NOT NOTICE that you are wearing sunglasses with ONLY ONE LENS. This was after twins but before I went back on my anxiety meds, and clearly I need them. Because I definitely walked through the grocery store parking lot wearing these, and back to my car.

Mental health, like pelvic health, is not discussed a whole lot. Like pelvic health, there is a shame that goes along with things like depression, addiction, anxiety. It's not talked about and when it is, there's a heaviness and an embarrassment that goes with it. It's the opposite of what you need when struggling with a mental health issue. Part of the reason I started a blog was to start normalizing pelvic pain, incontinence, prolapse, sexual dysfunction. All the things that make you uncomfortable to hear me talk about. Those are the things I want to throw out and rub in everyone's face until it becomes as normal as low back pain. Because seriously, who does not know someone with back pain? I'm willing to bet there is no one out there who doesn't. Well guess what, that means you most likely know someone with pelvic floor dysfunction or a mental health disorder like depression or anxiety. In fact, pelvic pain usually comes along with stress, anxiety, depression, so you may know someone with both.

Here's how it works: Pain is meant to be a built-in alarm system for our bodies to keep us safe. So, if you touch a hot stove or cut yourself cooking dinner, you want to feel pain to tell your hand to move away. It's an awesome evolutionary tool that has allowed us humans to survive all these years. Once you have this initial injury, you'll often feel the acute pain as the tissues heal over the next few days or weeks. The nerves at the site of the injury are stimulated which remind the brain that it hurts, and your brain sends chemicals and cells to the area to help things heal. This is all normal and good. 

The problem is that many of us end up with chronic and often seemingly unexplainable pain and often, there's a link with our mental state. For now let's talk about pelvic pain because that's my jam. Chronic, unexplained pain is usually happening even after the tissues have healed, so pain without any damage. It feels like something is damaged, but with chronic pain (3 months or more of pain) the tissues are usually no longer damaged. This kind of pain occurs because your nervous system is a little too excited. It wants to warn us of threats and dangers, but at this point those are gone. With chronic pain, our nervous system becomes overly sensitive, so the nerves in the body may turn on faster or stay on longer which tells the brain that your body is in danger. 

When you have anxiety, your brain can assume that your body is in danger, so it naturally sends chemicals throughout your body that tend to make things more sensitive. You become even more stressed from the pain and this makes your brain even more paranoid about everything that moves or gets touched. The mental stress over the pain you feel causes your brain to release even more stress chemicals that can cause inflammation, sensitivity and pain. It's a vicious cycle. It can be extremely debilitating. It is rough. It's hard on the person who hurts and it's hard on their caregivers and loved ones. It's kind of a nightmare. Many of the patients who walk through my door are at their wits end, they are depressed and they have lost hope. It's easy to see how you could get that way after not knowing how to break the cycle. Pain makes you exhausted, sad, sometimes angry. It takes over everything. 

But, the wonderful thing is that there is definitely hope and help. The first thing that PTs often do is some pain education. Sometimes I have patients watch this video and we talk about the brain, the nerves and the nervous system. I tell them that their anxiety and tension is causing part of their nervous system to be turned on practically all the time (the sympathetic nervous system). The thing is, unless a bear is chasing you down the street, you don't need your sympathetic nervous system quite so excited all day long. Back in the day if, I don't know, a wooly mammoth or something was chasing you down, you'd want that sympathetic nervous system to kick in so you can run like for your life, literally. However, sitting in your office on a normal ho-hum workday is not the time for it to be needed. In my case, the sympathetic nervous system was turned on practically all the time. My husband could tell me that we were out of milk and it would literally send me into a tailspin of anxiety and panic which would then make my neck hurt and of course my pelvic floor as well. It's not a fun way to live. 

The way to make it better is to use our "rest and digest" nervous system, the parasympathetic branch. It keeps us calm, it tells the brain not to be so sensitive, to stop letting out all of these crazy chemicals that circulate through our bodies and make us hurt. Learning how pain works, how to turn on the parasympathetic nervous system is often the beginning of the end of chronic pain. 

For me, I got into yoga, I started running, I learned to breath correctly (that's for another blog but you can check out this quick video for an intro), and I ended up going on an oral medication that helps keep my brain chemistry more regulated. Now, I don't have pain in my neck or my vagina. (I have pain everywhere else at the moment but that's thanks to my upcoming marathon and all the running. So. Much. Running.) I have seen first hand how my patients' stress increases their pain, which usually makes them anxious and perpetuates that pain cycle. When we work on breathing, calming down the brain and the nervous system, talking about things that make them laugh, their pain is often immediately reduced. It's awesome. Yes, there's a lot more that goes into the full healing process, but the brain is a huge part of it. Your body is NOT BROKEN. You are not broken. Your body does not have to be perfect to work well. Sometimes you just need to break the cycle. 

When your best friend is a yoga teacher you learn to be really good at using your breath to calm down. Also you have access to a free yoga teacher who is also an awesome physical therapist and just happens to be the BEST baker I know. Not a bad deal I've got going on here. This is her teaching a workshop, helping so many people to learn to manage their own anxiety through activating their parasympathetic nervous systems. 

Living with anxiety is hard and it can wreak havoc on your body, but it's not forever. We got through the crazy week. The house is super clean thanks to the house showing, my marathon is only a couple of days away and I get to celebrate with my family and one of my best friends from college, my husband's deadlines have been met and/or pushed back, and my kids aren't sick anymore. My pelvic pain is under control and I get to have amazing conversations with incredible men and women at work while getting to share my passion. Don't let your pain get the better of you. There's a PT who can help, and you don't even necessarily have to show them your vagina y'all. Let us help you heal. 

My de-stressors: peace and quiet, chocolate, a book (this one I am reading for book club just happens to be about being Present, not Perfect which was needed after this week), and a little red wine, you know, for my heart obviously. 

Dr. Lacy Kells PT, DPT
The Physio Down Low
Advanced Physical Therapy Solutions

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt