Thanks to Jocelyn Kirton RMT for her following article.
Jocelyn is an RMT currently based in Surrey, BC at ClaytonCrossingRMT.com and has a practice focused on treating pelvic and abdominal pain.
She is the first guest author for ericpurves.com
Chronic Pelvic Pain
Imagine experiencing pain in the most intimate of areas. The narrow variety of treatment options available yields increasingly frustrating results and massage therapy may be the final answer. It is a common occurrence to hear clients say they wish more massage therapists knew how to treat abdominal and pelvic pain. This predictable dialogue is enough to suggest the massage therapy profession has really dropped the ball when it comes to helping clients manage Chronic Pelvic Pain (CPP) and it is time to address the hurdles in the profession and move towards an informed direction so more therapists can effectively and confidently manage clients with CPP.
Incorporating Biopsychosocial Reasoning
Pelvic pain is not well understood. Because of its complexity, a broader biopsychosocial framework needs to be considered and implemented by therapists to assist in the management of CPP. The professional stakeholders prefer to take a biomedical narrative with regards to pain management. This implies there are linear pathways to manage CPP. However, the evidence and clinical experience suggests that a biomedical approach to CPP has a poor success rate. The unfortunate reality for clients is that by the time they discover a massage therapist who addresses pelvic pain, they have undergone almost every invasive or intense procedure to hopefully help them. Health care is leaning towards more conservative treatment interventions when it comes to managing chronic pain. Massage therapy should be one of the first, as opposed to one of the last lines of intervention for CPP.
Treating people with CPP through a biomedical lens might be why the profession as a whole is not adequate enough to manage these patients. Compartmentalizing pelvic conditions may lead therapists to deduce that pelvic pain arises from mechanical defects or conditions and create unintentional nocebic narratives around CPP. According to this study, almost fifty percent of the female population who experiences pelvic pain has had physical or emotional trauma associated with the area. As a profession that loves to stand out because of condition and modality based continuing education courses, they miss out on clients unique circumstances surrounding their pain experience. When therapists fail to identify and address that uniqueness, they fail the clients. Treatment of CPP needs to be person centered.
Setting Professional Boundaries in Pelvic Health
The subtle sexism in massage therapy is another issue that needs to be addressed. Male pelvic health is absolutely absent in the profession. With female therapists making up eighty percent of the professional population, there is a large unspoken bias towards treating exclusively female pelvic conditions. As health care providers, not discriminating someone from treatment is part of the ethical by-laws. When it comes to actual practice, the male pelvis is often dismissed because therapists don’t have a focus there. This is possibly intentional because of the risk that treatment may elicit an erection. Even though massage therapists are educated in creating and maintaining professional boundaries, they understand that erections may happen regardless of where the treatment is. However, the entire apprehension is unwarranted as people with CPP usually present with sexual and/or erectile dysfunction.
In the strive to disassociate massage therapists from being sexualized, the entire topic of sex or sexual health and function was disregarded. Humans have genitals, therefore have sex and that is a normal part of life. If having sex is absent in someone’s life due to pain, then that needs to be addressed by a health care provider. For a health care profession, massage therapists can be really sensitive around the topic of sex. They need to be more informed, biologically and psychologically, have the confidence to interact appropriately and effectively when it comes to the pelvis and can’t be particular about who is the best candidate for receiving pelvic treatment. Therapeutic touch can have great effects on the CPP population as introducing a touch that feels good through an area that hurts can have not only positive biological effects on pain reduction via descending modulation, but also psychological effects in the sense that people will start to associate positivity with an area that is normally persistently painful.
Adapting the RMT Treatment Framework
As a profession that exclusively focuses in touch, the potential to help clients with their pain is vast, but massage therapists have a tendency to believe that internal interventions are always necessary with pelvic pain and can’t offer effective treatment because this is out of their scope of practice. Internal treatments can be a small piece of the puzzle when managing the CPP population and classically, people who have CPP usually start with internal exams and physical therapy. The typical line of thinking when it comes to pelvic pain is that because pain may be perceived as internal, or someone has a “weak pelvic floor”, treatment needs to be internal. However, as more up to date literature arises, it is understood that pain is a protective output from the nervous system that may create a disproportionate response that encapsulates a larger region. Therefore a broader treatment framework is needed to address the entire picture. Massage therapy utilizes non-specific touch really well and seamlessly connects regions of the body together which is a huge missed opportunity for the profession to spear head more progressive non-specific treatment protocols for CPP.
The hesitation within the profession to address pelvic pain leaves therapists missing the mark when it comes to having critical thinking to potentially identify that pelvic pain may be an underlying problem. This takes away the opportunity for clients to speak out about their pain experience in intimate areas. Ignorance is not bliss when it comes to someone’s health. Opening the dialogue up in a safe space for clients to get their intimate concerns addressed without fear of judgement or embarrassment is a huge opportunity to provide education, more effective treatment planning and the ability to refer them to another health care provider. When more clients are referred back to other health care providers from massage therapists who have concerns, this is how the profession gets recognized for the role it plays in assessing and treating CPP amongst other health care professionals.
Massage therapist’s knowledge excels in therapeutic touch, and this is often where CPP intervention lacks effective treatment. The profession needs to step away from narrow views or narratives of treatment interventions and conquer their apprehension and hesitation managing all CPP populations. For a region of the body that holds vast complexity, massage therapists are better off learning broader frameworks of interaction and treatment with this population. Only then will they become recognized by other health care providers of the important role they contribute and perhaps one day, set the example for the management and treatment of chronic pelvic pain.