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Entries in trauma (4)


Urology as a subspecialty of neurology, a case study

"It's all about neuro-muscular coordination."

If you've taken my Bladder & Pelvic Floor Health class (whether for patients or for practitioners) you've heard me say this umpteen times. It's one of the major take-aways from the class. You've also heard me joke that "Your bladder doesn't pee, your brain does."  While this is not completely accurate, it serves to underscore an important theme: Your bladder is part of a very complicated neurological system and it operates within that system, not as an adjunct.

I have a patient whose story is an excellent representation. She had an existing bladder issue from a previous trauma when she came to my Bladder & Pelvic Floor Health class. Over time, she was healing herself with the exercises that I taught. However, she recently had a fall that caused a moderate head trauma. She didn't drive for four weeks and she was off of work for seven weeks. She found that her body prioritized the new trauma; her bladder issue, with the new stressors her body was going through, worsened. The concussion left her balance and proprioception compromised. She experiences dizzy spells. These are common neurological symptoms with trauma, and especially with head trauma.

At my Pelvic Floor & Core Workout Series she has shared with us how, in doing the slow movements and really paying attention and feeling her body, it fatigues her mind and body. She's noticed that she gets emotional with the movement and with her impatience in feeling fatigued, and that the emotion and fatigue are both signals for her to take a rest. But she's seeing improvement with these slow, intentional movements that challenge the core, coordinate proprioception and improve balance. Remember, these all contribute to and mirror the condition of each other because they are all neurologically based.

It truly is all about neuro-muscular coordination.


Tissue Talk: neurology of chronic pain

An item I share in my Bladder & Pelvic Floor Health for Practitioners class from Haslam & Laycock's "Therapeutic Management of Incontinence and Pelvic Pain", 2nd edition:

When pain persists, even after healing has taken place [from a trauma], the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become embedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate. Chronic pain no longer serves a useful purpose, but leads to physical, behavioral, and psychological changes that combine to produce the pain experience.

There are a couple very practical implications here. Firstly, chronic pain causes very real physical changes, even when the physical cause can no longer be detected. Secondly, the longer someone waits to get treatment for pain, the more established will be those physical changes and the more treatments they will require to try to reverse the pathology.

I have had patients who have become frustrated with western medical practitioners who told them that the pain "is in your head". It's an unfortunate (and rather dismissive) way to language it, but sometimes this is to what they refer. The physical cause has resolved; the pain now lives in their neurology. Chronic pain requires both physical modalities and CBT (cognitive-behavioral therapy) in order to be addressed completely. It will not be resolved by medications or surgery.


Lumpy forearms

I've had several female patients present with lumpy, painful forearms after significant hormonal changes (postpartum, perimenopause). The nodules feel very similar to those that formed on my thighs after I had suffered multiple fractures to my pelvis. They showed up months after the trauma, were massaged out over a period of six months, and recur on occasion. The difference seems to be that these women have pain with use of the arms; I had pain only with pressure on the nodules. Both feel like the beginnings of scar tissue if they don't get worked out. Fortunately, both tend to be responsive to friction. 

It's not uncommon for women to have major, unexpected changes in their bodies after hormonal changes. Many women report that their health changed either for the better or for the worse after a pregnancy. Some women experience change in hair texture (straight to curly) or a change in how fast their hair or nails grow. But the lumpy, painful forearms is something I've not heard of before.

A Google search yielded no relevant results. If you have experience with this, please let me know.


Scar Tissue Massage