Sarah lived in a cycle of pain, fear, self-doubt and confusion. She had been treated for depression, warned that she needed back surgery and told that she would never move normally again. During the birth of her second child, she sustained nerve damage in her lower back and a fractured pelvis. Five years after the fact and many specialists later, she arrived at Body Harmonics at the urging of her psychotherapist so see if there was any way we could help her.
Sarah and I spent most of our first session talking. We were in a shared space in our Dupont studio and listening to her story, I couldn’t hold back my tears. I was mesmerized by her matter-of-fact way of recounting the traumas she had endured and felt overwhelmed by the state she was in after so long and so many specialists.
Her laundry list of pain-related, movement impairments sent my mind into a spiral of questions to figure out the best place to start. From TMJ, to SI joint pain, to not feeling like her feet were on the ground, to searing pain in her vagina almost 24 hours a day, to digestive issues to constipation and simultaneous urge incontinence … the list went on. I knew there was a good chance she’d feel worse that first visit and decided the most important thing was to help her feel validated and heard and to let her know that she may experience heightened pain after the session.
Where to start
I probed Sarah about how she wanted to feel. In many different ways she told me she wanted to feel like a person again and that she thought she would like to feel strong.
I went through my checklist: work up or down the chain, work from the centre outward, try some breathing exercises, cervical spine and jaw motions, stand, sit, lie down. In the end we tried to work on support for her SI joints. And it backfired. She ended up with aggravated SI joint pain and difficulty walking for three days.
She did come back though and she was most curious as to how I knew her pain might get worse after moving. We discussed the moving target that “PAIN” is and how so many elements factor into the cycle of pain. It was fascinating to watch her face as we talked. Helping her know the why (or some of it) behind her experience changed her perception of it. Not in words but in her demeanour it was clear she was relieved to know that in some way the pain wasn’t 100% her fault. It was like she finally had permission to be “off the hook” for her inadequacies and that they weren’t the reason for her pain.
In subsequent sessions we moved slowly, reviewed lots, tried little ad-ons to what was familiar and spent lots of time looking at anatomy books and talking. Sarah grew stronger and in her case, gross movement, working with global muscles and external landmarks helped her more than working with protocols for deep core, pelvic and SI joint exercises. She gained strength and felt empowered doing squats, hip hinges, side leans, side bridges and rotary motions for her spine.
That kind of interchange became the most important and most liberating part for Sarah. She came alive knowing that she wasn’t at fault for the way she felt. Keeping explanations simple and concrete and always contextualizing them, I made a point of helping Sarah determine references for her experience that had formerly been deemed “all in her head”.
Bedside manner is not just a “soft skill”
A year before coming to me Sarah had seen a pelvic floor physiotherapist. I was impressed to hear this until she qualified it with “and I never went back because I was terrified.” Part of what a pelvic floor physiotherapist does is work internally with the pelvic floor muscles, fascia and deep hip rotators. Fingers insert into the vagina and anus to help calm or stimulate the muscles depending on what is needed. I will never know exactly how Sarah’s pelvic treatment but she never returned because she felt unable to do what was asked, her pain increased exponentially after the fact and because she didn’t know about the internal aspect of the therapy prior to the appointment, she felt emotionally distraught and violated by the experience.
Personally I have huge respect for pelvic floor physiotherapists and have seen excellent results for a variety of clients. And, at a gut level I knew that some day Sarah would benefit greatly from someone who could work with her pelvic floor manually. Clearly a no go zone in that moment, I didn’t say a word and decided that broaching that subject would hinge on building trust first and foremost.
Corny as it sounds… What helped Sarah most while she was at Body Harmonics was being part of her solution
From the beginning Sarah had strong kinesthetic awareness and more importantly, language to express it. We talked a lot about the power of sensing and feeling and that even if all the dots didn’t connect, the ability to express her sensations in words made progress possible.
On a side note, Sarah had been told repeatedly that she “separated her mind from her body” and that this was bad. I had the polar opposite experience with her. Without prompts she would say things like “is it possible I feel my femur moving in the hip socket?” Or, “I turn to the left from a different place than when I turn to the right.”
Over the years she had learned to shut down and simply feel broken, disconnected. To me it was like the professionals she’d seen simply missed the opportunity to hear her. In many ways she guided our studio sessions because she was so able to articulate what she felt. I was grateful for her insight and clarity and loved the collaboration.
About eight months into our work together Sarah felt ready to see a pelvic floor physiotherapist again. I was delighted and thought the two approaches would compliment perfectly. Then I didn’t see Sarah for six weeks. She missed pre-booked sessions, opting to pay for them instead of cancelling in advance. When we finally spoke I found out the physiotherapist had said Pilates was the worst thing for Sarah and that she should stop immediately if she wanted to see any positive results with her pelvic and vaginal issues.
I put aside my ego and asked Sarah about her progress with her physiotherapy sessions. She confided that she felt weaker, had to spend a lot of time trying to visualize her pelvic floor and do deep breathing exercises that seemed to lead to anxiety. I did not at that moment or now judge what her physiotherapist was working on. My only question is why she wanted to take away Pilates when it was something empowering for Sarah and something of clear benefit.
Long story short, I offered to speak to Sarah’s physiotherapist to clarify the types of things we were working on and to speak about Sarah’s progress while she was at Body Harmonics. We had a lively exchange that culminated in the physiotherapist saying: “I didn’t realize there were Pilates professionals who took a movement-based approach and who knew about functional anatomy. It sounds like Sarah should resume working with you for the movement part of her recovery and I can do the manual part.” The next week Sarah was back in the studio.
For more on this, I’ll be writing another article “How to talk Pilates to health professionals” soon!
Help people tune in… in whatever way makes sense for them
There is an evolution that happens as people learn to tune it and it often starts by chasing pain. Let it be and suggest other things to focus on in addition to the pain. And remember that many people need language for “tuning in”, a map to follow and questions to ask themselves. Above all, the message needs to be, “there are no wrong sensations or feelings – there is nothing to judge. Simply sense and feel.”
Don’t give up when you and your clients face roadblocks
If you have done your best to build trust with someone expect set backs and roadblocks as part of the process. In Sarah’s case she reverted to abiding the authoritative words of another health professional who told her to stop Pilates at Body Harmonics without knowing a thing about what we were working on.
Sarah had started to trust her thoughts, sensations, experience and questions as critical to her healing process. Prior to coming to Body Harmonics she had been on the receiving end of advice, recommendations, procedures, prescriptions. She had never been invited to be an active participant in the healing process. However, this new way of being was not yet embodied enough in her experience to outweigh an authoritative voice of a health professional taking a top down approach. She got scared with her physiotherapist told her Pilates was the worst thing for her and instead of trusting her gut and all that she had learned working with me, she took the familiar root of being the patient who needs to listen to the health professional.
For whatever reason, Sarah needed me to keep reaching out and when you see that as your responsibility, no roadblock or stonewalling is too much.
Be a cheerleader for small wins and make a big deal out of them
After about 18 months, Sarah decided to work with an osteopath who specializes in pelvic floor and reproductive issues. We decided to go on hiatus and that she would continue to walk and do her home exercise routine we had built. She was in a good place physically and emotionally: the constant burning in her vagina was intermittent by then; she could walk without pain for 1.5 km; she could tolerate sexual intercourse again (after 2 years) and her SI joint pain had calmed to a low hum.
These are actually HUGE wins by anyone’s standards but because healing happens gradually over a period of time the milestones can easily be forgotten or minimized. Make it your responsibility to keep bringing attention to the changes that have happened over time. Be realistic, mention the steps forward, the set backs and the overall results. Each milestone, big or small, is significant in its own right and deserving of recognition. Most importantly, they all contribute to an improved sense of wellbeing and overall health.