Menstrual Cramps Are Common, But Not Normal

According to a study by the National Institutes of Health (NIH), 30% of women of childbearing age (18-44) and 44% of women with endometriosis experience chronic and cyclic pain. In addition, women with endometriosis are more likely to experience pain during intercourse, menstrual cramping, pain with bowel elimination, vaginal pain and pelvic-abdominal pain. The researchers suggest that physicians and providers ask about pelvic pain during routine office visits.

I have had pelvic pain and although endometriosis was ruled out with two separate exploratory laparascopies in my teens and twenties, I continued to suffer until receiving attention to the adhesions in my abdominal wall. My experience linking adhesions with menstrual cramps came after attending a visceral mobilization class, taught by a physical therapist who worked directly with Jean-Pierre Barral, a French osteopath. As physical therapists, we spent two full days practicing techniques on each other before using the techniques clinically. Several participants had adhesions and scars that have never been addressed, including me. After receiving treatment, my menstrual cycle came without the typical spotting and cramps, which was VERY unusual for me. I felt "normal" for the first time in years! My hips were loose, my back was not restricted and I could activate my deep core with ease! The effects lasted for months, until I walked into my daughter's room and slipped on the hard wood floor and landed hard on my hip. It was like a scene from a movie, only I wasn't a stunt actor. I was unable to walk without a limp and my pelvis was out of alignment. I did some self correction and treatment techniques in order to go to work that day, but still felt stiff and my body in its healing process already began to make adjustments including collagen remodeling and my next menstrual cycle was horrific! I had cramps and spotting that lasted about a week and did not improve until I called upon the help of one of my therapists. Prior to this, I had not made the connection of trauma such as falling to adhesions and menstrual cramps. It is a question I ask of all my patients since then, as falling is a trauma.

My experience is not unique. Many women with painful menstruation, or dysmenorrhea, report that cramps diminish and in some cases, resolve completely after receiving myofascial release of the deep fascia in the abdominal wall, known as visceral mobilization. My clinical and personal conclusion is that adhesions are responsible for the majority of menstrual cramps and painful periods. Can you imagine if women could have treatment instead of suffering through unproductive and canceled days off work and school? This is a public health issue and holistic therapy that addresses adhesions is not often recommended. Although common, women have learned to live with cramps and pain as if normal. The good news is that adhesions are getting more attention as studies confirm the negative impact of fascia restrictions and how fascial mobilization can help!

My other significant finding is that adhesions contribute to hip and pelvic pain and dysfunction. Many individuals who come to our clinic have adhesions with hip pain or a range of motion deficit, in addition to an asymmetrical pull on the pelvis and spine, causing back pain or sacroiliac (SI) dysfunction. We have learned from osteopaths who developed visceral mobilization techniques, that there is more fascia on the right side of the abdomen with larger organs such as the liver and therefore, more adhesions on the right side. The abdominal fascia is continuous with the hip capsule and can lock up or restrict the hip. I can usually predict that a patient will have a right hip issue, whether they are aware of it or not. If there is a surgical history, it is obvious. I am astonished at the number of women and girls who have adhesions despite not a single cut or scar. If I dig deeper into their medical history, it usually comes out that they have had digestive issues or heavy menstrual cycles or they fell on their pelvis or tailbone as a child. All of these contribute to adhesions that are silent and without obvious symptoms, or so it appears.

Common complaints related to adhesions include:

• hip pain

• buttock pain

• pelvic pain

• sciatica

• coccydynia (tailbone pain)

• sacroiliac (SI) dysfunction

• abdominal or pelvic pain

• dysmenorrhea (painful menstruation)

• dyspareunia (painful penetration)

• constipation

• psoas syndrome

• piriformis syndrome

• frequency, urgency, incontinence of urine or nocturia (night time voiding)

• infertililty

When our 12 year old daughter had a laparoscopic appendectomy, the surgeon assured us she would be back to “normal” the following week and could resume all activity. I knew better from my experience; I didn’t like that she had a surgical history that increased her risk of developing adhesions. I was shocked by the fascial restrictions limiting her right hip range of motion so extensively. She presented exactly like my pelvic pain patients, but I did not expect it in with someone so young! She had right hip flexor tightness producing clunking of her hip and severe restrictions in her organ mobility. I knew if I didn’t mobilize the adhesions, she would not only be unable to exercise comfortably, but when she started menstruating, would most likely have severe menstrual cramps.

Further, adhesions were identified in a competitive ice skater I am treating. She came in initially with severe right hip pain after falling off a horse to the point she stopped skating and was about to give up on her dream. She had traditional physical therapy, but when the issues went unresolved for over six months, she decided to seek the help of a pelvic floor therapist (me)! When I probed further into her past, she reported having debilitating menstrual cramps even before falling off the horse. Unexpectedly, her fascia was more restricted than some of my postsurgical patients who have had abdominal surgery! (surgery is an obvious risk factor for adhesions). I have determined her adhesions and right hip dysfunction to be related to the frequent falls on the ice since she was a child. I am happy to report she went back to full competition and her menstrual cramps subsided significantly. She continued to see me for maintenance during skating season, since repetitive falls on the ice put her at risk for hip tightness and adhesions.

You might be asking yourself, what is wrong with scar tissue and why can’t I just have it surgically removed? The problem with surgery is that adhesions or collagen cross-links develop in the normal process of healing from surgery. Fascia has nociceptors or pain fibers so pain can be experienced when the fascia is under stretch or tension. The only way to truly mobilize fascia is to physically load the tissue in all three fascial planes, either through visceral mobilization or fascia rolling with soft tools, not hard objects like lacrosse balls or foam rollers, according to the latest evidence. It is important to note that scar tissue will not go away on its own! Restoring fascial mobility is important for the core to function as it was designed to. The fascia around the organs is continuous with the fascia that envelopes the muscles in the lumpopelvic region, including the thighs. A muscle contraction or workout can actually reproduce the symptoms or tug on the fascia more, perpetuating the problem, hence the “catch 22” that so many individuals are in.

There is not a lot of published research in the area of natural treatment for menstrual cramps. However, some studies have shown the benefit of vacuum cupping to relieve symptoms. In our clinic, we use cupping along with a manual therapy technique known as visceral mobilization, a form of myofascial release around deeper structures in the abdomen, hips and pelvis. Visceral mobilization is laborious and time consuming, requiring one-on-one attention and can only be performed by a highly skilled provider who has experience. It can be performed on the abdomen, thighs and even internally (vaginally or rectally) to address restrictions around the tailbone, urethra or pelvic floor. Currently, physical therapists are one of the only providers that can perform internal treatment, although this varies from state to state. At Healthy Core, we will also educate you in self mobilizating techniques to keep your fascia healthy in the long term.

Debilitating menstrual cramps are not normal and you should not have to live with pain that disrupts your daily life. There is help and expert treatment that can reduce and even eliminate your menstrual cramps. Do your research and ask questions to ensure you will be in good hands (pun intended). Contact us at (330)528-0034 to schedule a free virtual appointment with one of our pelvic health physical therapists.

*Source: "Pelvic pain may be common among reproductive-age females", nih.gov.news, August 2015.

Written by: Janine Laughlin, PT