I have tendonopathy which limits my ability to do some stretches, will I still be able to do the Overcome Pelvic Pain program?
By: Dr. Brianne Grogan, PT, DPT
The short answer, is "yes!" But allow me to go into more detail. Let's just use a high hamstring tendinopathy as an example in my response.
As you know, a high hamstring tendinopathy occurs where the proximal hamstring tendons connect the hamstring muscles to the sit bone (ischial tuberosity).
The pelvic floor muscles are situated between the sitting bones, and some of the pelvic floor muscles attach directly to the sitting bones themselves. Therefore, the stretches we do in Overcome Pelvic Pain WILL be releasing the region associated with your tendinopathy as well... which is a good thing! You can work on your pelvic tension as well as the tendinopathy at the same time.
To avoid aggravating your tendinopathy as you move through Overcome, keep reading.
Conservative treatments for tendinopathy include rest (taking a break from activities that include a lot of repetitive movement that can aggravate the tendinopathy, such as biking, running, etc), ice and heat (I'll explain more about that below), massage, stretching, gentle strengthening, and reducing inflammation. These items are covered in the Overcome program.
Re: stretching, lack of flexibility is a risk factor for chronic high hamstring tendinopathy, and so the stretching exercises in Overcome will be great for you. However, I encourage you to 1) breathe deeply into the stretches, 2) don't push too far/too fast, and 3) use props to modify and ease into the stretches as needed. By props I mean yoga block(s), a yoga strap or a belt, etc. Be aware that it can take time -- sometimes months -- to notice improvement... slow and steady is key here.
Re: strengthening, the Overcome program gradually rebuilds strength in the surrounding hip and core muscles in Month 2, and hones in more specifically on the pelvic floor in Month 3, always with an emphasis on letting go between contractions. For rehab exercises specific to your tendinopathy, consult with a PT in your area. As long as you ensure proper form/technique during Month 2 and 3 of Overcome -- and as long as you listen to your body -- there should be no concerns about moves that conflict with your hamstring rehab protocol.
Re: massage, the trigger point release videos in Overcome will be helpful for you, but please avoid irritating any points that are in the high hamstring area by pressing too hard. You can use gentle pressure, but "less is more" when working with tendinopathy. Increasing circulation via gentle massage is good, but pushing too hard and irritating the tissues will create an unhealthy rebound effect that creates more tension and more irritation/inflammation.
Re: reducing inflammation (which is key for any type of chronic inflammatory condition such as high hamstring tendinopathy), the nutrition information in Overcome will be helpful for you. What's going on in the gut impacts the entire body, and eliminating inflammatory foods has been profoundly helpful for many of our clients.
You might also consider using hot and cold to help reduce pain and inflammation. Ice (i.e. cold packs, ice baths, and ice massage) can be applied for 10-15 minutes following activity and/or every 3-4 hours throughout the day. You can also use heat (i.e. hot water bottle, warm compress, or heating pad) to help loosen fibrotic or tight tissue, followed by stretching. Apply the ice and/or hot packs directly over the area of pain. Protect with a cloth (as needed) to avoid injury to to excessive exposure to the extreme temps.
If you have the time and inclination, you could consider 10-15 minutes of heat, followed by your Overcome stretches, followed by 10-15 minutes of icing.