How Do We Know When To Prioritize the Nervous System in Pelvic Health?

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Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

• Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
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• Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!

Transcript

Intro New and seasoned OTs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box OTs, we are Pelvic health OTs. I'm your host Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal So by now it is no secret that I'm just a little bit obsessed with the nervous system. I truly believe that if we're working with the pelvic floor, we are working with the nervous system. It's definitely one of the reasons why I created the first and only trauma informed Pelvic health certification with my amazing colleague, Laura DeRosa. There is such a need for us to immerse ourselves in how we can actually serve our clients best by being a trauma informed nervous system. Informed Pelvic health Therapist. However, our clients are coming to us so they can feel relief from their pelvic floor concerns. Has it ever felt like a bit of a bait and switch to then bring up nervous system regulation? If so, I totally get it. I totally get it. I struggled with this for years in my private practice in New York City, especially. The more I got exposed to nervous system regulation and the importance of feeling safe in our body. In order for any healing to occur. I mean, look, our clients may have assumptions around what the session is going to be like, right? And so I encourage you to take every option to share with your clients how you work. For example, usually or most often they find you or they're looking at your web page, Right? And so my question for you is, does your Web page represent your unique approach? Does your Web page speak about the nervous system? Give your client some sense that you are going to go there and that you look at them for the whole person, that they are through a bio psychosocial approach? And it's simple language that can give them that information. Does the person who answers the call from a potential client, even if it's, you know, how to talk about what sessions are like and what your approach is? Does your intake paperwork represent you well? These are all three distinct opportunities to share with your ideal client that your approach may be different. And then in the session you have with them, how do you decide when to bring in nervous system regulation tools? How do you prioritize that? One of the ways that I like to choose whether we focus on nervous system regulation tools or to prioritize dipping into some of your own unique tools, such as, you know, hands on techniques, movement approaches, behavioral approaches is by giving our clients the central sensitization inventory or the CSI to fill out with their intake paperwork. First of all, it does send a very clear signal that you take a biopsychosocial approach to therapy because and by the way, if you haven't seen the CFI, Google it when you get a chance because you're going to know immediately and your client's going to know immediately that the questions that it's asking, definitely, definitely let them know you are not a conventional therapist. It also helps you to triage what I'm going to prioritize with my clients because here's the thing. Their symptoms alone often don't give us enough information. I going to take a step back and quickly define central sensitization before we go any further, because I think it's important to have a solid understanding. So when someone is experiencing central sensitization, a light touch might feel like searing pain or stabbing. A toll could elicit pain throughout the entire body. A person experiencing central sensitization can undergo really extensive medical investigation. Perhaps received multiple medication prescriptions, has had surgery, has seen numerous specialists in both conventional and alternative medicine, and ultimately ends up suffering for months or even years without finding relief from their symptoms. And I'm course, I bet along that journey they have felt a little bit crazy because A no one can find a solution and B, they don't know where else to turn. And I think this is even more relevant for those of us in Pelvic health. I recently came across a study that basically talked about pelvic floor muscle tenderness and how it's often associated with central sensitization. This article that I found was published in the Brazilian Journal of Physical Therapy, and basically it shared that pelvic floor muscle tenderness on digital palpation, confirmed convergent validity with central sensitization inventory scores, basically telling us that the client had central pain mechanisms at play. That was their primary reason for their pelvic floor muscle tenderness. So I really believe that clinicians may need to consider the role of central pain mechanisms in their clinical decision making when treating pelvic floor muscle dysfunction. Now, the CSI is a validated instrument that is used to measure nervous system sensitivity. And this is really important because when an acute pain is not treated effectively, it can develop into central sensitization. So this will help you start to triage whether your client's concerns would benefit from a nervous system first approach versus a more traditional pelvic floor therapy approach. So giving this assessment at the first session or during the evaluation really does help you determine if this client is centrally sensitized. Is that the reason for their pelvic floor muscle concerns? As Sara Sidner, one of my guests on right here in this podcast, has shared with us in previous episodes. The sensory system is the fast track to safety. So what a great way to help them start to gain some insight into their sensory preferences by giving them a sensory profile inventory to do as well. Right? It's also helpful in increasing intersection and sensory checklists provide a way to explore and identify our specific sensory preferences and needs. These checklists, they offer a range of sensory options organized by different categories, allowing us to really reflect on the ones that resonate with us most. So you start with giving them the CSI. If you determine they're more in the moderate to severe category after you score it, I love to then give them a sensory checklist. It's usually organized and categorized by the different senses, and it does provide a starting point to identifying what sensory experiences and preferences can enhance their regulation, because when they feel more regulated in their sensory system. So many other parts to their experience start to fall in place. They can start changing their environment right away. They can start speaking up for their needs there. Perhaps they're working in a really loud office and they tend to get overwhelmed by loud noises. Being able to advocate for themselves to say, Hey, I need to be able to work in a private space can just be that thing that helps them in their full time job start to feel more regulated. Now, I innately believe that everyone can benefit from nervous system regulation tools, despite whether or not they have central sensitization. Incorporate them in. Sprinkle them in like spices throughout your session versus starting with them. And always bring your client into your rationale and your approach. This will help create buy in and increase intrinsic motivation. 

Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health podcast.