Circadian Rhythms & Pelvic Pain: What OTs Need to Know

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Transcript

Welcome to the OTs and Pelvic Health Podcast. I am really excited into light, mitochondria, and bioharmonizing our pelvic health clients for better pelvic health outcomes. So this is kind of a personal podcast episode for me because I actually have began a deep dive about a year ago into how light really affects my nervous system.

And so I'm excited to bring some of this research to you today, how it can actually shift things in your own life, your family's life, your client's life, and by the way, beyond pelvic health. It'll definitely impact their pelvic health, but it's gonna impact that whole person health in such an incredible way. This conversation is really inspired by someone I deeply admire.

Her name is Dr. Alexis Cohen, who is really obsessed with bioharmonizing through therapy. And when I say obsessed, I mean, she literally sits outside on grass every morning at sunrise working. And I'm gonna explain why her approach is backed by incredible serious science and actually could be the missing piece in your client's healing puzzle.

INTRO

So before we dive deep, let's talk about why Dr. Cohen uses this term bioharmonizing.

I think in the past, we've heard the term biohacking. I've never been a big fan of that. And as she puts it, we're not trying to hack our biology.

We're trying to find out how our biology is working and work with that instead of trying to, I don't know, cut corners or get to the end result before putting in the work. And I think this mindset shift is crucial for us as public health practitioners because we're constantly looking for ways to optimize our clients' outcomes. But what if there's been a foundational piece that we just haven't learned yet? And so that's where I'm gonna refer to it as something I've heard Dr. Cohen say, which is the light biology revolution.

Basically, what has caught my attention in this whole light biology conversation is that if we get light right, it's going to improve our health in literally every arena of health, every organ system, our cognition, our mood, our relationship quality, and literally our ability to critically think. So think about your public health clients for a moment. How many of them struggle with things like chronic pain and inflammation, digestive issues, hormonal imbalances, sleep disorders, mood issues, anxiety, even poor wound healing? And literally, my friends, what if I were to say that addressing their light environment could support all of these areas simultaneously? 

 So I wanna talk about the three pillars of light, and I want you to think about them as essential nutrients. The first is red and infrared light.

Now, these are longer wavelengths that can penetrate multiple centimeters into the body and directly stimulate mitochondrial function.

They interact with something called cytochrome C oxase in the electron transport chain, which basically directly boosts ATP production, okay? So that's red and infrared light. Second is blue light. This is a shorter wavelength light that's highest around noon.

It's detected by receptors on our skin, our corneas, our retinas, and it basically tells our master circadian clock what time it is. The third wavelength that I wanna talk about is UV light. This is probably the most important one, but definitely the most, I don't know, demonized, I guess.

UVA and UVB light have profound effects on our biology that actually go well beyond vitamin D production, and it's very misunderstood. So why does any of this matter for pelvic health practice? The modern environment that most of our clients live in, and you probably listening to this and me a year ago, is consistent of waking up under artificial lights, spending our days in fluorescent lit offices, staring at screens, and never really getting outside until maybe the weekend. And when we do go outside, we're probably wearing sunglasses.

And here's the problem with modern efficient light sources. I'm talking those LEDs, I'm talking those fluorescents, those device screens. They're highly enriched in blue light and completely devoid of red and infrared.

And because of that, we're essentially creating a massive imbalance with light. And this is where it gets really interesting for us healthcare providers. Mitochondria are the powerhouse of ourselves, and they're incredibly sensitive to light.

All right, I wanna share a real example from my practice that perfectly illustrates why any of this matters. So I had a client named Sarah who came in, she had it for over two years.

She was a 34-year-old marketing executive who worked launder fluorescent lights, spent most of her day staring at multiple computer screens and rarely saw daylight except through her office window. She tried traditional pelvic floor therapy, medications, dietary changes, stress management techniques. And while some of these interventions helped her, it was always temporary.

Nothing really gave her that lasting relief. Her pain levels were consistently six out of seven, out of 10. Her sleep was really disrupted.

She was lucky if she got five hours and she was really developing anxiety around her symptoms. So during our intake, I noticed a couple red flags from a light biology perspective. First of all, she woke up to artificial light and immediately checked her phone.

She would be on her phone for a good five minutes before she ever got out of bed. The phone has so much blue light and that's what we don't want right when we wake up. She worked about a 10 to 11 hour shift under LED office lighting that flickered.

She wore sunglasses religiously when outside, even on cloudy days. She had evening screen time until bedtime and her bedroom had light pollution from street lights and electronics. So I decided to integrate light optimization into our sessions alongside traditional pelvic health interventions.

And here's what we did. Week one to two, I asked Sarah to spend six minutes outside every morning within an hour of waking without sunglasses. She didn't think she's gonna have time to do it, but she agreed to try.

And by day six, she noticed her energy levels were more stable through the morning specifically. I'll take it, right? Week three to four, we implemented an evening light hygiene. So we added blue light blocking glasses for her evening screen time.

We switched her bedroom lighting to red bulbs and she reported falling asleep 20 to 30 minutes faster within a week. Week five to eight, we started into red light integration. So I introduced red light therapy sessions during our treatment appointments.

I used a company by the name of Boncharge who I personally use at home. And we put a panel positioned over her pelvic region during our sessions together, especially during abdominal massage because she had an unplanned C-section. Sarah started noticing that her pain levels were consistently lower for about 24 to 48 hours after these sessions compared to what she felt like before the red light panel got introduced.

Weeks nine to 12, this is where we shifted things even more. She began taking red light, She completely eliminated artificial light after 8 p.m. I'm gonna tell you, friends, the results were remarkable. By week eight, Sarah's pain levels had dropped to 10.

By week 12, she was having pain-free days for the first time in two years. But what was most striking was her anxiety decreased and her energy levels became more consistent throughout the day. And I remember she told me later on, after discharge, you know what, Lindsey? I literally never realized how much my environment was working against my healing.

The light changes felt so simple, but they seemed to unlock everything else we were doing in therapy. And I thought that was so beautiful. It was just said so succinctly and it was my hope for her.

And I love that she saw that. So this case really illustrates how modern environment of our clients creates a massive imbalance, right? They wake up under artificial lights. They spend their days in fluorescent lit offices, staring at screens.

They rarely get outside. And all of these, quote unquote, energy efficient light sources, LEDs, fluorescents, device screens are highly enriched in that blue light and completely devoid of red and infrared light. We're essentially creating a chronic state of mitochondrial dysfunction.

Dr. Cohen explained something fascinating. When you eat food, your mitochondria don't actually see carbohydrates, fats, and proteins. They see electrons.

And the whole purpose of eating is to extract electrons from nutrients so they can enter the electronic transport chain and support ATP production. But here's the kicker. You can also get electrons from red and infrared light, grounding, which is basically walking on the earth, specifically barefoot if you could, and sunlight interacting with the melanin in your skin.

And so if you think about this in the context of your clients who are dealing with chronic fatigue, fibromyalgia, persistent pelvic pain, what if part of their healing actually involved feeding their cells with light? So how do we translate this into actionable advice for our public health clients? Okay, here are some practical recommendation. First up, morning light exposure.

Encourage your clients and you to get outside within the first hour of waking, even if it's just for 10 minutes. When you do this, morning light helps to optimize your cortisol rhythms, it supports circadian biology, it begins the process of melanin production, and it really stimulates alertness and focus. If you can't get outside, you can Google full spectrum light bulbs, even a red light panel can help, but natural sunlight is always the best.

Now, let's talk in evening light hygiene, okay? Evening light hygiene. So this is crucial for anyone who is struggling with sleep issues, and that, I'm even speaking to you, not just your clients, and this is basically a huge amount of our clients, a huge percentage of our population in general, and a big contributor to this is blue light because blue light in the evening from screens, from LEDs suppresses melatonin production, and so some practical recommendations to kind of get away from some of that blue light at night is switching to red or amber lighting two to three hours before bedtime using blue blocking glasses if you have to use screens, consider red light bulbs for evening use in the bathroom and definitely in the bedroom, and encouraging complete darkness for sleep.

I'm talking blackout curtains and eye masks. Now, these are the things that I actually did right away after studying with Dr. Cohen. Basically, it's exactly what I just shared with you.

When I wake up, I actually walk my dog for about 10 to 15 minutes, and I will stand on my lawn barefoot when we get back, so I'm getting that grounding, and I got that walk-in and that exposure to that morning light. Definitely helps me sleep better, I noticed. The second thing I did about a week later is you're gonna probably find this super weird, but I literally do have red light bulbs in my bedroom, and I only have those on.

That is signaling to your body it's a wind-down period. It's similar to the hues of sunset, and that really helps prepare your brain for sleep. I definitely don't have any devices in my bedroom.

I am not exposing myself to as little of that blue light as possible, and then the most black we can make our room is going to be better because it's another signal to the brain that it's time for rest. So especially now, I'm recording this episode at springtime. We're starting to get more light earlier in the day, and that's really when those blackout curtains or eye masks are important because you want complete darkness.

Even something as little as a night light actually shifts this whole dynamic, and there's a connection there actually with increased rate of diabetes, type 2 diabetes, if you have a little bit of light on when you're going to bed at night. So, I mean, it's just so important, and those shifts have made such a difference for me.

For our clients dealing with chronic pelvic pain, endometriosis, or even things like post-surgical healing, the anti-inflammatory effect of proper light exposure is actually huge because red and infrared light therapy have been shown to reduce inflammatory markers, accelerate tissue healing, and it definitely improves blood flow and circulation, and it supports mitochondrial repair. UVA light helps with nitric oxide production as well, which is essential for proper blood vessel dilation and tissue perfusion, and this is crucial for anyone healing in the pelvic area.

There's also a huge impact on hormonal health and fertility because something called leptin, L-E-P-T-I-N, is regulated also by light exposure, and it's actually responsible for initiating puberty in girls and plays a major role in the hypothalamic pituitary axis, and research shows connections between proper light exposure and fertility outcomes, mood stability during hormonal transitions, sex hormone production, and nutrition. So immediately, how many of my clients have those issues? Probably at least like 90% of them, and how if we optimize their light environment, what a fun intervention to support everything else we do. And the thing I love about this is it's one and done, right? Like if you make the decision to not watch TV at night or to wear the blue blocking glasses, if you make the decision to put in red lights, if you make the decision to wake up in the morning and go for that morning walk and expose your eyes to that, you're not adding anything to your day, right? Like you're actually optimizing your environment.

Okay, maybe getting outside and walking first thing is adding something to your to-do list, but those other things I mentioned, they're just shifts in your environment that already completely change the environment in such a way that just optimizes you for healing. 

Okay, now you might be thinking like, how do I add questions in my assessment to get to this? Right, none of our outcome measures, none of our intake forms talk about this. So I'm just gonna mention a couple of questions that I started asking my clients probably about six months ago, because I got into this a year ago.

I personally wanted to see the shifts in my own life before I started adding it into my client's health. And so about six months ago, some of the assessment questions that I was adding in are things like how much time do you spend outdoors daily? What's your morning routine regarding light exposure? Do you wear sunglasses regularly when you're outside? What's your evening screen time and lighting situation? How do you rate your energy levels throughout the day? And then I would basically give them a basic light hygiene protocol. If they can, 10 or so minutes of outdoor light right when they wake up.

If they can, at noon, get brief sun exposure without sunglasses, right? Just 10 minutes because the biomarkers are the morning, the midday and the evening sun, right? So we want that light right when we wake up, we want that mid day light to signal to our brain that it's halfway through the day. And then we want that afternoon sunset light to signal that it's time to go to bed. If they can't do the evening routine, I'm asking them to switch to red or amber light in their house.

And then at nighttime, complete darkness for sleep, right? Now, if a client wants to take that a step further, I might be talking about red light therapies at that point. So maybe adding red light panels to the client's home or even your treatment space as a pelvic health OT, getting about 15 minutes of red light exposure before meals to really improve the glucose metabolism. You could use red light during your manual therapy sessions, combining with all your other pelvic floor exercises really do lead to better recovery.

Now, when I start talking about this with my clients, one of the things that came up pretty quickly was my client's concern around safety concerns over skin cancer. And Dr. Cohen has shared some really eye-opening statistics, which is sun exposure prevents cancers that have death rates of 20 to 65% while potentially causing cancers with a 0.3% death rate. Okay? The other thing is the key is building what she calls a solar callus, which basically means gradually increasing exposure to build that melanin without burning.

And for most clients, it just means starting with 10 or 15 minutes of mid day sun and slowly increasing response. What I personally find so compelling about this whole topic is how it connects so many aspects of health that I think we see fragment health clients, right? In sleep issues separately from pain, separately from mood, separately from hormone problems, we have a foundational intervention that can support all of these systems simultaneously, right? We spend so much time as a society and money on supplements, right? Manual therapy techniques, sophisticated exercise programs. But what if the missing piece is as simple as helping our clients optimize their relationship with light? So I recommend starting really small with your clients, pick one or two who are interested in lifestyle interventions and begin with basic light hygiene recommendations.

Track their sleep quality, their energy levels, their pain scores for like four to six weeks. And then after they choose one or two simple things, check back in with them after those four to six weeks. Ask them the same questions, right? How is their energy? How is their cognitive function, their sleep quality, their energy levels, their pain scores? And together you guys will see what kind of impact these shifts have made.

I'll also ask you to consider your own environment, right? Because we have to take care of you as well. Is there any choices of light you can add into your office? Can you get away from those LED lights, specifically the ones that flicker? So flickering actually signalizes to your nervous system to be in a fight or flight state. And how do you know if your lights flicker? Grab your phone, turn it on to slow-mo and record your light source for about 10 seconds.

If when you play it back, you see flickering, that is like the one action I very much feel passionate about you changing or your clients changing today. Because that flicker is adding so much disruption to your base level of nervous system. 

Okay, I really think that this intersection of light biology and pelvic health is like an exciting frontier to the really complex multi-system issues our clients are facing.

And there's a common thread here and that is disrupted light exposure patterns that affect everything from cellular energy production to hormone regulation. So adding this foundational layer could really enhance everything else we do with our clients. And when their mitochondria are functioning optimally, when their circadian rhythms are synchronized and their stress response is balanced, think about how all the other interventions become more effective.

Try the interventions yourself, observe the effects, consider how they may help your client. The beauty of light-based interventions is that they're safe, they're inexpensive and they're really natural. As we continue to evolve as pelvic health OTs, integrating insights from fields like mitochondrial medicine will only make us more effective and well-rounded, right? Our clients are looking for those holistic approaches that address root causes, not just symptoms.

And light therapy and circadian optimization just may be the missing piece that many of them have been searching for. 

I'd love to hear about how your experiences go if you start implementing any of these strategies until learning, keep growing and keep trying to achieve their best outcomes possible.