As some of you may know, I’m doing a lot of work at present to free up my pelvic area from adhesions and tightness caused by pulled fascia and a tight pelvic floor, which in physio speak is a hypertonic pelvic floor.

So I thought  this would be a great time to talk about some strategies you can bring into your daily life to help loosen adhesions and a frozen pelvis.

Transcript:

I’ve talked about adhesions and fascia before, but let’s do a quick recap of what adhesions and fascia are. 

So fascia is a thin sheet of tissue made from collagen that sits beneath your skin and holds your organs and muscles in place. It also surrounds all the organs, nerves, blood vessels, etc.

Fascia surrounding the body is like a bed sheet, if you pinch it or one end, the rest will wrinkle. So what can happen when we’ve had surgery is that these incisions create puckering and scarring in the fascia, which ends up tightening the fascia and pulling it in other directions. Fascia can also become distorted from inflammation, injuries and muscular problems like pelvic floor dysfunction.

Adhesions are a form of scar tissue. They are web-like structures and bands of collagen that grow in response to injury and trauma, to ‘knit’ back together a wounded area and as part of the healing process from infection and inflammation. Collagen strands bond together to protect the damaged area to allow healing to occur in a safe and isolated environment, and if an infection is present, they protect the rest of the body by preventing the spread. 

Adhesions occur in nearly all cases of abdominal surgery, the results vary from study to study but one large and long study found that between 55% to 100% of women who had pelvic surgery developed adhesions, and up to 90% of people who had major abdominal surgery - so something like a caesarean - developed adhesions. So, if you’ve had one or more surgeries for endo, it’s very likely that you have some adhesions. 

Adhesions can also form from inflammation, which we know occurs in those of us with endo due to the lesions and can occur in those of us with SIBO, because the body sees it as an infection. Again, as you probably know by now, research has shown that up to 80% of us with endo may have SIBO, so this could be an additional cause of your adhesions and frozen pelvis. It’s also worth noting here that adhesions can actually cause SIBO too, because they prevent the normal flow of gut. 

 So, what can we do about it? Thankfully, there are numerous ways to loosen adhesions and free up a frozen pelvis, and as a result, lower the pain and other challenges associated with them. So let’s dive in to my top 8 strategies. This list isn’t exhaustive by any means, and you don’t need to do them all! Just pick those that feel the most helpful for you and suit your lifestyle and budget. 

 

1. Foam Rolling

Number one is foam rolling, which is an effective and affordable at home strategy which you can use every day if you’d like to! With foam rolling, we’re really looking at loosening the fascia rather than working on the adhesions directly. As I said earlier, fascia can get tight, pulled, puckered, and wrinkled, and if it’s experiencing it in one place, it can affect other areas in the body. 

Foam rolling helps to release a distorted fascia and is when we literally use a long foam cylinder to roll back and forth across various areas of our body. With foam rolling for endo or other pelvic pain issues, we’re not just rolling back and forth on our pelvis, we’re rolling across our hips, bums, back, upper back and legs. 

In the show notes I have linked to videos on how to do this, by physiotherapist Dr. Nicole Cozean.

You can order foam rollers from Amazon for about £11 and in the beginning, I would suggest starting gently with a soft roller that’s smooth, especially if you’ve experiencing a lot of pain.

Now with all of these methods, listen to your body. Some discomfort is normal when we’re working with releasing facia and adhesions, but if it’s really painful, ease up and go lightly or if it doesn’t feel right at all, appreciate that this may not be the right approach for you at first. 

In an ideal world, we’d use these strategies under the guidance of a physiotherapist, but I know that’s not always an affordable option for everyone, so carefully watch the tutorials and if you’d like to do some further research to be really comfortable, I suggest reading Know Your Endo by Jessica Murnane, as she interviews Heba Shaheed, who I’ve had on the podcast before as well, and they talk about foam rolling extensively in the book.

 

2.   Visceral Manipulation 

Next up is visceral manipulation, which honestly, if you can afford it, I really believe is worth a try! Visceral manipulation is a form of organ massage which was designed by physiotherapist Jean-Pierre Barral with the particular intention to free up organs from adhesions and other structural issues that are restricting them. Organs are supposed to be able to expand and move gently as our body moves, and glide smoothly over muscles and nerves as we go about our day. When adhesions or some kind of other structural problem is keeping them stuck, that’s when we can experience pain and organ dysfunction. 

Visceral manipulation is very effective for releasing these organs and loosening adhesions and I’ve seen some incredible results with my clients. What I will caution here is that it can feel quite intense and aggressive at times, and if your pelvis is very stuck, you may be better off starting more gently with a different type of massage like some kind of womb massage such as the one I’m going to suggest in the next point. 

If you’re going to try visceral manipulation, make sure you’re comfortable with your therapist and be very clear with them about the pain or discomfort you experience within the session, so they know when to ease up or when to stop working on an area if it feels too much. I can tell you from personal experience that gritting your teeth and baring it does not always end well! 

Other greats forms of organ/abdominal massage include Mercier Therapy and Clear Passage. Clear Passage is really the holy grail with lots of research behind it for endo and SIBO, but it’s incredibly expensive, so you may be better off trying the other techniques first. However, I do highly recommend it if you can afford it! 

I’ve linked in the show notes how to find practitioners for all of these that I’ve just mentioned.

 

3.  Arvigo Massage

Third on our list is Arvigo Therapy, which is a form of abdominal massage that is much more gentle than the ones I just mentioned previously. The benefit of Arvigo Therapy is that you only need one session, which can be done over Zoom, to learn it from a therapist, and then you can just practice it daily at home every evening. 

Now in my conversation with Tara Ghosh, who is an Arvigo Therapist and actually taught me personally, she shares that whilst Arvigo Therapy doesn’t directly loosen adhesions like visceral manipulation does, it does encourage circulation to the area and helps to relax the muscles and organs in the area, which can then have the indirect effect of loosening a frozen pelvis.

However, I have seen some articles by therapists claiming it can loosen adhesions, perhaps they mean indirectly or perhaps there are differing opinions, but you can listen to the interview with Tara in episode 127 to learn more. 

I highly recommend working with Tara because she’s just the loveliest person, and you can reach out to her directly via the details she shared in the interview (and I’ll put her Instagram in the show notes) but if you want to find another therapist, I’ve linked to the directory in the show notes. I’m pretty sure Tara sees clients from all over the world.

 

4.  Breaking up your time sitting down

Number four is all about breaking up the time you spend sitting down at your desk, specifically by using a standing desk and by taking regular breaks. 

Now, there’s been a lot of debate and controversy over this in the past few days. You may have seen in my stories I posted about my standing desk, which I use at varying intervals during the day, alternating between sitting and standing. I do this because my own physios and my colleagues, many of who are pelvic floor physios and my pelvic pain training, have always taught me that sitting for long periods of time without a break can worsen pelvic floor dysfunction symptoms through shortening and weaking the muscles in the area and restricting blood flow. 

My understanding was that sitting down for long periods of time without breaks shortens the muscles in the front of our hips and pelvis, which means when we stand, walk or do anything else that isn’t sitting, we have restricted movement, tension, tightness and are more likely to experience pain. And if we have adhesions in the area, sitting down for long periods of time lessens the opportunity to stretch them and release them, making their hold on our organs stronger and tighter.

However, I had quite an strongly worded message form a physio informing me that this simply isn’t true and that muscles don’t shorten or lengthen, which absolutely threw me. So I went away and spoke to some colleagues and they all said that yes, muscles shorten and that sitting for prolonged periods of time causes this and can worsen pelvic floor issues. So I was quite confused! 

I wanted to dig a bit deeper to understand why this physio said they don’t and I think what it boils down to is terminology, and oversimplification to make physio language easy for patients to understand. From what I gather through my own research and conversations is that the muscles don’t actually change length, but they lose their ability to stretch so they become restricted. Here’s how one of the PTs I spoke to put it. 

Martha Spalding, Circle of Health Physical Therapy, CA: “Muscle length stays the same so no, they don’t elongate but they can be contracted, weak in both eccentric and concentric contractions, strained, sprained, torn and severed. Ligaments can be overstretched and they can have laxity, which is common during pregnancy and some people just have genetic ligamentous laxity. Prolonged sitting is stressful on the entire spine and pelvic floor as it is a prolonged static position in weight bearing on the pelvis. The pelvis is generally rotated posteriorly. Depending on the muscles, you can determine the stress component in the sitting position. This prolonged position does impact the fascial slings which can become restricted.”

So to help understand this better, eccentric contraction means when muscle length increases from tension during a movement, like a stretch. In contrast, concentric contraction is when a muscle shortens and tenses in order to bear weight and counteract resistance, so think about lifting a dumbbell in a bicep curl. So in short, the ability to perform these contractions can become weaker.

Laxity is defined as ‘looseness of muscle’, but I wouldn’t say this would be occurring here, it’s just an example she’s providing to demonstrate how muscles change.  

After these conversations, the physio who originally contacted me also replied to say that sitting all day without any movement would cause joint and muscle stiffness, but she was also very clear to state that there are no detrimental effects on the pelvis with sitting. 

So clearly there are some cross overs here, but also some differing of opinions. As I’m not a physio, I can’t really give you a definite answer so I’m providing you with the information I have gained and also what I have learned in my own time in training and working with physios. To my knowledge, yes, sitting without breaks and movement can have an impact, but I’ll leave it to you to decide. 

My practice is to alternate between sitting and standing throughout the day, as I feel comfortable. When I start to feel tired and my legs need a break, I sit down, and when I feel like I’ve been sitting for long enough, I stand. And every 30 minutes to an hour of sitting at my desk working, I get up and do some form of movement, usually it’s a couple of minutes of rebounding, stretching, walking around the house or a few minutes of exercise and literally it’s just like 3 to 5 minutes.

Now I appreciate that if you have chronic pelvic pain and a weak core from pelvic floor dysfunction and from living with chronic pain, that using a standing desk can be difficult to do. So I suggest starting when only you’re ready with smaller periods of time to build up the strength in the core and to also have a cushioned mat under your feet or cushioned slippers to soften the impact. If you need to first spend some time just practicing taking breaks with gentle movement to build up your strength, or if you need to do some physio first or work on pain alleviation, do that first. This is just an option and you have to do what feels right for you – don’t rush into using a standing desk just because I’ve talked about it today, make sure it’s the right choice for you. 

If you do buy a standing desk, you should also be swapping your positions when you’re standing up, so you’re not just constantly bearing down on your joints. I’ve linked to a helpful article in the show notes on different positions to adopt and how to stand in a healthy way when using a standing desk.

There’s now mounting information on the health risks of sitting for long periods of time without breaks or movement, including heightened inflammation, which you guys know is super important for us to keep on top of, so if you’re employed by a company, they really shouldn’t be surprised by you asking for a standing desk. And in fact, it should fall under reasonable adjustments to help make you feel more comfortable when living with endometriosis. If you have trouble getting your company to agree, I suggest having a listen to my interviews with Vickie Williams and Clare from See Her Thrive, which are both about your rights as an employee with endometriosis in the workplace. If you’re curious to learn more about the health considerations and research behind prolonged sitting, I’ve linked to a couple of articles in the show notes.

If you’re self-employed like I am, you can easily order a standing desk online. Prices range dramatically from whole desks which adjust to become either a seated or standing desk at about £1000 or cardboard desk toppers that you just put on top of your desk, and that you rest your keyboard and computer or laptop on, and these are around £15. 

If you’re not quite ready for a standin