Endometriosis affects 14% of females and those assigned female at birth, but is really only recently starting to get the air-time it deserves. With awareness growing, more research is being done and we are gaining knowledge around the pathophysiology and treatment strategies available. It is exciting to see the progress in this space and the validation that women who have struggled with the symptoms of endometriosis are starting to experience.
Endometriosis is a condition where cells that are similar to the endometrial lining of the uterus, grow elsewhere in the pelvic cavity. These cells can grow on other organs, such as the bladder, bowel and ovaries and cause inflammation, adhesions and scar tissue to form. Some of the symptoms of endometriosis are abdominal pain and bloating, nausea, fatigue, painful intercourse, changes to bladder and bowel actions, changes to your menstrual cycle and depression or anxiety. There can also be musculoskeletal symptoms, including hypertonic (overactive pelvic floor), tightness and pain around the hips and lower back, jaw clenching and neck pain/headaches as a result of our body’s natural protective mechanisms.
When your body is in pain, your brain perceives that there is a threat to your tissues and creates tension in some muscles and causes you to adopt postures (such as crossing your legs, curling forward) that can cause even more tightness and pain in your muscles and joints. Your brain also keeps you in fight, flight or freeze mode, while you are in pain to give you the best chance of getting yourself out of danger and back to safety. This is a handy system when needed, but functioning in this state for longer periods of time can be detrimental to our overall health.
While exercise will not change what is happening to the cells within your pelvic region, we can make some really effective changes to your musculoskeletal and nervous systems. This can help to relieve some of the symptoms, improve your mood, boost your energy and have a positive impact on your mental health.
Pilates in particular can be very beneficial for anyone with endometriosis, as long as it is done correctly and taught by someone who understands the condition. Large group or reformer Pilates can actually exacerbate some symptoms by focusing on engaging the pelvic floor and deep abdominal muscles and overworking the hip flexors. If your pelvic floor is already hypertonic, doing exercises to strengthen these muscles without learning how to properly relax them, can aggravate your symptoms.
So how can Pilates help?
- By mobilising your tight muscles and joints - Stretching your hip flexors, adductors, glutes and lower back muscles can offer a lot of relief when there is unnecessary tension being held here. Exercises that mobilise your spine, shoulders and hips can also relieve the discomfort that is associated with joint stiffness.
- By teaching you to move mindfully - Pain can cause us to move in very limited ways. When our body has fewer and fewer movement patterns to choose from, this can lead to overuse of some areas and weakness of others. Pilates teaches us to move in ways that can be more beneficial for our body, rather than staying in autopilot and reinforcing our habits.
- By focusing on breathing - Breathwork is central to Pilates and can have a big effect on the way we move. When we are in pain, our breath tends to become quite shallow and isolated to the top of our lungs, around our chest. Focusing on taking deep, controlled breaths helps to expand your chest and mobilise your diaphragm (the top of your pelvic cavity).
- By stimulating your parasympathetic nervous system - Another benefit of improving your breathing pattern is the promotion of your parasympathetic nervous system - the antidote to the constant fight, flight or freeze state you are in. Lengthening your exhale has been proven to lower levels of cortisol in your bloodstream, demonstrating that your parasympathetic system is taking over from your sympathetic. By taking the time out to focus on yourself and move gently, in a way that you feel safe and supported, you are also reinforcing that your brain can let its guard down a little.
- Releasing your own natural pain killers - Exercise has the added benefit of increasing the levels of endorphins and serotonin in your blood stream. You can think of these as your own internal pain killers as they actually reduce pain. You may still need to use medication as prescribed by your doctor, but some gentle exercise is a great way to reduce the frequency or amount of medication that you need.
It’s important to have a movement option that you know you can turn to that won’t flare your symptoms so that you can keep moving throughout your cycle. This might be a 5-10 minute gentle stretch, or slow walk around the block. The main point is that you have something you can do, even when you are in pain and don’t feel like moving at all.
We now have a category of classes available in our Women's Health category that are safe for our members who have endometriosis to choose from, even when going through a flare up.