Hi Pelvic Care family!

We’re so glad you’re joining us for this month’s blog, focused on involuntary bracing. In the medical world we code it “muscle spasm.” What we’re talking about is the tension you hold in your body without intention or control. People say, “I carry my stress in my shoulders,” or, “I can’t stop squeezing my pelvic floor.” Yes. This is what we’re talking about. This chronic tension is often linked to both physical and emotional factors. Someone may always tense their shoulders both because they work a desk job with poor body mechanics, and because they have anxiety. If you’re interested in learning mind-body techniques to release your chronic tension patterns, read on. 

Tension can be a response to, and a cause of physical pain. Initially, in an acute injury situation, tension is useful. When we have an acute injury, our bodies brace around the injured part. This is a protective instinct. I tell clients who throw out their backs and get all locked up: Your body is forming a muscular back brace for you. For acute injuries this is perfect! We are so well designed. The muscular bracing we experience when physically hurt is a useful component of our body’s healing response. It stabilizes injured tissues by preventing movement, so that healing cells can move into the secured perimeter, sweep the area clean, and rebuild or replace the damaged structures. 

The problem is, sometimes we fail to stop bracing once the repairs are complete. The bracing changes how we move. Now movement is less efficient, less variable, less free. We start to feel pain now because of the “spasm.” There’s a pain-tension-pain cycle bodyworkers and movement specialists talk about with chronic pain, meaning pain lasting longer than three months. For chronic pain, pain and tension can be in a positive feedback loop: Sometimes, as pain ramps up, tension ramps up, then pain ramps up some more.

There are physical reasons why some people stop bracing after injury, while others don’t. Some have overactive healing systems. Their bodies form too much scar. The scar glues structures together so they can’t move fluidly. Other people don’t “mobilize” or “load” their injured parts properly. We have to show our bodies all the ways we want to use our healed tissues after the initial repair is complete. If we don’t gradually move the injured area through its full range, in all available directions, in a variety of complex movements (and optimally, with LOAD, meaning weight), then our healing systems won’t refine the initial repairs to accommodate these complex, loaded movements. We get stuck in the braced position. Finally, some people have a long history of prior lingering pains. Their nervous systems catch the scent of something familiar and brace for the worst when a new injury manifests. These people’s sensitive nervous systems double down on the seeming security of the initial brace long after it’s needed. In their experience, it’s only a matter of time before the next terrible thing happens, so sacrificing freedom for security seems a viable survival tactic. Of course, all this happens beneath the level of conscious awareness. It is a nervous system setting, like a thermostat stuck on high. 

Now–here’s the really interesting part. Our body doesn’t really know the difference between physical and emotional pain. When our heart is broken, when our dreams are crushed, when our trust is violated–we brace. We inflame. Our nervous systems sensitize. Often, we stop moving–or we move too much, compulsively, in a fierce attempt to numb our emotional pain. If resolution isn’t timely, our acute emotional pain can become chronic and cause involuntary bracing, just like physical pain. People in alternative realms of healing have been talking about this stuff for a long time. We are just now, just now, starting to talk about these things in medical circles. Gabor Mate is one of the authors I’ve read who speaks on a deep, and medically legitimate, level about the connections between emotion, psychology, stress, and physical health. I highly recommend you check him out, if you’re interested in these things.

Involuntary bracing is seldom just an emotional/psychological thing, or just a physical/orthopedic/systemic thing. It’s complex, it’s multifactorial, it’s often even multigenerational. And it may or may not have to do with a specific "injury," per se. Sometimes we have chronic tension because of the (non) ergonomic positioning we employ while working. Sometimes it's how we hold our body because of how we feel about ourselves or our appearance. Sometimes it's a result of how we posture and gesture and move to make an impression (consciously or unconsciously) on other people through nonverbal communication. 

If you have involuntary bracing, you probably know it, and hopefully you have a narrative surrounding why that tension is in place. I say hopefully because I think these narratives can give you a map for healing. If you take the time to study your narrative, you can find clues to set you on the right path for getting that pain and tension out of your body. 

An involuntary bracing narrative might look like this. I’ll use myself as an example. I tend to brace my deep posterior pelvic floor, on the left. This pattern snakes up my butt, along the edge of my sacrum, up the left side of my spine, and it grabs at the place where my left bottom ribs meet my spine. It gets worse when I sit, and when I’m stressed. It gets better when I exercise (yoga is my body’s favorite), and when I rest and spend time with my kid. I think my brace has to do with several things. On the physical side of things, I used to use a bicycle for transportation in my early 20’s. I got hit by a car on my bike once and landed on my butt. I didn’t seek medical care after. I had sacroiliac joint pain after that, and a wonky left hip. Then after I gave birth and did active pushing for 3 hours in my thirties, I had 3rd degree perineal tearing, a cystocele, and a rectocele. I know from my experience as a PT, prolapse can induce muscular bracing. On the emotional side of things, I believe this bracing also has to do with my trauma history.

This is my narrative. How is it a map for healing? When I took the time to first, locate my brace; second, question the origins; and third, determine what made my bracing feel worse and better, I knew what steps to take. I completed physical therapy, chiropractic care, and personal training for my back, pelvic floor, and hip rehab. I found an excellent trauma focused mental health practitioner who helped me unravel and remember my trauma, shaking the trauma out of my brain with the tools of internal family systems therapy and EMDR. I cultivated daily somatic movement and bodywork practices for myself, incorporating yoga, strength and mobility coaching, Feldenkrais, and trauma informed bodywork. My mind and body have significantly reset and normalized–and, of course, the process is ongoing! I find trauma healing to be recursive and non-linear, and I am at peace with this. I have found a way to be patient with my healing, as it unfolds. As a pelvic floor physical therapist specializing in trauma informed care, I am now able to use what I have learned from this experience to create a safe, empowering space for people to heal their bodies and minds from physical and emotional pain.  Healing never really ends in this human life. But when we work smarter not harder, when we listen to our bodies and care for ourselves, feeding ourselves what we know deep in our hearts we need: We do get better. Life is so much easier now for me, than it was before. And I know this is a pretty specific indicator of wellness–but I can move my pelvis normally again. It feels like joy, like freedom, and most importantly: It feels safe.

And here’s what drives me forward, with this interest in involuntary bracing. During my healing journey, it’s felt like I’ve been stumbling around in the dark. Knowing how to discern my narrative, how to distinguish the next step on the path: It’s honestly all felt like a miracle to get through it, to know what is the next step. Why does it have to be so dark and mysterious? Why are we too often facing our trauma alone? Why are we, as a culture, so bad about talking about trauma, and the intersections between physical and emotional pain? About the body? About rest? About prioritizing our own healing above more culturally condoned versions of “success?” I want to do my part to not just point at “embodied healing,” but to flesh it out, to talk practically about how we get both physical and emotional/psychological trauma out of our bodies. Below, I’ll list some strategies I use with my clients to deal with bracing and embodied trauma. 

What to do about involuntary bracing:

• Locate it. People who pay a lot of attention to their bodies, know in exquisite detail where they are automatically bracing. Others who have a more cognitive personality, or who dissociate from their bodies because of a history of trauma, have a hard time finding the area of brace. If you are in the latter group, work with a trusted bodyworker like a massage therapist, physical therapist, or somatic healer to help you make a body map of your tension. 

• Why is your tension there? Is it a physical cause, an emotional/psychological cause, or both? Can you associate it with particular events from your life history? Are there dominant thoughts or feelings associated with this area? Is it how you're sitting, standing, or moving at work, at home, or in your sport? Remember, your tension likely has to do with a multitude of factors, not just one. 

• Discern aggravating and alleviating factors. When does your tension get worse? When does it get better? Are you worse when stressed? Are there specific stressors that really make you brace (money issues, fighting with your spouse or a child, conversing about specific topics that trigger you?) What makes all that tension melt away (vacation, meaningful family time, specific self care practices, rest?) Some people like to think about this step cognitively, as aggravating/alleviating factors. Others thrive on speaking to their body directly. Body focused meditation works well for this. Have you ever tried asking your body what it needs? When your body speaks, what does it say? What is it thirsty for? Talk to your body out loud, or inside your own head. You may be surprised it has a voice. 

• Once you’ve framed your narrative around your bracing, strengthen or build a support network who can help you with your particular concerns. Figure out who in your life really, really has your back–and make time to connect with them on a regular basis. Tell them what you’re going through, and about your healing goals. Ask them for help. This journey may be challenging, and you don’t have to do it alone.

  Part of building your support network is picking your professional care team. If your trauma is primarily or partly physical, find the right physical therapist/chiropractor/specialist/surgeon/personal trainer/etc. for you. You may need help from just one professional, or from a sequence of several different practitioners, or from a team of people all working with you and for you at the same time. If you have a healthcare team, see if maybe they will talk to each other and collaborate on your care! Sign a release of information, or carry around hard copies of your medical records from different providers, so that interprofessional dialogue is more likely to occur, if you think it will help you make faster progress. If your trauma is primarily or partly emotional/psychological, find a mental health practitioner who is right for you. Figure out what modalities of therapy might be most useful for you by doing research and talking to people who are on similar paths as you. I highly recommend the Psychology Today website as a source for locating specific mental health practitioners in your area.

• Start giving your body what it's asking for. At least a little bit. Every day. What is on your list of alleviating factors? How can you fit at least one of these things in, every day? Maybe you need to give something up, to make time/space. Figure out what can go with minimal collateral damage.

• Develop the healthy habit of “checking in” and consciously releasing your tight areas as often as you can. If you work a desk job, perhaps set a timer to go off every 15-60 minutes (whatever feels tolerable to you). When the timer goes off, check in on your tight area and notice if it is braced. If so, release it! Some can just say, Relax!, to themselves, and it works. Others need a technique. Here’s some ideas. See which techniques work for you, and repeat them throughout the day. At first, you may only remember to check in a few times a day. Over time, make relaxation of your braced area a nearly constant habit of mind. 

• Try the contract-relax technique. Squeeze the tight area hard for 5-10 seconds, then release it! 

• Try breathing into the tightened area so that it expands and retracts as you breathe, like a wave pattern.

•  Try shaking the tight part. 

• Try tapping the tight part. 

• Try laying your hand over the tight part and visualizing warmth and relaxation spreading through it. 

• Start a regular prayer or meditation practice. 30-minutes a day of prayer and meditation is amazing if you can swing it! If not, grab 5 minutes when you can.  My favorite time for this is 6 am, before my daughter wakes up. I force myself from bed, and even if all I manage to do is turn on a youtube guided meditation and curl up again on a yoga mat on the ground–such a simple 2 steps–my entire day is transformed from mundane, to meaningful. From disembodied, to embodied. From distracted, to present. 

  For those managing involuntary bracing, body specific meditations are ideal. I use body scan meditations (seek out Jon Kabat Zinn’s work on youtube) with my clients to help them resolve emotional/physical pain. 
  I also find visualization to be deeply healing. Imagine healing energy flowing into your feet, flowing up your legs, flowing up your trunk, and out your arms and hands, and into your body again as you lay your hands over or even just see in your mind's eye the area of your involuntary bracing. Picture this healing energy like a ray of healing light. These things sound woo woo, but here’s the real science behind the placebo effect: Our brains don’t know the difference between imagination and reality. If you imagine it, you become it. Imagine yourself healing: And you heal. 
  

• Start a tension-releasing movement and self massage practice. I recommend determining at least 1 self manual therapy technique, 1 active range of motion exercise, 1 dynamic stretch, and 1 dynamic strengthening exercise specific to your braced part. The goal is to design a “mini-routine” of about 5-10 minutes that you could perform easily before or after bed, during your lunch break, or while your family is hanging out and watching TV. This way, it’s more likely to be sustainable. 

  I’ll walk you through a model tension-relieving practice. Remember my pattern of chronic tension I described above? I’m chronically tight in the posterior pelvic floor, glutes, and low back spinal muscles on the left. Here’s a routine I love to do to get this tension out of my body:

• Self-manual therapy technique: lacrosse ball on piriformis with active internal and external rotation of the hip, 2 mins each side

• Stretch: supine figure 4 stretch moving into supine figure 4 twist with active internal and external rotation of the hip, 2 mins each side

• Range of motion exercise: standing or supine pelvic circles, 1 minute each direction

• Strengthening exercise: split squats, moving deep and slow to provide loaded eccentric input to pelvic stabilizer muscles including hip flexors, glutes, and posterior pelvic floor, at least x10 reps each side, with option to hold dumbbells for additional loading.

A few notes about important things to consider when designing your tension-releasing program. 

• Stretching is good, but I think for many of us static stretches are our go to and I find dynamic stretches to be more effective for “talking to the nervous system” and resetting elevated muscle tone. By dynamic, I mean to find some movement as you hold your stretch, rather than holding still. 

• What do we mean by a “range of motion” exercise? We mean moving the braced area into a fully shortened, and then a fully elongated position, fluidly and repeatedly. Here, somatic movement practices like Feldenkrais become really useful tools. We can repeat a movement, like say pelvic circles, over and over and over again, with a mindful curious attitude about where the movement is irregular and where it is smooth. And often, even without conscious effort, just by showing up, paying attention, and repeating the movement, it smoothes itself. The glitches un-glitch. Its not even hard; it’s the magic of our nervous systems at work.

• Usually, the areas that are chronically tense are also very weak. But strengthening the braced part needs to be timed right. As I’ve spoken about previously in regards to whether/when kegels are appropriate, if we start strengthening a tense part before it knows how to relax down to an appropriate baseline of myofascial tone, we slow or reverse our progress toward the goal of releasing involuntary bracing and trauma from the body. So, if your “body sense”, your proprioceptive awareness, is a little lacking–seek professional help with knowing when to start strengthening your braced part. Sometimes we can strengthen the antagonist musculature, the muscles that move in the opposite direction of your targeted area, in the interim. Ultimately, strengthening the area that is braced is the most important step for long term release of the tension. When we get strong and coordinated in this previously tight region, we lastingly re-integrate that part into the whole of our proprioceptive body map again. 

• Do your routine on both sides, not just your tight side. This will be the most efficient way to create whole body, integrated change.

• Over time, allow for variety in this routine, swapping in different methods for pulling and stretching your tight areas to keep surprising your nervous system into beneficial adaptation and response. The nervous system gets bored and stops responding to things that stay the same.  

In closing, one quick caveat for you fellow body nerds out there: I do want to acknowledge that "tension" and “bracing” are pretty non-specific terms. In professional and academic fields, we’re constantly developing new vocabulary. For example, when I first graduated PT school we were using the word “overactive” to describe pelvic floor tension. Now we’re encouraged to be more specific, saying “elevated muscle tone” or other phrases instead. We body nerds like to remind folks that tight is really a medical misnomer, that a more technically accurate phrasing could be "shortened and weak." These details are super important for certain discussions.  I choose to use the words “tension” and “bracing” now when speaking to a general audience because I feel the common understanding of the terms is congruent with my goal of helping non-professionals develop personalized programs for releasing their pain.