Endometriosis and
Osteopathy Physiotherapy
Endometriosis is sometimes associated with osteomyofascial dysfunctions, which may cause pain that persists despite appropriate medical or surgical treatment. Osteopathic treatment may nevertheless be of benefit.
Introduction to osteopathy
Osteopathy is a manual therapy whose aim is tomaintain or restore the mobility of the body's various structures to enable them to function optimally.
The osteopathic approach is based on the recognition of the interrelationships between the body's various systems (skeletal, muscular, visceral, nervous).
Organs and tissues are linked closely or remotely by mechanical (joints, muscle or ligament insertions), neurological (nerves, spinal cord, brain) and vascular links.
Endometriosis in osteopathy
Endometrial tissue, under hormonal influence, changes with menstrual cycles: it develops during ovulation and bleeds during menstruation.
This mechanism leads to inflammation and the appearance of irreversible lesions such as adhesions and nodules, which require surgical treatment depending on the degree of damage, as well as reversible tissue reactions in the same tissues and surrounding areas, which can be treated with osteopathy.
As endometriosis is classically located in the abdomino-pelvic zone (pelvic peritoneum, bladder, ovary, digestive tract), this is where the reversible tissue reactions take place:
- Pelvic-perineal hypertonia: permanent involuntary contractions of one or more muscles, which can be the cause of certain types of dyspareunia and pelvic heaviness.
- Altered viscoelastic properties of abdominopelvic organ attachment and support systems.
As ligaments and fascias lose their flexibility and deformability, the organs linked to them will lose their relative mobility, which may affect their function.
The mode of expression will depend on the location of the injury:
- colon: digestive problems, constipation...
- uterus: deep dyspareunia, dysmenorrhea (menstrual pain)...
- bladder: bladder pain, urethral syndrome, interstitial cystitis...
All these tissue changes can also lead to osteoarticular disturbances.
Indeed, the increased stress exerted by these tissues (ligaments, fascias, muscles) on their insertion sites (pelvis, vertebrae) can disrupt joint mobility. This can lead to lumbar pain, sacral pain, coccygeal pain, chronic sciatica...
Session sequence
After a detailed interview recounting the patient's entire gynaecological history, a precise analysis of her pain picture will be carried out, with a precise description of each of her pains, date of onset, circumstances of occurrence, times of day, and a search for any associated trauma (fall, traumatic delivery, surgery).
The osteopath will carry out a clinical examination, looking for loss of osteoarticular mobility and tissue changes (hypertonia, changes in visco-elasticity).
A gynecological examination should be carried out to investigate the region of the small pelvis. This can only be carried out by a qualified practitioner: physiotherapist-osteopath, midwife-osteopath, osteopathic physician.
Once the diagnosis has been made, the osteopathic work can begin.
It will most often include visceral work, pelvic work and osteoarticular manipulations.
When to consult an osteopath for endometriosis?
Consulting an osteopath can be useful in various cases:
- For superficial endometriosis where surgical treatment is not proposed or is ineffective, or where certain types of pain persist despite appropriate hormonal treatment.
- Pre-operatively, particularly in cases of pelvic hypersensitivity, to improve local tissue condition and reduce post-surgical pain.
- Post-surgery 3 months after surgery, if certain pains or dysfunctions persist, treatment is indicated to soften scars, restore visceral and pelvic-perineal myofascial tension and joint mobility.
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