Sunday, November 24, 2013

Uneven pelvis and sciatic pain in endo

I found this interesting as before I had excision of endo on my uterosacral and round ligaments (and other areas!), my hips were consistently uneven despite constant work with physical therapy. After I had surgery, they have, so far, been in alignment every time I've been to therapy! Also, many ladies with endo have expressed sciatic type pain in relation to their endo.

Symptoms/Causes:

"A common site for endometriosis is on or below the ligaments that support the uterus from behind, at the level of the cervix, and which lie just below the ovaries. These ligaments are the uterosacral ligaments, running from the sacrum (the lowest part of the back-bone) to the uterus, and endometriosis affecting them is one reason why dysmenorrhea is often felt in the back.
Because these ligaments are located behind and to the sides of the uppermost part of the vagina, pain with sex (dyspareunia), is another symptom of endometriosis; it's characteristically felt deep inside the vagina, sometimes particularly after a period, when the endometriosis will have become congested. The dyspareunia might be felt from the time of first intercourse or it can develop in sexually active women who previously had no symptoms with sex.
If scarring occurs in the uterosacral ligaments from the repeated irritation and bleeding each month, the uterus can be pulled backwards -- a producing a retroverted uterus -- which can make dyspareunia worse." http://www.jansen.com.au/silver/ch_txt15.htm

"If the rectovaginal septum or uterosacral ligaments are involved

with disease, pain may radiate to the rectum or lower back.
Alternatively, pain radiating down the leg and causing cyclic
sciatica may reflect posterior peritoneal endometriosis or direct
sciatic nerve involvement." http://www.mhprofessional.com/downloads/products/0071472576/0071472576_chap10.pdf"When endometriosis is present on the uterosacral ligaments, vaginal examination may reveal thickening or nodularity. There is often tenderness around the ligaments just before or during menstruation." http://www.gynaecologyclinic.com/endometriosis/endometriosis.htm

"Low back pain is a very common syptom of endometriosis. It often is caused by endo on the uterosacral ligaments. The uterosacrals, along with the cul-de-sac, are the most common site in the body to find endo. These ligaments are at the bottom of the uterus and help support it. Nerves that run through these ligaments supply the lower back (the sacral area). Hence, endo lesions or adhesions, or both, can irritate the nerves and cause you to experience pain in your lower back. Sometimes the pain can radiate through the buttocks and down the leg. The best way to relieve this pain is to remove the endo from the body." http://centerforendo.com/askcec.htm

"Common symptoms of endometriosis include abdominal, hip, and pelvic pain, cramping, irregular bleeding, painful menstruation, low back pain, sacroiliac joint pain, bladder pain or painful urination, digestive problems, abdominal bloating, painful bowel movements, painful intercourse (dyspareunia), and can lead to infertility. Endometriosis can also be a cause of or related to pelvic floor muscle dysfunction. Endometriosis can lead to trigger points in the abdominal muscles and pelvic floor muscles causing even more pelvic pain." http://www.pamelamorrisonpt.com/linkpage1.php?link=_665

"Endometriosis can compress the sciatic nerve within the pelvis, at the sciatic notch, in the gluteal region distal to the notch, or within the sheath of the sciatic nerve [155, ]. The commonest site is the sciatic notch where fibrosis, organised haematoma and endometrial tissue involving the muscles envelop the sciatic and sometimes the gluteal nerves []. Hip pain due to endometriosis in a lumbar foramen has been described [175]. Typically, patients present with pain in the hip and the buttock radiating in the leg and foot that has its onset few days before menstruation and becomes progressively more severe, subsiding 2 or 3 days to 2 weeks after cessation of menstruation; hence, the term cyclical or catamenial sciatica. As time goes on, the duration of sciatic discomfort may increase until it is constantly present with excruciating exacerbation during menses [, , , , , , , , , , , , , , , , , , , , , , , , , , 156, , , , ]. Diagnosis is usually late. Vercellini et al. [] found that two-thirds of patients with sciatic nerve endometriosis had right-side lesions." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200714/

"Sciatic pain in a young woman was not relieved by orthopedic treatment. The gynecologist found a large hard tumor-like mass in the uterosacral ligament extending to the pelvic wall. Cytologic examination of fine needle aspirate indicated an endometriotic lesion. The large tumor-like mass was extirpated by an extraperitoneal technique and the pain disappeared." http://www.ncbi.nlm.nih.gov/pubmed/3604600

Anatomy of the Misaligned Hips:
(not to be confused with "Anatomy of a Murder" by the way)
(courtesy of http://www.yoganatomy.com/2012/11/gluteal-psoas-relationship/)

"I have found that the two sides of their pelvis are not even relative to one another. Usually one side of their pelvis has an anterior rotation relative to the other. An anterior tilt is where one side has rotated down and forward. It is usually (there are always exceptions) the one that has the stronger anterior tilt that complains. There are a number of muscles that can contribute to this such as:

Iliopsoas
Rectus femoris (a quadricep)
The adductors
Or even Tensor fasciae latae

I am starting to think that this difference between the sides of the pelvis may be the common factor in the pattern that I’m seeing regardless of the symptoms that may be appearing. As of late, the symptom has just seemed to revolve mostly around tight gluteals and a tight iliopsoas.

How Does the Pelvis Get Like This?

There are many ways in which this can happen, too many to list them all, but sometimes it’s an anatomical difference in size between the right and left side of the pelvis, or an anatomically longer leg. We’ve already mentioned that the tension of various muscles can create this. A fall onto your bottom, or more specifically onto your sit bone can be the culprit. As I mentioned in a recent article, scoliosis can create an imbalance in the pelvis as well.

muscles - anterior tilters of the pelvis

I would suggest that the practice of yoga by itself is unlikely to cause this to happen. I say this because the practice of postures is usually balanced in terms of stretching and strengthening tissues as well as in terms of front/back and left/right. Some practices however could lead to furthering an imbalance if it already exists.
It is also possible that an injury sustained while practicing could over a period of time lead to an imbalance. For instance a torn hamstring could either create compensations, or a change in balance between the front and the back of the pelvis that other muscles then tighten around.

How To Check Your Pelvis

If you do have any of the mentioned issues going on then it might be worth having someone check your pelvis to see if an imbalance might be part of your problem. If you’re curious whether or not there is a difference between the sides of someone’s pelvis here’s how you would check someone else’s pelvis.
Have them stand in front of you while you kneel down and place your thumbs on their ASIS. That’s the bump on the front of your pelvis, sometimes known in yoga as hip points. They can be difficult to find on some people so it may be helpful to have them fold just slightly at their waist to soften some of the hip flexors. Just make sure you have them stand up straight after you’ve located them. Another way would be to have them find their ASIS for you.

You’ll also want to slide your finger up from just below the ASIS so that you hit the bottom of it on both sides with both thumbs. This helps you to feel that you’re in the same spot on both sides.
Most people will have at least a very slight difference in the height of these relative to one another. If it’s a significant difference then it’s more likely to be a component of the problem.
To confirm that one side is actually rotated, you should also check the PSIS, which can be even more difficult to find. This one is the bump you feel on the back of your pelvis on either side of your sacrum. It may be helpful to have the person you’re checking find them for you so you can then place your thumbs on them once again while you note if one is higher or lower than the other. The best way to find it yourself is to make slide all of your fingertips over the approximate area where you think it should be. Make circular motion and see if you can find it.

If you found that their left ASIS was lower than the right and then when you checked the PSIS and found that the left one was higher this might lead us to conclude that the left side is tilted forward in an anterior tilt. In other words lower ASIS and higher PSIS on the same side could be indicating that.
There are certainly more sophisticated ways of confirming these imbalances; this is just the simplest way of doing it. More importantly than me trying to teach you how to interpret these differences in a newsletter is noting the differences between right and left side. Then note any differences you find in the student’s postures around the pelvis. Also the “symptoms” that you find in the student. Is there a correlation?

Understanding the Implications

Since I went with the more simple and common one side tilted down and forward a couple of things go along with this. It’s hard to say which comes first. If the pelvis is tilted down and forward (anterior tilt) on one side, we would expect to find that muscles that attach to the front of the pelvis, such as the adductors, rectus femoris (a quadriceps), and the iliopsoas might be short and tight.
This could mean that at the back of the pelvis we find that the hamstrings are longer than they should be, maybe even complaining with some pain at the sit bone. We often think long is good but what we really mean is that there is flexibility to get long when needed, not in a constant state of being stretched.
In addition to the hamstring getting long, it also means the area above the pelvis on this same side is usually short and compressed. The quadratus lumborum is the typical muscle people would suspect to be short here and it very well could be, but even the more simple paraspinal muscles or “erector spinae” muscles may also complain and feel tight, or painful due to their constant state of being short.

With this pelvic difference it wouldn’t be unreasonable that the gluteals are also not particularly happy. If this is also the case then we might see that the student has a hard time externally rotating their thigh at the hip joint. Perhaps not an issue for students trying to do a simple janu sirsasana, but maybe it shows itself as knee pain in a lotus or as a restriction for some students trying to get a leg behind their head.
What we want to do is factor in what we’ve found in terms of the balance of the pelvis. Then we want to mix in what the student describes, or rather what areas of their body are feeling tension or even pain. Based on the coming together of these there are a number of things we might try to change in the practice or even add specific poses to help bring length to some of those shortened tissues.

On the Mat

Continuing to assume an anterior tilt on one side we will almost always want to bring length into the front of the hip and lengthen the hip flexors. This can be anything from a simple lunge to a supta virasana. Feel free to use any other postures that you know put length into these tissues.
If the gluteals and lower back are involved then make sure the student isn’t over tightening their buttocks in their up dog or other back bending type postures which may lead to more tension in these tissues. Maybe also encourage postures that lengthen these tissues such as pigeon or us the lotus preps that I describe in my youtube video." http://www.yoganatomy.com/2012/11/gluteal-psoas-relationship/

Scar tissue & pain/exercise

What is scar tissue and how does it hurt you?

"Muscle scar tissue usually forms after an injury. The scar tissue that forms doesn't function as optimally as the old tissue did, and therefore can cause pain. While muscle scar tissue can be painful, it may not always be apparent while you are exercising, unless the scar tissue is being stretched....When connective tissue is injured, the nerve tissue in that surrounding area is injured as well. When nerve tissue is damaged, it reacts by growing smaller, immature nerve branches, which the Doctor Schierling website explains are up to 1,000 times more pain sensitive than normal tissue." http://www.livestrong.com/article/531583-does-muscle-scar-tissue-cause-pain-during-exercise/

"A build up of scar tissue makes muscles feel tight or achy, possible weak. This build-up or web-like 'muscle plaque' fixes itself in muscles, tendons or ligaments and can cause imbalance and pain. Scar tissue can also:

Cause muscles to "catch" between each other

Cause weakness

Cause repeated injury.

Prevent adequate blood flow

Restricts and binds nerves

Create Biomechanical Imbalance.

"Muscles that are in a constant state of tension or contraction will result in 'Tissue Hypoxia'. Not enough blood and oxygen flows within the muscle. A muscle that is tight is a muscle that is having to do work to stay tight, meaning that it is burning energy, and needs oxygen and glucose and other nutrients. But with a decreased blood supply, the muscle begins to starve and chemical damage occurs. This leads to the same process of inflammation, bleeding and scar-tissue adhesion buildup. Injuring just a few microscopic strands of muscle leads to bleeding. Bleeding signals fibroblasts to come into the area and begin preparing the scar-tissue adhesion.

"The entire injured area then becomes 'sticky'. Sticky "fibrin glue" seeps throughout the layers of damaged muscle like a web. As the healing process completes itself, the glue leads to a tough scar tissue buildup. The big problem with this process is that the body is NOT very specific about what it 'glues' together. What happens most of the time, is it glues ALL the tissue in the area back together... whether it's damaged or not! The Vicious Adhesion / Cumulative Injury Cycle: Whether it's a small strain of your forearm muscles or years of tight hip flexors from sitting at a computer, the result often has to do with inflammation and scar tissue build up over time. If not treated early, the cycle continues, and the problem worsens."

http://www.activespinal.com/treatments_scartissue.html

What can be done about it?

See here for a previous post on adhesions: http://endocomprehensive.blogspot.com/2013/06/adhesions-and-myofascial-release.html

"A scar’s healing progression consists of two phases, immature and mature.

Immature – Immediately after a wound heals, the scar is immature. During this period it may be painful, itchy or sensitive as nerve endings within the tissue heal. While it is typically red in appearance, most scars fade to normal flesh color with maturation. Exercise, massage and heat application will have the greatest positive effect on an immature scar.
Mature – Depending on the size and depth of the wound, scar tissue will cease production 3 to 18 months following wound healing. When scar tissue is no longer produced, the scar is considered mature. While techniques to reduce scar tissue in a mature scar are effective, a more disciplined and vigorous approach is necessary.

Six Techniques

As soon as the wound is knitted, massage therapy can be performed. During the initial immature stages of wound recovery, it is imperative that a gentle approach be taken. The following six techniques are well-known ways bodyworkers can improve scar tissue:

Manual Lymph Drainage optimizes lymphatic circulation and drainage around the injured area. Gentle, circular, draining motions within the scar itself or a firm stretch to the skin above and below the scar, first in a straight line and then in a circular motion, are two drainage techniques. Placing the fingers above the scar, then making gentle circular pumping motions on the scar also helps drain congested lymph fluid. As the massage therapist gently works down the scar, the tissue will feel softer. Drainage techniques should not hurt or make the scar redden.
Myofascial Release helps ease constriction of the affected tissue. To stretch the skin next to the scar, place two or three fingers at the beginning of the scar and stretch the skin above the scar in a parallel direction. Then move the fingers a quarter of an inch further along the scar and repeat the stretch of the adjacent tissue, working your way along the scar. An alternative method is to follow the same pattern of finger movements using a circular motion instead of straight stretches. Work your way along the scar in a clockwise and counterclockwise fashion.
Deep Transverse Friction can prevent adhesion formation and rupture unwanted adhesions. Applied directly to the lesion and transverse to the direction of the fibers, this deep tissue massage technique can yield desirable results in a mature or immature scar. Never progress beyond a client’s comfort level.
Lubrication of the scar helps soften and increase its pliability. Mediums such as lotion, castor oil, vitamin E oil or other oil can prevent the scar from drying out and re-opening.
Stretching aids in increasing range of motion. This is most important when approaching scars that cross over a joint. Scar tissue will lengthen after being stretched, especially if the stretch is sustained for several seconds and is combined with massage.
Heat Application helps the pliability and flexibility of the scar. Common tools used to apply heat are paraffin wax, moist heat packs or ultrasound." http://www.integrativehealthcare.org/mt/archives/2007/07/six_massage_tec.html

"Physical Therapy Exercises for Abdominal Adhesions

by Rachel Nall, Demand Media

An adhesion is another name for scar tissue. Abdominal adhesions most commonly form following abdominal surgery but can also be caused by inflammation related to appendicitis or infection in your organs. This scar tissue can be painful, causing you to experience cramping and even intestinal obstruction. If you experience abdominal adhesions, you can use physical therapy exercises to relieve symptoms and soften scar tissue. Obtain permission from your physician before beginning a stretching program to ensure you can stretch safely.

Cobra Pose

The cobra is a yoga pose that is very effective in stretching the abdominal wall. Begin by lying on your stomach, with your hands at your shoulders, palms facing down. Push your hands against the floor to lift your upper body. Your hipbones and pelvis should remain on the ground. Avoid letting your shoulders rise toward your earlobes. Take a few deep breaths as you feel the stretch in front of your abdomen and lower back. Hold for 15 to 30 seconds, and repeat three times.

Side Twists

Twisting stretches can stretch your adhesions from a different angle. You can perform this stretch while seated or standing. Hold your arms out to your sides at shoulder height, with your palms down. Maintain your arms at shoulder level as you twist to your right, putting the left hand forward and right arm backward. Take deep breaths as you feel the stretch in your abdomen. Hold this position for 15 seconds, then rest and alternate to your opposite side. Repeat three times for each side.

Cat/Cow Stretch

The cat/cow exercise gently massages your abdominal walls to facilitate abdominal stretching. Begin on all fours, with your back straight and pelvis tucked slightly in. Slowly arch your back and round your shoulders to create a C-curve -- like a cat with its back arched -- in the spine. Hold this position for 10 seconds. Release the stretch to lower the back, creating a reversed U shape with your back. Your head should look forward. Hold for 10 seconds, then release the stretch. Repeat the cat/cow position three times through.

Supta Virasana

For more advanced exercisers, the supta virasana, or reclining hero pose, stretches the lower pelvic region. Start by kneeling, with your hands at your sides. Slowly lower your buttocks toward the ground while moving your feet outward until you are seated. Lean backward, and place your hands on the ground, walking them back until your entire torso is on the ground. You may wish to place a rolled-up towel or bolster pillow under your back for support. Hold your arms at your sides with your palms facing up as you stretch and breathe deeply. Remain in this position for one to five minutes. Use your arms to push your torso up, and then unfold your legs." http://livewell.jillianmichaels.com/physical-therapy-exercises-abdominal-adhesions-4763.html

Saturday, November 23, 2013

Estrogen Receptors Importance in Endometriosis

The role of estrogen type in the establishment and mediation of endometriosis:

Main point: "...We find, as shown previously (–), that estradiol is not required for establishment of endometriosis-like lesions.... Finally, endometriosis-like lesion growth is mediated predominately by estradiol signaling via ERα to increase lesion size, fluid volume, increased epithelial cell height, and epithelial cell proliferation...." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404357/

So what does that mean? Get a snack and get comfy.

First a little basic background on estrogen receptors and what they do and do not do:

(Cute, isn't it?)

So your cells have a protein in them called estrogen receptors (ER) that are activated by estrogen. These receptors just hang out in your nucleus waiting for something to happen- ready for some action. When they meet up with estrogen- game on! Once activated, the ER finds its way to your DNA and it controls how your DNA is read & transcribed.

"Estrogens are made in the ovaries and then delivered within seconds throughout the body in the blood...Estrogens pass directly into cells throughout the body, so the cell can use receptors that are in the nucleus, right at the site of action on the DNA. When estrogen enters the nucleus, it binds to the estrogen receptor, causing it to pair up and form a dimer. This dimer then binds to several dozen specific sites in the DNA, strategically placed next to the genes that need to be activated. Then, the DNA-bound receptor activates the DNA-reading machinery and starts the production of messenger RNA." http://www.rcsb.org/pdb/101/motm.do?momID=45

So estrogen binds to your estrogen receptors (like a key & a lock) and starts your genes to workin':

It "reads" your DNA and starts copying portions of it to make your cells do certain stuff.

You have several sites for estrogen receptors:

(more on ERα and ERβ later)

Gene expression is the way your body takes part of your DNA and uses that to make materials(a "gene product"- mostly proteins) that affect how your body works. If something goes wrong with this process- watch out! Trouble!

So, estrogen can do a lot of good stuff for your body:

But how does estrogen affect endometriosis? The search continues.....

"Estrogens influence many physiological processes in mammals, including but not limited to reproduction, cardiovascular health, bone integrity, cognition, and behavior. Given this widespread role for estrogen in human physiology, it is not surprising that estrogen is also implicated in the development or progression of numerous diseases, which include but are not limited to various types of cancer (breast, ovarian, colorectal, prostate, endometrial), osteoporosis, neurodegenerative diseases, cardiovascular disease, insulin resistance, lupus erythematosus, endometriosis, and obesity. In many of these diseases, estrogen mediates its effects through the estrogen receptor (ER), which serves as the basis for many therapeutic interventions....Finally, diseases exist for which estrogen has been implicated in their pathogenesis but a definitive role for the ER has yet to be established. These include endometriosis and polycystic ovary syndrome,...What role the ER may play in the risk or severity of these and other diseases will no doubt increase our ever-expanding knowledge of the relationship among estrogen, ERs, and disease." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2373424/

Now these receptors don't do it all by themselves. Other stuff comes into play. Now maybe it's time to take a look at just what estrogen does to your uterus and what other hormones come into play with a woman's cycle. This explains it pretty well:

"Hormones are chemicals that are made in small organs called glands. Hormones move about the body, usually through the bloodstream, and change or regulate the function of other organs and structures. In effect, the release of hormones is one of the ways that different parts of the body communicate with each other. The hormones we are most concerned about here are estrogen, progesterone, and testosterone....

"The ovaries make estrogen and progesterone, as well as various other hormones, in a cyclic fashion, and the levels of these hormones rise and fall with ovulation. For most women, this will be a monthly cycle, interrupted now and then by pregnancy or disrupted by stressful events....Thought of as the primary female hormone, estrogen builds up the uterine lining, stimulates breast tissue, and thickens the vaginal wall. It also affects almost every other organ in the body. Estrogen plays a critical role in bone building and is thought to have important protective effects on the cardiovascular system.

Progesterone, which is made only during the second half of the menstrual cycle, prepares the uterine lining for an egg to implant, but progesterone also has other important effects on many of the tissues sensitive to estrogen. Testosterone, also made in the ovaries, plays a role in stimulating sexual desire, generating energy, and developing muscle mass.

The balance of hormones in your body at any given point is affected by many factors. The pituitary gland, at the base of your brain, and your ovaries are constantly communicating via their respective hormones, dictating the changing hormone levels of your monthly cycle and the production of eggs. The pituitary produces follicle-stimulating hormone and other hormones. Stress, body weight, time of day, time of the month, and any medications you take can all cause temporary changes in your hormone levels." http://health.howstuffworks.com/wellness/women/menopause/how-menopause-works2.htm

So your hormones should cycle something like this:

And when estrogen is high, it makes the uterine wall thicken (gotta get ready in case of baby!):

So what role, exactly do estrogen and its receptors play in endometriosis?

"Estrogen signaling is a balance between two opposing forces in the form of two distinct receptors (ER alpha and ER beta) and their splice variants. We have also become aware that ERs do not function by themselves but require a number of coregulatory proteins whose cell-specific expression explains some of the distinct cellular actions of estrogen. Estrogen is an important morphogen, and many of its proliferative effects on the epithelial compartment of glands are mediated by growth factors secreted from the stromal compartment. Thus understanding the cross-talk between growth factor and estrogen signaling is essential for understanding both normal and malignant growth." http://www.ncbi.nlm.nih.gov/pubmed/17615392

"...We find, as shown previously (–), that estradiol is not required for establishment of endometriosis-like lesions.... Finally, endometriosis-like lesion growth is mediated predominately by estradiol signaling via ERα to increase lesion size, fluid volume, increased epithelial cell height, and epithelial cell proliferation...." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404357/

"Using a mouse model of endometriosis, we demonstrate the importance of ERα and ERβ activity and estradiol-mediated signaling in multiple components of the development of endometriosis-like lesions.... We find, as shown previously (–), that estradiol is not required for establishment of endometriosis-like lesions.... These findings suggest the important role of paracrine-mediated responses in lesion responsiveness. Finally, endometriosis-like lesion growth is mediated predominately by estradiol signaling via ERα to increase lesion size, fluid volume, increased epithelial cell height, and epithelial cell proliferation.... Our results demonstrate the important role for the host estradiol, ERα-mediated signaling on lesion responsiveness. The effects of estradiol are dependent on multiple criteria including the immune stimulus, the cell types involved during different phases of disease, the amount of estradiol, and the microenvironment (). The roles of estradiol on inflammation and neoangiogenesis via ERα oppose each other in endometriosis, and this is seen in our model system. The WT to WT estradiol group, having increased mitogenesis and a decrease in inflammation results in larger, cystic, proliferative lesions. This opposing role of estradiol in this model and in women with endometriosis requires in-depth focus on the mechanistic actions of ERα for the development of selective ER modulators that will allow for the uncoupling of these mechanisms of action to focus efforts for disease treatment." Full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404357/

So, to sum it up, the estrogen receptor alpha relates to how the endo lesions grow. When using treatments to lower the estrogen in your body, you're essentially trying to lower amount of activation that the ERα receives. By doing that, you are hopefully controlling the endo lesions' size, fluid volume, increased epithelial cell height, and epithelial cell proliferation. But in doing so though, you also affect your central nervous system, cardiovascular system, liver, breasts, gastrointestinal tract, and bones (which accounts for the side effects of medications like GnRH, etc). With excision, you are removing the lesions themselves. But the question stills remains, how do endometrial lesions get there in the first place? If you remove them, can more arise? More research needs to be done, but most theories support stem cell involvement:

"The pathogenesis of endometriosis is likely multifactorial, and extensive investigation has explored the role of genetics, environmental factors, and the immune system in predisposing patients to developing endometriosis. A series of recent publications have described the identification of endometrial stem/progenitor cells....The origin of endometriotic implants and the pathogenesis of endometriosis has long been an area of active investigation. Multiple hypotheses have been explored, including retrograde menstruation, coelomic metaplasia, embryonic rest theory, and the lymphovascular metastasis theory.... the data suggest that endometrial stem/progenitor cells function in the development of endometriosis. Additionally, bone marrow–derived stem cells can target the uterus and differentiate into a functional endometrium and, experimentally, extrauterine stem cells can target endometriotic implants. Furthermore, the contribution of stem/progenitor cells to the pathogenesis of endometriosis could account for the observations that drive all theories of the cellular origin of ectopic endometriotic implants. Endometrium-derived stem/progenitor cells residing in the basalis layer can be shed through the fallopian tube to establish endometriotic implants, accounting for the findings that support the retrograde menstruation theory. Stem/progenitor cells derived from either the bone marrow, the endometrium, or an alternate source may be responsible for the observations that support the theory of coelomic metaplasia. Potential stem/progenitor cells that persist in the remnants of the mullerian system can form endometriotic implants and account for the embryonic rest theory. Finally, extrauterine stem/progenitor cells, derived from the bone marrow or an alternative source, are likely to travel to distant ectopic sites via the lymphovascular spaces." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107843/

Does your head hurt now? Mine does! Some days it's interesting to study this, other days all I know is:

I like how Dean Ornish put it when it goes to science and healing:

"In our work, we present the "stress management techniques" as tools for transforming our lives. Yes, they are powerful ways of managing stress, but they are also much more. They are really about redefining who we are....We can use science to measure a lot of different things but even Albert Einstein once said, 'Not everything that can be counted, counts; and not everything that counts can be counted.' Not everything that is meaningful is measurable. Often, the kinds of transformations that we see in people's lives that are the most meaningful to them are the hardest to measure....Science is not just about what is observed, it's also about what is experienced. It's sometimes hard to measure what's most meaningful just because we don't yet have the tools for it. Awareness is the first step in healing, and science is a powerful tool for raising awareness—but it's not the only one." http://www.edge.org/conversation/changing-lifestyle-changes-gene-expression

Not have enough yet? Want to read on about food and estrogen? You glutton for punishment!! Here ya go:

"To date, research has shown that promoting the growth of certain beneficial intestinal microorganisms can help to improve overall health. 'In this study, we wanted to determine if steroid hormone nuclear receptors, specifically estrogen receptor beta, affect the composition of intestinal bacteria,' said Dr. Joseph Sturino....Some steroid hormones, like estradiol, and dietary phytoestrogens are known to influence the development of chronic gastrointestinal inflammation and estrogen-responsive cancers of the breast, prostate and colon," Sturino said. Some of these effects are the result of differential and tissue-specific gene regulation by estrogen receptor beta...'Interestingly, however, we also found that the microorganisms differed between mice that expressed estrogen receptor beta and those that did not.' Distinct patterns for Lactobacillales were exclusive to and highly abundant among mice fed a complex diet containing isoflavones, Sturino explained. 'Some Lactobacillales have probiotic function when taken in adequate numbers in food or dietary supplements, so indigenous species might also act to promote gut health,' he said." http://www.sciencedaily.com/releases/2013/11/131108124854.htm

In other words, mice while eating a plant based (isoflavone rich) diet had more good bacteria to help regulate GI and immune function; but, when they switched to a diet high in refined sugars, they had more bad bacteria (think E coli and salmonella).

Different Nutrients and Their Effect On Estrogen:

(thanks to http://info.spectracell.com/bid/87780/Nutrient-Correlation-Wheel-on-Estrogen )

Choline - Estrogen stimulates the breakdown of phosphatidylcholine (cell membrane) so those with low estrogen (postmenopausal women) require more choline; Detoxifies excess estrogen via methylation pathway.^1,32,33
Folate - Deficiency reduces estrogen levels; Excess folate is linked to some types of estrogen-related breast cancer; Detoxifies excess estrogen via methylation pathway; Regulates estrogen’s effect on genes.^1,2,3
Vitamin B6 - Protects genes from estrogen-induced damage thus lowering risk of hormone related cancers; Detoxifies excess estrogen via methylation pathway; Estrogen-based oral contraceptives cause B6 deficiency.^4,5,6,7
Vitamin D - Regulates synthesis of estradiol and estrone; Enhances estrogen’s protective effect on bones.^8,9,10
Vitamin C - Increases the most potent estrogen (estradiol) in women on hormone therapy; Lowers aromatase (enzyme that converts testosterone to estrogen) in ovaries.^11.12.13
Vitamin K - Inhibits estrogen activity by binding to estrogen receptors; Lowers the ratio of estradiol (strong estrogen) to estrone (weaker estrogen).^14,15
Vitamin E - Deficiency impairs estrogen detoxification pathway; Some forms of vitamin E inhibit estrogen action, especially in breast tissue; Low levels linked to higher estrogen.^1,16,17
Vitamin A - Helps metabolize the biologically active estrogen (estradiol) to an inactive form (estrone).^18,19
Calcium - Calcium-D-glucarate lowers estradiol levels; Helps breakdown estrogen in the liver and convert it to a less toxic form.^1,20,21
Selenium - Estrogen levels affect how selenium is distributed to various tissues in the body.^22,23
Magnesium - Cofactor for the enzyme that removes toxic forms of estrogen (catechol-O-methyltransferase); Estrogen alters magnesium levels throughout menstrual cycle.^1,24,25,26
Zinc - Estrogen lowers risk of zinc deficiency; Zinc dependent proteins metabolize estrogen.^26,27,28
Cysteine - Prevents oxidation of estrogen into a dangerous form that causes breast cancer.^29,30,31

Dietary estrogens and estrogen receptors:

"In this month’s issue, Georgi N. Nikov of Tulane University in New Orleans, Louisiana, and colleagues examine the activity of dietary estrogens in humans.

They confirm that

dietary estrogens have different affinities for human estrogen receptors.

They also found that, once bound, each estrogen can also alter a receptor’s shape and size.

When estrogen binds to a receptor, the resulting complex interacts with a site within a target gene’s regulatory region. That interaction may either promote or inhibit gene transcription. Alterations in the receptor’s shape may affect how well the estrogen receptor complex can initiate or inhibit gene transcription. Nikov and his colleagues focused on four phytoestrogens—genistein, coumestrol, daidzein, and glyceollin—and the mycoestrogen zearalenone. Genistein and daidzein are normal components of soybeans, which also produce glyceollin when subjected to certain stresses.

Coumestrol is produced by clover, and zearalenone is generated by

Fusarium molds, which infect grains.

The team first measured the estrogens’ affinities for two estrogen

receptors, ERα and ER (beta), as compared to estradiol, the form of estrogen

normally found in the body. But knowing that an estrogen binds

to a receptor is only half the story; what follows is perhaps even more
important. Therefore, the researchers also investigated how receptor
complexes interact with estrogen response element (ERE) sequences,
regulatory sites that turn genes off or on....

The researchers found that, except for glyceollin, all ofthe tested estrogens had a greater affinity for ER (beta) than
ERα; glyceollin had the opposite preference. However,
the glyceollin–receptor complexes, unlike the other complexes,
did not interact with either ERE sequence. The
interactions that did occur varied according to the specific
estrogen and which receptor and ERE sequence
were involved; however, none were stronger than those
involving estradiol.

The researchers concluded that just knowing the affinity

of the estrogen for the receptor is not enough. Equally important is
the way the estrogen–receptor complexes interact with ERE
sequences. These interactions may in turn affect transcription of target
genes and thus affect the myriad functions of estrogen in the body.–Julia R. Barrett"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556941/

Adenomyosis Vs Uterine Fibroid

"Most commonly adenomyosis is mistaken for another common condition, uterine fibroids. There is however a fundamental difference between a fibroid (a distinct tumor) and adenomyoma. Each fibroid originates from one abnormal cell. Under the effect of estrogen this cell multiplies. The growing tumor may displace and compress tissues but it does not invade the surrounding uterine muscle. Because of this growth pattern of fibroids, it is possible to remove all of the tumor without removing any normal uterine tissue during myomectomy (surgical removal of fibroids). In contrast, adenomyoma is not a discrete tumor but rather a local swelling of the uterine wall as a result of the penetration of endometrial tissue. Therefore it is not possible to remove tissue affected by adenomyosis without actually removing the involved uterine muscle." http://www.adenomyosis.org/#WhatisAdenomyosis

Friday, November 22, 2013

Video: Endometriosis and Pelvic Physical Therapy--Nurse Conference 2013 - Sallie Sarrel, PT, ATC, DP

Saturday, November 9, 2013

Some stretches to help pelvic pain

Here are some stretches/yoga poses that I have found to be beneficial for my pelvic pain. With all of them, remember easy does it. Don't feel like you have to force yourself as deep into the poses. Only go as far as it feels comfortable (i.e. if you're thinking "I really wanna get out of this" then you're in too deep- back off some). It's also helpful to hold them for a longer period of time (one minute would be good). And, naturally, do both sides.