Body pain and why it happens at PeriMeno. How can physiotherapy help, why I used it and how it has improved my pain to be more active and engaged.

That muscle pain or even some muscle spasms you are experiencing could be because of changing hormone levels. As we know pain is not straightforward to diagnose, given there are many contributing factors such as our previous sports history and injuries and general life injuries, genetics and even your mental health. I personally went on quite the journey but have ultimately come out the other side unmedicated and almost pain free and I am sure you can too, so here is what I discovered and what I am sure you want to know!

Let’s start with some facts about what is going on during the Meno change with our pain. The first thing is that as the levels of oestrogen decrease in our bodies and as oestrogen is responsible to regulate the natural painkilling hormones, like endorphins, if our levels are low, then you may feel pain in way that you haven’t before, and this is why the aches and pains you have been putting up with for years can suddenly feel wicked and unbearable.

Oestrogen plays a role in collagen replacement in our tendons as well and is known to inhibit inflammation. Inflammation is a process started by our own body as part of its response to stress, whether physical or emotional. During the Meno change, due to lower levels of oestrogen you may notice that inflammation in your body seems to last longer and be more intense. There are studies that show during this time, women who are already living with medical conditions caused by inflammation may notice flare ups and unfortunately if you injure yourself, it takes longer to heal!  

You should consider what other reasons could be the cause of your pain, such as different medical conditions, some of which are not always obvious, and can include, but are not limited to:

  • Iron Deficiency
    If your menstrual cycle has become erratic, extremely heavy to flooding on a regular basis then you could have an iron deficiency. Low iron causes muscles to fatigue easier due to a lack of sustained oxygenation of the muscle. By comparison iron-rich haemoglobin carries oxygen to body tissues that need to repair, meaning quicker recovery and less pain.

  • Thyroid problems
    As the Lucy Rose Clinic explains 40% of menopausal women struggle with an undiagnosed thyroid condition and if this has not been treated it can lead to joint and muscle problems. You could have a thyroid condition such as hypothyroidism or adrenal fatigue and that may be the cause of muscle aches, tenderness, stiffness, joint pain, or simply pain of unknown origin.

  • Abnormal Vitamin Levels
    More than 1 in every 3 adults has mild, moderate, or severe vitamin D deficiency. Vitamin D deficiency is common in Australia, but some people are at a greater risk, for example if you spend limited time outside, or have a poor diet and don’t get what you need in your food. If you are in the Meno change then it is important to be aware of this deficiency as it can lead to osteoporosis, bone, and joint pain. It is not recommended to start self-medicating however, as taking too many supplements can cause vitamin D toxicity!

  • Low Electrolytes/ Salt Levels
    We all know the word, electrolytes, but did you realise that this is referring to the chemical elements in our body known commonly as sodium, potassium, calcium, chloride, bicarbonate, phosphate, and magnesium.  When dissolved in water, electrolytes become ions that are responsible for conducting electricity throughout your nervous system, which includes your muscle function.  There are numerous reasons why you may have low salt levels, some of the obvious ones during the Meno change is all the abundant sweating you are doing, general hormonal changes, or low thyroid hormones, as well as the classic dehydration. Some, not all symptoms that can indicate low sodium levels include body aching, difficulty with memory, impaired balance and coordination, lack of energy and muscle spasms, weakness, and cramps. Does this sound familiar? Well don’t go self-medicating here either, if you drink too many electrolytes (e.g., Hydrolyte) you could make yourself sick by disrupting the balance.

For me pain had become an enormous part of my day to day. It was all consuming, in that, I couldn’t sit for long periods of time without intense hip pain or shooting pain up the back of my left leg, I stopped wearing jeans and pants, because my left knee would be in agony and then there was the ankle injury that I did while undertaking a half marathon in 2019! I would wake myself up from rolling onto my left hip in the night, which was not only painful, but infuriating, because I was already not sleeping well. I had developed strong lower back pain, so I stopped wearing heals because my back and hip said no! Then there was the recurring neck and shoulder pain and don’t let me forget to mention the internal pelvic pain!

My movement was significantly impacted. I stopped training at the end of 2021, my daily walk had become three times a week, if I was lucky, and I would find myself holding my left hip or digging my fingers into it to try and reduce the pain. I would have to frequently stop to stretch my back on a park bench or just sit down. I struggled through Yoga, because I knew I needed to stretch, and I continued to cycle to the office a few times a week because I wanted to stay active, but every movement had become an exercise in pain threshold. I am not ashamed to say that I had become hysterical with pain. It was all I could think about. I knew more was going on and I wanted answers. I was sick of being in pain and not being able to move freely. I simply felt constantly inflamed! In Latin, the original root of the word inflammation means “setting on fire” and I was a fire starter!

The first step for me was explaining all of this to my trusty GP. I got a referral to see an orthopaedic surgeon, and while the MRI showed wear and tear on my left hip and knee, a little more than usual for someone my age, I was not about to have any surgery. So, this resulted in a referral to a sports physician in November 2022 and through them a physiotherapist in December 2022 and so began the change in my pain experience.

I don’t know if it is just me, but I didn’t know a sports physician even existed, I am glad I was referred though! What I discovered is that they are a specialist medical practitioner who provide diagnosis of musculoskeletal injuries. They get to the root causes, tailor a treatment and prevention plan and they can prescribe medications/ supplements if needed. They have broad specialist skills so are a one stop shop for pain management and know who else to involve in your treatment program.

After establishing that nothing serious was going on that would have resulted in surgery or a lifelong use of pills (other than my hips being rotated and tight, having patellofemoral pain syndrome (PPF), and some IT band syndrome, with a touch of gluteus medius pain and a sprinkling of torn ligaments in my left ankle), but that I was in a lot of pain for me and really needed to reduce the inflammation situation, I started on a course of low dose daily anti-inflammatory called Meloxicam.  Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause pain, fever, and inflammation in the body. It helped a lot!

At the same time, I was referred to a physiotherapist within the same practice. I had done physio in the past, after injuries and accidents, but I was sceptical about how they would help me at first. However, I am pleased to say that the assessment and treatment prescribed was awesome. Because I was still getting my head around the Peri Meno situation and that I had just started on HRT, it was good that I had a female physio, because I could let it out to her, and she understood what was happening for me from a perimenopause perspective, which was a huge relief.

My physio undertook a thorough assessment which included all the normal bending forwards and backwards and side to sides, but also included testing my leg strength which came up on an app, so we could see that my left leg (the injured and inflamed side) was operating at around 30% of my right one. Also, that the muscles, especially my quads of my left leg were weaker than they should be. My physio actually felt my legs all over and not only released my ITB (yes, I did shed a tear) all the way up to my glutes, but also released my Gastrocnemius, which helped to free up my ankles. Just those few things gave immediate relief. But I had homework!

Let’s face it, any sort of medical treatment is not cheap, and while you do get some money back on Medicare, what is the point of going to see a specialist, if you are not going to do what they ask. I am a firm believer in doing the work and I had a lot to do. To build on my core strength, as well as activating muscles, isolating and strengthening others, getting control back to the knee, ankle and hip joints and improving balance, increasing stability, and improving posture, I was prescribed a series of 9 exercises, and this was sent to me in in the PhysiApp, which is awesome, because I could watch the videos on my phone and, I could tick off the task as complete each day. I like completing a task! Throughout the almost 12 months of treatment, I had regular check-in’s and tailoring of exercises to keep the momentum going, all the while feeling an improvement in my leg and hip, and seeing it qualified as a percentage improvement on my physios’ records of me, which was encouraging.

 I did choose to have ‘some work done!’ with the sports physician, being hyaluronic acid to my knee. The pain was persistent, and I didn’t want to continue taking pills. Hyaluronic acid is found naturally in joints and other parts of the body. In the joint it is found in the cartilage and the synovial fluid that lubricate the joints to keep them working smoothly. If, however, like me and most middle-aged women who have done any serious sports for extended periods of time in your life, you are likely in the early stages of osteoarthritis, which means our cartilage is breaking down and becomes thin. This leaves the ends of the bones unprotected and the joint loses its ability to move smoothly, so hence you will experience pain, but the injection was quick, painless, and complementary to the physio exercises, so I did it.

Twelve months after my first meeting with the team I can say that I am back baby! I am walking on average 10kms a day, I am gardening and cleaning without pain and to keep me motivated to do my physio treatments and for a new goal to aim towards, I completed a 35km walk with Coastrek, which was pain free! Amazing right! I literally thought I would be on full time pain meds or using a mobility aid a year ago. The other amazing thing is I have now just gone back to group personal training for the first time since the end of 2021.

In summary, there is a lot going on in our bodies during the Meno change, and the moral of my story is your pain may not actually be what you think it is, don’t make assumptions and don’t preserver with it, that will just make you depressed and worried. I had several things going on being, Peri Meno, Iron deficient, Vitamin D deficient and an undiagnosed thyroid condition. You need to make sure you are not just focusing on one thing but taking a holistic approach to your health. You can get help and you can be pain free.

The 3 things I recommend if you are experiencing pain:

  1. Make an appointment with your GP, Gynaecologist, Sports Physician or Physiotherapist (you don’t need a referral for a physio). It is best to find a practitioner who specialises in women’s health. Prepare your list of pain points, where is it, when it is happening (worse in the morning/ night) and ask for blood tests/ urine tests, MRI’s, CTs, or X-Rays to get to the bottom of the pain quickly and determine if you are deficient in other areas, that could be contributing to your pain. And if you are experiencing perimenopause or menopause, discuss that with your practitioner, so they have the full picture of what is going on.
  2. Slow down, there is no point injuring yourself further. If like me, you are used to intense exercise, just take a moment. A gentle walk or low impact stretch with Yoga (I have done yoga weekly with Centred Ground throughout my recovery and physio treatment and I am positive this complemented my healing process) or talking up swimming maybe just what you need currently. But check with your doctor and see what they say. You can go back to your intense work outs once you are 100%, if that is what you choose to do.
  3. Lastly and most importantly, do the homework! Make the time (most exercises can be done in your lounge room, without equipment)! It is worth it!

For me this round of physiotherapy was a game changer. If I don’t do my exercises at least once a week (I was doing them daily), I can feel knee pain, but nothing like it was. The pain now is a reminder that your body is a constant work in progress, and physiotherapy is a hugely beneficial treatment. By doing the homework you are improving your movement, reducing pain and stiffness, and speeding up the healing process, which in turn will improve your quality of life. Like they say, prevention is better than cure, and physiotherapy will help prevent further damage and injury, if you take the medicine, so to speak!  

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