Endometriosis is a disease that affects many women around the world. Discover how Jacobson method and physiotherapy can help relieve the pain of endometriosis.
Epidemiology of endometriosis
First of all, endometriosis is a disease that affects 10% of women according to INSERM data. This figure is not really representative, as it only takes into account women who have undergone clinical examinations. However, many women suffer from chronic pelvic pain (40% according to INSERM data) and many of them do not consult for clinical examinations. Unfortunately, nowadays, women tend to normalize pelvic pain. This may be a first therapeutic education message for health professionals: it is NOT normal to have pelvic pain, you need to consult an ob-gyn !
What is endometriosis ?
In the first place, endometriosis is the abnormal presence of uterine tissue (endometrium) outside the uterine cavity. It is a complex pathology and the etiological mechanism has yet to be defined (genetic, environmental, stem cells). During menstrual cycles, the physiological uterine contractions regurgitate blood made up of uterine cells towards the fallopian tubes. This blood will arrive in the abdomino-pelvic cavity and migrate towards different organs such as : the peritoneum, ovaries, fallopian tubes, bladder, ureters, intestine… The endometrial cells implanted in the sites will create microhemorrhages, lesions and adhesions which will be at the origin of pelvic pain.
It is important to stress that there are 3 types of endometriosis :
- L’endométriose superficielle (foyer à la surface du péritoine)
- L'endométriose ovarienne (kyste ovarien)
- L'endométriose sous-péritonéale (foyer à plus de 5 mm de la surface du péritoine).
What are the symptoms
You have to konw that endometriosis can be characterized by different symptoms depending on the case. Women affected by endometriosis may have some of the following symptoms :
- Painful and heavy periods
- Pelvic and back pain
- Sciatica or cruralgia
- Urinary disorders (pollakiuria, dysuria)
- Dyspareunia (pain during sexual intercourse)
- Digestive disorders (frequent diarrhea or constipation)
These are symptoms that can alert us as physiotherapists since we are often in contact with this type of population. During a physiotherapeutic assessment called BDK for low back pain in a woman, we must not forget that endometriosis may be an underlying cause and take it into consideration during our treatment !
The Jacobson method, a link between physiotherapy and endometriosis
According to the franch High Authority of Health, non-medicinal treatment options may be alternative methods of relieving pelvic pain. Currently, no diet or vitamin supplements have been shown to significantly reduce pain. However, a muscle contraction-relaxation method called Jacobson significantly improves quality of life and pelvic pain.
The Jacobson method consists of 4 steps:
- Contract
- Maintain the contraction
- Release
- Observe the limb
A randomized controlled trial studied the effect of the Jacobson Method on pain following gyneco-obstetrical operations. It was shown to significantly improve pain, sleep quality and exercise tolerance. To date, there are no scientific studies proving the effectiveness of the method in relieving endometriosis. However, it is undeniable that the Jacobson Method generally improves pelvic pain.
The Jacobson method and the contracted-released, two complementary techniques
We can therefore compare Jacobson’s method with the contracted-released method that physiotherapists use to relieve muscle tension. This is why I found it interesting to share this discovery which can be complementary to our practice as physiotherapists and beneficial to that of the patients. This is why it would be coherent to apply the contracted-released techniques inspired by the Jacobson method. This method does not cure, but it can improve women’s comfort and quality of life.
There is no direct evidence linking it to endometriosis, but sometimes you have to innovate to try to make progress!
Today, improving the quality of life of women with endometriosis is a real challenge. At the rehabilitation fair I attended this year, there was a multidisciplinary conversation between an ob-gyn, a midwife and two physiotherapists.
The ob-gyn was insisting that physical therapists have a real role to play in improving the quality of life of patients, even though the current methods are not yet proven.
Bibliographic references
- Wolters Kluwer. Iranian Journal of Nursing and Midwifery Research. Volume 26 Issue 4. July-August 2021
- Haute Autorité de Santé décembre 2017 – N° ISBN 978-2-11-152307-4
- Chr-orleans. La relaxation progressive de jacobson.
Article about physiotherapy and endometriosis written by Claire Guillemin, 3rd year student in physiotherapy school at the University of Rouen.