Chronic pelvic pain is one of the most dismissed conditions in women's health. Years of symptoms, multiple clinicians, clean imaging, and eventually the quiet suggestion that it might be in your head. In this episode of The Hole Shebang, Kristen Parise sits down with Carolyn Vandyken, registered physiotherapist, co-founder of Reframe Rehab and recipient of the Canadian Physiotherapy Association's Medal of Distinction, to explain what is happening when pelvic pain persists without a tissue cause. They cover nociplastic pain and central sensitization in plain language, why diagnostic labels like vulvodynia can act as nocebos, how overlapping pain conditions like migraines, IBS and low back pain cluster around the pelvis, and the biopsychosocial approach that treats the whole nervous system instead of hunting for one tight muscle. Carolyn also shares the lifestyle changes that calm a dysregulated system, including her 150 minutes of walking a week.
This episode is brought to you by SRC Health. Shop SRC garments at blueberrytherapyshop.ca and use the code SRC15 for 15% off.
In This Episode
- [00:40] Working with her daughter: co-owning a clinic and co-founding Reframe Rehab with Brittany Vandyken
- [03:53] What biopsychosocial care means, and why clinicians stay stuck in the biomechanical model
- [09:09] For the woman with years of pelvic pain and clean imaging: your pain is real
- [10:30] The Age of Diagnosis: when labels like vulvodynia become nocebos
- [13:29] Overlapping pain conditions, and new research putting pelvic pain at the centre
- [16:12] STAND UP: stress, trauma, anxiety, neglecting rest and distress
- [20:07] What CBT training changes about a physiotherapy session
- [22:06] Invitation over prescription: why patients skip exercises they never chose
- [25:32] Trauma informed care and the pelvic floor as protector, dysregulated rather than dysfunctional
- [27:59] Central sensitization and nociplastic pain, explained for the listener at home
- [31:41] The inconvenient truth: sleep, food, stress practices and 150 minutes of walking a week
- [33:58] The sandwich years: why perimenopause looks like a dysregulated nervous system
- [35:29] The teaching ripple: Sinead Dufour, Kim Vopni and Jill Mueller
- [41:04] Where to find Carolyn: Embodia and the Year of Mentoring
- [45:07] Theme song: Walk Beside Me
What Listeners Will Learn
Listeners will leave knowing that persistent pain with normal tests is real, common and treatable. Carolyn explains how an overprotective nervous system produces pain, bladder urgency, gut symptoms and muscle guarding at once, why the pelvic floor braces to protect you, and why releasing muscles without regulating the nervous system keeps patients stuck. She walks through the questions worth asking a prospective provider, the risk factors that load the system, and the evidence-backed lifestyle changes that start recovery at home.
About Carolyn Vandyken
Carolyn Vandyken is a registered physiotherapist with more than three decades in practice, co-owner of Physio Works Muskoka in Huntsville, Ontario and co-founder of Reframe Rehab, the teaching company she built with her daughter Brittany to break down the silos between musculoskeletal pain, pelvic pain, pain neuroscience education and psychology. She co-wrote Why Pelvic Pain Hurts with Adriaan Louw and Sandra Hilton, co-authored the definitive reviews on the overactive pelvic floor and sexual dysfunction, and her 2018 study with Dr. Sinead Dufour found that 95 percent of women with lumbopelvic pain had signs of pelvic floor dysfunction. Her honours include the YWCA Women of Distinction Award (2004), the Ontario Physiotherapy Association's Distinguished Education Award (2015) and the Canadian Physiotherapy Association's Medal of Distinction (2021). Her Year of Mentoring on Embodia draws faculty from five countries.
Theme Song: Walk Beside Me by Celtic Woman
Key Topics Covered
- Chronic pelvic pain with normal test results
- The biopsychosocial model in pelvic health physiotherapy
- Nociplastic pain and central sensitization
- Diagnostic labels, nocebos and the power of words
- Overlapping pain conditions (migraines, IBS, TMJ, low back pain)
- Trauma informed care and co-creation
- CBT tools in physiotherapy and graded exposure
- Lifestyle medicine: sleep, nutrition, stress practices and walking
Resources and References Mentioned
Listen to More Episodes Like This
All episodes at podcast.blueberrytherapy.ca
- Episode 91: Pelvic Pain Is a Symptom, Not a Diagnosis with Dr. Alopi Patel
- Episode 47: Rewiring Pain: From Velociraptors to Victory with Dr. Laura Katz
- Episode 30: The Missing Link in Endometriosis Care with Physiotherapist Jill Mueller
- Episode 82: Prolapse and Pessaries: Losing the Shame with the Vagina Coach Kim Vopni
Our Sponsor: SRC Health
SRC makes medical grade compression garments for pregnancy, bladder leaks and mild pelvic organ prolapse. The Restore short is the one Kristen reaches for most in clinic. It supports your pelvic organs while you and your pelvic floor physiotherapist do the strengthening work.
Blueberry Therapy has carried SRC garments for years. Shop the full range at blueberrytherapyshop.ca, same price as buying direct and shipped from the clinic in Canada. Use the code SRC15 for 15% off.
Many extended health plans cover compression garments with a prescription, so check your benefits before you assume you are paying out of pocket.
Connect with Carolyn
Work with the Blueberry Therapy Team
Persistent pelvic pain deserves whole person care. Our physiotherapists, psychotherapists and naturopath work together under one roof, which is exactly the interdisciplinary model Carolyn describes in this episode. Book a free discovery call at blueberrytherapy.ca
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