Edit: I WAS CURED AFTER 22 YEARS! I had a vestibulectomy Dec. 2016. The recovery was easier for me than having sex ever was. It took about 5 weeks. I have included my recovery photos. Look for the blogpost "I'm Cured!" and "My Vestibulectomy".

I’m a great woman with a pissed-off vulva. I have “primary vestibulitis." Most people are uncomfortable discussing their genital pain in public. My hope is that my obsession to find help for myself will make your experience shorter, easier, and less painful. P.S. Recently "vestibulitis" has been renamed to "vestibulodynia."

Neutral Spine and Strength Training

In terms of mastering the neutral spine, pelvis and neck mentioned below, the book "Eight Steps to a Pain Free Back" by Ester Gokale at really helped my overall posture standing, sitting, and sleeping reduced my overall body pain significantly. This is a positioning book and not a strength book. Another thing to check out is the Egoscue Method "Pain Free: The Revolutionary Method for Stopping Chronic Pain" by Pete Egoscue. This book addresses muscular imbalances and habits that result in a twisted pelvis or other poor placement; it has a strong strength training approach to fix these imbalances. These two books have been my best resources on this issue. Esther's is easy to do. Pete's requires quite a bit of time every day (40 minutes or so).

Many people with pelvic pain are asked by doctors if they ever danced. I certainly have been asked this. This is because dancers tend tend to have loose ligaments, do wacky things with their pelvis, and have horrible posture (especially, ballet dancers). This article summarizes things that anyone can think about in terms of overall alignment and what muscles might be imbalanced for better pelvic function. If you do strength training at a gym, I would think this information would help you create a better program than you might on your own or with a trainer giving you a "regular" fitness plan.

From: The Dance Training Project at danceproject.ca

Top 5 guidelines for dancers beginning a strength training program:

Assuming you’ve begun with a good assessment, no injuries or symptoms of over-training are present: Cleared to begin strengthersize.
1) Master neutral spine, pelvis, neck, and every joint, really.
Teach you students to neutralize. This is so fundamental. Neutral isn’t sexy, but neither is hip replacement surgery when you’re 30 because you never cared enough about where you put your femoral head (snug in the acetabulum, where it belongs, I hope).
Many dancers want more flexibility, but what they really need is stability first. They need more muscle activation so that they can actually get to a neutral position, because their ligaments sure aren’t holding things in place anymore. THEN they can start to consider if they really need that extra flexibility.
Start with the saggital plane. Once that has been mastered you can move into the frontal and transverse planes of movement. Using the lumbo-pelvic area as an example, first work on getting out of lumbar extension and anterior pelvic tilt (saggital plane), make sure their the adductors and abductors are balanced and functional (frontal), and then work on hip internal and external rotation (transverse).
But maybe you’re thinking, “But dance isn’t neutral- Why should I train that way? Won’t that screw up my ability to dance?” Nope. That’s the exact reason you need more neutrality. You won’t ever get it in a dance class.
Finding neutral for a hypermobile person is like getting the splits for a stiff person. It takes daily work to get that range of motion.
2) Emphasize postural education, not just exercises and stretches.
Educate dancers on awareness of their current posture, and teach them what “good posture” feels like. From foot to head. Many dancers don’t even consider that they have bad posture. And even scarier is that many dancers take pride in their poor postural tendencies, like walking with their feet pointing out, even if it’s causing them pain. That posture is part of what makes them feel like a dancer.
The worse their posture is, the more they’ll compensate to make them appear to have taller posture. But compensation is hard work. Don’t spend your energy on compensating for bad posture. Take the time and energy required to assess your alignment, fix it, and enjoy the ease that follows.
Postural education is even more important that the training sessions you’ll do. Even though you do good, important work for a few hours (if you’re lucky) per week, there are so many other hours in the week to undo it. Moment to moment postural education is so important for injury prevention, and to continue to progressively develop strength and improve alignment in dance class, too.
And give ‘em a smack upside the head if you seem them slouched over their precious iPads. And do they really need all the stuff they have in that backpack?
Just kidding.  Please, no violence.
3) Common muscle imbalances to keep in mind:
Here’s a short list of muscles that I often see are weak and need to spend some time “waking up” initially:
  • Quadratus lumborum
  • Psoas
  • Rectus abominis/ TVA
  • Lats
  • Mid and lower trapezius
  • Glute max
  • Adductors
  • Hip internal rotators (TFL, glute med/min)
Keep in mind that depending on the individual, this will vary. But I am shocked when I meet a dancer for the first time who can activate their glutes and core on command (which includes QL and psoas, in my books).
And on the flip side, many dancers will have compensations in which muscles are up-regulated and need to be released first (via some form of soft tissue work, stretching, etc). Here are some common ones:
  • Diaphragm
  • Iliacus
  • Calves (gastrocnemius, soleus, and some others too, depending on the person)
  • Spinal erectors
  • Neck extensors
  • Sternocleidomastoid
  • Piriformis
  • Pec minor.
And again, those are the common ones. Obviously there are exceptions to the rule and other things to consider. But it wouldn’t hurt for your piriformis to spend some time quality with a lacrosse ball, I bet.
 4) Train like any other athlete.
If the dancer is structurally ready and has no weird pain or injuries that need addressing, train hard!
Dancers are no different from other athletes in the respect that they still should train with full body compound exercises in a well rounded program that is complimentary to the competitive/performance season they are in. Use full body movements like squats, lunges, deadlifts, rows, push-ups, etc- the usual staples. Use perfect technique, with the ever-awareness of the compensation-masters that dancers are.
In fact, science (again) has demonstrated that push-ups and vertical jump height are correlated to improved dancing in several studies. The staggeringly high injury rate in dancers should not deter you from resistance training, because it’s the absence of said training is that is correlated to the injury rate.

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