Central sensitization (CS) or central sensitization syndrome (CSS) is a syndrome in which the central nervous system (your brain and spinal cord) becomes hypersensitive and has stronger reactions to stimulation or pain.

You are able to feel pain thanks to sensory signals transferred through your nervous system.

These pain signals are important to protect you from day to day dangers, but in the case of central sensitization, your nervous system begins to misinterpret other signals as pain—even things that shouldn’t be considered dangerous stimuli.

Many different things can be a stimulus. Soft or strong touch, temperatures, light, smells, and even feelings. When the body reacts incorrectly to some of these stimuli, the result is pain that can be widespread, chronic, and confusing. There is no reason to hurt, yet the body creates pain.

This syndrome not only creates chronic pain for the individual, but they also have stronger reactions to pain than a person without central sensitization. This means that chronic conditions that cause pain are often worse for those with central sensitization.

Not only does central sensitization create worsened or unexplained pain, but an individual with this syndrome may also experience mood swings, dizziness, headaches, fatigue, sleep troubles, and more.

To add to this, the nervous system interacts with all other systems of the body, which means that your immune system, hormones, and other body processes can be affected.

Central sensitization is often confused with fibromyalgia, which at first glance may present similar symptoms. However, central sensitization is thought to be a contributor or cause of other chronic conditions.

Therefore, central sensitization is considered a syndrome, and conditions affected by it (such as fibromyalgia) are categorized as central sensitization syndromes.

Some conditions that can be affected by central sensitization can include:

• Fibromyalgia
• IBS and other gastrointestinal disorders
• Endometriosis
• Chronic pelvic pain or other bodily pains
• Interstitial cystitis
• Dyspareunia (painful sex)
• Temporomandibular disorder
• And more

Central sensitization can vary from person to person in terms of both pain amplification and sensitivity to stimuli. The severity of pain can vary greatly, and so can the other non-pain related symptoms mentioned previously.

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Central sensitization is still not fully understood. It is thought to be related to neuroplasticity, which refers to how your nervous system and sensory pathways change and adapt based on life experiences.

Neuroplasticity can be a good thing, but it can also create problems such as with central sensitization, where the brain adapts to stimuli in a way that causes widespread, unexplainable pain.

This adaptation is often due to other chronic pain conditions, such as the ones mentioned before. Experiencing chronic pain, having previous surgeries or long-lasting injuries, or even a family history of central sensitization can be risk factors for the syndrome.

Individuals with autoimmune conditions are also at higher risk of experiencing central sensitization.

Other aspects such as hormone abnormalities, chronic inflammation, or psychological factors such as stress and anxiety may also contribute to central sensitization.

As mentioned before, central sensitization is characterized by three factors:

• Widespread or chronic pain without an identifiable cause.
• Amplified pain, such as from other conditions, injury, etc.
• Hypersensitivity, even to stimuli that is not harmful.

These aspects can translate to worsened symptoms for a variety of conditions that physical therapy is often used to treat or manage: Chronic body pain, temporomandibular disorders, headaches, gastrointestinal disorders, pelvic pain, painful sex, bladder and bowel dysfunctions, pelvic floor dysfunction, endometriosis…the list goes on!

Central sensitization can significantly affect a variety of conditions, as the nervous system plays a large role in pain.

While this syndrome can be frustrating and confusing, the good news is that orthopedic physical therapy and pelvic floor physical therapy can provide immense support and symptom management for a very wide variety of situations.

The physical therapists at Hive Therapy and Wellness are highly trained and very experienced. They are experts of the body, and are committed to holistic, comprehensive care that will help patients regain function and a higher quality of life.

For individuals with central sensitization, the goal of physical therapy is to:

• Find techniques and strategies that calm the nervous system
• Teach about nervous system regulation
• Incorporate behavioral modifications for managing stress and encouraging relaxation
• Practice desensitization to reduce hypersensitivity
• Improve muscle function and reduce pain through manual therapy and pain-relieving modalities
• Provide pain neuroscience education
• Improve movement biomechanics to reduce strain and support better function

These goals may look different depending on the patient’s individual needs, as central sensitization can vary from person to person.

Additionally, the treatments used to reach these goals can vary slightly, depending on whether the symptoms are from an orthopedic condition or a pelvic floor-focused condition.

Orthopedic Physical Therapy for Central Sensitization

Orthopedic physical therapy focuses on reducing pain and improving function through a variety of treatments and education, such as the following:

Education

One of the first steps towards treating a condition is to better understand it! Therefore, your physical therapist will teach you about pain neuroscience.

This concept simply explains how you feel pain and how the nervous system can affect pain signals—a large factor in central sensitization.

Therapeutic Activities

Your physical therapist will lead you through therapeutic activities and movements that will help retrain your nervous system to recognize non-harmful activities.

This practice will start out slow, using relaxation techniques and low intensity exercises that will become progressively more difficult.

Manual Therapy

Gentle manual techniques that manipulate and mobilize tissues can help safely activate the nervous system to reduce sensitivity and modulate pain signals.

Additionally, your physical therapist can provide pain relieving treatments such as dry needling.

Relaxation

Relaxation techniques such as diaphragmatic breathing will play a huge role in managing central sensitization.

Individuals with this syndrome are often anxious and in a fight-or-flight state, and therefore your physical therapist will provide treatments and guidance to encourage relaxation of the nervous system.

Lifestyle Changes

Your physical therapist will suggest a variety of lifestyle changes that are designed to relax the nervous system and improve your symptoms. This can include improving sleep, learning stress management, exercise, and more.

Although these aspects may seem obvious or simple, they play a very large role in your health and management of a dysregulated nervous system.

If you want to take small steps to get started today, check out this free guide: Restore Your Dysregulated Nervous System.

Please note that central sensitization is like a more amplified form of nervous system dysregulation, and while making lifestyle adjustments may prove beneficial, you should still consider professional treatment for better results.

Feel free to explore Hive’s other free health guides, too!

Exercise Prescription

While exercising may seem difficult for individuals with central sensitization, treatment of this syndrome actually benefits from exercise. Low-intensity aerobic exercises can help manage central sensitization by releasing endorphins and reducing pain sensitivity.

In simple terms, exercise can help calm down the nervous system and reduce pain signals.

Pelvic Floor Physical Therapy for Central Sensitization

Pelvic floor physical therapy can provide all of the above-mentioned treatments for central sensitization as well, but also provides other treatments that help focus on the pelvic floor.

This is essential for conditions relating to the pelvic area, such as endometriosis, chronic pelvic pain, interstitial cystitis, dyspareunia, and more.

The pelvic floor is a sling of muscles in the pelvis that allows for urination, defecation, and sexual activities. However, these muscles can become hyperactive, sensitive, weak, inflexible, and tight—known as pelvic floor dysfunction.

This is often exacerbated by central sensitization, especially when coupled with pain from other conditions like endometriosis.

When these muscles are in poor condition, it causes symptoms like painful bowel movements, pelvic pain, painful sex, difficulties with urination, and many other unideal experiences.

Therefore, some individuals with central sensitization will benefit from additional treatment that focuses on pelvic health.

Some pelvic floor-focused treatments can include:

Education

Sensitivity and anxiety involving the pelvic floor can be exacerbated by a lack of understanding of the bodily anatomy.

Your pelvic floor therapist can provide education about this essential area of the body, how your pelvic pain relates to the nervous system, and how pelvic floor functions may be affected by your condition or central sensitization.

Pelvic Floor Training

In addition to learning about your pelvic floor anatomy, you’ll engage in practice to better feel and control your pelvic floor.

This can involve treatments such as neuromuscular re-education and biofeedback, which will allow you to understand pelvic floor contractions and relaxations in real time as you practice.

Gaining control of the pelvic floor will help you better apply relaxation techniques, as well as start strengthening exercises, too.

Manual Therapy

Manual therapy for the pelvic floor can involve both external or internal techniques. Your physical therapist may gently manipulate sensitive tissues of the pelvis, abdomen, lower back, and hips to reduce tension or pressure on the pelvic floor.

Additionally, internal techniques may be utilized to address trigger points or tension in the pelvic floor. Internal techniques may be performed using tools such as a pelvic wand.

Not only will manipulating these tissues help with tension, pain, and retraining the nervous system, but also will address hypersensitivity to touch.

Another desensitization method to address hypersensitivity and pain is dilator therapy. Dilators are insertable tools varying in length and width, which help individuals become more tolerant of penetration and touch.

Dilator therapy involves a process of slowly increasing the size of the dilator in order to increase toleration progressively at your own pace. Dilators are made in a variety of shapes, allowing for either vaginal or rectal penetration.

Behavioral Modifications

Certain activities, postures, and habits can significantly affect the pelvic floor and contribute to your pain.

Therefore, your pelvic floor therapist will address aspects such as your posture or restroom habits, which can include things like:

• Straining during bowel movements
• Prolonged sitting on the toilet
• Holding urine for too long
• Using the restroom too frequently
• And more

Addressing these habits and modifying them is an important step towards reducing pelvic floor tension!

Relaxation

As mentioned before, relaxation is an incredibly important aspect of managing central sensitization. While relaxation techniques can be helpful for calming the mind, they can also actively relax the pelvic floor and reduce tension in the area.

Therefore, you can expect to learn relaxation techniques for the sake of pelvic health, too!

As explored in the examples above, there are many ways that orthopedic physical therapy and pelvic floor physical therapy can support individuals with central sensitization.

The providers at Hive Therapy and Wellness are even prepared to collaborate with other professionals as needed in order to provide you with a holistic and comprehensive care experience.

While working with one of our providers, you can expect an individualized plan of care that is suitable for your unique needs. This plan of care could include any of the treatments available at Hive, such as the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback