Wintering Well in Pelvic Health

Rest, Boundaries and the Art of Caring Without Burning Out

There’s a time in every pelvic health physio’s career when the work feels heavier than usual. Not because anything dramatic has changed in clinic, but because we have. Sometimes it’s grief. Sometimes it’s months (or years) of holding space for other people’s pain. Sometimes it’s simply the accumulation of stories we’ve sat beside, day after day, with no real chance to exhale.

In many ways our job sits close to counselling. We listen to trauma, we receive vulnerability, and we try to help someone feel safe enough to speak the unspeakable. The emotional load is real, but unlike counsellors we often don’t get taught how to carry it. There isn’t a built-in debriefing culture and often in private practice there’s often no regular supervision. No structured tools for the wear and tear this work creates.

And when life throws in something huge: grief, family illness, burnout, sheer overwhelm, there’s no pause button. We keep going. Until we can’t.

My own wintering

When my dad was dying, I felt myself slowly sinking. I loved my patients, loved the profession, but I was surviving clinic to clinic. Each session felt like another mountain to climb. I worried constantly that I wasn’t “giving” enough and then beat myself up for feeling too empty to give more.

Compassion fatigue hit hard. The world shrank into knots of tension in my chest. Even small clinical interactions felt enormous. And although I stepped back for a few months, grief doesn’t follow timetables. Returning to work didn’t magically reset anything.

At some point in the cold stillness of January I accepted that I was burnt out. That wintering is a process, not a failure. And that I couldn’t go back to practising the way I had before.

Wintering as a practice, not a pause

What I’ve learned since is that wintering isn’t about stopping everything. It’s about softening your edges. It’s about choosing where your energy goes and building habits that allow recovery rather than demand endurance.

1. Acceptance

The first step is the one we always encourage our patients to take: acknowledge what is. Not what you “should” be able to do, or who you “should” be. If your identity is wrapped tightly around “being a physio”, stepping back feels like stepping into a void. It isn’t. It’s making space.

Now, I keep a very small clinical caseload so I can be fully present. The rest of the week, I explore, create, write, teach, walk, breathe. I’m still a doing physio, I’m just not only a physio.

2. Boundaries (a.k.a. the oxygen mask principle)

“Boundaried generosity” is a phrase I come back to often. You can give wholeheartedly, but only within limits that keep you upright.

A few things that help:

• I protect my mornings: no email or social media before 1pm

• I stop altogether at 5pm (and usually at 3pm for the school run…)

• I move between every session

• I spread out complex cases

I also work hard not to carry patients’ emotional burdens home with me. Some days I’m better at this than others.

3. Reframing your clinical role

It’s easy to slip into the “expert who fixes” mindset. But the evidence is clear: the best outcomes come when control sits with the patient, not us. So I go in curious, ask permission to share ideas, and support people to set their goals. It’s lighter, more collaborative, and much less emotionally loaded.

4. Caring without crumbling: the clinical bubble and shield

So many physios quietly take on the emotional weight of what they hear. Early in my career, one pelvic pain session could take the legs out from under me. I thought I needed to “build tolerance”. What I really needed was skill.

A few small tools I was taught changed how well I coped:

• The bubble imagine the session as a shared bubble. You can sit inside it with your patient, or move yourself gently outside if the emotion becomes too much.

• The shield during especially heavy moments, visualise a shield between you and the patient. It doesn’t block empathy; it softens the impact of trauma.

• A mindful reset one breath, feel your feet, feel the chair, then continue.

• The puzzle mindset once the story is heard, shift to constructing the clinical picture on paper. It creates emotional space to think.

 And after tough sessions, debrief! Even briefly. You don’t need to share identifiable details, just how you felt.

5. You cannot heal the world

Some people won’t improve, no matter what you do. It’s not a failure. It’s reality. Letting go of that pressure doesn’t diminish your care; it preserves it. And always remember that Physio doesn’t exist in a vacuum, we’re always part of the MDT. If your patient isn’t making the progress you’d expect then reach out to the MDT to think about other ways they (and you) could be supported.

6. Mentoring keeps you alive in this work

Burnout grows where outcomes are unclear and support is thin. Pelvic pain especially can feel like a long road with few landmarks. Having someone to walk alongside you matters.

If you don’t have mentoring in-house, seek it out wherever you can. I’m immensely proud of our 1:1 and small group mentoring pods. They’ve developed into a robust community where they regularly support each other and problem solve nationally. It’s everything I wished I would have had when I started in private practice.

And finally… winter well

We talk a lot about helping others regulate their nervous systems, but rarely about regulating our own. “Wintering”, whether literal or metaphorical, is an invitation to slow down, reset, and rebuild with intention. Fill your own cup. Let what overflows feed your work, keep your cup full.

Pelvic health physio is meaningful, profound, and at times emotionally heavy work. We can only sustain it if we honour our limits, our humanness, and the seasons we move through, especially the cold, quiet ones.

Be gentle with yourself. The world needs you well.