Look into Muscle Tension Disorder!

[TK]

In brief, two things have worked extraordinarily well for me.

1) An anti-inflammatory regimen, involving dietary changes and a range of supplements that addressed different aspects of the inflammator y cascade. There has been a wealth of information on this site about dealing with inflammation so I won't go into specifics here.

2) Treatment for muscle tension disorder. If you have been through all sections of this forum, then you may be aware that a number of people have been reporting very good results from this kind of treatment.

If you have not done so, I strongly urge that you visit the "Muscle Spasm" section of this forum, where you will more specific information.

Just to make things clear: from time to time, we have all observed that people have posted on this forum with some kind of clear idealogical (or worse, commercial) motive to steer people toward one particular mode of treatment. I have no such connection to any ideology, practitioner, or product.

[Gabriel]

This may be a stupid question, but what exactly does physical therapy for this condition involve? It's an avenue I may wish to explore, and if I can get a referal from my GP and have it done on the NHS for free, that would be great. However, I need to get my facts straight before I go him with it, I don't want to sound like I'm just picking up on vague information I found on the net (which I know is not the case, but convincing him is probably going to be harder).

[TK]

Large numbers of people can benefit from therapy for pelvic floor disorder bacause , even if this is not the principle cause of the condition, it is becoming increasingly clear that pelvic pain of any origin is going to cause these muscles to tighten, compress nerves, further aggravating the vicious cycle.

[And -- not particularly relevant to your request, Gabriel, but this bears repeating for others: a number of urologists believe what my own experience confirms: THIS DOES CAUSE PROSTATITIS! ]

But despite the positive reports coming in many many others, we cannot proclaim that this is the answer for everyone. But this is the approach that is most likely to help large numbers of people.

So my first advice would be to find a physician who can do a soft tissue examination and determine if PFD (Pelvic Floor Disorder) is an important factor in your condition.

But as to what the treatment involves: There are some variations in methods and -- perhaps as expected -- some important differences in approach between different propoents. But the basic idea is:

The muscles involved have developed "Trigger Poiints" (muscle spasm forum has some links to explainations). The trigger points are severe constrictions, which impinge on nerves. And the muscles loose their ability to both fully contract and relax. So trained therapists use a gloved finger, inserted through the anal sphincter to carefully stretch the muscles that lie just beyond. Massage and stretching/strengthening excercises for attached and adjacent muscles are also part of the program.

An important part of the process is for people to learn to "feel" and identify their pelvic floor muscles so that they can learn to relax them and perhaps stop the unconscious habit of holding tension in these muscles... which may well predispose people to this condition in the first place.

Exercises which gently stretch the muscles of the upper leg, thigh, buttocks, etc are also an important part of the program.

Relaxation techniques are also important. Dr. David Wise, co-author of A Headache in the Pelvis, is a pioneer in this area. Many have found individualized routes to this goal.

The formal Stanford Protocal does not mention anti-inflammatory supplements. (We all understand that when you are doing research, you want to avoid extra "variables") But many of us on this forum have learned that it is important to address the ongoing, self-sustaining process by slowly reducing it. The supplements section contains a lot of information about various ways to approach this.

Understand that the Pelvic Floor / Anti-inflammatory approach is not a quick fix.
Some people do respond dramatically to the first therapy sessions, but for most of us progress comes in slow increments of several months. It's sometimes hard to see day by day, but at some point you look back and realize: my worst days now are the same as my best days 4 months ago. And as you continue to progress, you find that you get your life back.

I advise you to review the Muscle Spasm section of the forum, also the Supplements ssection and also the "Success Stories" the where you will more information from members and some very helpful links.

Good luck!

[MS]

Good posts, TK

Some physicians also use a technique called "dry" needling. There are also some protocals involving injections. I don't know much about these protocols beyond what I have read. Perhaps other members of the forum

Dry needling and Procaine injections can be used to release myofascial trigger points in several pelvic floor muscles, and muscles connecting to the pelvic floor (e.g. obturator internus, levator ani, pectineus). It is difficult to find a physical therapist that performs needling, or a Dr. to inject Procaine. It sounds a lot worse than in feels.

An important part of the process is for people to learn to "feel" and identify their pelvic floor muscles so that they can learn to relax them and perhaps stop the unconscious habit of holding tension in these muscles... which may well predispose people to this condition in the first place.

As others have posted, biofeedback can help identify when your pelvic floor muscle resting tone is too high (i.e. in spasm). Specific exercises, like Kegels, can help "retrain" the pelvic floor muscles.

Matt

[webslave]

Specific exercises, like Kegels, can help "retrain" the pelvic floor muscles.

Wise is against Kegels, which are mainly for woman with slack post-partum pelvic floors. He feels it can worsen the situation.

[TK]

As I mentioned in another post, Kegels were a bit of a conundrum for me.

My physical therapist -- who has earned much more confidence than any of the Uros I went to -- wanted me to do some strengthening execercises which are somewhat like Kegels to the extent that they involve voluntary contractions of the pelvic floor muscles.

Based on Dr. Wise's revervations, I was reluctant to do this. But in the end, I started doing these excercises-- very gingerly -- for the following reason.

My understanding of the Pelvic Floor Disorder is that over time, the muscle spasms and trigger points lead to a situation where the muscles become "hypotonic" -- unable to fully relax or properly contract. So at some carefully chosen point in the process, you need to slowly re-strengthen the muscles.

Is this re-strengthening a necessary part of the process? If so, how else can this be achieved without a process that involves contracting the muscle?

[The therapist also explained that these contracting excercises also have a secondary benefit in that they fatigue the muscles, allowing them to revert to a more properly relaxed state. But there are clearly other routes to this goal]

In any case, I should report that there have been times when doing these excercises just a little too vigorously may have contributed to mild flares. And given the variation in individual cases, I could see how Kegels / Contracting excercises could cause big problems for some.

For myself, I intend to continue ... but carefully.

My original post here in this "success" category was meant to serve as a kind of pointer to the Muscle Spasm area, so that people would not miss the fact that a lot of good results are being reported.

Thanks again to all who serve as keepers of this lighthouse!

[alprost]

TK - Could you provide some specific details re. your rehabilitation exercises/Kegel variations? For example: How many contractions; length of contraction/relaxation; how often per day; do you use a biofeedback machine?

I'd be greatful for any info you could provide.
Thanks.

[TK]

Alprost,

My therapist gave me a set of excercises that generally stretch the muscle groups adjacent to the pelvic floor. I believe that, while these are generally safe -- especially when done carefully and in moderation -- I hesitate to provide details here on the forum.

But I have learned much from your posts over a long period of time, and there is no doubt that you will use the information carefully. So I will send you specifics by E-mail.