How do you know you've got a "good" PT?
How do you know you've got a "good" PT?
Recently there was a very informative thread on this site that explored the fears, anxieties, embarassments, etc. associated with internal PT treatment of the pelvic floor. I think it would be equally useful to share details of PT treatment regarding frequency of treatments, assessments by PT's, duration of treatments, procedures performed, pain levels experienced during treatment, post-treatment pain levels, symptom relief related to numbers of treatments, effectiveness, etc. In this way, some of us may learn if we have a "good" PT, or if we are just wasting our time. I know Dr. Wise is very reluctant to recommend PT's and feels there are very few out there qualified to administer effective treatment for CPPS; still, I know that there are many dedicated PT's now trained in myofascial trigger point release for treatment of pelvic floor dysfunction. I believe some of these PT's can administer effective treatment for CPPS. My hope is that we can share experiences so that we know when we have found a "good" one. Descriptions from those who have experienced significant relief would be especially helpful.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By:
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winding_road
I totally agree with you harring.
While most probably Dr Wise PTs are the best we can t go there everyweek if at all. So it would be intersting to get some posts from those very experienced with PT and share what they think that are the signs that you are dealing with a GOOD or BAD PT.
I am going twice a week to a PT. I just finished my fourth week without noticable improvement at all. Neither do I feel a strong correlation between pain or relief and the 1 hour PT session that I get.
However during the session she eally put her fingers on some points that hurt. At the same time I am not sure she knows which points are more important in producing my pain.
For example here is a question on my mind :
Although I have trigger points in abdomen and legs and internal ,
I feel the NEED to massage my groin. That s where it hurst more . I kind of indirectly told her that my groin is the worst part, but whenever she massages my legs she never really go up. IS there any points to be massaged in the groin ? Is she not wanting to go there, or is the pain there is most probably from the lower abdomen or the legs, and then she is right about not doing it .
While most probably Dr Wise PTs are the best we can t go there everyweek if at all. So it would be intersting to get some posts from those very experienced with PT and share what they think that are the signs that you are dealing with a GOOD or BAD PT.
I am going twice a week to a PT. I just finished my fourth week without noticable improvement at all. Neither do I feel a strong correlation between pain or relief and the 1 hour PT session that I get.
However during the session she eally put her fingers on some points that hurt. At the same time I am not sure she knows which points are more important in producing my pain.
For example here is a question on my mind :
Although I have trigger points in abdomen and legs and internal ,
I feel the NEED to massage my groin. That s where it hurst more . I kind of indirectly told her that my groin is the worst part, but whenever she massages my legs she never really go up. IS there any points to be massaged in the groin ? Is she not wanting to go there, or is the pain there is most probably from the lower abdomen or the legs, and then she is right about not doing it .
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LightningTree
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I know how you feel. I saw a rolpher who was clearly not comfortable approaching the groin, even know I think it would help.
I also saw a PT who pushed directly on trigger points on the bublocavernous muscles (right in the groin) and I found that it helped me.
I think if your PT is avoiding parts of your musculature that hurt, you may have found a critical weakness in your PT. That is just my thought.
I also saw a PT who pushed directly on trigger points on the bublocavernous muscles (right in the groin) and I found that it helped me.
I think if your PT is avoiding parts of your musculature that hurt, you may have found a critical weakness in your PT. That is just my thought.
This is not medical advice, and I am NOT a doctor of medicine or a related field.
* Age:33 Onset: February 2004.
* 99.9% IMPROVEMENT in 2.5 Years with the first year being the really hard part
* Current Symptoms: Mild irritation of perineal muscles on occasion. Relieved for days at a time by a specific stretch (see below).
* Initial Symptoms: Terrible penile, urethral, rectal, and perineal burning/aching with addition afferent sensations.
* Current Treatments: Deep stretching of the legs and pelvis. Most effective: Deep psoas and levitar ani stretch using the first phase of the "pigeon pose" from Yoga. When a deep pulling is felt in the middle of the pelvis next to the upper rectum, symptoms are completely alleviated for several days.
* Past Treatments Hyperprotection of the perineum for 1.7 years, Walking, Rectal biofeedback, Stanford/Wise-Anderson Protocol, Conditioned deep relaxation practice, Men's Multi-Vitamin and an Extra B-complex pill, all seemed to help.
I finished 30 sessions with my PT in January. I felt very comfortable that she was competent since she had treated quite a few females with pelvic pain. She was not uncomfortable about touching any anatomical region. I mean how much more intimate can she get when she has her finger inches deep in my butt. She knew all the muscles she was treating and would tell me which ones they were and where she was pressing as she did it. She depended a lot on my feedback. We really worked as the team of two in treating the pain. I usually felt a lot better as the treatments. I did not have much of a flare up usually. Some of the results have been lasting and I do not have pain in certain areas that really hurt before the treatment. I still have some pain which she said were not trigger points but she could not identify.
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Because improvements with chronic prostatitis / chronic pelvic pain syndrome can be so incremental, it is hard to rate a PT in just a handful of sessions. Some people take months to get better, some get WORSE before they start getting better, and in many cases, extremely painful flare-ups are all par for the course. The only thing I would offer regarding a PT's success in treating your chronic prostatitis / chronic pelvic pain syndrome is whether you felt pain during the PT session. They have to be hitting trigger points or taut muscles at some point, or else it is a waste of your time. You don't want to just irritate trigger points (causing needless flareups with no return on investment), you want to treat the trigger points and stretch the sore muscles. Obviously, if someone won't even do internal work, you won't be getting a complete treatment.
Feeback with your PT is very important. They can't see where they are going, and they can only rely on feel and on what you tell them. So be communicative, and point them to the spots that hurt. Don't be embarrassed to tell them what to do every once in a while.
And regarding how hard it is to find competent PT's - remember that Dr. Wise is fully supportive of having spouses and partners trained in doing the therapy. There are many stories on this board of partners doing therapy on chronic prostatitis / chronic pelvic pain syndrome sufferers, and doing a good job, if not better than the PT's themselves, if only because they can go slower, will listen to you more, and are willing to really learn. My wife is an example. After 5-10 sessions, I think she does as good a job as the PT. If you are telling them where the trigger point is, it doesn't take an expert to push on it. Communication can make up for a lot of inexperience.
And in response to the original questions:
regarding frequency of treatments: early on, I did two a week, then one a week, and now I am lazy and do less. some of this depends on your budget.
assessments by PT's: usually 1-2 hours; they will feel around, poking here and there, stretching limbs, etc... to assess your condition
duration of treatments: 60-90 minutes is typical, with 20-30 external work, 20-30 internal work, and sometimes stretching and teaching involved for up to 30 more minutes.
procedures performed: mentioned above - external massage on abdomen, gluts, perineum, hamstrings, lower back, internal on pelvic floor, stretching, and demonstrations of more exercises
pain levels experienced during treatment: some people experience a LOT of pain during treatment. I experienced a medium-high amount. you have to separate this from the "uncomfortable" sensations generated from all the internal work. in most cases, you should at least feel like they are hitting a trigger point somewhere; it doesn't have to be painful to be treated.
post-treatment pain levels: flare ups are common, especially early. stick with it. if you aren't getting any flare ups at all, this isn't a bad sign, but it could also indicate you aren't hitting the right spots. but this all depends on your condition
symptom relief related to numbers of treatments: I experienced my first incremental improvement after 10-15 sessions, but others have reported 60 sessions. everyone is different, from how severe their pain is to the number of trigger points and muscles involved.
effectiveness: if I look at the big picture, I'd say things have been very effective. I do all self management now and things are moving in the right direction. don't focus on the day to day pain levels, as these can vary significantly
Mike
Feeback with your PT is very important. They can't see where they are going, and they can only rely on feel and on what you tell them. So be communicative, and point them to the spots that hurt. Don't be embarrassed to tell them what to do every once in a while.
And regarding how hard it is to find competent PT's - remember that Dr. Wise is fully supportive of having spouses and partners trained in doing the therapy. There are many stories on this board of partners doing therapy on chronic prostatitis / chronic pelvic pain syndrome sufferers, and doing a good job, if not better than the PT's themselves, if only because they can go slower, will listen to you more, and are willing to really learn. My wife is an example. After 5-10 sessions, I think she does as good a job as the PT. If you are telling them where the trigger point is, it doesn't take an expert to push on it. Communication can make up for a lot of inexperience.
And in response to the original questions:
regarding frequency of treatments: early on, I did two a week, then one a week, and now I am lazy and do less. some of this depends on your budget.
assessments by PT's: usually 1-2 hours; they will feel around, poking here and there, stretching limbs, etc... to assess your condition
duration of treatments: 60-90 minutes is typical, with 20-30 external work, 20-30 internal work, and sometimes stretching and teaching involved for up to 30 more minutes.
procedures performed: mentioned above - external massage on abdomen, gluts, perineum, hamstrings, lower back, internal on pelvic floor, stretching, and demonstrations of more exercises
pain levels experienced during treatment: some people experience a LOT of pain during treatment. I experienced a medium-high amount. you have to separate this from the "uncomfortable" sensations generated from all the internal work. in most cases, you should at least feel like they are hitting a trigger point somewhere; it doesn't have to be painful to be treated.
post-treatment pain levels: flare ups are common, especially early. stick with it. if you aren't getting any flare ups at all, this isn't a bad sign, but it could also indicate you aren't hitting the right spots. but this all depends on your condition
symptom relief related to numbers of treatments: I experienced my first incremental improvement after 10-15 sessions, but others have reported 60 sessions. everyone is different, from how severe their pain is to the number of trigger points and muscles involved.
effectiveness: if I look at the big picture, I'd say things have been very effective. I do all self management now and things are moving in the right direction. don't focus on the day to day pain levels, as these can vary significantly
Mike
This is NOT medical advice. I am NOT a doctor.
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
Very helpful thread.
Last edited by kevin on Sat Mar 25, 2006 4:59 am, edited 1 time in total.
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.
Not medical advice. Consult your doctor.
Not medical advice. Consult your doctor.
How do you know you've got a good PT?
After some success using the AHIP book as a self-help guide, I found a PT in my area using the Internation Pelvic Pain Society webpage. She said she was thoroughly trained in myofascial trigger point release therapy for pelvic floor dysfunction, but I would be her first male patient. She offered to help me find an other PT if I preferred.
Impressed with her honesty, I set up two 1-hour sessions per week for several weeks.
The first session she did a thorough evaluation, checking for pelvic mobility, external and internal trigger points (this hurt) and tight muscle bands, and tight ligaments including the hamstrings. I gave her my copy of the AHIP book and referred her to an essay by Dr. Wise on PT. She read both of these with interest and enthusiasm.
The following session went like this:
The first 5 minutes she reviewed my pain log and asked if I had any questions or concerns. The next 10-15 minutes she looked for and treated external trigger points (mine were mainly on the upper glutes near the hip). The next 30-35 minutes she did internal trigger point release, soft tissue message and muscle band stretching. She would maintain steady pressure on a trigger point for 90 seconds, all the while asking if I could tolerate the pain. During the muscle band stretching she would ask me to contract the pelvic floor for 5-7 second intervals while she stretched the muscles. The final minutes of the session she would perform an external calming message and we would go over one of the stretches in the AHIP book. She also taught me diaphram breathing exercises to get me through the very painful part of the sessions. She has offerred to train my wife
These sessions were very painful at first and almost always fallowed by a flare-up day. They have become much less painful in recent weeks and the right side treatment is now easily tolerated, with only a few trigger points.
The "golf ball" feeling has faded, but I still sit with a special pad because of pain while sitting.
Does anyone's experience confirm I've found a good PT who's doing the right stuff. Thanks.
Impressed with her honesty, I set up two 1-hour sessions per week for several weeks.
The first session she did a thorough evaluation, checking for pelvic mobility, external and internal trigger points (this hurt) and tight muscle bands, and tight ligaments including the hamstrings. I gave her my copy of the AHIP book and referred her to an essay by Dr. Wise on PT. She read both of these with interest and enthusiasm.
The following session went like this:
The first 5 minutes she reviewed my pain log and asked if I had any questions or concerns. The next 10-15 minutes she looked for and treated external trigger points (mine were mainly on the upper glutes near the hip). The next 30-35 minutes she did internal trigger point release, soft tissue message and muscle band stretching. She would maintain steady pressure on a trigger point for 90 seconds, all the while asking if I could tolerate the pain. During the muscle band stretching she would ask me to contract the pelvic floor for 5-7 second intervals while she stretched the muscles. The final minutes of the session she would perform an external calming message and we would go over one of the stretches in the AHIP book. She also taught me diaphram breathing exercises to get me through the very painful part of the sessions. She has offerred to train my wife
These sessions were very painful at first and almost always fallowed by a flare-up day. They have become much less painful in recent weeks and the right side treatment is now easily tolerated, with only a few trigger points.
The "golf ball" feeling has faded, but I still sit with a special pad because of pain while sitting.
Does anyone's experience confirm I've found a good PT who's doing the right stuff. Thanks.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By:
Sounds right on to me. The page you recommend to find the PT is a good one.
I can't stress enough for those of you with spouses to get them involved in the PT after you've had your first 5-10 sessions. Your spouse can become an excellent therapist with YOUR help. But the most important thing is that you've had enough experience with a trained PT to be able to tell your spouse if she is doing it right or wrong. Plus, you will have more confidence that she isn't breaking anything in there (this is key when flare ups are still very common in the beginning). Since this is a LIFELONG pursuit, and flare ups will happen from time to time, having your wife involved will save you money. It was the best move I ever made, and Dr. Wise fully encourages it.
Mike
I can't stress enough for those of you with spouses to get them involved in the PT after you've had your first 5-10 sessions. Your spouse can become an excellent therapist with YOUR help. But the most important thing is that you've had enough experience with a trained PT to be able to tell your spouse if she is doing it right or wrong. Plus, you will have more confidence that she isn't breaking anything in there (this is key when flare ups are still very common in the beginning). Since this is a LIFELONG pursuit, and flare ups will happen from time to time, having your wife involved will save you money. It was the best move I ever made, and Dr. Wise fully encourages it.
Mike
This is NOT medical advice. I am NOT a doctor.
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
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LightningTree
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My PT taught my spouse the basics of internal work, but we haven't done it at home, mostly because I feel guilty about it. I mean, I know she said "in sickness and in health", but I don't think she pictured this.
Anyhow, I should just get over that, I know.
Anyhow, I should just get over that, I know.
This is not medical advice, and I am NOT a doctor of medicine or a related field.
* Age:33 Onset: February 2004.
* 99.9% IMPROVEMENT in 2.5 Years with the first year being the really hard part
* Current Symptoms: Mild irritation of perineal muscles on occasion. Relieved for days at a time by a specific stretch (see below).
* Initial Symptoms: Terrible penile, urethral, rectal, and perineal burning/aching with addition afferent sensations.
* Current Treatments: Deep stretching of the legs and pelvis. Most effective: Deep psoas and levitar ani stretch using the first phase of the "pigeon pose" from Yoga. When a deep pulling is felt in the middle of the pelvis next to the upper rectum, symptoms are completely alleviated for several days.
* Past Treatments Hyperprotection of the perineum for 1.7 years, Walking, Rectal biofeedback, Stanford/Wise-Anderson Protocol, Conditioned deep relaxation practice, Men's Multi-Vitamin and an Extra B-complex pill, all seemed to help.
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webslave
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I can understand that this may be a difficult area for some couples.
What we need in the US is for some enterprising individual to set up a clinic to do this at a low cost just across the border, employing well-trained Mexicans. I'm only half joking. The current choices presented are between the expert but pricey and short-term Stanford group, and doing it at home with someone with whom you're trying to maintain a romantic love relationship, & both are sub-optimal.
What we need in the US is for some enterprising individual to set up a clinic to do this at a low cost just across the border, employing well-trained Mexicans. I'm only half joking. The current choices presented are between the expert but pricey and short-term Stanford group, and doing it at home with someone with whom you're trying to maintain a romantic love relationship, & both are sub-optimal.
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I too felt very guilty about having my wife do it early on. I still to this day apologize to her after she has to do these sessions. I thank her endlessly. But never once has she ever expressed any dissatisfaction with the arrangement. She felt worse not being able to do anything to help me. She hates when I'm in pain, and she wants to help more than anything. So most of the worry was all in my head. And remember, women are must more experienced having people reach in places than we are. This is nothing new to them.
Mike
Mike
This is NOT medical advice. I am NOT a doctor.
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
I wish someone here with a little influence could convince Dr. Wise to conduct paid phone consultations with willing Physical Therapists-- the object being to: (1) Impart critical information for pelvic floor rehabilatation per the SP; (2) Assess the competence of the PT;(3) Based on the findings of the PT, determine the appropriateness of trigger point release therapy to effectively treat the patient.
I, for one, would be willing to pay for this consultation. I completely respect Dr. Wise's position that he does not want to offer half measures or partial solutions when a comprehensive protocal is required. But, let's face it: the toothpaste is out of the tube. In writing his book, he has given hope to many who cannot make it to one of his clinics. Many of us our trying our best at self-administration of the Stanford/Wise-Anderson Protocol and that is that. There are many talented, dedicated PT's out there. Finding them, training them and spreading the word by whatever means available could only help.
I, for one, would be willing to pay for this consultation. I completely respect Dr. Wise's position that he does not want to offer half measures or partial solutions when a comprehensive protocal is required. But, let's face it: the toothpaste is out of the tube. In writing his book, he has given hope to many who cannot make it to one of his clinics. Many of us our trying our best at self-administration of the Stanford/Wise-Anderson Protocol and that is that. There are many talented, dedicated PT's out there. Finding them, training them and spreading the word by whatever means available could only help.
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webslave
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As far as I can remember, DW was very keen to train PTs to do this in the early days (see viewtopic.php?t=1067 ), but I think the uptake on his offer was meagre. I think he is still willing to train and advise PTs, or have Tim Sawyer do this, but you'd have to contact him yourself to gauge the extent of this willingness.
The number of men who have gone through this treatment is still in the low hundreds, not thousands. It is still not widely accepted. We are in the earliest days of this new era. Ten years from now, the current situation (of poor therapist access) will be inconceivable.
The number of men who have gone through this treatment is still in the low hundreds, not thousands. It is still not widely accepted. We are in the earliest days of this new era. Ten years from now, the current situation (of poor therapist access) will be inconceivable.
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harring,
You live close enough to the Bay Area that I would seriously consider using one of his personally recommended therapists in and around Sebastapool (if you haven't already found someone local). I live 3 1/2 hours away from there, but made the trip frequently for 3 months to get therapy. Given that you are only 6 hours away, I think it is worthwhile for you to at least give one of the local PTs a try. Since they work at his clinic (on a rotating basis), you'll know they are doing the right thing. The therapist that he recommended to me is:
Jeff Franceshci
Franceschi & Associates
Offhand I don't have the phone number handy, but I'm sure you can find it on-line in any number of places.
Mike
You live close enough to the Bay Area that I would seriously consider using one of his personally recommended therapists in and around Sebastapool (if you haven't already found someone local). I live 3 1/2 hours away from there, but made the trip frequently for 3 months to get therapy. Given that you are only 6 hours away, I think it is worthwhile for you to at least give one of the local PTs a try. Since they work at his clinic (on a rotating basis), you'll know they are doing the right thing. The therapist that he recommended to me is:
Jeff Franceshci
Franceschi & Associates
Offhand I don't have the phone number handy, but I'm sure you can find it on-line in any number of places.
Mike
This is NOT medical advice. I am NOT a doctor.
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
Age: 43 CPPS: 10+ Yrs Recovery Status: 80-85% Symptoms: Pain in testicles, scrotum, rectum, prostate, perineum Makes Worse: Anxiety, Tension, too much Nookie Makes Better: Stretching, Abdominal Massage (Go Theracane!), Relaxation
I agree with this. My wife's desire to help me, after seeing how much pain I was in, overcame any thoughts of not wanting to do this. The benefits of having a spouse be able to do this are incredible:CppsDad wrote:I too felt very guilty about having my wife do it early on. I still to this day apologize to her after she has to do these sessions. I thank her endlessly. But never once has she ever expressed any dissatisfaction with the arrangement. She felt worse not being able to do anything to help me. She hates when I'm in pain, and she wants to help more than anything. So most of the worry was all in my head. And remember, women are must more experienced having people reach in places than we are. This is nothing new to them.
Mike
-cost (free, besides buying gloves & lubricant)
-location (don't have to leave the house)
Age: 36 | Symptoms: Started with urethra/penis pain. Now have low back and posterior pelvic pain. Have been doing SP since May 2004.