No trigger points found in PT; What gives?

[timberdoodle]

Would appreciate anyone's perspective on PT as I am getting a bit discouraged. I want to believe in the Standford Protocol, but after several doses of thorough PT (internal and external), my therapist can find no trigger points. There are areas that are painful, but then again, wouldn't anyone feel some level of pain and discomfort being examined internally?

My frustration comes from the fact that we can locate no areas that refer pain to my penis, which is where most of my pain is located.

I have very little problems with urgency; occasionaly I get sharp pains in the tip of my penis, and it always feels sensitive and achy throughout the day. As some others have mentioned recently, it can hurt with shower water running on it or simply the rubbing of it against my boxers when I walk.

Are we missing the trigger points? Could there be no trigger points? Is it possible for the nerves in the penis itself to just be out of whack with no link to a trigger?

[CppsDad]

Everyone would feel some level of pain if a therapist was pressing hard enough. What is probably more important is the relative pain compared to a) the same area on the opposite side and b) other areas internally. From my experience so far, areas that don't have trigger points and aren't unduly shortened don't hurt so much when pressed. Pressing the non-sore sports is uncomfortable (in some case very much so, especially when pressing on/near the bladder wall), but not really painful. In some cases I had to ask the therapist if they were pressing as hard on the non-sore spots because I could barely feel any pain.

Also, in some cases trigger points may be "hidden" under other taut bands of muscle. You can't really reach those until you remove the tough layers above them. If you tried to reach them up front, you'd cause a lot more pain. Remember - you may have many layers of muscle to work through. The bands have to be broken down before you can get underneath.

Now, make sure your therapist is experienced in pelvic floor therapy. There are probably different threshholds for trigger point massage on the back verse the pelvic floor. It's possible that what your PT considers a trigger point may be too tough of a definition for the pelvic floor.

Also make sure you are investigating the abdominal and stomach muscles.

Now, as to your questions:

1) Are we missing trigger points? Possibly.
2) Could there be no trigger points? Possibly. Pelvic pain can come from painful shortened muscles as well. But trigger points are probably involved somewhere.
3) Is it possible for the nerves in the penis itself to just be out of whack with no link to a trigger? I don't know the answer to this one. My feeling on painful nerves is that SOMETHING must be causing it, even if it is not apparent. Perhaps somebody else can chime in here.

In my case, I can press on my stomach, and feel a strong pain response near my sphincter. That's a long way for the pain to travel from where I pressed. Therefore, your pain could be coming from a lot of different nerves.

[Viking]

timberdoodle:

I seem to be sharing some of your symptoms like the ache and sensitivity in the penis throughout the day. I think you should investigate the stomach muscles, like Mike said, and see if they are somehow related to your pain.

Waking up this morning, I could pretty much tell that it was going to be a reasonably bad day. In the shower though, I sort of pressed around on my ab muscles and it felt like it loosend up and god better. I often catch myself tightening the abs unconciously and this might be one of the things causing my pelvic pain.

As I am sitting here at work, I can still feel the penile pain, but it is less than the previous couple of days. I believe the pressing on the abs did some good.

I will continue to massage the abs and see if it does more good.

[Paul D]

Hi ,I also have similar symptoms ,and have had trigger point therapy ,my therapist found some painful areas but they didn't reproduce the penile urethral pain ,which keeps me awake at night .My doctor thinks the pain could be being referred from the trigone of the bladder ,although I dont have bladder pain very often ,but have some IC symptoms .I'm still seaching for the correct trigger points ,usually for penile urethral pain they are close to the prostate on levator ani muscles .I know its very frustrating when no trigger points are being referred to the painful areas .
Paul .

[latte]

My experience is similar. My PT says my internal muscles feel healthy now but my abdominals are keeping the pelvis too tight. I still have some sitting pain but it is overall much better. When she works on my abs the pelvic pain gets better. I am doing daily stretching exercises to lenghten the abdominal muscles. I am hopeful that when we get rid of the trigger points in the abs I may be close to pain free at least some of the time. I can literally push on one major TG just left of my bladder and get my pelvis to stop hurting for a few minutes. My PT told me this but I was skeptical until the last few PT sessions.

[timberdoodle]

Thanks for all your replies. I am encouraged to hear from some who have similar problems and issues.

One of the things that worries me is that the development of my chronic prostatitis / chronic pelvic pain syndrome is somewhat backwards from others. I initially had a UTI, and tested positive for bacteria in my urine at an ER. I later went to a urologist, whom I really respect and like as a doctor, but interestingly, she refused to believe I ever had a UTI, because she believes in the Stanford/Wise-Anderson Protocol! I even had the lab results from the ER with me. Go figure!

To her credit, we did all the standard tests and cultures, which came back negative, which is why she doesn't think I really ever had a UTI to begin with.

The point of all this is to say that I sometimes wonder if I have a lingering infection, given the fact that I cannot find trigger points and don't seem to be making much progress following the Stanford/Wise-Anderson Protocol. Could I have been turned on to the Stanford/Wise-Anderson Protocol too soon? Does this make any sense?

[latte]

Initially my doctor found a few staph cells in my urine and declared that I had an infection. Later on my uro said that the staph bacteria found were normal flora. Also the uro found my white cell blood count to be lower than normal so we concluded that I did not have an infection. I was very confused for a long time since this was in 2001 and the Stanford/Wise-Anderson Protocol had not been introduced. As a matter of fact, I was confused for two years and desperate. I have found that the stretches that my PT shows me help a lot. I can reduce my pain immediately by doing the stretches but the pain comes back. Now we are working on the abdominals. Hope these comments help a bit.

[rgparrish1]

For what it's worth, "all PT's are not created equal," from my personal experience, as well as the experience, from what I've read, of MANY others. For example, the first person who worked on me (a RN with a PhD, who's been doing Myofascial/TP Release Therapy on women for years), found only a couple of TPs inside my rectum. One of her co-workers, a LMT found over 20 on my first session with her! I had my second session with her yesterday, and she found ANOTHER 10+! (AND I did experience some pain attenuation). Also, my pain, primarily in the supra-pubic area, which has recently spread to other areas, STARTED with a kidney infection...which adds another demension to my case (I haven't heard from anyone who's had this same experience.) My advise to you is to "shop around" for a good PT (I know it's a lot easier said than done...guess I was just "lucky" to find someone early on.) I have to run now, but I'd be happy to continue this conversation at another time. I know how frustrating this can be, but I really believe there are people out there who can help! Good luck!

[timberdoodle]

After my last session with my PT, she called to suggest that I see the other PT on staff that deals with pelvic pain. So in a few weeks, I will work with a PT who has actually been out to Stanford and hopefuly has some more experience.

I really like the PT I have seen so far. I feel like I have a level of trust with her, so it will be difficult switching, but maybe it will be worth it in the long run if we can find some trigger points.

[rgparrish1]

Timberdoodle, Definitely switch PTs, if you're not getting any relief with the one you're working with now. In my case, it made all the difference in the world (especially when she started the intrapelvic work).

In my OPINION, this is critical! A good TP must have good tactile skills, in addition to good intuition. Also, it's important that the two of you "communicate," during the process. My therapist can feel things (TPs) as soon as she goes in, and the I guide her from there. By working together, we're making good progress. I've heard so many stories about people getting "no relief ." But, after my recent experience, I suspect that many of these people DO have active TPs which the therapist has yet to find. Good luck, and please keep in touch. I'll keep you all posted on my progress.

[CppsDad]

If you've only had a few therapy sessions, that probably isn't nearly enough time to give up on the SP. Repairing this damage to your muscles and nerves takes many many months, not many many weeks. I'm sure there are some quick healers, but most of us take 6 months or longer I would bet. Also, as the prior poster mentioned, the tactile abilities of the PT are important, as is their ability to listen to you, go slowly, and explore the various areas. Your trigger points may be smaller or softer than your therapist is used to seeing; but that doesn't mean they are sitting right on top of nerves and causing pain.

Where do you live? You don't mention it, but perhaps you live near someone on the board who can recommend a PT that they've used. Even having a single session with a good PT can at least give you an idea of what to expect from your own PT.

Mike

[timberdoodle]

Mike,

I live in Ohio and am currently seeing the therapists at the Cleveland Clinic, OH. Both have training in pelvic pain therapy, but one has actually been to Stanford as well. The urologist there, Dr. Jeanette Potts, is also mentioned in AHIP. I recommend her as a compassionate, competent doctor.

If there's anyone else in the Ohio area with PT reommendations, I am happy to hear of them.

[CppsDad]

I only asked you for your location so that you can benefit from the wide range of members and hopefully get additional recommendations. It sounds like the PT you WILL be seeing (the one that has been to Stanford) is the right way to go. If that doesn't meet your needs, however, consider taking a short plane trip and getting therapy from other therapists recommended on the boards. You would just stay over for 2 or 3 days and have back to back treatments. This will help you learn about your trigger points and muscles so that you can take this information. This is even more feasible now with plane fares dipping down so low. I see one of the therapists that works with Dr Wise, and he treats out of town people on "crunched" schedules all the time.

Michael

[cppsyoungsufferer]

Hi everyone. I am ready to take the plunge into seeing a good PT for treating my symptoms. I am 25 now, and have been suffering for over 3 years. After seeing several well respected uros, having a myriad of tests performed and trying everything possible, I am positive I have CPPS.

I would be so grateful if anyone could recommened a PT specializing in treating our conditions in the Central New Jersey area. How would I even go about finding a PT / Myofascial specialist in my area? New York is about an hour by train and I would feel much more comfortable seeing someone locally.

Much of my pain exists in my lower back, in addition to the typical chronic prostatitis / chronic pelvic pain syndrome symptoms we all seem to share. I just had an MRI done which shows 2 minimal disc bulges at L2-L3 and L4-5. Could this be the source of all my pain?

Thanks in advance. All of your help has given me confidence again that this problem is treatable.

[CppsDad]

cppsyoungsufferer, I'm glad you found this site. You don't provide enough detail for me to speculate on what the cause of your pain is, but bulging discs that cause muscular pain in the back can certainly be one factor in your chronic prostatitis / chronic pelvic pain syndrome symptoms. I don't live near NY so I can't offer a recommendation, but you should post a brand new topic that states you are searching for a recommendation, that way it doesn't get lost at the bottom of this one.

This community has a lot to offer. Feel free to tell us your story, your symptoms, what you have tried and not tried, and perhaps you will get some valuable suggestions from the group that range from therapeutic to dietary to psychological. There's no reason to battle this by yourself any longer. I'm pretty sure that I've improved slightly since joining this site solely as a result of the support I've been able to receive. My mood is better, and my outlook is brighter. This causes me to do therapy more often and keep on my daily stretches.

Michael