I had 50 or so sessions of PT that did not manage to get rid of a single trigger point.
PT would release my muscles temporarily and then a day later the PFD would be back.
T.Sawyer advised me to consider trigger point injections. I had it in the adductors, the levator ani and the transverse perineal muscle.
The effect has been immediate. The muscles released instantly and the PFD never came back.
It is also extremely safe and almost painless.
The trigger point injection technique is the "original" treatment developped by Janet Travell, JFK's MD.
some good information at: http://www.aafp.org/afp/20020215/653.html
Alternative to physical therapy
Alternative to physical therapy
Age:46 | Onset Age: 43 | Symptoms: Burning | Helped By: Sleep/Ultram | Worsened By: As the day goes by
Who performed the injections? Physio, Uro, other?
Richard.
Richard.
Not medical advice: Read my progress to date : Read about my W-A clinic visit
Age: 54 CPPS: 20 Yrs Recovery Status: 95% Symptoms: Pain around perineum Makes Worse: Tension, sitting Makes Better: Stretching, triggerpoint therapy, relaxation
Age: 54 CPPS: 20 Yrs Recovery Status: 95% Symptoms: Pain around perineum Makes Worse: Tension, sitting Makes Better: Stretching, triggerpoint therapy, relaxation
I've been suffering from chronic prostatitis / chronic pelvic pain syndrome for the past 3 years, the oneset was following an adductor muscle strain, stressful family sitaution, and excessive sitting during university exams. I've been going around in ever bigger circles to try and sort my self out. There is no question that my pain is caused by a neurological wind up of my CNS around my pelvis, and in turn muscle tension, I'm literally in suicidal pain when I sit down. I've explored all sorts of treatment, including flying up to see the PT Bill Taylor in Scotland and a PT in Bradford - there's no dam decent PT in London, in any case they didn't do me much good. I know that I need to develop a comprehensive self treatment programme to help myself but I lack the motivation because I've been dissapointed so many times in the past. If anyone's interested, recently I've been having trigger point injections in my legs and lower back, weekly for the past five weeks, from a pain specialist in London. However, they haven't done me much good. Following the post by MB, I'm going to ask my specialist if he can directly inject my pelvic floor, I'll report back next week if I have any success.
Age: 23 | Onset Age: 20 | Symptoms: Horrendous perineum, sitting bone, groin, pubic bone pain while sitting; general tightness and discomfort of muscles around the pelvis, very tight and painful adductors | Helped By: stretching, gentle exercise, hot bath, eating food (not all at the same time) | Worsened By: sitting, after sleeping, stress
Good luck Graduate! I'm so adverse to needles, that the mere thought of injecting anything into my pelvic floor is enough to cause a flare-up. But I hope it works in your case. And try to keep your spirits up. There is some way to work out your muscles, you just have to find the strategy that applies best to you. I look forward to hearing your results.
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
Thanks for your words of encouragement. I hate needles as well but in my desperation I'm willing to try anything. Talking of other strategies, one thing that I can recommend, apart from a hot bath, is the new version of gabapentin, it's been mentioned a few times on this forum -- pregabalin. I was definitely less drowsy and it was more effective than the cocktail of other pain killers that I've tried in the past few years. My pain specialist has been raving about the results of pregabalin with his patients, particularly the ones with FMS/CFS, you've got to be on it for 4-5 months in order to give your body a break and the CNS can calm itself down and in turn the muscles can learn how to relax again. In the end I had to stop taking it because I'm just about to start up a new business and in the next few months I need my full concentration so that I've got a fighting chance of making a success of things. When I've established myself I would definitely think about going back on the pregabalin. As with all these pain medications the most common side effect is drowsiness!
Age: 23 | Onset Age: 20 | Symptoms: Horrendous perineum, sitting bone, groin, pubic bone pain while sitting; general tightness and discomfort of muscles around the pelvis, very tight and painful adductors | Helped By: stretching, gentle exercise, hot bath, eating food (not all at the same time) | Worsened By: sitting, after sleeping, stress
The external TrP were treated by a physiatrist and the internal stuff by a urologist.Who performed the injections? Physio, Uro, other?
The difficulty of course is that a physiatrist will not do pelvic floor injections and a urologist will not touch non-pelvic muscles.
In general, a urologist will refer you to a physiatrist.
It takes a couple of minutes to do the external trigger points. The internal stuff is more tricky.
He uses his gloved finger inside the rectum to find the muscle to be injected then lines up the needle with his finger.
You need a urologist that has very good knowledge of the pelvic anatomy. You don't want to hear a "Oops!"
Age:46 | Onset Age: 43 | Symptoms: Burning | Helped By: Sleep/Ultram | Worsened By: As the day goes by
Thanks.
Not medical advice: Read my progress to date : Read about my W-A clinic visit
Age: 54 CPPS: 20 Yrs Recovery Status: 95% Symptoms: Pain around perineum Makes Worse: Tension, sitting Makes Better: Stretching, triggerpoint therapy, relaxation
Age: 54 CPPS: 20 Yrs Recovery Status: 95% Symptoms: Pain around perineum Makes Worse: Tension, sitting Makes Better: Stretching, triggerpoint therapy, relaxation
I have serious safety concerns about this form of treatment. The colon is filled with different species of bacteria, and we depend on them in order to carry out normal digestion. However, puncturing the tissue of the colon with a needle may introduce these bacteria to where they do not belong, which may result in an infection.MB wrote:He uses his gloved finger inside the rectum to find the muscle to be injected then lines up the needle with his finger.
You need a urologist that has very good knowledge of the pelvic anatomy. You don't want to hear a "Oops!"
This is not medical advice. Please consult your physician.
Re: Alternative to physical therapy
What was the estimated cost of that failed form of treatment?MB wrote:I had 50 or so sessions of PT that did not manage to get rid of a single trigger point.
T.Sawyer advised me to consider trigger point injections.
Could you cite published, peer-reviewed, medical studies that establish the safety of intrarectal trigger point injections?It is also extremely safe...
This is not medical advice. Please consult your physician.
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LightningTree
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What substance are they injecting?
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.
About $5K out of my pocket.What was the estimated cost of that failed form of treatment?
I realize that I wasn't clear. The needle goes through the butt and not through the rectum.I have serious safety concerns about this form of treatment
He uses his finger through the rectum to find the landmark. With his other hand he aims his needle towards his finger.
It is the same technique used for a non-guided nerve block for example.
Age:46 | Onset Age: 43 | Symptoms: Burning | Helped By: Sleep/Ultram | Worsened By: As the day goes by
Either nothing or a little bit of lidocaine to ease the pain afterward. The goal is to disrupt the trigger point with the needle.What substance are they injecting?
If the trigger points are in the connective tissue close to the skin, acupuncture needles can be used as well.
Age:46 | Onset Age: 43 | Symptoms: Burning | Helped By: Sleep/Ultram | Worsened By: As the day goes by
I, too, have had a lot of experience with trigger point injections, and it is very effective. My glutes and adductors were so knotted up that the injections were the only things that would loosen things up enough for my myotherapist to be able to do effective massage. During the course of my injections, I too had a few into the pelvic floor, but only on the "butt" part of the pelvic floor, i.e., the fleshy part along your crack. I didn't have any perenial injections. It was safe and there's only a little mild soreness that treated with hot baths and stretching goes away after a few days. If you get some major knots in your adductors and glutes injected, you can be sore up to 3-4 days, but it's a good sore, like that needed to be done, not the bad burning pain of CPPS.
For those who don't really understand, they're not really injecting anything, it's the needle that's doing the good. It breaks up the knotted myofascial tissue and you get a twitch response, and it releases all the toxins locked up in the myofascial knot. Then the tissue heals at its normal length, blood flow is restored, and pain is gone. Hot baths and stretching after the injections facilitates the healing. Sometimes the doctor can just use a dry, tiny needle, like a sewing or acupuncture needle. sometimes they use a bigger needle and inject a little lidocaine just to ease your soreness a bit. but the lidocaine is not doing anything to the trigger point, the needle is. Just like massage, you have to "interfere" and "interrupt" trigger points.
My question to MB is this: When they injected your transverse perenial muscle, did they inject into your perineum, i.e., about halfway between the back of your scrotal sack and your butthole?
For those who don't really understand, they're not really injecting anything, it's the needle that's doing the good. It breaks up the knotted myofascial tissue and you get a twitch response, and it releases all the toxins locked up in the myofascial knot. Then the tissue heals at its normal length, blood flow is restored, and pain is gone. Hot baths and stretching after the injections facilitates the healing. Sometimes the doctor can just use a dry, tiny needle, like a sewing or acupuncture needle. sometimes they use a bigger needle and inject a little lidocaine just to ease your soreness a bit. but the lidocaine is not doing anything to the trigger point, the needle is. Just like massage, you have to "interfere" and "interrupt" trigger points.
My question to MB is this: When they injected your transverse perenial muscle, did they inject into your perineum, i.e., about halfway between the back of your scrotal sack and your butthole?
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By:
Could you be a bit more specific please? What "toxins" are locked up in the myofascial knot?boudreaux wrote:For those who don't really understand, they're not really injecting anything, it's the needle that's doing the good. It breaks up the knotted myofascial tissue and you get a twitch response, and it releases all the toxins locked up in the myofascial knot.
This is not medical advice. Please consult your physician.
i use "toxins" loosely, not like I'm a doctor. if you read claire davies book or dr. janet travell's Myofascial Pain and Dysfunction, you'll understand that when a muscle contracts, natural chemicals flow in and out of the myofascial tissue. when the tissue is knotted, i.e., a trigger point forms or a cluster of trigger points form, the chemical/blood in and out flow cannot happen correctly. the bodily chemicals get trapped in the tissue and can't get out. blood can't get in. the trapped chemicals are what I'm calling "toxins". davies or travell explain it a lot better than me, but that's the best I can do.
the knotted up, chemical-entrapped tissue becomes tender and painful because it cannot be flushed by fresh blood. and trigger points foster surrounding trigger points until, wala, your entire pelvis, or shoulder, or adductor becomes chronically painful.
if you "interfere" enough with the trigger points through needling or massage, the tissue actually breaks up, becomes sore for a while because it's been shortened for so long, but then ideally heals back at its normal length. of course this isn't like pressing buttons on and off. and that's why the baths, stretching, and relaxation become so important, because it fosters the healing of the tissue to its original length after the trauma to it by interference through needling or massage.
i'm getting a bit long winded now, so I'll defer to dr. travell and clair davies. the books are a must read for those with CPPS. you've got to conceptualize what's happened to your body.
the knotted up, chemical-entrapped tissue becomes tender and painful because it cannot be flushed by fresh blood. and trigger points foster surrounding trigger points until, wala, your entire pelvis, or shoulder, or adductor becomes chronically painful.
if you "interfere" enough with the trigger points through needling or massage, the tissue actually breaks up, becomes sore for a while because it's been shortened for so long, but then ideally heals back at its normal length. of course this isn't like pressing buttons on and off. and that's why the baths, stretching, and relaxation become so important, because it fosters the healing of the tissue to its original length after the trauma to it by interference through needling or massage.
i'm getting a bit long winded now, so I'll defer to dr. travell and clair davies. the books are a must read for those with CPPS. you've got to conceptualize what's happened to your body.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By: