Exercise and Muscle Spasm

[alprost]

Those men who have a Chronic Fatigue Syndrome (CFS/ME/Yuppy Flu/Fibromyalgia etc) component to their chronic prostatitis / chronic pelvic pain syndrome suffer most after vigorous exercise, IMO.

I'd also say that those with significant pelvic floor muscle spasm are very likely to suffer after exercise, due to mechanical changes within the muscle which are likely to result in inflamation and pain, particularly for the 2-3 days after a bout of exercise.

[alprost]

When I first came down with this disorder, I simply exercised through the pain... I don't think there is any correlation between flare-ups and heavy exercise.

This post seems to assume that everyones symptoms are caused by the same factors, and I am certain that this is not the case. I'm really pleased that you were able to exercise through the pain but many cannot. For example, 2 days after attempting to do this myself several months ago I had to urinate every 15 minutes for the following week - what a lot of fun that was.

I am still under the impression that this is an auto-immune disorder.

I'm sure it is - for SOME people.

It really is an individual thing, and experimenting is the only way to find out if exercise helps or hurts. My own feeling is that when exercise HELPS individuals they do not have significant pelvic floor muscle spasm, and the pain releif they feel can be explained by mainly CHEMICAL mechanisms, e.g. increased endorphin secretion.

When exercise HURTS individuals, this is likely to be caused primarily by MECHANICAL factors due to pelvic floor muscle spasm. Briefly, a shortened pelvic floor places the muscles in a weak mechanical position due to what is known as the' length-tension' relationship of skeletal muscle. As the Pelvic floor muscles are involved in all exercise, and undergo prodominantly eccentric (or lengthening) contractions during exercise, this weak position and the fact that that they are probably already inflamed, means that they are then very suseptible to exercise induced pain and inflammation.

Al.

[webslave]

When exercise HURTS individuals, this is likely to be caused primarily by MECHANICAL factors due to pelvic floor muscle spasm.

Possibly true for some. However for me, strenuous exercise leads to complete CFS-type whole-body exhaustion and malaise lasting for days. Remember that exercise is a big mast cell trigger.

[alprost]

However for me, strenuous exercise leads to complete CFS-type whole-body exhaustion and malaise lasting for days.

And I thought I had it bad

[webslave]

Just keep an open mind. I'm waiting for the new book from Stanford University called A Headache in the Pelvis to see how sensible the muscular spasm theory really is.

[alprost]

Just keep an open mind.

I DO have an open mind! I never said that my points related to everyone -only those who do have muscle spasm. If you read this and previous posts here I frequently state that I don't believe ANY of the various 'theories' explain chronic prostatitis / chronic pelvic pain syndrome in all patients.

I'm waiting for the new book from Stanford University called A Headache in the Pelvis to see how sensible the muscular spasm theory really is.

I don't even think we need to wait for this to find out if many men with chronic prostatitis / chronic pelvic pain syndrome have pain from muscle spasm - it is already well documented in the literature. For example Zerman et al (1999) found that 88% of men with Type IIIb chronic prostatitis / chronic pelvic pain syndrome had myofascial tenderness of the pelvic floor and pelvic floor dysfunction as diagnosed by urodynamic testing (Zermann, D.H., Ishigooka, M., Doggweiler, R., Schmidt, R.A. (1999) Chronic Prostatitis: A Myofascial Pain Syndrome? Infect Urol 12(3):84-88, 92) They also reported that many of these patients responded to 'modulation based therapies' although they do not provide any details of these treatments. Like yourself, I also like the idea of performing clinical trials and working backwards to a cause. Although it is hardly a clinical trial, I have IIIb CPPS, and have improved by around 70% as a result of treatment for PFM spasm, so I'm certain that muscle spasm is a major problem - IN ME.

The one thing I don't like about this and other 'theories' is that they give the impression of hoping to explain ALL cases of CPPS. I belive muscle spasm is a major problem for a subset of chronic prostatitis / chronic pelvic pain syndrome patients. Even within this subset I feel there are likely to be different scenarios:

- Some people possibly have developed PF muscle spasm as a result of stress; excessive sitting and tensing the PFM, which is basically the theory the book mentioned above is likely to be postulating.
- However, I'm certain that others have a vicous cycle of muscle spasm and pain which was set up by a Urological condition (such as prostatitis) which has now resolved, which is what I would say has happened to myself. Therefore, I do not believe what is commonly referred to as the 'Neuromuscular Theory' applies even to me!
- Another group within this subset may have PFM spasm which is a protective mechanism to an unresolved urological condition.

The role of muscle spasm in chronic prostatitis / chronic pelvic pain syndrome is something which could be quite easily researched, as there are effective methods in existence which have been used to successfuly treat PFM spasm in women with chronic pelvic pain. However, only a few Urologists seem interested in researching these treatment modalities, which is a real shame.

Al.

[Richard.N]

I'm pretty sure I have a muscle spasm component. Indeed, I would guess that many people who benefit from Alpha Blockers have muscle spasm.

[webslave]

Richard, that depends on what muscle spasms you are talking about. Alpha blockers relax smooth muscle in the gland. The Stanford and other protocols relax skeletal muscle in the pelvis around the gland (I think). So there are different groups of muscle we must think about. I certain agree the smooth muscle thing is a factor. I've felt the effect this last week with Hytrin. The hydroxyzine antihistamine tensed the smooth prostatic muscle painfully, the Hytrin loosened it and removed all pain → proof positive. But the skeletal muscle, is that a cause or an effect of prostate/bladder dysfunction and pain, a "guarding" response? And is there a chance that the Stanford (and other muscle-oriented protocols) are actually having an effect on the smooth muscle inside the prostate, even though the proponents think it's affecting the skeletal muscles only? This is still a hazy area for me.

I may move this discussion to the Muscle Spasm forum...

[Richard.N]

Hmmm - Mark - I see what you mean: smooth vs. skeletal.

Can't wait to read the book though.

[Ralph]

The theory of skeletal muscular spasm contributing to pelvic pain is why benzodiazepines such as Valium have a role is this disorder. Valium is commonly used to treat back spasms and other muscular spasms. Valium and Librium has helped me in the past . Valium will make you sleepy whereas Librium will not. Both also help with anxiety which can create a vicious cycle.

[webslave]

That's a very interesting comment. Thanks. I'll work that into the protocol page.

[alprost]

But the skeletal muscle, is that a cause or an effect of prostate/bladder dysfunction and pain, a "guarding" response? ......... This is still a hazy area for me.

Webmaster, if you believe that muscle spasm is only ever likely to be a protective response in pelvic pain syndromes you should read this paper:
http://www.obgyn.net/cpp/cpp.asp?page=/ ... lazer_0300

Regards,
Al.

[Richard.N]

The theory of skeletal muscular spasm contributing to pelvic pain is why benzodiazepines such as Valium have a role is this disorder.

Absolutely Ralph. Baclofen - which is a MS anti-spasm drug - helped me with back and pelvic pain. Messy side effects for me though.

[webslave]

Webmaster, if you believe that muscle spasm is only ever likely to be a protective response in pelvic pain syndromes you should read this paper:
http://www.obgyn.net/cpp/cpp.asp?page=/ ... lazer_0300

You can call me Mark, Al.

I did not say that I believed it is only a protective reponse to pain. I said it may be.

I read the paper you referenced. It was written in 1995. If you go to Medline and look at some of the recent papers on vulvar vestibulitis (which we know is linked to a certain genetic profile, and which is similar to chronic prostatitis / chronic pelvic pain syndrome and IC in many ways), you see no mention of Kegels exercises, even though the author of your paper claims it cures most patients. So a degree of caution is advised. I note also that the biofeedback machine linked to in the paper is no longer made - not a vote of confidence, is it? But thanks for the heads up, Al.

Interesting note: most VV patients probably have CPPS/IC. Here's a quote from a 2002 Nov study by Parsons:

RESULTS: Of 244 patients with pelvic pain, 197 patients (81 %) had a positive result from a potassium sensitivity test. Positive potassium sensitivity test rates were comparable across all four sites and all clinical diagnoses that included endometriosis, vulvodynia (vulvar vestibulitis), and pelvic pain. Urologic symptoms were reported by 84% of patients, but only 1.6% of the patients had received an initial diagnosis of interstitial cystitis. None of the 47 control subjects were tested positive with the potassium sensitivity test. CONCLUSION: Interstitial cystitis may be a common unrecognized cause of pelvic pain in gynecologic patients and deserves greater, if not primary, consideration in the differential diagnosis of pelvic pain.

[alprost]

You can call me Mark, Al.

Mark, I meant no offence by calling you Webmaster - sorry if it came across that way.

I read the paper you referenced. It was written in 1995. If you go to Medline and look at some of the recent papers on vulvar vestibulitis (which we know is linked to a certain genetic profile, and which is similar to chronic prostatitis / chronic pelvic pain syndrome and IC in many ways),

I could not agree more - that was my point.

you see no mention of Kegels exercises, even though the author of your paper claims it cures most patients.

This does not mean that it does not work - only that it has not been researched fully. The treatment I have been receiving for the past 3 months in not mentioned anywhere in the chronic prostatitis / chronic pelvic pain syndrome literature, but it has still helped me greatly. I'm not trying to be antagonsitc, but the point I was trying to make is that PFM spasm treatments DO need to be investigated by high quality clinical research to answer this question once and for all.

There is one small study (by a different research group incidentally) using biofeedback in chronic prostatitis / chronic pelvic pain syndrome which did demonstrate a degree of effectivness:
http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

Rather than being conclusive proof, I would consider this as preliminary evidence, worthy of further investigation. Since there is no conclusive evidence either way at this stage, all we can do is speculate.

I note also that the biofeedback machine linked to in the paper is no longer made - not a vote of confidence, is it?

To the best of my knowledge it has been updated.

Al.