Can I do the Trigger Point Internal Massage Myself?

[Tomass]

I read with much interest and hope the discussions about the new way of thinking that you initiated on the forum (Pelvic Myoneuropathy). I suspect that my CP is pure muscle tension disorder. Therefore I am very interested in trying self-massage to relax my muscels.

Could you answer, please:

How often did you do self-massage?
How long did one massage last?
How long did it take until the improvement started to appear?
How did you find trigger points?

[webslave]

I am expecting some data on self-massage from David Wise, author of the book "Headache in the Pelvis", shortly. I will post the information here. I'd rather not describe what I did because I don't want you trying it and possibly hurting yourself. I was haphazard in what I did in those days (pre-Internet and before I had talked to anyone else besides my clueless uro about CPPS).

I advise others too to be careful about telling people how to insert objects into their bodies. If someone perforates the thin and delicate lining of his rectum, your words could come back to haunt you legally. So if you do want to give advice on this topic, post it as what you did in a standalone thread, not in response to someone's question.

[webslave]

From David Wise:

Dear Mark,

In response to your reader's question let me be clear that we do not advise people to do medically unsupervised myofascial/trigger point release on themselves for a number of reasons. We talk about this in "A Headache in the Pelvis." We do believe it may be possible with proper training and medical supervision and the correct kind of instrument for someone to do self-administered myofascial/trigger point release. Starting around 1999 at Stanford University, Dr. Anderson and I began designing and testing prototype instruments for this very purpose, as our goal has always been to make our treatment protocol capable of being self-administered. But there are significant clinical, medical/legal issues that need to be resolved before we can offer this as a standard treatment option.

We are very aware that our protocol is expensive and inconvenient, especially when people have to come to California to see us. We regret this but expect this to change as our treatment methodology becomes more widely known.

But the good news is that our protocol is available now, even though the myofascial/trigger point release must be administered by someone trained in our protocol.

Note that the NIH (the National Institutes of Health) will be considering our protocol for a national clinical research effort and this will ultimately help many more men in this country. We anticipate that the final national protocol design will include self-help and personally administered therapy.

David Wise, Ph.D

[webslave]

From David Wise:

I want to respond to the issue of self-help in "A Headache in the Pelvis" which was raised by some of your readers in an email you sent me.

We wrote "A Headache in the Pelvis" to indicate that our orientation to treatment for the most part is self-help. In fact, without the patient's active participation, the abatement of symptoms is not possible. This is the whole point of our book (p. 167 "The majority of the treatment is done at home. In this way. you are the one responsible to do the treatment").

Our purpose in writing this book was to introduce a new paradigm, a new understanding of the nature of prostatitis and how to treat it. (p. 49 "The way that you see a problem is the key to solving it."). "A Headache In The Pelvis" contains the insights we have had that have come from the treatment of many hundreds of patients with pelvic pain over the years with our protocol.

Our approach comes from a different paradigm than the conventional medical approach in which the patient is a passive recipient of the doctor's treatment. In our view, the 95% of prostatitis that we treat can't be fixed by someone doing something to you. Chronic pelvic pain syndromes tend to be the result of a lifetime of inappropriately tensing the pelvic floor. This habit of chronically focusing tension in the pelvic floor has usually been practiced hundreds of thousands of times. Can there be a medication or a procedure to fix to this tendency? I believe not.

Resolution of the symptoms of most cases of prostatitis is an inside job. In our protocol, myofascial release rehabilitates the chronically shortened pelvic tissue and the practice of paradoxical relaxation helps the person to stop the habit of focusing tension in the pelvic floor. Reducing anxiety is a major issue in breaking the cycle of tension, anxiety and pain. A lifestyle shift has to be made. We make this point repeatedly in our book.

I mentioned in a previous email that the NIH (the National Institutes of Health) will be considering our protocol for a national clinical research effort and this will ultimately help many more men in this country. We anticipate that the final national protocol design will include self-help and personally administered therapy (which will hopefully include a specially designed wand for supervised self-administration of myofascial release).

But it is also equally clear that some form of initial and then ongoing instruction and guidance will always be required. I think it is a real unkindness and disservice - very simply it is a bad idea --under any venue -- to support or encourage people in doing self-administered internal myofascial release without initial and then periodic ongoing medical supervision. Infection, perforation, bruising and inappropriate pressure leading to hemorrhage and other physical complications arising from the introduction of a wand or finger exerting significant pressure inside the pelvis are matters or of of concern without appropriate safeguards and supervision. The inevitable exacerbation of symptoms initiated by the internal myofascial release, which can go on for days, especially during the first number of sessions that can lead to misinterpretation and panic on the part of some patients when there is no guidance from someone experienced in the protocol. I believe you need a 'quarterback'--- someone seasoned in the process of our protocol- to help you keep the big picture and guide you as treatment continues.

After initial training and consultation in the methods, (followed by appropriate ongoing guidance), the patient is then ready to begin the journey which only he can take to the resolution of pain and dysfunction. But let me be clear. The initial instruction and ongoing guidance we offer is aimed at the patient becoming ultimately independent of this instruction and guidance.

Sincerely,

David Wise, Ph.D. Co-author "A Headache in the Pelvis"