Stanford/Wise-Anderson Protocol

[Adam Boyd]

There's been a lot of discussion lately about the Stanford/Wise-Anderson Protocol of myofascial release and progressive relaxation. Results in patients with chronic prostatitis / chronic pelvic pain syndrome were presented last year at the meeting of the International Continence Society. The treatment clearly benefits some patients, but it's definitely not a miracle cure for all of us.

http://www.icsoffice.org/publications/2002/PDF/144.PDF

[webslave]

Those results are better than virtually anything else we've seen to treat this disorder so far.

The study seems a bit loose, with people having as many internal massages as they saw fit. It would be better to have a more rigorous approach.

I'm not surprised at the comment about variable durability of improvement. Wise and Anderson make clear that the entire thinking of the patient has to shift. A lot of the book is devoted to that point. With the extensive experience I have of men with CP/CPPS, I can confirm that they are indeed usually type-A, highly strung, overly alert, anxious people, far more so than the run of the mill patient. Doctors openly discuss CP/CPPS patients as "difficult", "demanding" and sometimes even "hostile". We have always blamed the physicians for these seemingly pejorative adjectives, but they may well have validity.

A powerfully effective protocol would probably combine:

• Internal trigger point massage,
• Muscle relaxants/anxiolytics like the benzodiazepines
• Quercetin or Quercetin to ease mast cell woes
• Botox injections into key pelvic nerve points
• Any number of other nerve and mast cell palliatives (antihistamines, a-blockers, neurontin, Elmiron - the list is long)
• Psychotherapy to aid in applying the "paradoxical relaxation" Wise describes.

I would guess this protocol would sweep up the vast majority of patients to a new level of wellness.

[alprost]

I agree entirely - with the degree of input of each of these therapies tailored to the individual case.

Our next challenge is to ensure all patients are offered these therapies as standard practice.
Al.

[TK]

And it would be great if we could spread the word so that the typical urologist was aware of the muscular aspect and trained to do the soft tissue examination as part of the diagnostic process.

[jd]

With the extensive experience I have of men with CP/CPPS, I can confirm that they are indeed usually type-A, highly strung, overly alert, anxious people, far more so than the run of the mill patient.

What you described there is completely me, high strung, anxious, tense, impatient(especially when driving), which also progressed into becoming somewhat of a hypochondriac over the years.

It took me a long time to realize how incredibly powerful the physiological effects of being that way are.....and especially how they manifest themself in clenching my pelvic region.

But now that I have been practicing meditation/skilled relaxation twice a day for the past 4 months, I am totally relaxing as a person in all aspects, and my IC/CPPS symptoms are GREATLY reduced.

Once I learned how to do that effectively, to truly relax in normal life, but especially during skilled relaxation, was I able to physically feel how my muscles in my pelvic region, and other parts of the body were subconciously tensed up, and ultimately learn to relax them.

It's an ongoing process, but I am getting better, my life is nearly back to normal. I still have flares, but they are almost always caused by stress......however they are less frequent, less intense (they used to be pain and frequency, now they are just increased frequency), and if I am able to do a 20 minute skilled relaxation session, they almost always go away.

I sh*t you not, a 20 minute relaxation always reduces my symptoms(breaks my flare), its nothing short of amazing. Especially since the pills I took for this did nothing close to as powerful and dramatic as this.

I think the protocols I've learned from Dr. Stoll's website are quite similar in nature to the Stanford/Wise-Anderson Protocol, although the Stanford might be a little more related directly to the pelvic region.

Here's a nice article on stress

http://askwaltstollmd.com/stress.html

another on bracing and how it results in Fybromyalgia...which is related to IC/CPPS

http://askwaltstollmd.com/fibrom.html

skilled relaxation --which there are a variety of ways a person can do this -- meditation, progressive relaxation, autogenics, etc....the key is having your brainwaves into the alpha/theta state

http://askwaltstollmd.com/relax.html

and the original article I read on IC that so greatly improved my life

http://askwaltstollmd.com/cystitis.html

The major medical establishmeant is so tied into big business, they would far rather make $$$ on surgeries and prescriptions than suggest something as simple as reducing stress. Although reducing stress is not simple in this fast paced and crazy world, the benefits are incredibly immense.

[alprost]

There's been a lot of discussion lately about the Stanford/Wise-Anderson Protocol of myofascial release and progressive relaxation. Results in patients with chronic prostatitis / chronic pelvic pain syndrome were presented last year at the meeting of the International Continence Society. The treatment clearly benefits some patients, but it's definitely not a miracle cure for all of us.

http://www.icsoffice.org/publications/2002/PDF/144.PDF

The key factor you need to bear in mind here, is that the average number of treatment sessions in this study was only 7 sessions over a 3 month period - this is next to nothing.

I have now had around 25 treatments over a 5 month period, and I am still experiencing significant improvements every few seseions, although I still have a fair bit to go. I've read that David Wise had over 50 treatments.

I DO believe this treatment method will benefit a large number of men, but like they say in the Stanford book:
- It is a slow fix not a quick fix;
- It is inconvenient and painful;
- It takes time and self discipline;
- It is a '2 steps foprward 1 step back' process.

I've been extremelylucky that in addition to having excellent diagnostic and clinical skills, my Physio has an absolute determination to get me better.

[webslave]

this post was moved

Between January and Early March of this year, I had 18 sessions of physiotherapy.

In my case, there was definite and dramatic improvement after the first session.

After 10 sessions, I was no longer aware of the pain that I had learned to associate with the muscle spasm/trigger points.

Then I relapsed a bit. I spoke to Dr. Wise at the time of this relapse (This is when I ordered the reprint of his book). Dr. Wise told me the same thing as my therapist: that as the muscles released it was normal to experience flares.

But these flares had also been preceeded by a moment of overexuberance on my part. If felt confident that I was "really getting better" and I may have overiindulged on some of the "tightening" excercises and also the gentle INTERNAL massage recommended by my therapist.

[It should be noted that Dr. Wise does not recommend Kegel excercises. Other posts have addressed resons why some therapists think it is important to do similar excercises that strengthen . I mention this here only to explain that my total of 19 sessions may have been extended because I crossed the line of good sense in sense in doing these excercises.

So whatever the reason for this "flare", which also involved a return of the sensation that I related to the muscle spasms, it took another 8 or 10 sessions until the time when I stopped therapy early in March.

In any case, if I correctly recall what I read in "A Headache in the Pelvis" , my total of 18 sessions is close to the "average" experience. But clearly there is a lot of variation here.

At this point, my remaining symptoms are minor . I think the problem is mostly neurological. What has been written about Central Sensitization closely matches my experience and, so far, nutritional and behavioral strategies (posted elsewhere in this section) seem to be taking me in the right direction.

[andya]

I am new to the forum, have been cp for 2 years following affair. over ten months of antibiotics, no infection or std and have tried virtually everything. A few weeks ago I read about stretches and Dr wise in this forum and began to do minor stretches with results. I bought Headache in the pelvis and read it 3 times. I have been doing relaxation and stretches every day. Overall pain has reduced but the muscle wedgie is maddening. I have been off antibiotics for 4 weeks now. I e-mailed Dr. Wise and he called me just to talk about my condition. He impressed the hell out of me as he did not try to sell me anything and gave me hope. I live across country from Stanford and cannot travel. He offered to train a PT but I can't find an internal Myo person. Any suggestions would be appreciated i.e. PT in florida or do it your self technique.

[alprost]

Overall pain has reduced but the muscle wedgie is maddening.

That is exactly hiw I used to describe the sensation when my pelvic floor muscles were in severe spasm! When you think that the pelvic floor slings from the pubic bone to the coccyx, a 'wedgie' is exactly what is happening.

I e-mailed Dr. Wise and he called me just to talk about my condition. He impressed the hell out of me as he did not try to sell me anything and gave me hope.

That was my experience as well - A sincere individual with integrity who has a genuine desire to help people. The conspiracy theorists would prefer not to beleive this however - it appears they would rather suffer from chronic pelvic pain.........

I live across country from Stanford and cannot travel. He offered to train a PT but I can't find an internal Myo person. Any suggestions would be appreciated i.e. PT in florida or do it your self technique.

I wouldn't 'do it yourself' unless under the guidance of a qualified individual.

Try this link here -
viewtopic.php?f=45&t=6289

There are 3 pelvic floor trained therapists listed in Florida - if they are too far, they may know of someone nearer to you.

Hope this helps, Al.

[latte]

Wow, that is interesting. My whole problem started with an achy, pulling feeling in the left side of the perineum and the left side of the crack in my butt. When I stretch this area by stretching the hamstring the pain would go away for about 10 minutes. Does anyone know what muscle this is? Fixing that area may "cure" me.

[alprost]

Wow, that is interesting. My whole problem started with an achy, pulling feeling in the left side of the perineum and the left side of the crack in my butt.

That's what I had too - aparently it is common for this to be a one-sided phenmoenon, and it usually occurs on the left.

Does anyone know what muscle this is? Fixing that area may "cure" me.

It sounds like the pubococcygeus (sp?), but you would need to be assessed by a physio trained in myofascial release of the pelvic floor to be sure. I had problems in a whole host of related muscle groups also.

[TK]

That's what I had too - aparently it is common for this to be a one-sided phenmoenon, and it usually occurs on the left.

I am likewise a "lefty". Interesting.

[andya]

My tight area is my right side. It actually feels like a band pulled tight from the right abdomen over the right testicle and into my but crack for lack of a better word.i also have slow urine stream at times. I have had muscle tremors in the perineum and abdomen area with sharp needle pain before muscle release usually during and after stretches and relaxation. Last night my whole abdomen dropped or at least thats what it felt like, causing great relief and 2 spots in my lower back released only to tighten back up by morning. I know I walk around tensing my lower gut and levator or pucker muscle and this causes tightening. I am diligent with the moment to moment relaxation and the daily stretches and relaxation. My questions are these. What exactly is internal myofascial massage, I mean what exactly do they do in there, and would external deep tissue massage help since I have not got access to an internal person? Does this constant back and forth drive anyone else as crazy as it does me? I'm really tired, really tired.

[TK]

My questions are these. What exactly is internal myofascial massage, I mean what exactly do they do in there, and would external deep tissue massage help since I have not got access to an internal person?

Briefly:

Therapist inserts (gloved, lubricated) finger into rectum, reaching beyond the immediate band of sphinchter muscle to reach pelvic floor muscles further within.

Therapists are trained to detect "trigger points" by feel and by using very measured pressure, they press against specific spots to alleviate the trigger points by a method called "ischemic compression". Some pressure is also applied with the goal of restretching muscle which has lost it's elasticity. The internal portion of the work is fairly brief, usually no more than a few minutes.

Some people report considerable pain, at least in initial sessions. In my own case, the pain was not that bad.

In terms of locating a therapist: for many years, physical therapists have been using these methods to treat incontinence and other pelvic floor problems. So if you make inquiries with the local medical community, you may well find practitioners who are skilled in these techniques.

Obviously you have to ask careful questions to make sure that you find people who know what they are doing. But practitioners who are experienced in working with pelvic floor issues among the elderly, the incontinent , those who are recovering from surgeries or accidents... will generally take a careful, incremental approach.

Good luck!

[andya]

thanks. what is your current symptom state? I know that over time my symptoms have reduced, but the constant redness(penile tip and testicular) and tightness is ever present. as well as reduced urine stream and post ejac pain. has the internal reduced those symptoms as well?also dr wise has something in the works this fall for pt/protocol training country wide.