Lymph nodes or trigger points?

[Hacksquat]

Hi!

The one part of the Stanford/Wise-Anderson Protocol I don't fully understand are the trigger points. I press all over and try to find tender spots. I work mostly on my abdomen, since my main symptoms are urethral burning (worse after peeing or ejaculation) and frequency.

The problem is, how do I know if I feel a trigger point or a lymph node. I read on Wikipedia that there are lots of lymph nodes in the abs.

Anyway, the area that is most tender for me, is right above the base of the penis. I have lots of tender spots there, but I don't know if it's muscle tissue, other soft tissue or lymph nodes... ?

I don't know how far down the rectus abdominis and the pyramidalis attach to the pubic bone?

It would be much appreciated if someone with knowledge in this would shed some light on these questions.

Thanks,

Hacksquat / Sweden

[webslave]

The lymph nodes in the groin are in the crease between leg and abdomen, not above the penis.

The pain you are experiencing in that area is from trigger points or fibromyalgia-type pain from the insertions of the rectus abdominis muscle. Fibromyalgia (FM) and chronic fatigue syndrome (CFS) frequently accompany CPPS.

[Hacksquat]

I do find "lumps" deep down to the bone there. I don't have any particular pain if I just grab some skin and fatty tissue, I really have to go deep to the bone and grab all of the tissue. Some of them feel like long hardenings of tissue, and some are more like peas.

If it were fibromyalgia tender points, they shouldn't be physically manifested that way, right?

I found this chart too, showing there are lymph nodes in this area, it doesn't show that they are next to the penis, but at least in the front abdominal wall: http://catalog.nucleusinc.com/generatee ... p?ID=14530

I have a really hard time differentiating trigger points, lymph nodes and now what you mention, fibromyalgical tender points. Any thumb rules?

As far as fibromyalgia is concerned, I don´t seem to have the 18 tender points and I don't generally "hurt all over" that is described when I googled it, I am only sore in my pelvic region. And, given my other symptoms, rectal spasms and tightness, urethral pain and general discomfort in my pelvis, I hope its CPPS, cause I believe fibromyalgia is even worse to get rid of...

The area I mention does not refer pain anywhere else then local, but that doesn't mean its not trigger points right?

I had some nasty spots in my abdomen as well that didn't refer pain anywhere but local, and I managed to massage them away. Hope I can with these nasty ones in the insertions as well.

[webslave]

I found this chart too, showing there are lymph nodes in this area

Notice that the lymph nodes are within the abdomen and much higher up.

Tender points can manifest as lumps, and that's most likely what you have. Have you read Wise's book, or the Davies book?

[Hacksquat]

Yes, I have both HITP and Davies' Trigger Point Manual.

Being a hypochondriac I start to catastrophize over having fibromyalgia now . But, I don't have any muscle or joint ache anywhere else than those tendons / muscle insertions / soft tissue around my penis. Can this be caused by doing to much stretching, irritating the tendons?

I've been stretching my adductors and pectineus a lot the last week, and some abs too.

The lumps may have been there when I felt alright too, I just didn't pay attention to this particular area then.

[webslave]

If you had fibro, you'd have insertion pain in many more areas too. So forget about that.

If the pain has recently come on following extensive stretching, then yes, the stretches may have caused them by unmasking some TrPts.

[Hacksquat]

From the article here on the site about Pelvis Joint Dysfunction:

This pain is generally located above the penis, in the midline, and sometimes just off to the side. The testicles are not usually as tender to palpation, or are nontender, and there is no difficulty wearing clothing. Response to a diagnostic-therapeutic trial of manipulation is often immediate and complete.

This is where I'm always tender when I have the symptoms, maybe it's my Symphysis joint. Have to ask my PT about that next week, and maybe book an appointment with a chiropractic too. I have a history of lower back pain, in addition to my other chronic prostatitis / chronic pelvic pain syndrome symptoms. The lower back pain started maybe 6 months before I had my first case of chronic prostatitis / chronic pelvic pain syndrome in dec 2006. Given that I have a misaligned pelvic, maybe it has caused both of these symptoms (pubic bone / symphysis tenderness / pain and lower back pain). At least worth to investigate further

So much to sort out here in finding a proper diagnose... but this time I owe it to myself to rule out all possibilities. This includes seeing a PT skilled in intrapelvis muscles as well, so I can finally get an answer to whether my intrapelvic muscles are short or tight and if they have trigger points. Will probably go see Bill Taylor in Scotland next month. I was preparing to go see him already in November 2007, but then my symptoms waned for some reason and I sort of forgot all about it in 2008. Too bad it didn't stay that way .

At least I want to rule out all structural / muscular causes before I go for the more uncommon stuff, PNE (no more pain upon sitting, so probably not), Reiters (had conjunctivitis on my first bout with this in 2007, but that can as well just have been a coincidence) and others.

[garyholc]

There are some videos on youtube about massaging tp's in the abs area. Be sure to massage them sideways and not press down and in on the abs area. I tend to place a fist in my abs on both sides, pushing in sideways, then push one up and one down so they go in opposite directions to each other and massage the abs that way. I also use a electrical back massager which vibrates and dig that in sideways into my abs to massage them....

[The Komrade]

Holy cow! Just happened to see this topic, and man, have I (and several doctors) been overlooking the lymph gland system! I think much of my abdominal pain for years has been coming from an irritated lymphatic system and I hadn't realized it. If so, no wonder the SP didn't "work" for me in the past - I'd been self treating and aggravating lymph nodes all over the abdominal region. After some self-checking with diagrams, I'd guess I still do have trigger points on the abdomen, but fewer than I thought. It would also explains why I haven't felt hardly any release as a result of working my abs in comparison to the inside of the pelvic floor.

I wonder if anyone else has been making the same mistake in trying to "release" these "lumps"?! Boy, am I glad that I saw this topic!!

So, how does one tell the difference between painful, aggravated lymph nodes and trigger points in the abdominal region?

[The Komrade]

It seems I overreacted about the importance of lymph nodes. For anyone who is interested, here is what a lymphedema therapist had to say about the accessibility of abdominal lymph nodes, and the difference between a trigger point and a swollen lymph node.

Lymph nodes sit very deep it is the capillaries that transport the fluid to the nodes that are very superficial (close to the surface of the skin). When lymph nodes are palpated it is very uncomfortable but unless they are swollen they are very hard to palpate. If you are able to palpate you are probably on a trigger point. They usually will not refer pain to other areas as you will get the discomfort right over the area that you are pushing on. If you do irritate a lymph node you will notice that it will swell up and usually you will get some swelling to the area.

[benzo]

I do find "lumps" deep down to the bone there. I don't have any particular pain if I just grab some skin and fatty tissue, I really have to go deep to the bone and grab all of the tissue. Some of them feel like long hardenings of tissue, and some are more like peas.

I've been wondering myself what these pea-like lumps are. If I palpate, I can feel them too.
Are these actually trigger points?

Sometimes it's really obvious you stumbled upon a tp because it hurts and you get instant referral to other regions but these 'peas' puzzle me.