Self Trigger Point Release work (Manick's Case)

[Manick]

Well that is certainly good news; I do feel better overall now than I was at the beginning of the summer, and it was only recently that the tremors began. But I am still curious why I sometimes can feel in more pain while lying down as opposed to sitting down. Sitting down can still hurt over long periods without breaks though.

[webslave]

Some muscles are stretched when lying down. If these are the muscles with trigger points (hyperirritable bundles), it can be uncomfortable.

[calguy]

I also think my pelvis is out of aligment and when I lay down it just puts pressure on it and other muscles and even my bladder. When my frequency ramped up last week it was worse at night when I lying down. I went to pt and chiro and stretched out my lower back and hips and seemed to really help. I actually get tight on my left side in the rear around my hip level when things seemed to go crazy. Just my theory and could be wrong but after working to get everything aligned frequency calmed down and feel less pressure when lying down.

[Manick]

A lot of sources and posts I've read seem to claim that sitting for long periods seems to exacerbate symptoms that are already present. However, I wanted to share my experience with sitting to see if anyone could relate to me on this issue.

If I sit down at the computer and am doing work, or something mentally exhausting, boring, or just tedious in nature, then I find that symptoms are much more obvious and noticeably unpleasant, hindering my ability to concentrate on work. Just a couple of weeks ago I could not sit for more than 30-45 minutes without feeling extreme discomfort to the point where I couldn't work anymore, and I was unable to finish a project for the deadline because of this.

On the other hand, if I am sitting down playing console games, watching television, or just doing what I want to do in general in my free time at the computer, symptoms are much less severe and easier to ignore.

Even now, as I write this message, I feel pain; but just 5 minutes ago I felt fine as I played mindless but extremely entertaining and engaging video games. I am however taking good care of my mental and emotional needs and keeping stress down to a minimum with the help of meds and a weekly meeting with my psychiatrist, so I am not constantly upset or anxious about it.

I also find that sitting down isn't nearly as bothersome if I am not wearing tight jeans or at least have them opened and loose. Hunching over or forward also seems to do quite a bit of damage if I do it too much.

Can anyone relate to this?

[snoopy]

Definitely. My sentiments exactly...

[Jay]

Hi,

Distraction is an extremely powerful thing. When your mind fixated upon something that truly interests you, this often results in a reduction of pain. Your attention isn't with the discomfort, and so you're less braced against it, reducing tension. The same isn't necessarily true of work, which more than a few people find uninteresting. Nevertheless, it's a great thing that you're also caring for your mental health in the ways you've described.

The issue with your pants may be a case of clothing intolerance, which happens with CPPS. Tactile allodynia. I have this myself, and in order to cope, I switched from briefs to extremely loose boxers. My pain management doctor also gave me lidocaine patches, which are very helpful.

[charles]

I sit 8+ hours a day for work. I try to get up and walk around every so often. If my symptoms are bad, I sit on a racquetball under my perineum. I position it under different sore points throughout the day. It tends to relieve my symptoms for a while.

[Manick]

I've had to make a lot of changes lately to hope for a quick recovery, because I cannot afford to stay like this much longer. I've cut off all caffine (period), and drink primarily just water. I've cut off all spicy foods from my diet. I never drank alcohol that much to begin with and now I don't do it period. I've completely withdrew from any sexual activity (period), and am on my second week of abstainance. I've made sure not to sit down for too long and either work while standing up or from bed. I've started taking Elavil and Valium at night, and then Valium again in the morning. I've been taking care of my mental and emotional health by seeing a psychiatrist and overall for the majority of the time have been in high spirits. I've changed my diet to make sure I get 100% daily recommendation of fiber to make sure I have frequent bowel movements. I walk around the block almost every day of the week for my exercise. I've included nap/resting time into my every day schedule, which I would count as my "relaxation technique" as opposed to meditation. I take showers/baths much more frequently. I pre-emptively take Aleve (naproxen) if I think that I may have to strain myself even in the slightest on any given day. I drink lots of water, and I mean A LOT. I've improved my lifestyle by eliminating as many stressors as possible and even improved my relationship with my parents (who were worried I would become a cripple for the rest of my life).

I have made all of these changes over the course of a month. I had began to feel pain free the past few days, and was enthusiastic about finally being rid of this forever. But just one hard stool. One, single, bowel movement.. And now I feel like I've been set back by an entire week and went from feeling perfect, to shitty all over again. All that effort feels like it went down the drain, but please tell me its not.. I really want to do everything, and I mean EVERYTHING to get over this as soon as possible. I've given up so many of the joys of my normal life, and have been treating my body with as much care as possible, but when will it be enough? How long does this take? Weeks? Months? Years? I have seen some people on this board have this condition for years and it scares me to death to think that I would have to continue living like this for months, much less years to come.

The only thing I have not been able to do yet is get an appointment with a PT because both Urologists I've seen have not been able to make a diagnosis in order to forward me to one yet. However, I will hopefully be able to set up an appointment this Wednesday because the psychiatrist I am seeing says he can do that since the other doctors have not. I also have absolutely no clue what stretches I should be doing and how many per day and at what frequency. To be perfectly honest, I've never been that fit throughout my whole life and exercise is a very rare thing for me to engage in. I have no idea where to even start. I am not panicking, but I am beginning to worry, because I have had to live with this condition for an entire summer and had hoped to get better before the beginning of fall, because now I am in school as a full time college student. One course over the summer was hard enough, but four, at 21 hours a week, will be hell on earth if I cannot get better soon. Thankfully I have not been showered with assignments yet, so things have been pretty easygoing these last two weeks, but its only a matter of time until I will have some serious volume of work and studying to do. Can I expect to get better shortly if I continue as I am? Or is this horrible pain going to always come back to haunt me whenever it feels like it regardless of my sacrifices? Please, someone tell me that it is not the latter.

Also, does a single flare-up necessarily even cause enough damage and impose on the recovery process? Will I still get better just as fast if I have the occasional, unavoidable flare-up?

[webslave]

The good news is that pain caused by a bowel movement means you almost certainly have the trigger point type CPPS, which is eminently curable and amenable to treatment strategies, although, as you have now discovered, not quickly or easily vanquished.

[Jay]

Hi Manick,

Your post contains a great deal of catastrophic thinking. It's easy to fall into that pit, but don't allow yourself to do it. Right now, you need to slow down. Yesterday is in the past, and tomorrow's too far away. Take each day for what it is and do your best.

As Webslave said, pain with bowel movements is a really good sign of muscular dysfunction. I actually have a doubly whammy here, as my chronic prostatitis / chronic pelvic pain syndrome is accompanied by IBS-C. It's really difficult for me to not have the hard, difficult-to-eliminate movements you've described, and they have a way of flaring me up. When this happens, I just try to have a tub of hot water ready, which I squat down into for a while. The heat will help the muscles to relax, and resting up thereafter may further soothe things. I do this three times a day. Try adding a gentle stool softener like Colace, or you could sprinkle some ground flax seed on your food (be conservative with this - a little goes a long way).

It's great that you are seeing a psychiatrist and making time for relaxation. These things are important. You've mentioned that you don't exercise, which I think is a vital contributor to your mental health, as much as physical. Try very gentle things, such as walking (my favorite) or swimming. These are great for you and don't much strain the pelvic area. Try to avoid anything intense, like lifting heavy weights. Light weights might be okay, but honestly, my personal opinion favors cutting them out entirely.

Realize that - and don't panic, here - this is a chronic condition. It will always be with you. However, with proper treatment and self-care, it's entirely possible to go into an asymptomatic state. Many guys here, past and present, have done so. It takes hard work and there are bumps along the way, but you can get there. When you are properly prepared to address them, future flares will be shorter and quicker to resolve. The worrying will only be to your detriment, as it promotes further tension and riles up your nervous system. What will be, will be.

[Manick]

I am distressed to hear that it may remain with me for my entire life, but how can it even necessarily be considered chronic? I have only had this ever since the beginning of summer, and immediately began to see doctors. Unfortunately, the first urologist did nothing more than make matters worse by encouraging me to increase my already frequent sexual activities/ejaculation due to his assumption that it was bacterial. And furthermore, he knew of no PTs to forward me to. Neither did the second Urologist. But this only went on for three months till I learned about the real deal and started treating my body better, and over the course of the last two weeks I have been rapidly getting better. As a matter of fact, I already practically feel pain free tonight after that bowel movement from yesterday. Does that still not necessarily mean it will completely subside sooner than later and hopefully forever?

[Jay]

Hi Manick,

Don't let that first portion of my prior post fly over your head. You have no pain right now, and that's a great thing. It may last. As I'm neither a doctor nor a psychic, I'll offer no opinion, save that I encourage you to take today for what it offers and not worry about tomorrow.

It's quite possible that you could go into a long-term or even permanent remission. Doctor Wise and Webslave, to name two examples, have been asymptomatic for quite a long time. They just needed to figure out how to properly manage their situations. I can't soften the blow for you, though. If you have CPPS, it's for life. That doesn't mean your symptoms are forever (they likely aren't), but neither can you rush back into doing the things which may have created and/or intensified them.

Once you get this condition under control, it tends to be much easier to keep subdued. Continuing that trend may require a hot bath and some regular self-PT maintenance, but I think that's a small price to pay. chronic prostatitis / chronic pelvic pain syndrome is not the end of the world, trust me. I have a severe case compared to most people here, and I'm still getting along in the world and pursuing the things I enjoy.

[Manick]

This morning I woke up with a somewhat sore and burning sensation right above and behind my pubic bone, enough to make me worry that I'd be in pain for the rest of the day. This is not the first time it has happened though, and it used to be far worse. When it was worse, and when I went to press into below my tummy, it clearly hurt and was incredibly sore to the touch (this was back when I thought it was a swollen prostate as the doctors told me). Did that mean that the area I applied pressure to was my trigger point? But today, when I press down on the same area, it barely hurt at all, so I am not so sure anymore that it was a trigger point. The only indications I know of to tell if I am feeling a trigger point, are if it hurts like hell if pressed on, feels warm, or feels like a "partially cooked macaroni or spaghetti", as I read from "The Trigger Point Therapy Workbook; Second Edition".

For the past two weeks, I had also had very tense muscles on both sides near the bottom of my ribs, and I have been very gently massaging them. And now, they feel fine, and furthermore, when I pressed in and reached under my ribs to see if it hurt, it did not. After a broad range of massaging almost all areas of my lower and middle abdominal area, I didn't feel hardly any pain at all. However, one week ago, I did feel a very strange, almost ticklish, and slightly painful yet pleasant sensation on the opposite side of the area I was massaging. Did I hit the target most likely? This was the only case where I felt a sort of electric surge throughout my mid and lower abdominal area.

P.S.
Prior to massaging myself this morning, I also applied a wrapped ice pack onto the area that felt warm and somewhat sore. It seemed to help a great deal and I was getting better even as I was sitting down reading.

[Manick]

Well, I did have a very bad case of a coughing fit that went on for like a month and I was diagnosed with chronic bronchitis. I coughed so much and constantly that it made my chest hurt horribly and gave me a sore throat. But now, the symptoms are virtually non-existent, and hardly noticeable or disturbing in the least. It is nothing more than a single and gentle cough every now and then.

Similarly, today, I woke up with a somewhat painful and burning sensation behind my pelvic bone, but all I had to do was apply an ice pack to it and do a little massaging and just an hour later the pain subsided very rapidly. I do however also take Valium every morning, so that may have been a factor more or less.

[Manick]

I would still like to hear from someones perspective about how to find/feel for trigger points, especially from someone who also reads the same self-treatment guide as I do, "The Trigger Point Therapy Workbook; Second Edition" by Davies.
I am not quite sure if my massaging is working or not, but today after I woke up I felt good as usual (my pain is almost non-existent throughout the morning and early afternoon). However, as soon as I had a bowel movement, I began to do a deep external massage right behind and above my pubic bone, and slightly to the left. It felt very sore and sensitive while I was massaging that specific area, but after about 4 more massages it no longer felt sore. Does this mean I did something right? I am very new to this and am afraid I may do more damage than good if I am not careful, which is what I hear can happen if you are too rough.