Kegel + biofeedback regime?

[hodologica]

I have PFD. My PT knows about the Stanford/Wise-Anderson Protocol and does perform PFMFTPR, but wants me to first try a month-plus regime of kegels (start slow, gradually increase to 10 min, 3-5x per day) and weekly biofeedback sessions. I am not too enthusiastic about this idea, and I know David Wise for one opposes kegels. Does anyone have any information on the efficacy of such a regime? Four days of kegels (5 sec on, 10 sec rest, for 3 min, 1x / day) seemed to make my pain worse, and I stopped. I'm inclined to request PFMFTPR and, if she won't do it, look for PFMFTPR in Washington DC. My current PT has nigh two decades specialization in pelvic floor issues, but given the history of chronic prostatitis / chronic pelvic pain syndrome (mis)treatment I dont feel I can go on one person's opinion on a treatment, no matter what their experience. MS, can you elaborate on your good experience with kegels+biofeedback noted at the thread below?
viewtopic.php?p=5525

Another reason I'm not too stoked is that during an EMG session, my reading dropped only around 15% just after doing kegels - which seems to jive with what Alprost posted on the above thread. Whereas I'm almost sure my EMG would be normal during meditation, since I can feel the muscles release as I enter the meditative state (2x per day, 20+ min).

[MS]

. MS, can you elaborate on your good experience with kegels+biofeedback noted at the thread below?
viewtopic.php?p=5525

Before PF training (Kegels and stretches) my pelvic floor resting tone was elevated. The PT had me follow a routine for several weeks, which included two PT sessions per week, Kegels daily (some short/some long), and stretching of pelvic and back muscles. The PT treatment included internal strecthing and dry-needling.

If you are in the DC area, I highly recommend an evaluation: http://www.painpoints.com

[hodologica]

Thanks for you input MS. Shortly after my above post I did 10 min of sets of kegels during biofeedback with my PT. Once more I was in increased pain for 5 days, which is similar to what some others have reported. That they caused me (and others) pain doesn't prove they werent ultimately beneficial, but I decided not to continue with them.

[alprost]

Shortly after my above post I did 10 min of sets of kegels during biofeedback with my PT. Once more I was in increased pain for 5 days, which is similar to what some others have reported.

My take on biofeedback is that if it is used to help teach someone the difference between tension and relaxation in their PFM, and if it is combined with myofascial release, it is beneficial. BUT, when 'biofeedback' instead consists of multiple sets of kegels, this will simply aggrevate any trigger points which exist in the pelvic floor, and will consequently exaccerbate someones symptoms.

[hodologica]

I lean towards your anti-Kegel position (which is similar to David Wise's and Mark's). Basically tho, I know of no controlled data, so as far as I know we have anecdotal evidence:

1. people's positive and negative experiences posted online, and
2. the anti-Kegel stance of Dr. Wise, who presumably formed his opinion based on personal communication with many patients - probably a very large number of people. However, most people who had satisfactory results from kegels would tend not to come into commnication with Wise. On the other hand, Wise is no slouch and is perhaps well aware of that fact.

It remains that some people like MS report benefits from kegels, and my (former) PT claims to have successfully treated many CPPSers with them, which I doubt is completely inaccurate, tho I am a bit leery.

To my knowledge, kegels are almost always done in conjunction with biofeedback, and this finding, apparently involving Kegel-less biofeedback, seems to show that biofeedback is beneficial by itself:

viewtopic.php?t=1762

Alas, that abstract does not sketch the biofeedback protocol in question.

Anyway, none of this evidence makes the Kegel issue totally clear to me, one way or another. Intuitively, exercise seems like a poor therapy for hypertonus and trigger points, but (in my case anyway) thats merely an intuition. Were it not that my CPP is resolving (after 5 months prostaprotek + meditation, etc), I would probably still have quit kegels, but would want to know more about them if for some reason I couldnt get stanford-like treatment. A person with PFD who has the opportunity to get the latter treatment would be foolish to worry about kegels or the like, in my opinion, since the anecdotal evidence for the stanford approach is extremely clear.

Not unlikely, someone will know of some evidence I'm missing...

[MS]

Alprost makes a good point: during biofeedback, you are able to both see (on a computer screen) AND feel the effects of a Kegel. So when you constrict your pelvic floor, the graph jumps up. When you relax, the graph lowers. Thus, after a few session, if you do a Kegel at home, you "know" if your pelvic floor is tense or relaxed.

So my personal advice would be to perform Kegels ONLY while under the care or instruction of your PT or Dr.