Can't break cycle

[tiger]

I recently cancelled a 300 unit Botox procedure because my pain level was only a 3 and the doctor thought there was too much risk in making it worse. About the same time I started stretching again. My very experience PT says all my previous internal trigger points are gone, but I am extremely tight in my hamstrings and pelvic floor. The stretching has made things flare up. The last time I did the stretching I face a similar flare and it was debilitating. I can't seem to break out of the cycle. Should I just let things stay tight and settle with the level 3, or suffer through the agony of limbering up?

[Jay]

Hi tiger,

I'm not a doctor, so just take the following as the random layman's thoughts that they are ...

If your doctor feels that there's too much risk in doing the Botox, then I would trust him. My urologist recently canceled a cystoscopy I'd scheduled because he felt the chance of making me worse outweighed the potential benefits. This is one of the times when, I think, we either have to trust their judgment or find another practitioner.

As to whether you should live with maintaining a 3, well ... That's really a decision only you can make. Are you satisfied with a 3? Is your quality of life acceptable to you? Even if it is, I'd still encourage you to do something aimed at maintaining that level of pain, perhaps by continuing physical therapy. Simply abandoning the effort would probably chance getting worse again. If you are still noticeably tight down there, even to your PT's perceptions, then something should be worked on to remedy that.

Who is your physical therapist? I wouldn't be afraid to shop around a little. It's not that I think your PT is bad. Rather, one experienced PT can sometimes find trigger points and issues that another experienced PT misses.

Have you been to Stanford? If you have the financial means, that would probably be a good route to try. There are no guarantees, but Tim Sawyer is widely regarded as the leader in pelvic floor PT, and Dr. Wise's relaxation techniques would no doubt be beneficial to you. It's a great step to take when you have a case that's difficult to crack elsewhere.

Speaking of relaxation, are you doing any? Many posters I've conversed with say they didn't quite get over that last hump until they incorporated some sort of relaxation into their days. It doesn't have to be Dr. Wise's paradoxical relaxation. I know some do skilled relaxation, meditation, or other things. The important part is calming yourself, and by extension, helping to calm the nervous system.

You might consider looking into Ultram or Valium. A lot of guys here found these medications to be invaluable in forcibly breaking the pain cycle. They may not take away all of the pain, but they'll relax you and ease the sensations. This helps to shatter the circle of pain -> anxiety -> tension, because you don't have quite as much of the first two steps.

[tiger]

Thanks. I have recently tried Elavil and neurontin. I got off both and was not any worse. I felt good about getting off meds for the first time in many months. My only thought now is to continue the stretching but get back on Neurontin to dull the flares expected with stretching. My PT is very experienced but frankly I can do the stretching on my on and the absence of internal trigger points is encouraging.

[Jay]

Thanks. I have recently tried Elavil and neurontin. I got off both and was not any worse. I felt good about getting off meds for the first time in many months. My only thought now is to continue the stretching but get back on Neurontin to dull the flares expected with stretching. My PT is very experienced but frankly I can do the stetching on my on and the absense of internal trigger points is encouraging.

Hi there,

I know what you mean about being without medication. I hate taking pills, and I've a habit of researching every one I'm given. Elavil caused retention for me.

When I was recently at a very low point, I started on 50-100mg/day of Ultram, and I'm glad that I gave it a chance. It has certainly improved my quality of life a bit. It isn't an answer, but it will enable me to remain a little more comfortable and less depressed while I pursue therapy. If taking Neurontin helps you, then by all means, I'd encourage you to discuss going back on with your doctor. Lots of guys keep some form of medication around to assist in breaking flares (Ultram, Valium, Vicodin, etc) and there's no shame in it.

As for the rest, well, my prior suggestions stand. If you can afford it, I'd say to either continue with your PT, find a new PT, or try Stanford. Won't hurt, but may help. It's absolutely good news that your current PT is no longer finding trigger points, because that means your insides aren't full of them. I know it's not unheard of for some TPs to be very elusive, however. Your tight pelvic floor also needs to be worked on, I'd wager. Doubt it's doing you any favors!

[superuse]

Tiger, do read some of my previous posts about heavy exercise and stretching. For a large minority of majority of men, the (some) stretching just seems to make it worse. HITP mentions stretch injury as one of the causes of CPPS, with dancers, ballerinas, and karate folks showing up. Major reactions and protest from stretching by pelvic muscles can be a sign to lay off or lighten up.

Heavy stretching would be goal oriented, perhaps getting your fingers to touch your toes with legs straight from your previous knee limit and accomplishing this in 45 days, perhaps with ballistic (bouncing) and pulling on something at knee level to increase the stretch. That would be aggressive. Putting the muscles on a light perceivable stretch and taking what comes naturally, perhaps 3" in several months (but who's counting) would be preferable. I use this stretch as an example, not a recommendation. If you get your hands flat on the floor with knees straight in one month, and your pain level is higher, (for any kind of stretch) you haven't really accomplished anything, for our purposes