Anatomical/biomechanical abnormalities to be thoroughly checked

[Luxemburger1977]

With PT and dry needling, I have now recovered up to 80% or more with urinary symptoms resolving early on and no ED at any single point since it all started for me. The rest is a very long list of trigger points producing pain in left plant, quadriceps and glutes as well as in their counterparts in right iliopsoas, quadratus luborum, obliquii and serratus. PFD had been building up over years, symptoms (post-voiding dribble) had appeared 2 to 3 years before 'prostatitis'. I also realised the right side of my pelvis was lifted up and my right shoulder pulled down because of shortened right iliopsoas, quadratus luborum, obliquii and serratus, my right ribs were 'glued' together just in between. Pelvic floor and surrounding muscles had to work hard for many years to compensate for that. Still, diagnosis would be, for urologists who do not bother carrying out a proper physical evaluation, 'prostatitis'!

In the past, they used to blame it all on the prostate and then, with a HITP, on a stressful lifestyle. However, PT has made huge progress in understanding and treating PFD and now in 2016, Prendergast and Rummer very nicely summed it up in their book 'Pelvic pain explained':
A slew of anatomical/biomechanical abnormalities, such as having one leg that's shorter than the other, contribute to pelvic pain.

This is meant to help all those who have drastically changed their lifestyle and have much lower levels of stress, but are still in pain despite all efforts! Make sure you see a knowledgeable PT and have all possible factors, including anatomical/biomechanical abnormalities, checked thoroughly.

[webslave]

Yes, there are more factors than just psychological stress, although that's the biggy. Overuse syndromes can set off a neuromuscular pain condition, and, in theory, anatomical abnormalities too.

An example of how the slightest thing can cause pain is "fat wallet syndrome" also known as piriformis syndrome or "wallet sciatica" (pain down one leg, numbness/pain in foot, lower leg, and ankle, hard to lie down or walk around, or sit comfortably). The condition is caused by sitting with a large wallet in the side rear pocket of the trousers. I had it myself (many years ago) until I discovered the cause.

In trying to find the cause of pain, no stone must be left unturned, and (to use another metaphor) sometimes the boat only moves when all anchors are lifted. On the other hand, endless worry about the cause can be ruinous to attempts to get better, so if the cause seems psychological (often you can guess from the postings) I usually advise not fretting about the cause and getting on with strategies to improve.

But purely anatomical causes are relatively rare, I'd hazard, if indeed they do exist at all. Do the authors of that book suggest they are common? If so, I must disagree. There are no studies to back it up, nor anecdotal evidence on this forum. Hmm, I've just had a look at the book and I see that while they do refer to "A Headache in the Pelvis" as a resource to be used, they nowhere seem to mention that stress can cause pelvic tension (although oddly they train people to relax the pelvic floor), unless of course in my cursory reading I missed it. That means they are ignoring the major reason for pelvic pain and instead choosing to interpret the condition purely as a biomechanical issue, which is, I suppose, what you'd expect from a team of physiotherapists.

Their patients can join the dots though (see page 83 where one of their male patients says that stress is key).

[Luxemburger1977]

Purely anatomical causes are relatively rare, biomechanical abnormalities are definitely more common, overuse injuries are not uncommon either. Check the difference between anatomical and biomechanical abnormalities in their book. As far as I can say, It is surely a good investment.

Here is a good example they give:
For instance, a man works as a cashier at a grocery store, a job that requires him to repetitively rotate to the left as he scans groceries. As a result of this repetitive movement, the muscles on the left side of his body become tighter than those on the right. He then joins a gym to work out with the goal of becoming a better swowboarder. During his workouts he begins to do several sets of squats and sits-up, which recruit the muscles on his right and left sides equally, but because the muscles on his left side and tighter from his job and therefore more vulnerable to injury, left abdominal trigger points develop. [...] These trigger points begin to refer pain to the tip of his penis and perineum while he's working out at the gym. Finally, he falls on his tailbone several times snowboarding, so his penile and perineum pain becomes constant.

Blaming it all on a stressful lifestyle shows, to me, a lack of understanding of all causes of pelvic pain as there is NO one and single cause of pelvic pain. However, even if you have never experienced anxiety or stress in your life before, you do get anxious when it all kicks in because of the lack of answers. This is what obviously happened to me. For me, anxiety was short-lived and lasted only until I got on the right treatment path. Pain is another story and main factors for me seem to be merely physical by now. Whether all those who only believe in (common but not sole) factors put forward in HITP want to believe it or not, is not my problem. This is meant to help all those who have drastically changed their lifestyle and have much lower levels of stress, but are still in pain despite all efforts!

For the record, I should need to quote the example given on page 83 as it is wrongly summed up by webslave:
So why did my symptoms start to begin with? Stephanie's theory is that a combination of factors set off my pain. For one thing, I'm a super-active guy who's worked out hard with various trainers over the years. Add to that a history of low back pain, and voilà! Pelvic pain!
It is impossible to say in this example which came first: pelvic pain as a response to stress or stress as a response to pelvic pain!

It is now common knowledge that people with pelvic pain usually have too tight or what we PTs refer to as “high tone” pelvic floor muscles. A great exercise that helps patients decrease this high tone is called a “pelvic floor drop”. Often patients cannot simply “think about it” and let their muscles relax because the muscles have physiologically shortened. So, this exercise uses neuromuscular patterns to “turn off” the pelvic floor muscles until patients can do this on their own.
See: http://www.pelvicpainrehab.com/pelvic-p ... t-my-pain/. I do not recall reading about pelvic floor drops in HITP, which used to be the Bible of male pelvic pain back when it was first released, surely far less so in 2016.

While I do acknowledge that CPPS may be due mainly to psychological factors in quite a few cases, I do expect from those in that situation that they, in return, acknowledge that CPPS may be due mainly to biomechanical abnormalities. Unless the message here should be: 'just relax and the tension in your left Rectus femoris and Vastus intermedius (both pulling the left side of your pelvis down) will get better', which is absolute nonsense. All those who experience constant pain that does not just come and go in waves like stress would surely be thankful to find more answers out there than just 'relax'!

[webslave]

Here is a good example they give:
For instance, a man works as a cashier at a grocery store, a job that requires him to repetitively rotate to the left as he scans groceries. As a result of this repetitive movement, the muscles on the left side of his body become tighter than those on the right. He then joins a gym to work out with the goal of becoming a better swowboarder. During his workouts he begins to do several sets of squats and sits-up, which recruit the muscles on his right and left sides equally, but because the muscles on his left side and tighter from his job and therefore more vulnerable to injury, left abdominal trigger points develop. [...] These trigger points begin to refer pain to the tip of his penis and perineum while he's working out at the gym. Finally, he falls on his tailbone several times snowboarding, so his penile and perineum pain becomes constant.

Highly unusual 'magic pudding' story. It is most rare for men to develop CPPS because of trigger points acquired through unusual movements. MUCH more common would be trigger points acquired from habitual tensing of the pelvis (as it was in my case, and most members here).

This is meant to help all those who have drastically changed their lifestyle and have much lower levels of stress, but are still in pain despite all efforts!

Which is fine, although I have seen quite a few members claim that they have achieved a stress-free lifestyle, or are stress free, only to find out later that their lives are chock-a-block with stress.

For the record, I should need to quote the example given on page 83 as it is wrongly summed up by webslave:

Um, let's let our readers decide if I am wrong:

pelvic-pain-explained.png (64.23 KiB) Viewed 3071 times

I do not recall reading about pelvic floor drops in HITP, which used to be the Bible of male pelvic pain back when it was first released, surely far less so in 2016.

You're kidding, right? Dropping the pelvic floor is the key technique of the Wise & Anderson approach.

While I do acknowledge that CPPS may be due mainly to psychological factors in quite a few cases, I do expect from those in that situation that they, in return, acknowledge that CPPS may be due mainly to biomechanical abnormalities.

It's unusual, but I cannot see why a biomechanical abnormality, or even a repetitive motion such as the one you describe above, cannot set up trigger points that can lead to pelvic pain. But it is surely quite unusual. You are the first case I have seen here in nearly 20 years.

On the other hand, I worry about the "quick fix" attraction of a purely PT-type approach, as espoused by people like Prendergast and Kotarinos. These PTs, for whom every problem looks like a nail for their therapy's hammer, use simplistic, myopic and reductionist reasoning to distil it all to a physical level, with physical treatments. This is a little bit like the antibiotic crowd ("it's just an infection, blitz it with drugs"). Both approaches attempt to avoid the actual, more complex, more intractable cause because that would involve uncomfortable self-examination and an often difficult path to a cure.

reductionism, noun
1. the theory that every complex phenomenon, especially in biology or psychology, can be explained by analyzing the simplest, most basic physical mechanisms that are in operation during the phenomenon.
2. the practice of simplifying a complex idea, issue, condition, or the like, especially to the point of minimizing, obscuring, or distorting it.

[Luxemburger1977]

Everybody is here to share their experience. I am here to share mine and I do not mean to say this applies to anyone else. I would simple once again refer to previous posts for others to read about my experience. I cannot possibly see any reason why stress as such would lead to trigger points causing pain and discomfort in left Rectus femoris, Vastus intermedius and glutes and you cannot either, webslave.

It is most rare for men to develop CPPS because of trigger points acquired through unusual movements.

How many men have your physically examined? In the network of PT's I am seeing in Germany, young men doing long series of sits-up a few times a week seem to be commonly seen suffering from CPPS as trigger points develop in abdominal muscles.

It's unusual, but I cannot see why a biomechanical abnormality, or even a repetitive motion such as the one you describe above, cannot set up trigger points that can lead to pelvic pain. But it is surely quite unusual. You are the first case I have seen here in nearly 20 years.

You cannot see that because you obviously are not an experienced PT. Without being a PT, you cannot assess properly all factors leading to pelvic pain I suppose. I cannot either but I am willing to be open-minded and believe what experienced PT's have to tell us here.

Wise/Anderson mention a squat strech with no further comment. If you see any mention of 'pelvic floor drop' or 'pelvic floor', feel free to post a scan copy of it here. I could not find any such mention although I read the book from cover to cover more than once. The daily 'pelvic floor drop' routine helped me get rid of all urinary issues in less than 2 months early this year. They have not returned a single time ever since, whether I was in stress or not. Pain in left Rectus femoris, Vastus intermedius and glutes us still there, whether I am in stress or not.

As for stress, it seems you want to stick to the idea that pelvic pain always comes because of stress in all cases anyway and not the other way around. This is sad as now in 2016, research has come a long way forward since the first edition of HITP. You are the webmaster, you want to be right in all cases and seem to dismiss other theories without further consideration. So be it. I know what reductionism means and see it very well fit with your somewhat narrow vision here. Pelvic pain can develop because of stress, stress can develop because of pelvic pain, the latter obviously happened to me.

[webslave]

How many men have your physically examined?

None, but I've heard thousands describe their cases.

In the network of PT's I am seeing in Germany, young men doing long series of sits-up a few times a week seem to be commonly seen suffering from CPPS as trigger points develop in abdominal muscles.

Sit-ups a cause of CPPS? That's a novel theory, and I urge you to get these ideas published. It will surprise not just me, but the entire medical world.

Wise/Anderson ... If you see any mention of 'pelvic floor drop' or 'pelvic floor', feel free to post a scan copy of it here. I could not find any such mention although I read the book from cover to cover more than once.

Their whole protocol is aimed at relaxing the pelvic floor. Forcing a "drop" by pushing often involves the 'valsalva maneuver', which can cause a heart attack (that's how Elvis died, BTW ... ironic that he was known as "Elvis the Pelvis" ). The reverse kegels has an element of this, and I think Wise wants to avoid any form of effort or straining. The same effect on the pelvic floor can be achieved with deep relaxation, and it's a better long-term strategy.

As for stress, it seems you want to stick to the idea that pelvic pain always comes because of stress in all cases anyway and not the other way around.

Yes, stress and anxiety are the prime causes for most sufferers, based on case histories of the members here, although the condition can be initiated by a number of routes (see UPOINT).

[carbonevo]

Lol I have a rotated pelvis - confirmed by one chiro and two physios, also many trigger points on my abdomen and buttocks, also around the coccyx and still had a painless weekend.. did those have a weekend too?

In my humble opinion CPPS = stress disorder that in our case attacks our bodies in the pelvis, basically a state of extreme sensitization (could've been started by initial infection that was cured from the first atb dose)

There are people who get chronic back pain, others repetitive stress injury (RSI) in their arms, or fibromyalgia (pain in the entire body). I bet the PTs did help you because you believed on a gut level that it's helping you and that is very often all you need to reverse the stress/emotional -> body syndrome (read Claire Weekes book, or Alan Gordon's posts I posted here you will understand why).

I bet webslave already knows about this a very long time

[webslave]

Once something sets CPPS off, let's say not stress but an infection — because not all cases are stress related — then processes like central sensitisation can take over and give the condition a life of its own, independent of the initial trigger.

[carbonevo]

Yup, but after this takes place, what keeps the central nervous system aroused is the stress, emotional load, fear, anxiety and pre-occupation with the illness.. How to reverse this arousal and sensitization? Basically by not giving a f*ck about the symptoms ..By not feeding the arousal with fear anxiety and stress. Basically reprogramming the brain that it's safe, no need for the arousal/pain.

Which is not that easy I know...

[webslave]

Disregarding the symptoms is one way, if you can do it (and that's also why catastrophizing, the opposite course, is such a very bad idea!)

The basic idea is to dial down the nervous system, which —through a process called "wind-up"— has become regulated into a persistent state of high reactivity.

[Luxemburger1977]

If pelvic pain is a result of anxiety as Wise claims why would the brain produce spasms and pain on only one side of the pelvis?

[edited to remove link to troll's video - admin]

[webslave]

What makes you think central sensitization has to be symmetrical?