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Doing Our New Program At Home Without Coming To See Us

Pelvic pain robs the quality of life.  I know this.  I lived with it for over 20 years and tried everything I could find to no avail until I gratefully found a way to stop my symptoms.  The way that I found the solution to my symptoms became the basis of the protocol that Dr. Rodney Anderson and I at Stanford developed.  This protocol is we have used for the past 27 years in helping the majority of our patients reduce or resolve their symptoms.   It wasn’t easy.   It wasn’t quick.  But there is a way for the majority of our patients to genuinely help themselves to reduce or resolve their symptoms.

If you are watching this video, you or someone you care about is probably suffering from pelvic floor related pain.  You probably know how nothing you or your friend has done has helped very much, if at all.  You know how this disorder has deeply disturbed the quality of life. If you are suffering from pelvic floor related pain, you know how nothing in conventional medicine has resolved this problem.  Most people whatever their title are not able to help and don’t really get it.

You may worry that this problem might never go away.  You probably feel helpless around it. You probably see nothing of help on the horizon.  I say all of this because I lived with this condition for a long time as I have mentioned. I know this inner space of feeling helpless and not knowing where to turn, and that scared me more than anything.

Before I describe our home program, I want to talk about how this program came about.  For the last 27 years we have been treating this problem with the protocol we developed at Stanford.  I am amazed at how little has changed in the conventional treatment of pelvic pain.

Pelvic floor pain is essentially invisible. You can’t see it, there are no objective tests for it and most doctors have little interest in it. If you didn’t say something was wrong, very few people in your life would know you were suffering.  Doctors tend to focus on evaluating and treating the organs involved in pelvic pain. For the kind of pelvic pain located in the muscles and the nervous system, which I believe comprises the vast majority of pelvic pain,  such thinking is a major error and bound to fail.

It is clear to us that the problem of pelvic pain in the people we have treated over the years has to do with the muscles of the pelvis, not the organs. It is not an infection, edema, inflammation or some serious physical malady.   It is a stress related response resulting in irritated pelvic muscles that don’t relax back to normal.   Chronic anxiety, which you may feel so constantly it feels normal, causes a kind of ongoing pelvic charley horse, a chronic contraction of the muscles of the pelvis in response to years long, yet not obvious stress. Often, though not always, an intense period of stress then triggers the disorder that morphs a chronically tight pelvis into into a chronic condition of pain and dysfunction.

Pelvic floor dysfunction is a disorder in which the pain and sensations of the disorder can be referred from a place remote from the actual site of the problem.   But again, an outside person can’t see this. The sufferer typically doesn’t know this either.   Because you can’t see it, if you are a doctor or a health care professional, you have to project a concept on the person who has this problem and then treat your concept of the problem. If the concept of the problem is wrong, the treatment generally is a waste of time.

I know from many years of experience both as a patient and as a health care provider.  it is very hard for anyone to understand pelvic symptoms.   Unless you have had them, and especially if you haven’t found a way to stop them, you are guessing, going to school on someone with this condition or using methods yu have been taught that routinely fail.  There are 5 or 6 different names given to this disorder – names like pelvic floor dysfunction, prostatitis, pudendal neuralgia, chronic pelvic pain syndrome, pelvic floor hypertonia, levator ani syndrome and others.  All of these names in my view represent the misunderstanding of the problem because, in my view, these diagnostic terms all refer to the same disorder. Of all of the names, pelvic floor dysfunction is the most benign and the most useful.

I have discussed all this in many podcasts, videos, blogs and with my colleagues in numerous published studies.  We have gone into great detail in the book, A Headache in the Pelvis that I coauthored with my colleague, Stanford Medical School emeritus Professor Rodney Anderson.  Dr. Anderson ran the pelvic pain/prostatitis clinic at Stanford for many years.

Muscle based pelvic pain is ultimately a stress disorder, a psycho-neuromuscular problem in which the muscles in and around the pelvic floor are chronically contracted and remarkably, intimately tied to someone’s nervous system related to  chronic worry and emotions.  The interaction of the mind and body leaves the pelvic floor sore, irritated, tightened, with the increased tone and  tissue irritability and never having a chance to heal and return to a normal.

Pelvic floor related pain is a problem that shows up in different ways.  It can go on 24/7, come and go, wax and wane and typically sufferers feels helpless about stopping their discomfort.  The simple, normal functions like voiding, defecation, sexual intimacy, sitting, and the normal stresses of life keep pelvic pain going in a self-feeding cycle.  Conventional medicine has little to offer it.  Drugs, surgery, procedures and even simple physical therapy, even when done competently, offer little, or at best some short term relief.  We introduced pelvic floor physical therapy at Stanford many years ago  and consider it essential but must be done by the patient, him or herself in conjunction with our relaxation protocol.

Pelvic floor physical therapy is important in the resolution of pelvic floor related pain but by itself, it simply involves inserting a finger insider the pelvic floor rectally or vaginally, and pressing on tight, contracted pelvic tissue.  When it is done competently, external trigger points in the gluteal, adductor, quadratus lumborum, hamstrings, iliopsoas and abdominal muscles are also pressed on when tender.  But even the most well executed physical therapy offers temporary relief at best. It is rarely done enough times weekly (we generally ask patients to do internal trigger point release every other day for often a year more or less), and without changing the aroused nervous system habit of tightening up the pelvis under stress, or as a default mode, physical therapy intervention fades.

In our view internal and external physical therapy must be done daily or almost daily and must be put in an environment of nervous system quiet every day so the sore, irritated tissue in and around the pelvis can heal and become normal again.  Doing this is not a small thing.  It is a big deal and doing this, in our view, requires at least 2 hours a day for a long time until symptoms significantly reduce.

The treatment of pelvic floor pain has been particularly difficult during Covid.  Covid changed all our lives, including those of us treating prostatitis/pelvic pain/ pelvic floor dysfunction.

Up until Covid, we only saw patients in person.  They had to come to California and spend days with us as we taught them how to treat themselves when they went home.

We did not stop seeing patients in our clinics which we have done in a clinic form since 2003,   For the first several months of Covid in 2020 we cut the number of people we saw in our clinics in half and were doing our very best with masks and air filters,   We were able to show patients how to use our specialized devices, the Internal Trigger Point Wand, the Trigger Point Genie, and how to do all the internal and external trigger point release and stretching, how to do Extended Paradoxical Relaxation  which are all central to our protocol but it was not easy during the worst of Covid.

During this time, it became clear to us that travel for patients to come to see us was going to be more and more difficult. The number of people who contacted us often reached a level of over 40,000 a month.  A very large number of people suffering had no recourse to any kind of help as it appeared at that time that many doctors and physical therapists were often nervous about seeing patients in person and were not uncommonly unavailable.

So, we saw the need to do a home program where people did not have to come and see us in person which we still consider our gold standard treatment. We continue to do our in-person clinics every 6 weeks or so in California.

For well over a year of Covid, however, we devoted ourselves to creating a home program that appropriate patients could do at home without coming to see us in our clinics in California.