Healing pelvic pain means both stopping the local clenched muscular pain in the pelvis and reducing the arousal of the nervous system that is driving the chronic clenching of the pelvic floor.

It is indisputable that when someone has pelvic floor pain, selected muscles inside and outside the pelvis are painful upon palpation (that is when your press on them with an educated finger). The centers of the pain in these painful muscles are called trigger points, which you can think of as rice-grain shaped knots of spasm within a tight muscle. The presence of pain/soreness/discomfort when you press on certain muscle in and around the pelvic floor of the pelvic pain patient, recreating someone’s symptoms, is the definitive criterion we use to determine the appropriateness of our protocol.
As a rule, people who do not have pelvic pain do not have such pain, tenderness and symptom-referral upon palpation in and around the pelvic floor. Furthermore, when the muscles in and around the pelvic floor stop being painful in the person with pelvic pain, it has been our experience over years that pelvic pain has significantly reduced or has gone away.
In order to determine the presence of trigger points and their referral of symptoms upon palpation, one must be skilled at trigger point release, one must understand the location in the pelvis where trigger points reside, and one must be skilled in using correct pressure in pressing on this tissue.
We understand that the overriding question in treating pelvic floor pain is how to ultimately help the pain in the external and internal pelvic tissue go away and, importantly, for it to stay away.
It is important to understand that in general, physical treatment of chronically tightened pelvic and related muscles, while essential in our protocol, is clearly necessary but not sufficient in the long-term resolution of pelvic floor pain. Relief of pain from pelvic floor physical therapy, and sometimes even the flare up of symptoms from pelvic floor physical therapy which is usually indicative of pressing too hard in the pelvis, usually last for a relatively brief period of time.
If, you don’t understand this, then you can get discouraged that the pelvic floor myofascial/trigger point release, sometimes called pelvic floor physical therapy isn’t working. If it affects the pelvis one way or another, it is significant and in our view prognostic. Chronic guarding in the pelvis floor produces pain in the pelvis. My point here is that this ongoing physical release of the pelvic muscles, using myofascial trigger point release, must be combined with stopping the habit of re-tightening these muscles, for any long-term solution.
Said in the simplest terms, the chronically painful muscles in and around the pelvis that are the hallmark of the condition of chronic pelvic pain and occur because the sufferer typically inadvertently and reflexively tightens their pelvis and related muscles all the time, keeping the pelvic floor sore and painful. The inadvertent tightening is fueled largely by the habit of tightening the pelvis under stress and by the sore, painful pelvic floor which tightens on a hair-trigger.
This tightening is ongoing… throughout the day. Pelvic pain is not something that is triggered at one moment in time and mysteriously continues because of this one event. Certainly pelvic floor pain may be set in motion at one moment in time, but it continues as a chronic condition because you are inadvertently fueling it throughout your day in the self-feeding cycle of chronic guarding/tightening, which is potentiated by the hyper-irritable pelvic tissue, which triggers pain, which triggers anxiety, emotional distress and the ruining of any quality of life, leading to more chronic and uncontrolled tightening, pain and anxiety.
Without the regular physical release in these muscles and without the regular and deliberate practice of placing them in in a stress-free environment which is the role of Extended Paradoxical Relaxation, pelvic pain remains chronic. We see relaxation acting like a cast to a broken bone. It provides a healing environment for the healing mechanisms of the body to restore the normality of the sore, chronically tightened pelvic tissue. Extended Paradoxical Relaxation and our training patients to do their own internal and external trigger point release with our FDA approved Wand, is how we help our patients break the pelvic pain cycle. Breaking the cycle of chronically tightening the pelvis, which fuels pain, which trigger anxiety which triggers more pain —breaking this cycle is the whole point of the Wise-Anderson Protocol.
Unfortunately, there is no subspecialty that focuses on both the physical and mental components required to heal a sore pelvic floor. Strangely unless you have suffered from pelvic pain, and have recovered from it, it is difficult to understand what it is and what is necessary to resolve it. Because pelvic pain is invisible and the conventional tests cannot detect it, and the person who never experienced pelvic pain has difficulty in understanding it, the practitioner has to project a concept of what is wrong with the pelvic pain patient to treat him or her. Unfortunately, the current concepts of pelvic pain are either vague or off the mark in my opinion. In my own journey, I had to include, but venture well beyond the existing subspecialties and their ideas for me to get better.
In 2018, we published a meta analysis in the Gold Journal of Urology defining pelvic floor related pain as a psychoneuromuscular disorder—psychoneuromuscular meaning being intimately involved in mind and body. There are few who treat pelvic floor pain as a psychoneuromuscular disorder with a robust program involving both mind, nervous system arousal reduction and the regular releasing the internal and external muscles related to pelvic floor guarding
Extended Paradoxical Relaxation stands on the shoulders of my work with Edmund Jacobson who developed Progressive Relaxation in the beginning of the 20th century, and is the method we have developed over the years aimed at reducing nervous system arousal in someone who is suffering from pelvic pain.
The practice of Extended Paradoxical Relaxation is the method we use to put the pelvic muscles in a regular environment protecting them from having to tighten in response to the stresses of life. Extended Paradoxical Relaxation isn’t an easy or quick method. It must be practiced daily.
This method trains attention to focus on sensation rather than on thought. In the service of calming down an aroused nervous system, it asks those who want to learn how to do it to paradoxically give up attachment to an outcome to achieve the outcome – which is profound relaxation – it is a paradox. It asks to accept tension as the way of relaxing it – another paradox. It asks practitioners to return attention from what distracts them over and over again. Clearly, our method borrows from the storehouse of what all wisdom and meditation traditions that move the body into the relaxation response borrow from.
Extended Paradoxical Relaxation is the practice of effortlessness, the practice of giving the body an opportunity to do nothing while being present in the moment. It is the practice of not thinking, focusing on sensation and away from the movies and words that are the regular narratives of the mind. The instructions we ask patients to follow guide them in resting attention in sensation from moment to moment in order for the body to rest. When attention rests in sensation from moment to moment, thinking reduces, and this practice makes it most likely for the nervous system to shift into the relaxation response. We see this inner quiet as the healing room for the sore pelvis.
It is not well understood that the practice of relaxation or meditation is a profoundly psychological event… for it is the practice of letting go of your own inner defenses. I want to propose what is obvious to me after many years of the practice of relaxation – chronic tension is the expression – usually unconsciously — of not feeling safe and the tension is a primitive way, and not helpful way, of protecting us from harm.
In the lore of yoga, there are energy centers in the body that must remain open to permit the passage of the life force (kundalini) through the body to maintain heath and emotional balance. The centers associated with pelvic pain in the yoga tradition are the first and second chakras. The first chakra has to do with the anorectal area. The second chakra is associated with reproduction and is related to the genitals involving sexuality, creative expression and emotions. Pelvic pain can been seen from a yoga perspective as the blockade of the bodily energy involving the feeling of safety which is the first chakra, and issues around sexuality, which is the 2nd chakra.
When we look at the experience of those with pelvic pain, the issue of existential safety – of feeling safe in life — regularly shows up. The great catastrophic thought of the pelvic pain patient is ‘will I have to live with this pain that I can’t imagine living with’. In my view, the inability to relax is typically related to unconscious concerns about existential safety and survival and the worry that ‘If I relax, I will be vulnerable and can be hurt so I have to keep guarded’. In an upcoming podcast, I will go more deeply into the psychology of the inability to relax and my view of its solution.
Learning to profoundly relax with all of the unconscious inner fears of childhood showing up during relaxation, and in the midst of a world full of scary news and uncertainty is life changing. I say this from my own experience and from my experience working with many patients.
No app or deep breathing reliably brings the nervous system into the relaxation response. There is no royal road to learning to quiet the body and mind. It must be done daily, along with the physical loosening of the body, to have a chance of soothing the nervous system, along with loosening the pelvic floor, to resolve chronic pain and dysfunction in the pelvis.