Headache in the Pelvis:
David Wise Ph.D. and Rodney Anderson, MD
OF OUR UNDERSTANDING
have identified a group of chronic pelvic pain syndromes that
we believe is caused by the overuse of the human instinct to protect
the genitals, rectum, and contents of the pelvis from injury or
pain by contracting the pelvic muscles. This tendency becomes
exaggerated in predisposed individuals and over time results in
chronic pelvic pain and dysfunction. The state of chronic constriction
creates pain-referring trigger points, reduced blood flow, and
an inhospitable environment for the nerves, blood vessels, and
structures throughout the pelvic basin. This results in a cycle
of tension, anxiety, and pain, which has previously been unrecognized
this tension, anxiety, and pain cycle has allowed us to create
an effective treatment. Our program breaks the cycle by rehabilitating
the shortened pelvic muscles and connective tissue supporting
the pelvic organs while simultaneously using a specific methodology
to modify the tendency to tighten the muscles of the pelvic floor
is our understanding that the chronic pelvic pain syndromes begin
with a person’s habit of focusing tension in the muscles
of the pelvis. This tendency sets the stage for the disorder.
What triggers the symptoms can be a major stress or several minor
stresses occurring simultaneously. The stressors can be psychological
reason that chronic pain and dysfunction resist a simple mechanical
fix is that they tend to come out of a background of a life-long
habit of focusing tension in the pelvic muscles. It is necessary
to rehabilitate the pelvic muscles in conjunction with changing
the predisposition to pelvic tensing under conditions of stress.
order to make our understanding clear, we offer the allegory below
followed by a step-by-step analysis of the story. We advise our
readers to take time to read the allegory as it will help clarify
upon a time, there was a land called the pelvic floor upon which
the whole world depended for its survival and pleasure. The pelvic
floor provided vital services for the world including filtering
and eliminating wastes, providing sexual pleasure, and helping
structurally support the world in its various activities. The
land of the pelvic floor performed these services best when its
citizens lived a life of balance between work and rest.
came to pass that the world went through a period of strife, and
the citizens of the pelvic floor were required to work more and
more. Night shifts became common place. In some parts of the land,
citizens were required to work twenty four hours a day, seven
days a week, with no rest.
the pelvic floor citizens were completely exhausted and very unhappy.
They had stopped doing their jobs well. Their normal processing
of wastes was no longer done efficiently, and they became able
to give little pleasure to the world. Their cries of distress
were increasingly heard.
protests from the pelvic floor were made with demands for a return
to the balance between rest and work. The world, however, did
not seem to understand what the pelvic floor was trying to say.
the world hired a consultant who suspected the source of the problem
to be foreign troublemakers and recommended sending in legions
of anti-troublemakers. The troublemakers, however, could not be
found and the problem continued.
world became desperate and decided to hire a new consultant who
saw the problem differently. The new consultant said, “If
you want to solve this problem, you must go to the land of the
pelvic floor and listen to its complaints.” The world replied:
“We don’t know how to talk to or understand the pelvic
floor. We have never had a conversation with it.” The consultant
answered: “I know the language of the pelvic floor and will
teach you how to understand what it is trying to tell you.”
meetings with the pelvic floor and the consultant, the world finally
understood that its contribution to the problem was the demand
it made for the pelvic floor to work constantly. So the world
decided to change this. However, while the world agreed in principle
to stop demanding constant work, it often forgot this agreement
and lapsed back into its old habit of making unreasonable work
demands. The consultant had to remind the world over and over
to stop forcing the pelvic floor to work constantly. This was
not easy for the world to learn.
a while, the world said to the consultant: “Your method
seems to be working much of the time but why is everything not
completely back to normal?” The consultant replied: “Both
you and the land of the pelvic floor are used to the unhappy state
of affairs that has existed for many years. If you are not reminded,
you will continue to force the citizens of the pelvic floor to
work without rest.”
world, however, was not the only perpetuator of the problem. The
pelvic floor had also gotten used to the misery of constant work
and had forgotten how to rest even when the world allowed it.
a curriculum was set up for the pelvic floor as well. The people
of the pelvic floor went to special clinics where they learned
to stretch the contracted posture that they developed due to their
constant work. This stretching and their lessons in learning not
to fall back into the old habits enabled them to relearn how to
relax and rest.
the world and the pelvic floor learned to coexist in a balance
of work and rest, the land of the pelvic floor became a happy
pain and dysfunction result from overused and chronically tensed
our allegory, the world stands for you, the conscious person,
who makes decisions and sends commands to your body. You send
these commands, often out of habit. They feel normal and familiar
pelvic floor is your pelvis and the contents of your pelvis, including
your genitals, rectum, and the muscles that hold up the contents
of your abdomen. It also includes the structures that are involved
in urination, defecation, sexual activity, and physical movement.
These functions and their myriad of biochemical, nervous, and
mechanical processes go on often without requiring your awareness,
will, conscious effort, or attention.
see in the allegory that the problem begins when the world demands
that the pelvic floor work on a constant basis. Normally, the
pelvic floor muscles are dynamic, working, and resting throughout
the day. Even though they tighten, they have the ability to relax.
The relaxed state allows for proper oxygenation, nutrition, management
of wastes and rejuvenation of tissue.
pelvic floor muscles are not meant to be chronically contracted.
When muscles are chronically tensed, they tend to shorten and
eventually accommodate so that the posture of a shortened state
of the muscles feels normal. This chronic shortening impedes the
ability of the tissues to have proper oxygenation, nutrition,
management of wastes and rejuvenation of tissue.
who have pelvic pain syndromes tend to habitually focus tension
in the pelvic muscles as a response to stress, anxiety, trauma,
or pain. In our allegory, we allude to this by saying that the
continual strife of the world prompted it to make the pelvic floor
work too much.
tendency to focus tension in the pelvic muscles is not an accident.
Some have suggested that a person’s inclination to focus
tension in the pelvic muscles begins with toilet training. The
child is able to stop his parent’s reaction to soiling by
tightening his pelvic muscles. Over time, tightening the pelvis
becomes a conditioned reaction to any situation in which anxiety
arises. Let us be clear that this idea of focusing tension in
the pelvic muscles as a result of early toilet training is simply
an idea and we do not propose that it should be taken as fact.
It is however, a compelling explanation of how pelvic tension
may well begin early in life.
has shown, and it is our clinical experience as well, that people
with chronic pelvic pain syndrome have elevated pelvic floor tension
even when resting. The pain and dysfunction gets worse in the
presence of stress. Most of our patients notice this relationship
between stress and the severity in their symptoms. This observation
leads to the heart of our understanding.
our allegory, we see that the constant demand made upon the pelvic
floor leads to a disruption in its ability to function. It is
our view that, over time, a constant demand on the pelvic floor
to tense results in an environment that is inhospitable to the
nerves, blood vessels, and structures within it. The pelvic floor
is not made of steel and in certain individuals is quite disturbed
by chronic tension.
believe that the person who has the kind of pelvic pain we discuss
in this book has sore and irritated pelvic tissue. This tissue
is not viewed by conventional medicine as pathological. We believe
that this sore, shortened, contracted tissue is a very real physical
condition. People who have chronic pelvic pain feel this soreness
and irritation acutely. It sometimes feels like a burning, tearing
or area of raw tissue. When the doctor or physical therapist trained
in myofascial/Trigger Point Release feels the inside of the rectum
or vagina in patients with CPPS, he or she often reports feeling
areas of restriction and areas of tension and taut bands (trigger
points) which, when touched, cause patients to jump with pain.
Some professionals who work inside the pelvic floor of people
with pelvic pain describe the tissue as gunky or rock-like. Areas
within the pelvic floor which have been subjected to years of
continual contraction need time to heal even when the muscles
are no longer under tension. When physical therapy is properly
done, the gunky, rock-like tissue often becomes soft, supple and
painful pelvis is like a continually contracted fist
tightening your fist as hard as you can for an hour. You notice
that there are places of lighter color in your hand, which result
from squeezing the blood out of the blood vessels. Your hand will
feel uncomfortable and you feel relieved to stop the squeezing.
imagine you maintain this clenched fist for a day. Now imagine
you maintain this fist for a week. Now imagine a month of tightening
your fist constantly twenty-four hours a day. Now imagine doing
it for a year. Now imagine doing it for several years. This is
one way to understand the state of the pelvic floor in people
with pelvic pain.
after several years, you stopped tightening your fist. Do you
think the great discomfort and irritability of the tissues of
your hand would immediately stop? Almost certainly not. It is
not hard to imagine that you would want to rub your hand, massage
it, take each finger, and stretch it out to relieve it from the
contracted state it had been in. Nor would it be hard to imagine
that, even after you stopped tightening your fist, your fist would
still be sore. It would take some time, some pampering, and most
importantly, no chronic retightening of the fist before your hand
felt normal again.
continually tensing your pelvis
tightening your fist is one thing. Now
imagine you were asked to tighten your pelvic muscles for 30 seconds
as if you were stopping yourself from urinating. For most people
this pelvic tightening would not be the most pleasant thing to
do but it would be doable. Imagine you tightened up in the pelvis
like this for a minute. It would still be doable. Now imagine
you were asked to keep your pelvic muscles continually tensed
for 30 minutes… now 1 hour… now 6 hours,.. now 12
hours … now 24 hours … now 1 week,.. now 1 month …
now 1 year… now 2 years… now 5 years.
who have never had pelvic pain are incredulous at being asked
to contract their pelvic muscles for 30 minutes. The prospect
of continual tightening of the pelvic muscles for a week, month,
or year would be unthinkable and yet the research shows increased
tone in the pelvic floor for people with pelvic pain. Dealing
with such a condition is the focus of our protocol.
our allegory the consultant the world first chose refers to the
traditional physician who routinely assumes the presence of infection
as the source of the difficulty (foreign troublemakers). But,
treating these troublemakers, or the presumed bacteria, has failed
to resolve the problem of chronic pelvic pain syndromes. The recent
research has shown antibiotics to be no more effective that a
sugar pill or placebo. The second consultant who is called in
refers to a clinician trained in our viewpoint and protocol. The
clinician sees the problem emanating from within the individual.
In our allegory the new consultant offers the solution we suggest,
which is aimed at rehabilitating the chronically contracted posture
of the tissues in the pelvic floor as well as teaching the individual
to cease the habitual and chronic pelvic tensing.
our allegory, we make the point that ‘the world’ has
lost communication with the pelvis. Most of our patients tend
to be out of touch with what is going on in their pelvis. We offer
a method to open communication with the pelvis to help bring about
a healing of the sore and irritated pelvic tissues.
pelvic muscles by changing bad habits
chronic tension results in an irritation of selective contents
of the pelvic floor, which gives rise to pain, then anything one
does to reduce or eliminate the tension has the potential of eliminating
the pain. The restoration of the contracted tissues to a normal
state of flexibility and relaxation has to be done repetitively.
is the repetitive application of our method that gives the pelvic
muscles a chance to return to their normal state. The methods
used to accomplish this are called Paradoxical Relaxation
and Trigger Point Release. Paradoxical
Relaxation, as we discuss in depth in Chapter 4, trains the
patient to break the habit of chronically tensing the pelvic muscles.
Trigger Point Release, described in Chapter 5, makes
it possible for the pelvic muscles to adequately relax through
the aid of a therapist who literally lengthens the constricted
tell our patients to expect ups and down, and not to celebrate
when symptoms reduce, or to despair when they flare-up. This is
easy to say and not so easy to do when you are anxious and in
are important reasons why chronic pelvic pain syndromes are misunderstood
and why progress is slow. One reason is that the pelvic muscles
are almost always active in the service of the normal functions
in life. The pelvic muscles need a rest from their chronic contraction.
There are two factors that make this difficult. The first is that
you can’t simply rest the pelvic muscles for any extended
period. They are needed to allow you to stand up, to hold in urine,
to walk, to lift — to do the things that allow you to be
able to function normally. It is a delicate juggling act to deal
with the need for rest and healing of this vital part of the body
on the one hand and the demand on the pelvic muscles to do the
work required to function in life.
other factor that operates against the healing of the pelvic floor
is the conditioned tendency to focus tension in it when under
stress. This is usually a deeply ingrained tendency, especially
when this focus of tension has been practiced many times without
awareness. Modifying this habit so that contracting the pelvic
muscles under stress is not the default mode is no small enterprise.
Changing this habit is the focus of the method of Paradoxical
our allegory, we show that while the intervention of the second
consultant began helping the situation, the situation did not
immediately go back to normal. The process of healing takes time,
especially inside an active pelvic floor.
and emotional support helps pelvic pain syndrome
his study of prostatitis, Harry Miller, M.D., a urologist from
the urology department of George Washington University, reported
on his treatment of men who had prostatitis. Dr. Miller offered
stress management therapy for these men. He gave men very simple
and kindly advice not unlike that of a grandmother to her grandson.
Miller’s approach reinforced the idea to his patients that
there was a relationship between how they managed the stress in
their life and their symptoms. In doing so he helped most of his
patients reduce their symptoms.
Miller’s work focused on the person and not the prostate.
He addressed the social and psychological context in which pelvic
pain occurs. Similarly, the approach discussed in this book insists
that chronic pelvic pain syndromes are a problem of the person
which includes but is not limited to a sore part of the person’s
seems obvious may not be the problem: the source of the disorder
in interstitial cystitis may not simply be the bladder
locus of the problem in interstitial cystitis may not be limited
to the bladder, but found in the muscles of the pelvic floor.
Treatment protocols in traditional medicine have focused exclusively
on the bladder.
compelling evidence throws doubt on this view that the bladder
is the essential problem in interstitial cystitis. One study showed
that when the pelvic muscles of patients with IC were palpated,
the pelvic muscles appeared to be the source of the pain. The
bladder was rarely found to be painful when touched. In a Finnish
study, 25 out of 31 women who were diagnosed with IC reported
pain in the pelvic muscles and not in the bladder when the bladder
and the pelvic floor were palpated.
even more compelling is the experience we had with a patient whose
level of pain with IC prompted a physician to remove the bladder.
The bladder removal did not reduce the pain. Unfortunately this
is not the only patient whose bladder was removed and whose pain
are suggesting that the source of the problem with IC may not
be the bladder. Instead, the source may be the nerves, muscles,
and blood vessels in the pelvic floor connecting to the bladder.
multidisciplinary treatment protocol
treatment team is multidisciplinary and consists of a physician, a psychologist, and a physical therapist. The
urologist or gynecologist does the initial diagnosis and makes
sure that the condition is appropriate for our protocol. His or
her work involves an examination of the patient, the administration
of various medical tests, and interpretation of the results. It
is the physician’s findings that rule out serious illness
as a factor in the patient’s symptoms.
psychologist’s primary role in the treatment team is to
train the patient in Paradoxical Relaxation for the purpose
of profoundly relaxing of the pelvic floor and modifying the habit
of focusing tension in the pelvic floor under stress. The psychologist
on our team teaches a method to help the patient stop the catastrophic
and negative thinking associated with the condition of pelvic
pain and dysfunction. This method requires regular practice as
the negative thinking arises during the course of a day. The method
is simple and easily learned and applied.
physical therapist usually administers the Trigger Point Release
and teaches participants to do their own Trigger Point Release.
Self-administered internal Trigger Point Release is taught. The
physical therapist also teaches the patient a home program of
stretches, not unlike a home yoga program, except that these stretches
are oriented toward the rehabilitation of the chronically tensed
treatment is most likely to help when you reduce the
stress in your life
B., a 38 year-old small business owner, came to see us with pelvic
pain and urinary dysfunction. Upon examining him, we determined
that, in fact, he had no problems of an organic nature. He had
trigger points inside his pelvic floor that when palpated exactly
recreated his symptoms.
normal circumstances, John was someone we would be optimistic
we could help but it became clear he was not. He owned a car repair
facility where he employed 45 people, and his business consumed
his days from 6 in the morning until 9 at night. His wife was
unhappy because of his absence from their relationship. His children
had behavioral and academic problems at school. He was also involved
in a lawsuit with his brother-in-law with whom he had owned a
previous business. He was in the middle of a major renovation
of his house that left both he and his wife, on a mattress on
had no time for himself, let alone the time to do physical therapy
and daily relaxation to relax his pelvic floor. Under the circumstances,
the program we offered probably would have been wasted because
he would not be able to do it properly in the face of the demands
and stress calling for his attention. Only when John himself decided
that his life would have to change would our treatment have a
chance of helping him resolve his pelvic pain.
treatment requires adherence to the complete program
who seem to get the best results from our treatment are those
who are clearly committed to earnestly practicing our approach.
Usually these patients have suffered for a long time and have
seen numerous doctors and explored many avenues. These patients
often assume the attitude of “I will do whatever it takes
to get better,” and have no problem following the protocol.
We tend to discourage patients who are skittish or unsure about
doing our treatment. These are usually patients whose level of
pain and dysfunction is minimal and who have been suffering for
a short period of time.
pelvic pain as a functional disorder
and other chronic pelvic pain syndromes are sometimes seen as ‘functional
disorders’. This viewpoint is most clearly expressed by
Dr. Jeanette Potts, who has maintained that nonbacterial prostatitis
and chronic pelvic pain syndromes are functional disorders. Pelvic
pain syndromes are defined by the fact that these conditions show
no glaring physical abnormalities to account for the pain and
suffering they cause. They are defined as a problem in function,
not in structure. In other words, the structures within the pelvic
floor of those with chronic pelvic pain syndromes tend to have
healthy structures that display a disturbance in function. Hence
they are a functional disorder.
a functional disorder does not mean it is all in your head
do not dismiss functional disorders as any less real than a broken
bone. More than a few patients have told us that they have seen
doctors who have told them that there is nothing wrong and that
they should either live with their condition or go to a psychiatrist.
This is naturally disturbing to a patient who is faced with his
doctor telling him that his pain and dysfunction are somehow not
real or treatable.
with functional disorders often have more than one
our practice we have noticed that there is a high incidence of
irritable bowel syndrome in the patients we see with pelvic pain.
Given the proximity of the colon and the pelvis, it makes sense
that both could be the result of a chronic abdominal/pelvic tension.
While gastroenterology and urology make a distinction between
the urogenital system and gastrointestinal tract, the body doesn’t
necessarily make any such distinctions or recognize any such boundaries.
concepts of threshold, pelvic pain, and functional disorders
first facing pelvic pain, one faces what seems to be a monolithic,
undifferentiated curtain of pain and distress that feels incomprehensible
and overwhelming. Patients usually feel helpless in the face of
pelvic pain because they know little or nothing about what they
can do about their condition. Therefore, the concept of a threshold,
and proximity to the threshold, is often a useful idea to patients
because a perspective can be gained on one’s progress.
assess the effectiveness of our treatment by looking at the presence,
intensity, and frequency of symptoms. Consider the following graph
upon which you can locate your proximity to the threshold above
which you are symptomatic and below which you are not. When patients
are able to see their symptoms from the viewpoint of their proximity
to the symptom threshold, they can gauge their progress and relieve
their sense of helplessness and confusion when their symptoms
wax and wane.
proximity to the symptom threshold
#4 (chronically symptomatic)
#3 (symptoms wax and wane)
#2 (no symptoms when slightly below threshold
-- can become symptomatic at the slightest stress)
#1 (no symptoms)
In Figure I, the person who is located in position #1 is well
below the threshold, displays no symptoms, and can tolerate a
great amount of tension in the pelvic floor without becoming symptomatic.
Even when this person’s pelvic tension goes over the threshold
the pelvic tissue is not irritated, and the pelvic floor muscles
are flexible and immediately drop below the threshold after the
individual has stopped tensing.
person situated in position #2 represents someone who likely will
have pelvic pain but on an intermittent basis. It does not take
great increases in pelvic tension to throw this person’s
tension level above the threshold where he or she will become
symptomatic. The person at position #2, generally speaking, has
a reduced level of flexibility in the pelvic floor and often does
not relax as easily as #1 once the muscles are tensed over the
level of the threshold.
with pelvic pain who fall under #2 in our diagram are often bewildered
at what brings on their symptoms. They conclude that there was
nothing much that seemed to be associated with the onset of symptoms,
and that the pain is random. Our explanation is that, when someone
is slightly below the threshold, what is a non-event for a normal
person is often stressful enough to throw a #2 over threshold
and into symptoms.
position #3 is the individual who has mild but persistent symptoms
that wax and wane. This is the person who is ‘surfing’
the threshold. Symptoms associated with #3, while seeming to be
almost always present, occasionally drop below threshold only
to come back inexplicably. The person at position #3 usually experiences
chronic but more or less tolerable pain and dysfunction.
position #4 is the individual who has chronic and intractable
pelvic pain and/or dysfunction. He or she doesn’t drop below
the symptom threshold. When asked to describe the frequency and
severity of symptoms, this person will report that the symptoms
are always present, 24 hours a day, seven days a week, and that
the symptoms strongly impact his or her life. Our treatment aims
to lower baseline pelvic tension and irritability of individuals
in positions #2, #3, and #4 to the #1 position.
increases your symptoms
of the patients we see with chronic pelvic pain syndromes have
what we have referred to earlier in this chapter as trigger points
in their pelvic muscles. The way we determine the existence of
trigger points is discussed in the section on Trigger Point Release. To reiterate, a trigger point is a taut band within
a muscle that is painful either spontaneously or when touched
and which refers pain to a site remote from it when it is activated.
Trigger points are exquisitely sensitive and it is not uncommon
for the patient to jump when the trigger point is pressed. We
determine the presence of a trigger point through a digital/rectal
or digital/vaginal examination. The doctor inserts a finger inside
the rectum or vagina and presses on the muscles to assess the
tissue and to find trigger points.
1994 study sheds much light on the relationship between trigger
points and stress. McNulty, Gevertz, Hubbard, and Berkoff inserted
a needle electrode directly into a trigger point and monitored
its electrical activity with a machine called an electromyograph.
It appears that the higher the electrical activity in a trigger
point, the higher the level of pain. Another needle was placed
immediately adjacent to the first needle to monitor electrical
activity of the tissue there.
were given the stressful task of doing mental arithmetic. The
scientists wanted to determine what the effects of stress were
on the trigger points being monitored, and the differences, if
any, between the responses of the trigger points to stress and
the responses of the adjacent tissue. The results of the study
indicated that the electrical activity of the trigger points increased
during this stressful activity while the adjacent, non-trigger
point tissue remained electrically unresponsive.
findings are remarkable. They suggest that in some way the nervous
system that is connected to emotional activity and arousal is
selectively connected to trigger points and not to non-trigger
point tissue. Understanding this, it is easy to understand why
patients with pelvic pain and dysfunction routinely report that
their symptoms are aggravated by stress.
Anxiety, anger, fear, and sorrow can cause increased pain in areas
that have trigger points. Furthermore, your attitude toward your
body and symptoms can serve to aggravate your symptoms. If you
are aware of pain every day during urination or sexual activity,
and you feel anxious each time you are aware of your pain, it
is clearly very important to shift your thoughts and attitude
about your symptoms.
taught that we need to be kind to each other because each of us
is engaged in a mighty struggle in our lives. Compassion for the
most difficult of people comes from understanding their struggle.
Letting go of anger and fear toward the rectum and genitals is
simply an expression of your understanding and compassion for
your own struggle. Discovering compassion toward oneself and one’s
body is part of our protocol. As patients understand the language
of the pelvic floor and their struggle with their habit of chronically
tightening it, their attitude can change from fear to compassion
leads to anxiety which leads to pain
pelvic pain has been resistant to effective treatment because
of what we call the tension, anxiety, pain cycle. This is a cycle
in which chronic tension has shortened the muscles in the pelvic
floor and, as discussed earlier, created an environment in which
the pelvic floor can be said to be functioning like a clenched
fist. This leads to pain and dysfunction. The pain is a signal
of alarm to which the body responds with a heightened state of
arousal or anxiety. Anxiety always produces increased tension,
which then produces more pain, which then produces more anxiety.
often see patients in pain who are emotionally upset about their
pain. Their hands are often cold and clammy; they are agitated
and can’t seem to sit still. These patients are caught in
the active grip of the tension-anxiety-pain cycle.
difficulty of intervening effectively on behalf of these patients
is illustrated in the children’s jump rope game called “double
dutch.” In this game, two children, facing each other, turn
two ropes, one clockwise, and the other counter-clockwise, as
one child jumps both of the ropes.
difficulty in double dutch is found in entering through both swinging
ropes into the jumping space. Children who successfully “jump
double dutch” are able to watch the two ropes as they follow
closely one after another and to determine the split second when
there is a space through which they can enter. Even for an athletic
and bright child, double dutch is a challenge. Similarly, the
events that occur in the tension-anxiety-pain cycle follow so
closely one after the other, that we could call this “triple
dutch.” Entering into these events to stop the cycle is
not a small challenge.
gentle approach to break the tension-anxiety-pain cycle
intervene in this cycle in all three of its aspects.
Paradoxical Relaxation lowers pelvic tension and anxiety by lowering
autonomic nervous system arousal in general and habitual pelvic
tension in particular. Trigger Point Release deactivates
trigger point pain, lengthens chronically contracted muscles,
and makes the pelvic muscles more capable of relaxation. We have
found that an effective way of beginning therapy when someone
is caught in the grips of the tension-anxiety-pain cycle
is to start treatment gradually. If the patient can not tolerate
any pressure inside the rectum or vagina, we begin treatment by
simply inserting a finger with no pressure anywhere. If they cannot
tolerate the insertion of the finger, we hold the finger gently
touching the opening of the rectum or vagina without moving at
all. In backing up and reducing the intensity of the treatment
to a tolerable level, we find a baseline from which to begin.
J., a patient from Minneapolis, could not tolerate any pressure
inside his pelvic floor. When we instructed his wife in the Trigger Point Release, we told her to simply insert her finger inside
his rectum and not to press anywhere. She did this for a week
on a daily basis and, with our instruction, she began slightly
pressing on a trigger point. Gradually, as her husband could tolerate
more of it, she increased the pressure. After a few months, he
was able to tolerate the pressure that we normally exert at the
beginning of treatment with most patients.
John J. was not able to lie down and do the first lesson in the
relaxation training for more than three minutes. We instructed
him to do Paradoxical Relaxation for two minutes each day, which
he did for a week or so. Following this, we increased the relaxation
time gradually, until he reported actually relaxing for over a
period of half an hour.
summary: it is when you can find a method to rehabilitate the
chronically tensed and shortened muscles, restore their original
length and flexibility, and change the habit of continually squeezing
them and the nerves, blood vessels and structures they contain,
that a substantial number of patients with previously untreatable
pelvic pain can experience a marked improvement or abatement of
understanding is a radical departure from the conventional view
of prostatitis and chronic pelvic pain syndromes. We see pelvic
pain as often being a physical expression of the way a person
copes with life. We propose that pelvic pain is the result of
a neuromuscular state and not the result of a foreign organism
in the prostate gland or an auto-immune disorder. When certain
predisposed individuals focus tension in the pelvic muscles, this
chronic tension, over time, creates an inhospitable environment
in the pelvic floor that gives rise to tension, anxiety, and pain.
Once the cycle of tension, anxiety, and pain is set into motion,
it takes on a life of its own. Our treatment aims to restore the
capacity of the pelvic tissue to relax, to perform its normal
functions, and to return to a pain-free and dysfunction-free state.
This rehabilitative protocol consists of the simultaneous use
of Paradoxical Relaxation and Trigger Point Release
described in the next chapter.