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Pelvic floor physiotherapy vs. thiele massage vs. myofasial massage

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  • Pelvic floor physiotherapy vs. thiele massage vs. myofasial massage

    I've googled and so far found two clinics with pelvic floor physiotherapists in Vancouver. I called both to ask about costs and to try to get some info about what they would do in the treatments. I'm considering trying it, but haven't decided for sure yet. One bit that makes me hesitant is that some reports have the PT's getting you to work the Kegel muscle. Other things I've read said that Kegel muscle work accelerate problems for IC patients, can even trigger full flares. Just from how my body feels when I practice Kegels on my own (easy to do & learn without a PT), I think I'm in the Kegels-bad-for-IC group of patients.

    With those of you who have tried pelvic floor physiotherapy, have any of you come across PT's who specifically DON'T work the Kegel, and discuss other muscle groups instead? Are there any specific names they gave for those techniques or the kind of (non-Kegel) therapy they're doing?

    Also - what's the difference between pelvic floor physiotherapy, thiele massage therapy, and myofascial massage therapy (all of which are mentioned - and have had studies done - in relation to pelvic pain or interstitial cystitis)?

    Meanwhile - I came across these free audio lessons online, for those with incontinence or pelvic pain issues - by the New Zealand Continence Association. If you go to their page, it has links to the pelvic floor work out's (streaming audio - no downloads).

    Lisa
    ______
    Severe IC developed fairly quickly, autumn 2010.
    So severe that I was bed-bound & on 160mg/day morphine to cope with torturous pain levels, and unable to function other than hospital/medical appointments, for seven months. Then, miracle of miracles, something started working. I am steadily lowering the methadone dose level. I have been far out of that desperate nightmare hell zone for several months now and continue to improve.

    - Ranitidine (anti-histamine, H2-inhibitor) 300mg/day
    - Methadone 9 ml/day
    - Instillations:
    - 40ml Kenalog (steroid for inflammation) 2 x per
    week, along with rescue cocktail of heparin,
    lidocaine, sodium bicarbonate
    - 20ml Uracyst, monthly @ $100/per
    - Depo lupron injections for endometriosis, monthly @ $88/per

  • #2
    Biofeedback

    I went to a pelvic floor physical therapist in the Seattle-area for an evaluation and she did biofeedback, which was great. She first assessed my pelvic floor manually, and after confirming it was too tight inserted a probe which objectively measured the muscle activity. She then led me through relaxation exercises to reduce the muscle tension, which I could see on the computer screen. To further reduce the muscle tension she did have me tense up my pelvic floor several times but it was only to enable me to relax the muscles better afterwards, so a total of maybe 4 tense-ups (i.e. kegels). I was afraid to do the deliberate tensing-up because I had read the same as you had, that kegels make everything worse, but it worked great.

    I did ask her about pressure points and if I was a candidate for that, but if I understood her correctly she felt my pelvic floor was so tense that working any pressure points would just cause me pain, and she felt that biofeedback and relaxation sessions were best for me right now. Unfortunately I only saw her for one session as I live in Europe, and the pelvic floor specialist PT I plan to see here doesn't do biofeedback, so I'm a bit apprehensive but I'm definitely going to give it a try.

    Good luck, and I hope some others can chime in with more information! The pelvic floor can play a big role this disease, so PT can be the key to improvement.
    Symptoms began: January 2010
    Diagnosed with IC: May 2010

    Began with burning during/after urination, frequency, urgency, urethral spasms. Recurrent UTIs since 2002. Pelvic pain.

    Current Rx:
    Glucosamine/MSM tablets daily (1/2 a 1500 mg tablet Kirkland brand)
    IC diet
    stretches/relaxation/sitzbaths/heating pad

    Used in the Past:
    Gepan Instills (Chondroitin sulfate) 1x/mo until Sept 2010
    Loratidine (Antihistamine)
    Tilidin (opiate analgetic not commonly prescribed in U.S.) as needed
    Cystoscopy w/Hydrodistention: May 2010 (found this temporarily relieved my spasms and urgency)
    Reside in Germany

    Comment


    • #3
      biofeedback / PT

      That's helpful to me - thanks, I think I will now ask if a pelvic floor PT uses biofeedback, as one of the questions in determining if / who to try.
      Thanks
      Lisa
      ______
      Severe IC developed fairly quickly, autumn 2010.
      So severe that I was bed-bound & on 160mg/day morphine to cope with torturous pain levels, and unable to function other than hospital/medical appointments, for seven months. Then, miracle of miracles, something started working. I am steadily lowering the methadone dose level. I have been far out of that desperate nightmare hell zone for several months now and continue to improve.

      - Ranitidine (anti-histamine, H2-inhibitor) 300mg/day
      - Methadone 9 ml/day
      - Instillations:
      - 40ml Kenalog (steroid for inflammation) 2 x per
      week, along with rescue cocktail of heparin,
      lidocaine, sodium bicarbonate
      - 20ml Uracyst, monthly @ $100/per
      - Depo lupron injections for endometriosis, monthly @ $88/per

      Comment


      • #4
        I emailed my pelvic PT a question, and she responded with some info about specific techniques/visualizations to practice. I thought this might be useful for others.

        'You are correct -in that Kegels are generally not advised since this increases the tension in the pelvic floor muscles (pain). But for IC what you practice is like a 'reverse Kegel' in that rather than practising the contraction phase of the muscle action you are working on the relaxation phase. The aim is to learn how to 'let go' of the muscle tension. Some people find it easiest to perform a gentle kegel contraction before they focus on 'letting go' so that they can feel the muscle action. An analogy is to think that your pelvic floor is like an elevator and presently resting on the 3rd floor. When you contract the muscle (Kegel) the elevator moves up to the 4th floor. However, youir goal is to work on the 'letting go' of the muscle with the aim of the elevator (pelvic floor) resting at the lobby.
        This can be quite difficult to achieve at first since your body needs to learn how to perform the movement. For this reason I recommend practise this 'letting go' action 3-4 times a session but frequently (at least 5 times) during the day. The muscle 'let go' phase should take at least 10 seconds. To help you 'let go' of the pelvic floor muscles imagine that the tail bone is moving away from the pubic bone and the 2 sitz bones are moving away from each other to create more space in the perineum. Initially this is easiest to practise either sitting or lying down.'
        ______
        Severe IC developed fairly quickly, autumn 2010.
        So severe that I was bed-bound & on 160mg/day morphine to cope with torturous pain levels, and unable to function other than hospital/medical appointments, for seven months. Then, miracle of miracles, something started working. I am steadily lowering the methadone dose level. I have been far out of that desperate nightmare hell zone for several months now and continue to improve.

        - Ranitidine (anti-histamine, H2-inhibitor) 300mg/day
        - Methadone 9 ml/day
        - Instillations:
        - 40ml Kenalog (steroid for inflammation) 2 x per
        week, along with rescue cocktail of heparin,
        lidocaine, sodium bicarbonate
        - 20ml Uracyst, monthly @ $100/per
        - Depo lupron injections for endometriosis, monthly @ $88/per

        Comment


        • #5
          Thanks so much for posting that visualization from your pt for the 'pelvic drop'. My pt didn't explain it nearly that well.

          Comment


          • #6
            My PT (who trained under Dr. Weiss) specifically does NOT do kegels nor biofeedback for me. Just one kegel and that triggers severe issues for days. My muscles are so tight that biofeedback would do absolutely nothing for me. What I get done is myofascial release - my PT spends the entire hour massaging externally on my belly, thighs, and butt and internally by pressing on trigger points inside the vagina and rectum. It definitely hurts and I flare very badly afterwards. Each patient is different and the PT needs to understand that the best treatment plan is different for everyone.

            In terms of doing the "reverse Kegels" or "pelvic drops", my PT helps me practice them when she presses on trigger points internally. Without myosfacial release, I am too tight to perform a reverse Kegel on my own through visualization.

            If you find a PT that believes Kegels, stretching, and biofeedback are helpful in every single case, then this PT probably doesn't know his/her stuff. These modalities are for more "mild" cases and would do nothing or even worsen more moderate to severe cases.
            Current treatment:
            Elmiron 100mg 3x a day
            Hydroxyzine 75mg
            Lyrica 100mg 3x a day
            Pelvic Floor Physical Therapy started 12/10
            Ativan 1-2mg as needed


            Bloging my thoughts at www.thispatientperspective.blogspot.com

            Comment


            • #7
              Re: Pelvic floor physiotherapy vs. thiele massage vs. myofasial massage

              Hi guys... I hope u are all doing well!!! Did physical therapy help u guys.... Please help

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