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Physiotherapy and Chronic Pelvic Pain Syndrome (CPPS)

posted on 15th March 2012 by Maria Elliott

Increasingly, sufferers of Chronic Pelvic Pain Syndrome (CPPS) are turning to physiotherapy to help relieve their pain symptoms and are finding real benefit. A significant proportion of the urinary, bowel and sexual symptoms CPPS patients experience are signs of Pelvic Floor Dysfunction – a problem that responds very well to physiotherapy.

Pain referred from the internal organs, such as the bladder, can result in tight short muscles with “trigger points”. Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibres. These points may refer pain to the skin and muscles in the lower abdomen, low back, inner thighs and perineal area.

Irrespective of whether this musculo-skeletal dysfunction is a primary cause of symptoms or a consequence of pathology it is crucial to address this dysfunction to achieve a positive outcome for the patient.
Pelvic floor dysfunction is rarely the result of a single event but often results from an accumulation of injury, trauma, poor health and response to stress. Significant pre-disposing factors include childbirth, chronic straining, recurrent UTIs, hyper-mobility, chronic anxiety, habitual postural loading and central nervous system sensitisation.

When pain is present, the pelvic floor muscles become short and tight, and need to be relaxed. Patients may have been recommended to use strengthening exercises, unfortunately these can exacerbate symptoms. Experienced specialist pelvic pain physiotherapists recommend the use of Manual Therapy to relax (rather than strengthen) the pelvic floor. Most pelvic-pain patients have connective-tissue restrictions and myofascial pain in specific areas. Manual therapy is used to release “tight” areas, to improve blood flow and reduce pain. Excellent results can be obtained when these physiotherapy techniques are combined with Breath Release work.

At the New Medicine Group, we now have specialised pelvic floor physiotherapists who assess, treat and restore normal pelvic floor function. The results can often be astonishing, patients who have spent years seeking help may finally find relief and release from pain.

Book now, for an Initial Assessment and Treatment with Pelvic People.

 Physiotherapy and Chronic Pelvic Pain Syndrome (CPPS)

About Maria Elliott

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Dr Kaplan: Provocative Therapy

In December 2012, as result of a stress at work, I suffered from severe anxiety, fear, panic attacks, tachycardia and insomnia.These symptoms became increasingly severe and were associated with low self-esteem and loss of self-confidence. I consulted my GP who prescribed Citalopram and beta blockers for the tachycardia. The antidepressant did not suit me and I felt worse. I was then referred to Dr Brian Kaplan, to be treated with the ‘Provocative Therapy’. This treatment adapted by Dr Kaplan, is based on the principle that the therapist ask questions covering all aspects of the patient’s life, by exaggerating the meanings of it. During the 1 hour session, the patient experiences a strong reaction, triggered by the ‘Provocative’ input of the therapist. Initially, there is an increased fear with regression to the childhood, associated to strong emotions and sorrow, which may precipitate sobbing. Subsequently, this state is followed by a phase of self-analysis which is more constructive. The ‘provocation’ breaks the pattern of the patient’s own feelings of hopelessness and discomfort. In fact, there is an opening of the self-image and a critical strong desire for change, in response to the provocation, which can be at times, outrageous. I underwent 9 weekly sessions during which I progressively became free from fear. The anxiety and panic attacks reduced significantly and I started to know what I want from my life and became more positive and optimistic. At the end of the 9 weeks, I acquired my self-confidence and self – esteem together with a new approach in my life which initially appeared to me broken and rather useless. The 9 sessions – in my opinion – were sufficient to resolve the initial acute state with anxiety and I felt a person full of interest and happier.  It is more than one year since I started the ‘provocative therapy’ with Dr Kaplan and I have not had any relapse to the original symptoms and discomfort. I strongly recommend this this therapy as a novelty; this is medication- free and can produce resolution of the acute psychological/mental conditions, quicker than the conventional therapies. In order to be successful, it is crucial that the patient collaborates and has complete trust in the therapist. The scientific process of such a treatment is not yet known and /or clarified. However, a number of recent studies in Neurophysiology and Psychiatry have shown the importance of hexogen and endogen stimuli, which can triggers and induce changes in the brain in response to the external inputs, acting via the hypothalamic/endocrine axes. It can be suggested that some of these mechanisms may be involved in the therapeutic process of the Provocative Therapy, but a lot of work needs to be in hand.