Male Pelvic Pain(pelvic floor disorder)

95% of chronic prostatitis is non bacterial and very likely a result of pelvic floor dysfunction. Non bacterial means the pain is not a result of an infection and can "NOT" be treated by antibiotics. But has more to do with a musculoskeletal issues, your body being out of alignment. Alignment is how all the parts of the body are positioned relative to each other for optimal health.

I battled with what started out as chronic prostatitis, which turned into pelvic pain due to my body being out alignment for almost three years. I suffered with urinary  frequency, urgency and pain in the urethra, rectum and genital region, which affected me walking, sitting, sleeping and engaging in sex. I was taking a number of medications- antibiotics, pain killers, muscle relaxants, and meds for my bladder. I took a number of tests- urine, blood, STD, ultrasound, testosterone, and more prostate exams than a room full of 65 year old men. I went to numerous doctors- Urologists(4), proctologist, dermatologists, neurologists, etc...and numerous physical therapists(two which specialized in pelvic pain). I also saw a  massage therapists, rolfer, visceral manipulator, and carnio sacral therapist. And to add insult to injury, I started having foot pain(plantar fasciitis) and stomach/abdomen pain. I took a gastroscopy exam, which they put a scope down my throat and it came up negative, but  they found in my throat candidiasis from an excessive use of antibiotics.

My insurance company was writing me letters-"What is going on?...all these doctors..all these test...?" Like most chronic pain, pelvic pain is more than physical. Rarely talked about is the time and effort you put into trying to get out of pain...the money you spend, my bank account was disappearing...and your relationships- as years pass, family can get tired of hearing about your pain and your partner can tolerate so much. But, it wasn't until I found Restorative ExerciseTM, I was able to put the pieces together and live pain-free again!

Prostatitis isn't prostatitis, most of the time. When the pelvic floor is too tight, it can pull the sacrum out of alignment, bringing it forward into the bowl of the pelvis. When the pelvic floor doesn't function correctly, your organs start migrating downward, which creates a whole host of problems. When the organs rest on the prostate, it can cause inflammation and reduce blood circulation, waste removal and the flow of electricity to the area, which  can lead to decrease sexual function, prostate issues, bowel and  urinating problems. As you will see, the position of the pelvis, tight hips and weak glutes play a major role, all do to your Alignment!

 Men have a pelvis and a pelvic floor too, it's not  just a woman's issue.

ANATOMY OF THE PELVIC FLOOR(PF)

The PF is formed by a bowl shaped pelvic diaphragm.
Muscles-
PF= levator ani + coccygeus(this muscle wagged our tail when we had one)
levator ani= pubococcygeus + iliococcygeus
pubococcygeus= puborectalis + puboprostaticus
the Obturator Internus(attaches to iliococcygeus) and Piriformis make up the walls.
The PF muscles run from the pubic bone to the sacrum/coccyx.
The PF hold up your organs. If these muscles are tight and restricted, they pull all these muscles,  anus and prostate forward toward the pubic bone with the sacrum, pulling it out of alignment.

 The pudendal nerve can play a major role in pelvic pain. The pudendal nerve starts at S2, S3, and S4 and branches out to the rectum, scrotum, penis and bladder. Along the nerves path, it can get entrapped and cause irritation/pain that worsens with sitting. This is where lengthening and strengthening(generating force) your muscles can make a difference. Lets begin.

RELAX
First off, you have to learn how to relax and let go of your pelvic floor. You are probably  not aware that you are holding your pelvic floor tight all day long. And by tensing a muscle, you are shortening it and therefore making them weak. Muscles need to be at the correct length. Muscles need to be able to release and contract. Being mindful, first  you have to let the pelvic floor go and relax. Now, again relax the pelvic floor  because I'm sure when you let go the first time, you didn't fully let go. Throughout the day, be mindful of letting go of the pelvic floor. Your body doesn't let go, if its not safe.

FOOT
I  recommend Every Woman's Guide to Foot Pain Relief. I know you  might be saying, a woman's foot book, What? Don't let the title fool you guys, this book is for you also.

On the left is the cover of the book, but you might want to envision the book cover on the right.  Katy Bowman, Biomechanist, "walks" you through the anatomy of the foot, foot dysfunctions and what to do about it. She makes it simple and easy to do, as she explains how most foot dysfunctions are not in your DNA but has more to do with your alignment, movement and poor habits. When you mobilize and restore the function of the foot and the lower leg, it helps align the hips and positions the pelvic floor to function optimally. Lack of mobility in the foot, drags the entire leg and hip down.

FOAM ROLLER
Foam rolling is like having a deep tissue massage. Using a firm foam roller over tight tissues, will help loosen them up. This increases your flexibility and mobility. Foam rolling can be painful at first, especially in the adductor region. Where ever it is difficult to roll, that area needs more rolling. For each area, you want to roll from 1 to 3 minutes. If you feel a tender spot,  hold for 10 seconds and move on. I think the grid makes the best foam roller that doesn't fall apart, but you can buy less expensive ones. Black foam rollers are firm and inexpensive.

SHOES

You want to get out of positive heel shoes. A positive heel shoe instantly impacts the mechanics of all of your joints. Shoes with a heel, yes dress shoes and running shoes can have a one inch heel, preventing vertical alignment because of the angular changes created at the ankle.
Here are some websites for barefoot/minimalist type shoes-

birthdayshoes

Road Runners Sport

 One of my favorite barefoot type shoe recently is the Skechers GO bionic.

 It has zero heel to toe drop, it has a wide toe box for toes to move freely and the sole is thin & flexible. I even take the insole out to get a closer feel of  the ground. Less shoe, more you!

OPEN UP THE HIPS AND STRENGTHEN(generate force) YOUR GLUTES...and CORE
Sitting too much and not moving enough is a big part of the problem. And when we don't move our joints in a full range of motion, it can impact on our health. Some of the movements  help target lengthening tissues like the hamstrings, adductors, etc... and relaxing the quads or releasing the psoas. Tension in the tissue doesn't allow the pelvis to sit neutral, which you wind up with a weak core.
Tone glute muscles keep the PF muscles at the correct length and the sacrum in alignment.

The latissimus dorsi is a core muscle. The lats cover a large chunk of the back and attaches to the sacrum and coccyx via the lumbodorsal and sacral fascia into the glute max, which makes the lats the largest muscle applying force on the sacrum. Movements like pull ups, climbing, and swinging(like going across monkey bars) innervate these muscles. The lats help in stabilizing the spine and pelvis.

 WALKING

You can't have optimal PF health, if you don't have an optimal gait pattern. When ever I speak about *how to walk*, most people say "Walking? I've been walking since the age of two". Yes of course you've been walking for sometime, but years of shoe wearing, sitting and not using your body optimally could have made you use the inappropriate muscles while walking and made you more of a falling forward walker  instead of a hip extension walker(glute/hamstring muscles). Well here is a two year to show us how to walk. This is Amari's first day of school.

Look at his straight feet, heel strike, straight legs, and left leg is in hip extension. I won't talk about the Head, Arms or Torso(HAT), but you can see how the upper body stacks aligned.  Hip extension comes from your GLUTES and hamstrings.  You going forward is by pushing back(hip extension) with your GLUTES which  lengthens & strengthens  your pelvic floor. This action happens optimally when there is length in your hip flexor like your psoas. Also, if your hamstrings and calves  are tight, it prevents the psoas and the pelvic floor to function optimally.

 

The psoas and your  breathing mechanics can  affect the PF.

The psoas and breathing need their own blogs, which I'll write soon. With breathing, I'll discuss how a tight  PF affect  breathing and having a weak core. With the psoas, how the psoas plays a role in PF dysfunction and how I ended up in an ER with doctors thinking I had appendicitis and how my psoas rotated my pelvis and took my ribs with it.

SITTING
Sitting too much has compromised walking, running and standing in ALIGNMENT, but how to sit right can make a difference. This may seem silly to bring this up, more and more people do not sit correctly. On any given day, I can get on a NYC subway and the majority of people sit on their sacrum, sitting on a tucked pelvis. You can't make improvements if you are put unnecessary pressure to an area that isn't built to sit on! You want to sit on your ischial tuberosity(sitz bones, which is from the German word "sitzbeine"=bones to sit on). When you sit on your sitz bones, you balance your pelvis with you pubic bone and ASIS in alignment.

SQUAT
The Squat is one of the best all around exercise you can do, which opens up joints and target GLUTES, hamstrings, calves and quadriceps(depending on the position of your lower leg). Also, squats work your core and improve your balance, but most of all opens up your pelvic floor(the pelvic outlet). Many people complain of knee problems, which has more to do with the position of the lower leg. When your knees move forward, over your feet, which puts unnecessary strain on the knee joint and over use your quadriceps. But the success and power behind the squat comes from the GLUTES and hamstrings. The squat addresses full range of motion of all your joints and the correct strength to weight ratio of your lower body. One of the key elements while doing a squat is untucking your pelvis, the more tucked your are, the more pressure on the knee and the glutes don't fire. How to squat- feet straight, heels on the ground, shins vertical, legs shoulder width apart, pelvis neutral and untucked, lumbar curve...now, lift with your GLUTES, to build posterior strength. Most people, bring their knees forward and lift with their quads, which puts pressure on their knees. Before squatting, you may have to spend time opening up your hips. You may want to hold on to door handles, so you can get the movement down with correct form. The squat is a very complex movement, that also deserve its own blog.

As you can see, your daily habits- footwear choice, the way you sit, sitting too much, your gait pattern, etc... all play a role in pelvic floor dysfunction. Also, I failed to mention internal work that some PTs do. The internal work is done with putting a gloved finger in the rectum and  can be helpful palpating the pudendal nerve, releasing trigger points that can refer pain and sensation, etc. But that is only one part of the picture, we're not about spot treating, you have to fix the whole thing! For example, what's happening above the PF like in the shoulder girdle is just as much a problem to PFD, as what's happening below the PF like in the feet. You don't want to feel alittle better and still have flare ups for years to come. It can affect your quality of life- morning, noon, and night. You have to fix the whole thing! And get Aligned!

References
A Headache in the Pelvis by David Wise, Ph.D Rodney Anderson, MD
Chronic Pelvic Pain and Dysfunction by Leon Chaitow, Ruth Lovegrove Jones