How to understand + Fix your CPPS / Hard Flaccid | Post 1

[btcalvit Junior Member Find all posts View Profile Close btcalvit]

Hello guys, I normally post on the r/Hard_Flaccid message board but a few people over there told me I should put some of my posts here. I will just be compiling 2 of my posts from there over here.

I have cured my Hard Flaccid, and helped many people on the road to recovery.

Your hard flaccid / cpps is almost certainly not nerve damage/entrapment/ or physical injury.I am separating this post in 3 parts: The Muscular System, The Fascial System, and Building your own routine. The muscular and fascial system are heavily intertwined and work together in accomplishing the same roles, however, they are fixed differently and cause different problems which is why I am separating them into parts.
The Muscular System - The problems here are what allow your fascial system to changed in the first place, and are the physical cause for your HF/CPPS. Therefore, I will be covering this first in the top half of the post. This part will contain: How to correct your muscle imbalances, fix posture, pelvic tilt, and strengthen + stretch the muscles that need it. (It will also come with attached links and examples for you to create your own routine!)
The Fascial System - The problems here are what allow your symptoms to be chronic, and be painful. As I explained in my other post, a very low amount of people with these conditions actually have nerve damage, it is pain travelling through the fascial system. Your fascia literally encapsulates the nerves, pain from irritated and tense fascia is normal. Though the medical world is far behind and is bad at treating fascial pain, since it is the main way people experience chronic pain, I will be covering the way to fix it for good.
Building your own routine - I've seen a very common problem, people don't know where to start and what to do. I am making a small section for people who cant figure out what they want to do or make for their own exercise routine.
Part one - The muscular system:


https://preview.redd.it/jxx5p7uh7kt5...=webp&989361dc

All the bodies muscles are connected. When thinking about how a muscle could effect others, simply look at its placement on the body.

As most sufferers know, almost all Hard Flaccid symptoms are due to a chronically tight pelvic floor, this applies to CPPS on a lesser extent. To figure out how to fix this tight pelvic floor, we have to asses not just the pelvic floor, but the entire body.
Many treatment methods of Hard Flaccid focus on direct relaxation of the pelvic floor. Things like dry needling, massage, reverse Kegels, and de-stressing. None of these work permanently because they do not target the body, only aiming for temporary relaxation of the muscles in question. This is often the problem with physical therapy, most physical therapist don't look at your body as a whole, and just try to treat the pelvic floor. This is why most HF/CPPS patients don't receive much help from physical therapy.
So, we need to target the body, not the pelvic floor. Where do we start? A better question is: What are we looking for? We are looking for anything that can compromise your movement patters in any way. Anything that shifts the load off of where its supposed to be will cause a gradual buildup of muscle imbalances and fascial buildup problems. Posture is a big example, as it compromises the spines ability to keep things stable, and shifts the job of keeping stability over to the deep abs, or pelvic floor. Lets look through some things that can cause problems like this before we go any further. Make a mental note of any of these problems you have, and their muscular causes.
We can check for some of the most common and self diagnosable muscle problems first. You will need a person to look at you, or a mirror / camera. Check the image captions for the muscles that cause these issues.
If an issue has a **, then it is extremely common and you probably already have it.
Pelvic Tilt - By far the most common issue in CPPS and HF cases. Causes very bad load distribution for the body, and generally sets you body up for failure. Normally gained from excessive sitting. Anterior, posterior, and lateral tilt all possible.**


https://preview.redd.it/o1k49ouv7kt5...=webp&14552cc9

Anterior pelvic tilt is caused by: Weak abs, Weak glutes, tight hip flexors, tight lower back. Posterior pelvic tilt is caused by Tight abs, Tight glutes, Weak hip flexors, weak lower back.

https://preview.redd.it/z9t6r9n48kt5...=webp&1f978f73

Lateral pelvic tilt is caused by tight low back, tight psoas (hips), weak glutes, and tight adductors on the raised side.

Pronated / Supinated feet - As unbelievable as it sounds, your feet can have an impact on HF/CPPS. They are what set up your walking mechanics for failure first if you have foot problems. Flat (supinated) or high arched (pronated) feet can affect how loads are placed on your whole body and walking mechanics.


https://preview.redd.it/gmmsrqn99kt5...=webp&1fd7d2d1

Supinated feet are caused by weak foot arch muscles. Fix pronated feet by wearing looser, more comfortable footwear.

Inactive and possibly weak Transverse abs (Deep abs) - Most HF/CPPS sufferers have this. It sets your body up for failure as it cannot stabilize or breath properly. **


https://preview.redd.it/fpdl22vh9kt5...=webp&2be4ce30

Inactive or weak transverse abs usually connect to inactive glutes

Inactive and possibly weak Glutes - Almost all HF/CPPS sufferers have inactive glutes. The glutes and the transverse abs are one in the same. When there is dysfunction in one, dysfunction in the other is almost guaranteed. When your glutes are inactive, your hip flexors are used to make the legs move forward (flexion) when normal walking patterns should be pushing off the glutes or optimal leg movement. **


https://preview.redd.it/9k3lfk4m9kt5...=webp&44b3780f

Weak / inactive glutes usually caused by weak / inactive transverse abs

SIJ (Sacro-iliac join) dysfunction - Directly related to the glutes and deep abs, without proper SI join function, your pelvis cannot work correctly during movements, and thus it creates muscle imbalances and lower range of motion because of the lack of movement possible. *** nearly all cases of HF and CPPS have this


https://preview.redd.it/j0zqzjbs9kt5...=webp&3f8ab3ae

You could feel pain or no pain. All that matters is that your bio mechanics are not working properly, therefore your SI joint cannot rotate your pelvis properly and causes more problems down the line. Connected deeply to glutes and deep abs, usually caused by both being weak / inactive.

Valgus and Varus Knees - Directly affects walking mechanics and causes hip rotation. A no brainer.


https://preview.redd.it/h9qar2pi8kt5...=webp&285b2173

Valgus knees are caused by strong adductors overpowering weak abductors. It is the other way around for Varus knees

There are more of these problems, but these are some of the more common ones.
Weak muscles need strengthening, tight muscles need stretching, weak and tight muscles need resistance stretching. Those are the basics for what you need. There are a few types of muscle contractions, eccentric being the most important for this condition. Eccentric contractions are when your muscle lengthens with a load on it, strengthening and relaxing it. This is more commonly referred to as a resistance stretch. Do them for your tight muscles as well, just in case they may be weak.


https://preview.redd.it/t7uaffgp8kt5...=webp&0b107796

Types of muscle contraction, focus on the eccentric contraction.

Basic starting exercises for whatever muscles you need to work, or do them all, no harm in it:
Anterior Pelvic Tilt routine (Contains glutes, abs, hip flexors, and lower back): Scott Herman Fitness - Anterior Pelvic Tilt routine
Glutes: Glute bridge | One leg glute bridge | Resistance band glute stretch
Abs: Plank | 8 point plank | At home eccentric ab exercises
Deep abs: Deep Abs exercise compilation | 3 Deep ab exercises | 5 Pilates exercises to strengthen and active the Deep abs
Hip Flexors: Eccentric hip flexor stretches *Do not do non-resistance stretches for hip flexors
Quads & Hamstrings: Lunge and twist (Works many muscles, not just quads & hamstrings) | Deep Squat
Adductors: Copenhagen adductor exercise | Slider adductor exercises | Eccentric adductor groin strengthening
Abductors: Hip Abductions | Eccentric hip abductions (Hip drops)
Foot arches (For supinated feet): 3 Foot arch exercises | Flat feet exercise compilation
Lower back: 8 Regular lower back stretches | Eccentric back exercises
Psoas (Hip muscle): 3 Psoas exercises | Psoas stretches
All around eccentric exercise compilation: Eccentric exercises full body
Free compilation of resistance stretches specifically for CPPS/HF (PDF): Resistance stretches for CPPS/HF
*Notice there are no stretches or exercises for the pelvic floor, since it isn't actually the pelvic floors fault for the problems, there is no need for stuff like Kegels, and they can make your problem worse.
Exercises to avoid: Sprinting, Biking, Heavy weightlifting
Those are some exercises to get started, but you can also google more and use them, when fixing the muscular imbalances, expect the progress to be slow. You are changing body tissue. Do the exercises consistently to really feel change. All changes will be over time and gradual. For HF Cases, you will see your symptoms disappear 1 by one, for CPPS cases, if you have symptoms they will disappear over time. If you only have pain this will not treat it but you still need to do these exercises to correct the pain. Which brings me into the next topic:


Part two - The Fascial System


https://preview.redd.it/nhy5byq0akt5...=webp&0fa63ae4

The clear casing over the muscle is fascia, that is how closely related to the muscles it is.

The fascial system plays a huge role in many HF/CPPS cases. There are many fascial lines throughout the body that will carry tension and pain, went over in my post about "Why hard flaccid isn't nerve damage", refer to that post for the images. I covered most of the fascial topics in that post but I will go over them shortly again. When your muscular imbalances cause the issues gone over above, it decreases their ROM (Range of motion), which slowly but surely causes your fascia to adapt and compensate for this. It condenses and forms knots and tight cords that reduce range of motion further. In addition, excess fascia builds up to compensate for body orientation issues and around muscles and joints.
The fascial system needs hydration, normally, the hydration would be transferred all the time. When the range of motion is reduced, the hydration does not transfer. Causing some fascia to become tight, hard, and dehydrated. This creates "tight" fascia, it binds up in a double helix like DNA. Tight, dehydrated fascia which encases all nerves, muscles, and organs. You do the math one what happens next. Symptoms can be digestive dysfunction, pain, and lost range of motion. This tight fascia causes frictions and irritates the nerves and creates more tightness in the muscles. This is how most cases of HF/CPPS become chronic, by the time you develop CPPS, your fascial issues have probably already started.
So how do you get rid of this buildup of fascia? Well, you don’t get rid of your fascia, you’re just unwinding it and untightening it. Here is an analogy: A muscle knot / tightness / trigger point / etc. forms like a screw being driven into a piece of wood. The twisting motion drives the screw down, twisting all the wood (tissue) around and locking it in tight and compacting it, twisting your tissue and muscles and changing your posture and body.
So how would you get this screw out? You wouldn't press on it (like a massage). You wouldn't strengthen the wood. You would use force and pressure to to slowly remove the screw which would unlock the area that was screwed tight. But you still need to keep the wood (surrounding muscles) strong so you have the strength to pull out this screw.
Analogies aside, the only way to unwind fascia is with gradual, repeated force. Contracting the muscles and bringing back the range of motion, as well as lengthening and slowly unwinding the fascia. The best way to do this is with Eccentric muscle contraction, as was gone over earlier in the post. You need to target your problem areas (where you feel pain, tightness, or symptoms) and find resistance stretches or eccentric contractions to hold to release the fascia over time.
Fascia requires approx. 1,800 lbs. of force to change instantly, the only way to make fascial change is through repeated light force over time. This is the reason myofascial release therapy does not work.
I cant really list common fascial problems as they are extremely case by case. All I can recommend in this section is googling your problem areas and then searching YouTube for eccentric contractions or resistance stretches to do for your problem areas.
While controversial, the program known as DCT (Dynamic Contraction Technique) is very good for releasing fascia and treating CPPS. I will not endorse them, I am just simply letting you know of their existence in case you would like to research them more. A lot of their stuff is available for free on YouTube.


Part Three - Building your own routine


Your routine shouldn't be too hard to make. First set a schedule. Like this:
Mondays, Tuesdays, Fridays - [Some exercises]
Wednesdays, Thursdays - [Some other exercises]
Sunday - [Day off]
Feel free to change up the days however you want, but try to get at least 30 minutes of these types exercise into all days except your rest day. Normally you would fill those slots with strengthening, stretching, and resistance stretching. Maybe Monday Tuesday and Friday will be for strength while the other days are for stretching and breaking down fascia. Feel free to throw together the exercises included in the post + some more you find on google and use them in your routine!
Its also very important to add a functional, low impact exercise. Swimming is great for passively breaking down some fascia and building strength, and walking is great for re-learning and using our walking mechanics more often. Try to get at least 30 minutes of this type exercises 5 days a weak.
Here was my routine while I was fighting HF, I'll use it as an example. You don't need to total as much time as me, but the more time you put in, the quicker results you will get:


Monday, Wednesday, Friday - 30 extra min glute activated walking and 1hr swimming, pull-ups, pushups, normal plank, Leg strengthening hold
Tuesday, Thursday - 1 hour boxing, glute bridges and 8 point plank, hip adductions and leg lifts weighted) some hamstring resistance stretches and exercises, ab roller, single leg glute bridge, some arch exercises deep squats, lunges, 1 hour glute activated walking, and APT Routine (Core activation exercises, hip flexor resistance stretch, quad stretches and wide squat + deep lunge hold and rotation)
Saturday, Sunday - Glute activated walking


When I refer to glute activated walking, I refer to the correct type of walking that uses the glutes to push off instead of lifting the leg with the hip flexors. Video tutorial: https://www.youtube.com/watch?v=-fD2...RehabandRevive


I hope this was able to give you guys a good grip of your condition, and where to start. Thanks for reading, and good luck with your recovery!


- Benjamin Calvit

[incogneeetoe Moderator Member of the Month Sept 2017*Special Appreciated Moderator Nov. 2021* PEGym Hero Find all posts View Profile Close incogneeetoe]

There is a lot of information to unpack here.

I am not a hard flaccid expert, perhaps HansTwilight can offer some input?

(I will note that the links are all errors for me)