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Very interesting new scientific study abut chronic pelvic pain (any thoughts?)

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  • Very interesting new scientific study abut chronic pelvic pain (any thoughts?)

    I have been searching for different kind of approaches of how to tackle CPPS and HF issues before I finally take action. I have been googling a lot for last 10 days and I stumbled upon an interesting scientific study from november 2018 about Lumbosacral entrapment syndrome. The titel of the study:
    "Lumbosacral entrapment syndrome, a little-known but common cause of chronic pelvic and lower extremity pain"

    Abstract


    Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The lumbar plexus emerges through the fibers of the psoas major, and proximal sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may lead to entrapment neuropathy, resulting in diffuse and non-specific pain patterns throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking other diagnoses and is therefore likely to mislead the clinician. It is a pathology similar to that of thoracic outlet syndrome, but for the lower body. This manuscript was written in an attempt to demonstrate the existence, pathophysiology, diagnostic protocol as well as interventional strategy for LPES. The author documents the clinical course of 61 patients who were diagnosed and treated for LPES between May 2016 and October 2018. The main diagnostic criteria were compatible symptoms, 5 or more provocative Tinel’s tests yielding > 7 NRS, and weakness of one or more myotomes of the lower body. The most common complaints amongst the group were low back, groin, pelvic, posterior/lateral calf pain. Additionally, 17 patients (28%) stated that everything in the LPLE hurts, consistent with plexalgia. The group in its entirety were all treated with gentle strengthening of the psoas major and piriformis muscles. 13 patients were lost to follow-up as they did not reschedule treatment, for unknown reasons. Amongst the remaining 48 patients, 25 recovered fully (52%), 12 significantly (25%), and five moderately (10,4%). Five patients had a slight improvement (10,4%), and two no improvement whatsoever (4%). The average recovery times were mostly consistent with the time of affliction. Patients with a symptom duration of less than one year, generally recovered within 4 months. One to four years, within 10,5 months. Five to nine years, 7,5 months. And, finally, more than 10 years, within 18 months. A high correlation between the diagnostic & interventional protocols, and beneficial patient outcomes were demonstrated. However, more statistical and long-term research is needed.






    So basically they say that some symptoms caused by CPPS are related to weak Psoas Major and Piriformis muscles and that strengthening these muscles slowly over a period of couple of months can in many cases cure the symptoms. But this has to be done really, really carefully.

    Could this be eventually an additional approach for some of us to cure HF? Is there anybody here who is familiar with this study?Has anyone tried strenghtening these muscles and due to it experienced any success?

    Thanks


  • #2
    2 days and no feedback yet.
    This could be a potential game changer for many of us with hard flaccid, and nobody has an opinion about it?

    Comment


    • #3
      In the DCT course, there’s work on the psoas, have you considered giving it a chance?

      Comment


      • #4
        Originally posted by CelDub View Post
        In the DCT course, there’s work on the psoas, have you considered giving it a chance?
        That's interesting. Thanks for the information.
        First I am going to try to fix this with HANS-protocol+excercises for Psoas Major and Piriformis. If this doesn't work out maybe I can try DCT next year.

        Comment


        • #5
          Being under stength in these muscles is common in the western world . You could try Pilates to strengthen them. Caution though as P also does a lot of kegel /pf work.

          Comment


          • #6
            @swirly why not try both the DCT/hansprotocol? I’ve only started it a couple of months back but seeing/feeling a difference, it also makes a lot of sense. It’s based on strengthening/resistance stretching to all the muscles connected into the pelvis. Now I haven’t fully recovered yet, but it all makes sense to me now and gaining a much better understanding of my body and pelvic function. Also when you join the DCT programme you have an option of joining the Facebook group with many others suffering from CPPS/PFD/HF and everyone there is very helpful/supportive.

            Comment


            • #7
              CelDub how much is the DCT? That is David Mccoid program correct?

              Comment


              • #8
                Originally posted by Swirly View Post
                I have been searching for different kind of approaches of how to tackle CPPS and HF issues before I finally take action. I have been googling a lot for last 10 days and I stumbled upon an interesting scientific study from november 2018 about Lumbosacral entrapment syndrome. The titel of the study:
                "Lumbosacral entrapment syndrome, a little-known but common cause of chronic pelvic and lower extremity pain"

                Abstract


                Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The lumbar plexus emerges through the fibers of the psoas major, and proximal sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may lead to entrapment neuropathy, resulting in diffuse and non-specific pain patterns throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking other diagnoses and is therefore likely to mislead the clinician. It is a pathology similar to that of thoracic outlet syndrome, but for the lower body. This manuscript was written in an attempt to demonstrate the existence, pathophysiology, diagnostic protocol as well as interventional strategy for LPES. The author documents the clinical course of 61 patients who were diagnosed and treated for LPES between May 2016 and October 2018. The main diagnostic criteria were compatible symptoms, 5 or more provocative Tinel’s tests yielding > 7 NRS, and weakness of one or more myotomes of the lower body. The most common complaints amongst the group were low back, groin, pelvic, posterior/lateral calf pain. Additionally, 17 patients (28%) stated that everything in the LPLE hurts, consistent with plexalgia. The group in its entirety were all treated with gentle strengthening of the psoas major and piriformis muscles. 13 patients were lost to follow-up as they did not reschedule treatment, for unknown reasons. Amongst the remaining 48 patients, 25 recovered fully (52%), 12 significantly (25%), and five moderately (10,4%). Five patients had a slight improvement (10,4%), and two no improvement whatsoever (4%). The average recovery times were mostly consistent with the time of affliction. Patients with a symptom duration of less than one year, generally recovered within 4 months. One to four years, within 10,5 months. Five to nine years, 7,5 months. And, finally, more than 10 years, within 18 months. A high correlation between the diagnostic & interventional protocols, and beneficial patient outcomes were demonstrated. However, more statistical and long-term research is needed.






                So basically they say that some symptoms caused by CPPS are related to weak Psoas Major and Piriformis muscles and that strengthening these muscles slowly over a period of couple of months can in many cases cure the symptoms. But this has to be done really, really carefully.

                Could this be eventually an additional approach for some of us to cure HF? Is there anybody here who is familiar with this study?Has anyone tried strenghtening these muscles and due to it experienced any success?

                Thanks

                This is interesting. I wonder what type of exercises they used to strengthen these muscles, do you have any idea? I know that David Berceli TRE (Trauma Releasing Exercises) specifically releases tension in the Psoas muscle.

                Comment


                • #9
                  @jamoke125 It’s about $250 American.

                  Comment


                  • #10
                    Whilst we’re here can anyone tell me how to reply like the rest of you are doing it? And do you get notified when I somebody does reply in that manner?

                    Comment


                    • #11
                      Originally posted by jamoke125 View Post
                      This is interesting. I wonder what type of exercises they used to strengthen these muscles, do you have any idea? I know that David Berceli TRE (Trauma Releasing Exercises) specifically releases tension in the Psoas muscle.

                      The study is free to dowload in PDF. Before you start with excercises, read it.
                      The author of the study Kjetil Larsen has also a youtube channel called TrainingandRehabilitation. There are couple of videos there where it is shown how to strengthen Psoas Major and Piriformis.

                      I am messaging with a guy who was a former patient of him (but not in the study itself). He claimed, that Kjetil himself claimed that these excercises can worsen symptoms temporarily, but in the long term they can heal pelvic pain. He also claimed that it is a good sign if the symptoms get a bit worse after beginning the excersizes. This is also stated in the study.

                      The study has shown that there has been some great success with this approach, even though it is not only related to people with CPPS, but also to people who had pain in the back or lower extremities. What I'm still curious about, is wether in some cases even strengthening PF-Muscles very very, very slowly and gently could might bring long-term relief. I know this is against all rules from HANS-Protocol but as far as I have understood this buddy of mine, Kjetils theory is that symptoms are due to tight pelvic floor muscles either because the muscles are too weak, strained, or clenched up due to stress. Since the nerves run straight through the muscles, tight pelvic floor muscles will kinda clench on the nerves making them irritated. According to his theory the best way to heal those muscles are to focusing on keeping the pelvic floor and the stomach muscles relaxed throughout the day, and to strengthen the pelvic floor muscles rather than stretching them -- he said stretching only leads to temporary relief, while strengthening them (very very carefully) will lead to full recovery since a strong muscle is more stretchy and supple than a weak muscle according to him.

                      I don't know if this makes sense.
                      Swirly
                      Junior Member
                      Last edited by Swirly; 04-16-2019, 03:16 PM.

                      Comment


                      • #12
                        Originally posted by Swirly View Post
                        The study is free to dowload in PDF. Before you start with excercises, read it.
                        The author of the study Kjetil Larsen has also a youtube channel called TrainingandRehabilitation. There are couple of videos there where it is shown how to strengthen Psoas Major and Piriformis.

                        I am messaging with a guy who was a former patient of him (but not in the study itself). He claimed, that Kjetil himself claimed that these excercises can worsen symptoms temporarily, but in the long term they can heal pelvic pain. He also claimed that it is a good sign if the symptoms get a bit worse after beginning the excersizes. This is also stated in the study.

                        The study has shown that there has been some great success with this approach, even though it is not only related to people with CPPS, but also to people who had pain in the back or lower extremities. What I'm still curious about, is wether in some cases even strengthening PF-Muscles very very, very slowly and gently could might bring long-term relief. I know this is against all rules from HANS-Protocol but as far as I have understood this buddy of mine, Kjetils theory is that symptoms are due to tight pelvic floor muscles either because the muscles are too weak, strained, or clenched up due to stress. Since the nerves run straight through the muscles, tight pelvic floor muscles will kinda clench on the nerves making them irritated. According to his theory the best way to heal those muscles are to focusing on keeping the pelvic floor and the stomach muscles relaxed throughout the day, and to strengthen the pelvic floor muscles rather than stretching them -- he said stretching only leads to temporary relief, while strengthening them (very very carefully) will lead to full recovery since a strong muscle is more stretchy and supple than a weak muscle according to him.

                        I don't know if this makes sense.
                        The muscles in the pelvic region can be either just tight or tight and weak .
                        Strengthening the muscles in this region is something often mentioned in pegym practise there are threads on it
                        Typically in physio where a muscle is both tight and weak the emphasis is on dealing with the tightnes initially and then working on strength .
                        In general pegym practise has talked on strengthening the posterior chain . If there is evidence for a more isolated approach and exercises then can you pm me a link.?

                        Comment


                        • #13
                          Here is some discussion on different effects of squats re Kegel effect , rk effect and posterior chain effect.

                          Comment


                          • #14
                            Hi guys,

                            I have been doing the exercises recommended in this study for 4 months now and my situation has improved a lot so far. It is hard to quantify it, but I would say approximately 70-80%.

                            I can not say for sure that this was the reason for my recent improvement. Maybe it is time that heals some wounds. But nevertheless I just wanted to share my observations.

                            If you want to try

                            My routine (2 x week):
                            Excercise for Psoas Major muscle:
                            https://www.youtube.com/watch?v=CTVsxyYujyU

                            Excercise for Pectineus muscle:
                            https://www.youtube.com/watch?v=LiBTtqEWohc&t=10s

                            Excercise for Piriformis muscle:
                            https://www.youtube.com/watch?v=Lli_rI4Dj0Y&t=4s
                            Swirly
                            Junior Member
                            Last edited by Swirly; 09-20-2019, 05:16 PM.

                            Comment


                            • #15
                              Originally posted by Pegasus View Post
                              The muscles in the pelvic region can be either just tight or tight and weak .
                              Strengthening the muscles in this region is something often mentioned in pegym practise there are threads on it
                              Typically in physio where a muscle is both tight and weak the emphasis is on dealing with the tightnes initially and then working on strength .
                              In general pegym practise has talked on strengthening the posterior chain . If there is evidence for a more isolated approach and exercises then can you pm me a link.?
                              Correct, relieving tenson/pain is top priority. Strengthening the muscles comes second.
                              My Work

                              ARTICLES:

                              Comment

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