By Melissa Patrick, PT, DPT, RYT , PHRC Lexington
For the estimated 15% of men worldwide who suffer from pelvic pain, finding the right providers to properly diagnose and treat their pain can be a daunting task, especially when seeking local options in their community. As a result, some patients end up traveling long distances to receive care.
Fortunately, the pandemic has brought about increased accessibility to virtual healthcare, offering a potential solution for those struggling with pelvic pain. Jim, a 57-year-old successful teacher, mentor, and writer, is one such individual who found relief through virtual healthcare. He had been dealing with a history of several diagnosed bouts of non-bacterial prostatitis since he was sixteen years old, with the first episode occurring after his mother’s passing.
During these bouts of prostatitis flare ups, Jim experienced varying presentations of pelvic pain symptoms, including pubic bone pain and penile discomfort. In November 2021, he faced a particularly severe bout of pelvic pain which also included testicular pain and a unique “binder clip” pinching sensation near his urethra, precisely where his pubic bone was located. This sensation became more pronounced after moving student desks in his classroom. Furthermore, Jim often felt as though he was sitting on a golf ball, and this discomfort was exacerbated while riding or driving in a car.
Medical literature suggests that roughly 8-12% of men will experience symptoms that mimic prostatitis at some point in their lives and that more than 90% of those men have symptoms that are consistent with chronic pelvic pain syndrome, also known as CPPS, which occurs due to causes other than the prostate, such as neuromuscular impairments (muscles, nerves, connective tissue).
In March 2022, Jim came across my therapeutic yoga services through the PHRC Youtube page. We ended up working together virtually for nine months over Zoom. I am happy to share that with the help of virtual healthcare, Jim has successfully kicked his non-bacterial prostatitis to the curb and is now free of pelvic pain. To know more about Jim’s journey to recover and the impact of virtual healthcare, continue reading to discover his inspiring successes with this innovative approach.
One of Jim’s main frustrations when receiving his prostatitis diagnosis was the lack of clear indicators of an enlarged prostate, an elevated PSA, or any signs of infection, which made him hesitant to follow the repeated courses of recommended antibiotics. Men are often given unnecessary antibiotics without positive tests for bacterial infection. You can learn more about why this is the case, and educate yourself on urologic testing, by checking out this related blog article with information from a trusted urologist colleague.
After a familiar four-week course of Cipro antibiotics failed to fully alleviate his symptoms, Jim sought help from the Pelvic Health and Rehabilitation Center. He discovered my therapeutic yoga videos on the PHRC Youtube channel in March of 2022 and began practicing “A Stretch Routine For Your Pelvic Floor:”
Although initially skeptical of yoga, Jim decided to give it a try in the hope of finding relief from his symptoms. With consistent practice of the yoga routine, which included cat & cow, bird dog, low lunge, and hamstring stretches, he noticed a positive impact on his symptoms. Encouraged by the results, Jim scheduled a virtual therapeutic yoga evaluation with me through Zoom.
Although treating Jim over Zoom did mean that I was never able to get a full physical assessment of his musculoskeletal system, I could observe his movements on screen, gaining insights into his body mechanics and posture and how they influenced his symptoms. Through detailed questioning, I learned about repetitive activities in Jim’s daily life, such as commuting or moving student desks, which were triggering his symptoms.
Our ongoing virtual discussions allowed me to identify the likely culprits behind Jim’s pain: primary pelvic muscular dysfunction with secondary pudendal nerve irritation. It became apparent that Jim was overusing his rectus abdominis muscle (the ‘six-pack’) when flexing his trunk forward to move desks, likely aggravating and exacerbating tight, trigger points in the muscle. This repetitive motion caused the ‘binder clip’ sensation at the pubic bone, extending into his penis.
Jim’s standing posture, with his weight predominantly on the front of his feet and pelvis protruding forward in front of his ribcage, further strained his rectus abdominis and his pelvic floor muscles, too. Additionally, he admitted to unknowingly clenching his pelvic floor muscles during times of stress, which can lead to reduced blood flow and compression of the pudendal nerve, likely driving the stinging, needle-like pain he described at the tip of the penis.
The sensation of sitting on a golf ball after commuting was traced back to the overactivity of the obturator internus muscle, caused by prolonged abduction of the hips while driving and chronic muscle shortening.
Together Jim and I set goals, including enhancing core stability, improving hip and pelvic mobility, maintaining proper posture throughout the day, and modifying activities like driving and moving student desks.
Determined to address the root cause of his problems, Jim diligently worked with me remotely twice a month. He devoted himself to daily yoga, breathing exercises, and postural awareness, along with daily walks and weight loss. He was beginning to understand the value of pelvic floor physical therapy advice to help heal his condition.
As he focused on core stability, Jim mastered the bird dog pose from my Youtube yoga stretch routine and learned how to engage his transverse abdominis (TA), often referred to as the ‘corset.’ The TA facilitates spinal stability and encourages proper alignment of the ribcage over the hips. By utilizing his TA during static standing, Jim improved his posture and avoided straining the rectus abdominis, resulting in a reduction of pain.
A significant breakthrough occurred when Jim realized the connection between his symptoms and his commute. To address the ‘golf ball’ sensation that would arise after driving to work, we utilized stretches to improve internal rotation of the hip and reduce tension in the obturator internus muscle. I recommended he purchase a wedge cushion for his car seat to promote better pelvic alignment during rides, and this simple change made an immediate difference. He truly realized the power of good pelvic posture while driving when he briefly used a loaner car, without a wedge cushion, and his symptoms returned within two days.
When we sit with an anterior pelvic tilt, using either a wedge cushion or a lumbar roll for support, it helps maintain better pelvic muscle positioning compared to slouching and tucking the tailbone under. This adjustment also reduces hip abduction, enhancing optimal alignment for the obturator internus muscle.
To enhance pelvic mobility I recommended that Jim incorporate daily anterior pelvic tilting through the cat and cow stretch. This movement not only improves lumbopelvic motion but also strengthens and elongates the rectus abdominis muscle. Additionally, I suggested he practice spinal extension while standing at the wall to stretch the front of his abdomen. These exercises proved effective in alleviating the pain he experienced near his urethra by targeting and conditioning the rectus abdominis muscles and improving the mobility of his pelvis.
Furthermore, I provided instructions on how Jim should move the student desks in his classroom differently. Instead of rounding his spine forward and using parallel feet to pull the desks, I showed him how to stagger his stance in a lunge position and maintain a straight spine. This adjustment allowed him to utilize the strength of his legs to move the desks, thus reducing strain on his rectus abdominis.
Over the course of nine months, through dedicated adherence to my recommendations and unwavering commitment to a consistent routine, Jim experienced a dramatic reduction in his symptoms. Although his progress wasn’t entirely linear and included some setbacks, which are common in pelvic health rehabilitation, Jim’s resolute determination to overcome these challenges was evident.
Jim’s journey underscores the vital importance of cultivating an understanding of one’s body and paying attention to its dynamics throughout daily activities. Small micro-adjustments in daily sitting and standing can have a profound impact on pelvic health. In the long term, building a habit of mindfulness can empower individuals to seamlessly integrate these adjustments into their daily lives with minimal effort.
Furthermore, establishing a personalized regimen of stretches and strengthening exercises designed to complement one’s body tendencies proves indispensable especially with the passage of time. It was an honor to curate a therapeutic yoga routine tailored to Jim’s unique needs, one that he embraced wholeheartedly and sometimes even practiced twice daily.
Presently, Jim has been free from pain for nearly six months. His achievements extend beyond mere relief, with a remarkable 25-pound weight loss and a consistent incorporation of daily walks and yoga sessions. Perhaps most notably, Jim’s transformation includes a newfound identity as a dedicated “yoga kind-of-guy.”
Jim’s triumph serves as a powerful testament to the transformative potential of a holistic approach to pelvic health, one that can be effectively facilitated through telehealth. His story underscores the prospect of positive change through a combination of yoga therapeutics, heightened postural awareness and thoughtful lifestyle adjustments. As we reflect upon Jim’s success, it becomes evident that the journey towards lasting well-being is attainable through commitment, tailored guidance, and a comprehensive perspective on health and self-care.
A few closing words from Jim:
“Melissa Patrick has been a wonderful blessing in my life, she always encouraged me and changed my perspective on the healing benefits of yoga. She listened patiently to my struggles and modified my routines to consider what my body was telling me. She is extremely knowledgeable about all parts of the pelvic anatomy. I credit her with taking one of the biggest crosses of my life and changing it into a positive. Doing yoga is now part of my life moving forward. My positive outlook on life has returned and I can’t express in words how much Melissa Patrick has helped me. My car seat was the hidden piece in my journey to pelvic floor health!”
We are excited to announce our physical therapist, Molly, is now located in our 11th location in Columbus, OH. Now scheduling new patients- call (510) 922-9836 to book!
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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