2-11: Should I go to physical therapy to treat CPPS?

If you’re already in physical therapy, you can probably skip this lesson.

If you’re not in physical therapy, the goal is to learn what physical therapy can and can’t do to help you, and decide if you should go.

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Unlike urologists, physical therapists actually can help you fight CPPS. They specialize in imbalances and injuries to the musculo-skeletal system, so that includes your taint and surrounding muscles. Those ones that are failing and making your plumbing faulty.

Real men don’t see doctors

Of course I’m kidding, but there is a known pattern: women are much better at visiting doctors and specialists when they have a problem. Which is part of why this section exists.

Most men have trouble allowing themselves to get help – and that’s not because they’re stupid. It’s because they are afraid getting medical attention takes time and money away from their loved ones.

Men are designed to make sacrifices. It’s what we do.

And sometimes, we’re right about not getting treatment, too. Sometimes injuries and ailments will heal on their own, or it can be treated at home.

If I had gone to the doctor every time I got an injury in MMA training, I’d probably be at least $5000 poorer – and all for a doctor to tell me “put ice on it.”

Instead I read rehab manuals, alternated ice and hot packs, and did rehab exercises every day. I managed to fix everything but a hyperextended elbow, but the problem is minor.

So how much does physical therapy cost?

Ha! You want to know before you even know what they do!

So did I.

Here is my breakdown of costs:

  • I paid between $200 and $300 per session, depending on the expertise level of the therapist (and other arbitrary factors determined by the insurance cartels).
  • I did roughly one session per month for five months.
  • So my rough cost was between $1000 and $1500 out of pocket.

That’s not terrible for getting help ending a life-disrupting illness. Still, I understand the reluctance to spend the cash.

Where did I go, and how did I choose it?

If you’re curious, I went to Courage Kenny Sports and Physical Therapy in Saint Paul, MN. I chose it because they had therapists who specialized in treating CPPS. This is something you must ask about when researching a provider.

I loved going. My primary therapist was Aubrey Shamey, and she was both a great listening and great at triaging how anxiety manifested in my shambling corpse. If you’re in Saint Paul, see her.

Will insurance cover it?

Yes, if you’ve met your astronomically high deductible and received a referral from a primary care provider. I could be wrong about that last part – so check with your insurance if you need a referral or not.  

I don’t have insurance.

Well, dig up your grandparents and sell their wedding rings. Or demand that the U.S. stop allowing insurance companies to hide their prices and compete for customers like EVERY OTHER BUSINESS EVER.

Rant over.

If you don’t have insurance or you have a high deductible, calculate the costs and see if it’s worth it to you. Unless you have some very high-dollar insurance, it’s unlikely you won’t pay for therapy out of pocket without another major medical event to hit your deductible. In my case, my daughter had been born that year, but it still took all of my physical therapy (and several kids’ appointments) before we hit our $10,000 deductible!

How does physical therapy treat CPPS?

  1. Triage
  2. Testing muscle resistance/strength
  3. Stretches
  4. Testing anal tension
  5. Mindfulness training
  6. Massaging sore spots
  7. Advice and guidance

1. Triage

Triage is finding out what’s going on with your body. The therapist listens to your experience, and then moves to step 2.

2. Testing muscle strength and resistance

Testing muscle resistance and strength is done by having you do simple exercises, like lay on your back and try to push the therapist’s hand with the side of your leg.

I flat out couldn’t do it. That was because my adductor muscles were exhausted.

3. Stretches

Stretches are what you’d expect – they give you handouts with stretches to do every day, 2-3 times/day. They’ll show you how to do them. Later they’ll examine your form, which is very helpful. It’s hard to objectively assess whether or not your body is in balance by yourself.

4. Testing for tension

Testing for tension is a measure how hard your body clenches when in a resting position, such as sitting or lying.

They stick a probe up your rectum. No, I’m not kidding. It’s like meeting a friendly alien from outer space. They use a lot of lube, for what it’s worth.

I will say this practice, uhh, drove the point home that while my body should have been relaxed, it was instead behaving like a pack of grizzly bears were trying to get into my house.

5. Mindfulness training

So after having something shoved up your manhole, they tell you to learn to relax.

While this sounds a lot like the screening process for a film role at Weinstein Studios, the point is to teach mindfulness. The goal is to become aware of when you’re clenching, and then manually chill the heck out.

My PT made me go through this one more time after I practiced mindfulness for a few weeks. I made great progress. But I still had reservations. I didn’t find being “mindful” all the time a feasible solution. More on that shortly.

6. Massaging sore spots/knots

CPPS leaves you with a number of muscular knots, or sore spots, around your plumbing. Part of treatment is massaging them to get blood flowing.

If any part of PT is worth the most, it’s the massage.

Not because it feels good. It’s internal massage and it feels like…you know what? Let’s just say “ooof.” It hurts. A lot.

That is, until your knots start to come out. And that’s the point (there’s that awful pun again!). When the knots start to unglue, all the rest of your physical symptoms follow.

Now, you can and will be asked to massage the knots yourself. At first, I even did the internal massage myself – with a rubber glove and some lube. I wouldn’t have told you that, but hey, you need all of the information. That might be what’s best for you.

Later on, I discovered ways to hit all of my knots just by sitting on a PVC roller or a lacrosse ball, or by pressing over my clothes with my own fingers.

7. Advice

Physical therapists can teach you a lot. They’re the best kind of professionals – it’s not just a practice for them. Get it? Ha ha! I kill myself sometimes.

My therapists taught me ways to massage my own knots. They taught me to improve my stretches. They told me that unaddressed fears were, in fact, a big part of the CPPS equation.

They also taught me how to poop better. No joke. When you clench out of habit, it’s pretty hard to poop, and your poop is hard. There are simple techniques to poop easier, and I’ll include them in another post.

Ultimately, nobody but another person who has gone through CPPS will be able to relate and empathize with you about your suffering. But therapists come very close.

Why I still think you need this course and not just physical therapy (or, “what physical therapy CAN’T give you)

I think physical therapy is a gift from above. But its answer to anxiety – mindfulness – has big shortcomings.

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Mindfulness is not something you or anybody can functionally sustain all the time. You won’t always be “aware” enough to know that you’re clenching.

I found a better solution for dealing with your anxiety than mindfulness training. It’s addressed in Lessons 1-2, 2-6, 2-7, and to a lesser extent in all of the supporting lessons, such as meditation.

You have to find the root causes of your anxiety – your deep, hidden fears. If you fight your fears head on with a few good habits, you won’t have to be mindful all the time, because you won’t have the fears that cause clenching, or the movement patterns that make CPPS terrible.

Some people are prone to anxiety. I’m one of them. But in spite of the predisposition, Type-A people and spazzes like myself are still anxious about something, and that something can be addressed.

As the Buddha said, “all life is suffering.” Or as I like to put it, “suffering finds everybody.”

Fighting anxiety is a lifelong battle, but white belts and new weight-lifters progress very quickly. You’ll see results, and you will like those results.

Can I do PT at home?

You can learn the stretches. You can more or less triage your own pain just by probing yourself to find out where it hurts, and you can massage those spots yourself.

You can treat the “knots” yourself. I never used an internal massage wand (Therawand makes a well-rated one, if you’re interested), but I was willing to try if I needed one.

And you’re going to need to fight your underlying fears causing your anxiety mostly by yourself. You can get a therapist, but a good therapist will simply ask you questions and force you to reflect on your own. If you’ve had abuse or other nastiness in your past, that might be worth every penny.

But is physical therapy still worth the cash?

If you can spare it, yes, physical therapy is absolutely worth the cash.

To help make your decision, I propose you:

  1. Call local therapy providers
  2. Find out if they have pelvic pain programs
  3. Find out if their physical therapists specialize in care for men
  4. Find out what it costs per session
  5. Thank them for the information
  6. Consider your budget
  7. If you’re wary of paying for therapy, assess your progress up to this point. Are you making an improvement?
  8. If you’re still wary, work through Unit 3, then reassess
  9. If doing the work of Unit 3 doesn’t help – contact me. But it may be time to go to physical therapy.
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