Frequently asked questions

Below are a list of frequently asked questions about the DCT course. If you have any specific questions about the course please contact me at david@freedomfrompelvicpain.com. If you have started the course please contact me by email as as much as you wish with any questions.

I have been diagnosed with Chronic pelvic pain syndrome/C.P.P.S ? How can I recover?

Chronic Pelvic Pain Syndrome is characterized by chronic pelvic pain symptoms lasting at least 3 months during the past 6 months, in the absence of a urinary tract bacterial infection or identifiable bacteria in the prostate but in the presence of urinary symptoms and sexual dysfunction.  Symptoms include pain in the perineum, suprapubic region, testicles, or tip of the penis and are sometimes exacerbated by urination or ejaculation.  Men can also experience pain in the lower abdomen, hips and pelvis.

 
prostatitis index.jpg
 

If you suffer from Chronic pelvic pain syndrome it is important to remember you are not alone. CP/CPPS has a worldwide prevalence estimated between 11% and 16% (1,2,3) and is the most common urologic diagnosis in men below 50 (1). There are more than 2 million visits for prostatitis every year in the United States alone.(4)

C.P.P.S / Type III prostatitis is the most common form of prostatitis, accounting for 8% to 15% of urology outpatient office visits (5). Currently available therapies have limited effectiveness, resulting in frustration for patients and caregivers. Due to its high prevalence and lack of effective therapies, direct and indirect costs associated with type III prostatitis/CPPS are substantial. (5)

What causes C.P.P.S?

There are different proposed theories for what causes CPPS. However it is widely accepted that muscle tension is a causative factor in CPPS and pelvic pain in general. You will find this theory proposed in pelvic pain books and many physical therapy websites.  This is a theory that we agree with. In order to recover from CPPS excessive muscle tension must be treated.  

How is excessive muscle tension treated?

This is a question David McCoid was obsessed with for two years.  His research eventually led him to find the work of physical therapist Nic Bartolotta. Nic Bartolotta had developed a system for treating both muscle and fascial tension called Dynamic Contraction Technique™. While Nic was using this approach for pain conditions he had also established a reputation in professional sport and was using his technique with many elite sports teams particulary in the NBA.

As someone already working with pelvic pain patients and a former sufferer himself David approached Nic to enquire about DCT.  David made the decision to train in DCT. After completing his training David and Nic went on to create an online program instructing CPPS sufferers on how to apply DCT to their own body.  The program has been created specifically for CPPS. It is the first online course to be created for treating the muscle tension associated with Chronic pelvic pain syndrome.

How does DCT treat the muscle tension which causes CPPS?

DCT is a radical departure from the mainstream approach of treating CPPS. Mainstream treatments focus on relaxing muscles. Manual therapy is often used to relax muscles. Static stretching is commonly prescribed to patients. This was the form of stretching David was advised to do and is the type found in many pelvic pain books.  This is where patients are told to relax into a stretch and are often instructed to ‘let go’ as they move into the stretch.

When you start DCT you will not be relaxing muscles. You will be contracting them against resistance as they lengthen. DCT is a specific form of resistance stretching. Resistance stretching is new form of stretching and is not currently taught in any physical therapy degree course in the USA or the UK.

Resistance stretching requires the patient to abandon a certain belief around muscles and stretching. This is that in order for a muscle to lengthen you must relax it. This belief is false.

Muscles can lengthen while producing force (attempting to contract) with eccentric muscular contractions.   While DCT uses all three different types of muscular contraction it is the eccentric contraction which draws tension out of the muscle.

After pursuing many treatments which focus on relaxing or letting go of muscles DCT can seem like a strange approach for pelvic pain patients when first attempting it.  We believe that after performing  DCT you will never want to relax into a stretch again as it just won’t feel right to you anymore.  DCT is a form of stretching that can transform the body.

We are confident that you will continue to perform DCT even after you have recovered simply for the way DCT/ Resistance stretching makes you feel and the many health and fitness benefits that come from resistance stretching.

DCT treats both muscle and fascial tension with three different muscular contractions - concentric, isometric and eccentric contractions.  It is the final contraction which draws tension out of the muscle.  

 
 

I have been diagnosed with trigger points in the pelvic floor?  Can DCT help?

The short answer is yes.

Myofascial trigger points are a controversial concept. Myofascial trigger points as described by Travell and Simons have now been refuted. (6) No one doubts that people have sore spots that can create or refer pain but the thoery of taut bands or myofascial trigger points has never been proven.

When people are told they have trigger points in the pelvic floor what they essentially have is a shortened and weak pelvic floor.  The mainstream approach to treating CPPS is for physical therapists to treat the individual trigger points in the pelvic floor.  A stretching program is usually prescribed but this is usually static stretching as found in many pelvic pain books. For men this approach for men has been shown to be no more effective than performing a regular full body massage. (7)

Our approach is different in that we believe the pelvic floor is not the primary problem in CPPS. The pelvic floor is reacting to tension throughout the body particularly the hips and hip flexors.  Only by working on the whole body can the pelvic floor be successfully rehabilitated.

Many people have recovered from pelvic pain without internal trigger point treatment. Internal treatment is not necessary to recover from pelvic pain.

How is DCT different to regular stretching found in pelvic pain books

The type of stretching found in pelvic pain books or pelvic pain youtube videos is static stretching. This is the form of stretching where you relax into a position until you feel a stretch and hold it there for a time ranging from 15-60 seconds, you are often advised to repeat this several times in the day. This form of stretching does not create changes in the tissue or have an impact on muscle extensibility/length. The effects of static stretching are neural. It changes your nervous system but does not alter the structure of your muscles. This form of stretching changes your stretch tolerance, the point at which you feel the stretch and then cannot go any further. This is how this form of stretching increases your range of motion. It is not changing your tissues. (8.9)

DCT is an approach that will create permanent changes in both muscle and fascial tension. With DCT you are not relaxing into a stretch.  You are contracting muscles against resistance as they lengthen.  

Can I do yoga instead?

DCT is not similar to yoga. As soon as you start the course you will realise it is very different. Very often with yoga the goal is to simply become more flexible or achieve more impressive poses. This is not the case with DCT. DCT’s focus is on creating flexibility with strength.

Can I learn DCT from a pelvic floor physical therapist?

The answer to this is no. Dynamic Contraction Technique is a unique form of resistance stretching. Neither DCT or resistance stretching are taught on any physical therapy degree course in the USA or UK. DCT was created by physical therapist Nic Bartolotta, the co creator of the DCT for pelvic pain program. Dynamic Contraction Technique is used by many basketaball players and teams in the NBA. You can learn about Nic Bartolotta’s discovery of resistance stretching and his decision to train as a physical therapist in the presentation below.

 
 

Does DCT directly stretch the pelvic floor?

It is impossible for any treatment to directly stretch the pelvic floor as the pelvic floor is not connected to a joint.  The pelvic floor supports your organs above it and plays a role in urination, defecation and sexual function.  There is a misconception that internal pelvic floor physical therapy stretches the tissues of the pelvic floor, but this is not possible. Internal physical therapy or trigger point wands have no mechanical effect on the tissues of the pelvic floor.

The studies performed for trigger point wands demonstrate a reduction in trigger point sensitivity. This result is predictable. If you press on any point on the body repeatedly that area of the body will desensitise to that stimulus. This is simply what the nervous system does, it habituates to repeated stimulus. A reduction in trigger point sensitivity does not equate to there being any change in the tissues of the muscle.

While it may not be possible for any approach to directly stretch the pelvic floor, this does not mean the pelvic floor cannot be rehabilitated. No muscle or muscle group works in isolation. The pelvic floor will lengthen when the surrounding muscles and connective tissues have been lengthened. In the DCT course you will be working on the muscle groups around the pelvic floor such as the glutes, hip rotators, hip flexors, adductors and hamstrings.  

In pelvic pain the pelvic floor is not the primary issue.  If you think of a wetsuit around your hips, pelvis and legs.  This wetsuit needs to be lengthened and strengthened.  The wetsuit being an analogy for your connective tissue. The pelvic floor is merely a part of this wetsuit.

Recovery from pelvic pain is about loading tissues, not about relaxing them.

Botox has been recommended to me, will this help?

There is little evidence to suggest that botox can cure pelvic pain or pelvic floor dysfunction. Botox works by preventing signals from the nerve cells reaching muscles, therefore temporarily paralyzing the muscles.

While Botox does prevent a muscle from contracting treating muscle tension is not this straight forward. If treating muscle tension was this easy everyone would have their pelvic floor botoxed and eventually recover. 

As is discussed in the DCT course in order to treat muscle tension a muscle needs to contract against resistance as it lengthens.  If botox has been injected into a muscle a patient would be unable to attempt to contract the muscle while it is lengthened and therefore would certainly be unable to perform or receive DCT on the botoxed muscle. Botox for pelvic pain is based around the idea that recovery from pelvic pain is simply about relaxing muscles. Whereas we believe the correct approach to treating muscle tension is to make the muscle both longer and stronger.  

I am suffering from hard flaccid ? Can this condition be resolved?

Hard flaccid is a distressing condition where the penis is in a flaccid contracted state but is hard to the touch.  Hard flaccid is not a term recognised by the medical profession, there has only been one medical paper ever published on the condition. It is a term that developed from patient forums.  

Like CPPS there are different theories for the cause of this condition. On patient forums discussing the condition it is again widely accepted that muscle tension is a causative factor.  Sometimes CPPS sufferers also develop hard flaccid.  The solution we propose is the same as the one we propose for CPPS.  We believe that excessive muscular tension can create hard flaccid.  Hard flaccid can be resolved by releasing both muscle and fascial tension in and around the pelvis.  

How long will it take to recover?

The answer to this question is dependent on many factors- your dedication to the DCT program, how long you have had pelvic pain or dysfunction for and how tight your tissues are. Recovery though will happen over months not weeks. DCT can offer a full recovery from pelvic pain but it is not a quick fix. It will requeire dedication, patience and perseverence. We want people to succeed with the course so please email whenever you have questions - david@freedomfrompelvicpain.com

References

1. Chronic Prostatitis current concepts. Ram Vaidyanathan and Vibhash C. Mishra 2010

2. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Roberts RO1, Lieber MMRhodes TGirman CJBostwick DGJacobsen SJ.

3. Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. Collins MM, Meigs JB, Barry MJ, Walker Corkery E, Giovannucci E, Kawachi

4. How common is prostatitis? A national survey of physician visits Collins MM1, Stafford RSO'Leary MPBarry MJ.

5. Male Chronic Pelvic Pain Syndrome: Prevalence, Risk Factors, Treatment Patterns, and Socioeconomic Impact

6. A critical evaluation of the trigger point phenomenon Quintner and Bove 2015

7. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. Fitzgerald MP1, Anderson RUPotts JPayne CKPeters KMClemens JQKotarinos RFraser LCosby AFortman CNeville CBadillo SOdabachian LSanfield AO'Dougherty BHalle-Podell RCen LChuai SLandis JRMickelberg KBarrell TKusek JWNyberg LM

8. Increased range of motion after static stretching is not due to changes in muscle and tendon structures. 2014 Jun Konrad ATilp M.

9. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Weppler CH1, Magnusson SP. 2010

10. Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand Wise Anderson Sawyer Nathanson Smith 2016