Quintner's theories, neuritis and CP/CPPS

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cpps2020
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Quintner's theories, neuritis and CP/CPPS

Post by cpps2020 »

By the way, has anyone come across the YouTube videos of Jilly Bond, a pelvic physiotherapist in the UK? I found this very recent video interesting:



In it, she discusses recent research into trigger points and why she thinks they are less important than previously thought. This has led her to change her approach to relaxing the pelvic floor, avoiding pressing the trigger points directly. I'd be interested to hear what others think.
Age: 56 | Onset Age: 51 | Symptoms: groin pain, hematospermia, pain with ejaculation | Helped By: stretching and rolling my deep, upper hamstrings; Q-Urol | Worsened By: ejaculation
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Re: Quintner's theories, neuritis and CP/CPPS

Post by webslave »



The brain is a big part of this. I see it as an overuse syndrome provoked by the brain.
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Re: Quintner's theories, neuritis and CP/CPPS

Post by NeoKortex88 »

Some PTs don’t believe in triggerpoints. I am not sure.
Age: 32| Onset Age: 30 | Symptoms: “Cured“ now, no symptoms. Symptoms were: 8/10 pain, couldn't sit, bleeding anus, ED, HF (tinnitus too from stress), Insomnia or CFS | Helped By: Stretching, foam roller, hot baths, sauna, tennis ball, antidepressants (acupuncture and fasting improved the tinnitus a lot) | Worsened By: stress, sitting, chronic masturbation but yeah mainly stress | Other comments:
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Re: Quintner's theories, neuritis and CP/CPPS

Post by webslave »

Doesn't matter what you call them, they are real. You can feel them.
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Re: Quintner's theories, neuritis and CP/CPPS

Post by cpps2020 »

Agreed -- Bond makes a big point of saying that the symptom of sore muscles that hurt when you press on certain points is absolutely real. It's just that we don't really know what this phenomenon is, and that these sore points can also be felt in normal muscles (such as when you squeeze between your thumb and 1st finger). She says that tight bands are often found where a muscle changes direction (such as in your trapezius), and are needed to anchor the the muscle in order to allow the change of direction. (Not sure if this last point is a hypothesis.)

Here is Quintner's article on trigger points and myofascial pain syndrome:
https://academic.oup.com/rheumatology/a ... 2/1796114/

My take on this and Bond's discussions are that while it is abnormal for muscles to feel chronically sore when pressing them, the pain is neurogenic in origin, not myogenic. This video lists some key points on this (4:30 - 11:30 in the video):



- Our brains perceive that the pelvis is "under threat". (Why this starts is not really discussed.)
- The stimulus threshold for the nerves to fire is reduced, making the area hypersensitive. Touch (sitting, sex...) that would be no issue to a normal pelvis is felt as pain.
- Autonomic neuropathy (cause unclear) leads to poorer blood supply to the pelvic floor, increasing the muscle tension, creating neural inflammation and increasing the perceived threat.
- "Vast brain changes" occur as it tries to make sense of all the input from the pelvis, in particular becoming hypervigilant on this area.
- Longer term, the limbic system takes over the monitoring of the pain, adding a significant emotional component.

I think many of us can appreciate these last 2 points. I have started noticing that if I start to feel pain when sitting and tell myself to just ignore it, it can subside or even disappear for a time.
Age: 56 | Onset Age: 51 | Symptoms: groin pain, hematospermia, pain with ejaculation | Helped By: stretching and rolling my deep, upper hamstrings; Q-Urol | Worsened By: ejaculation
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Re: Quintner's theories, neuritis and CP/CPPS

Post by webslave »

Yes, I have no problem with Quintner's hypothesis that "trigger points" are actually the consequence of nerve behaviour, little areas of muscle hyperalgesia provoked by nerve inflammation.

But what is inflaming the nerves in the pelvis? Overuse through chronic, subconscious and subtle tensing at a low level. Similar phenomena probably underlie carpal tunnel and other nerve injuries. So CPPS could be a form of nerve injury, which takes us back to my theory of a "pathway through grass".

Of course, those pelvic nerves are being activated subconsciously by the central nervous system, and the CNS itself is eventually harmed by having to constantly activate those nerves and muscles. That leads to central sensitization.

If you want to do a deep dive on central sensitization, read this 2010 paper:
Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity

That article will help you accept that —unless you are doing a doctorate in biochemistry— you are never going to understand the nitty gritty of what underlies your CPPS, which is why I have always maintained that getting a total understanding of how CPPS works is not a worthwhile pursuit. Just accept the broad outlines of the problem, and then just get on with getting well.
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