"Pelvic Floor" treatment

[aaron m]

Hi everyone,

[Deep breath...] Okay, here goes. Got an email this week from a fellow saying, "Seeking regular therapist for sports injury rehab. I have a prescription from my physician. Please call today as soon as you get this to book an appointment today. I am staying in a hotel in ---, so I am not far."

When I called him, he explained he was a hockey player and a couple years ago had an accident on the ice that caused him to do the splits, with injury to his pelvic floor, associated scar tissue and whatnot, and had been receiving massage treatments related to erectile dysfunction.

Uh huh, I thought. A likely story.

He goes on to say that he was working with a therapist locally but that she'd moved and he was seeking someone new. He said he had a prescription from his doctor for massage treatment to the affected area. He acknowledged that he was asking about a sensitive issue for massage therapists.

I told him I'd have to think about the issue, that I was uncomfortable with just the information he'd presented (even though he seemed legit on the phone). He was going into a meeting so I had a few hours to decide. After we got off the phone, I had an idea and texted him asking him for his doctor's number as well as his last massage therapist's contact info. I expected not to hear back.

Well, today he's provided me with the info I requested. I've called his doctor, naturally she's on vacation. The doc's office said they'd fax me info (his prescription and related info) if I fax them a request including my credentials, so they are HIPPA compliant. (I'll be doing that in a couple hours.) I also left a message with his massage therapist, but have yet to hear back.

Now I realize that this could just be an elaborate ruse, but it sure seems like it could also be legit. We'll see what I hear back from the doc and therapist. But I'm wondering, has anyone done any kind of pelvic floor (perineum) treatment, or related treatment for an issue like this? If so, how did you deal with the family jewels? How did you deal with it at all?! I'm sympathetic to an actual injury, albeit in a sensitive area, but it makes me a bit squeamish.

Given that the guy suffers from erectile and ejaculatory dysfunction, I'm naturally very wary that he's going to have a "miraculous recovery" on the table...

I honestly can't believe I'm even considering this case, much less telling a public forum about it.

Thanks,
Marlene

 

[Navywife0827]

My first question would be: What are his goals? If he is trying to resolve the pain from the injury, massage/bodywork certainly can help. If it is to resolve his erectile issues, I'm not sure that either research or practice would support this. If he truly had scarring/restriction into the perineum that was interfering with his "function", deep tissue work/MFR done externally and internally may help with this. Much would depend on your state practice act as to whether you can do this work.

Even if these factors all pointed positively, the question remains whether you would wish to do so in a hotel room. I know out calls are common with MT's, though not for me, this may be crossing too wide of a boundary.

 

[~*RoCKAnGel*~]

http://www.youtube.com/watch?v=heWNnsKA4IE

This is a good move that does not seem to push boundaries.

 

[Y Y]

Even if these factors all pointed positively, the question remains whether you would wish to do so in a hotel room. I know out calls are common with MT's, though not for me, this may be crossing too wide of a boundary.

Indeed, I agree. However, in this case he would be coming to my professional office. He was just indicating that he's close by, not that he expected me to come to him.

Thanks for reminding me to ask about his goals! Usually that's a standard question of mine, but I got sidetracked with all of the other considerations. He did talk about scar tissue, so that's apparently a factor. I'm definitely NOT up for internal work! Like other states, Virginia's practice act indicates that an MT cannot work with a client if sexual boundaries are crossed ("d. Initiating or engaging in any sexual conduct involving a patient; ") and compliance with policies of the NCBTMB (more wordy but essentially the same thing), but that's about all it addresses. My intent, if I were to take on this client, would not be sexual in nature.

JLWmassage, thanks for the YouTube link.

 

[Killer]

Wow... if this is legit it is fascinating. Keep us updated.

Do you have experience asking clients to hold their genitals out of the way? I imagine this may be for you similar to my experiences learning to ask women to hold their breast tissue away while I work their pecs.

Just do your best to stay grounded in your good intentions, remember that what you are doing is "helpful" not "weird", and just be frank and real.

 

[keen2ts]

BCM - if he is legit, and it sounds really like he is, this will be a very interesting case for you to work on. Male pelvic floor issues have great impact on how comfortable the client is with urination, elimination, walking, sitting, athletic endeavors, work, sexual functioning, etc. It's no more fun for them than it is for a female client. Actually, it would be easier, from my point of view, to have a client who knows for sure that it's a pelvic floor issue than having to try to figure out some vague "down there" description that can be given when this is the actual issue.

fwiw - here's what has happened in my practice in this regard....


Several of my male clients have pelvic floor issues related to the way their bodies are torqued around at work - something that has helped them considerably with that particular issue is doing orthobionomy releases to the attachments on both the greater trochanter and the ischial tuberosity in addition to the pubic rames. We also use bastardized craniosacral over the trochanter and the real deal cst for the sacrum and hips. Yep, it gets really up close and personal for all of us, and, bless their hearts, "my fellas" are so willing to put up with me "punching those @%#$@ sore spots on the groin and pubes" [one fellow's description - not mine] as well as the ischial tuberosity. We also work on the inner thigh muscles (gracilis and sartoris in particular) clear up to, and some days including their attachments on the pubic rames ---- do I have any qualms about this work - no. Not something I enjoy, but, I behave very professionally, have them place their fingers on the points I'm working with using orthobionomy when I need to move body parts and can't hold the points myself, and we all have very frank and open discussions about what is going on. One fella wears his boxers, another his tighties, and the other 2 "go commando" - if they're comfortable, so am I. Draping isn't an issue no matter how it's done - sheets are moved where they need to be and off we go. These guys are gentlemen through and through and we all truly have a very trusting and secure client-therapist relationship. It's an honor to work with them to correct their problems because not everyone wants to have muscles worked on that close the their genitals without sexuality being brought into the situation.

We've never had a problem and given what you have said about this potential client, it sounds truly like you wouldn't have any problem with this gentleman either once you both set the ground rules for treatment, etc.

:2cents:

 

[Pompal 09.]

I am curious as to why he called YOU. Do you have any particular credentials or training that would make you the best person to see for his condition? If not - I don't see why you would even attempt to perform the work he is requesting.
I would refer out to some one with more specific experience.

However, if you are interested in going ahead with treatment, you might be interested in the Orthopedic Massage Group to see if someone there can give you suggestions.
http://health.groups.yahoo.com/group/orthopedic_massage/

 

[Jamal of Babylon]

I just deleted a post I spent 20 minutes typing up in response to this. I didn't realize the pain/drama was still so traumatic after a few years but I'm just not ready to share it just yet even after being back to my old/new self again.

Just know that, no matter if this guy turns out to be legit or not, that this issue is real and can take a man to the breaking point of his sanity and self-esteem depending on the circumstances and any thing we can learn to help would be worth more than anybody who hasn't been in this situation can realize.

Here's a book that helped me as both an MT but more importantly as a former sufferer:

http://www.prostatitis.org/aheadacheinthepelvis.html

Good luck to both of you.

 

[Farty McFart]

Have you worked with pelvic floor issues before? If not, this promises to be a great learning opportunity... but it could be out of your depth, too. There is no obligation for you to treat this man just because you are the MT he chose to contact.

It would be worthwhile to have a face-to-face talking consultation with this man before scheduling any bodywork sessions. This would help you get to know this man and discuss his case in great detail before deciding whether you wish to proceed with the work. It would also give you a chance to get better info and do some homework before embarking on a series of treatments.

When I have clients with pelvic floor issues, I never work on that specific area on the first visit. I will work on related areas and see how they respond, and then decide whether to "go there" on subsequent visits. If you feel uncertain about proceeding with the client, refer them to someone else.

There are a number of indirect methods to address pelvic floor issues, some have already been mentioned. I am a big fan of Active Isolated Stretching for the internal and external hip rotators - very powerful stuff for the pelvic floor. You'll want to stretch superficial structures first for maximum effect, and the client can even be fully clothed during the session.

Positional release techniques, such as Strain Counter-strain, are also very powerful if used well.

 

[P.U.M.A]

Such useful responses ... thanks everybody!

My guess is the client called me because I say on my home page, "In Pain? My specialty is rehabilitative massage. Advanced massage techniques can help relieve problems stemming from stressful living, fatigue, injury, poor posture, repetitive motion, surgery and so forth. I am presently pursuing additional certification in Orthopedic Massage, a form of medical massage. Orthopedic Massage focuses on restoring pain free range of motion throughout the body, and integrating complete structural balance, with special attention given to correct assessment of the problem, proper treatment and client self-care. The treatment is pain free and can be very effective."

When the client called I was right up front and told him I'm not certified yet (hope to be by the end of the year) and that my training and practice (been doing case studies) have thus far been focused on the upper body ... which of course includes pelvic stabilization but nothing else lower. I tried to refer the client to a much more experienced Orthopedic therapist closer to the client, but the therapist is male and the client said he was uncomfortable working with a male on this problem. Understandable in this case I guess. There's a woman doing an internship under that male therapist, I'm going to find out if she's ortho certified yet. If I can point the potential client to her, that would be great.

 

[Lula Bell Bumpass]

BCM, I think your decision to try to refer him to someone more qualified is a good one. And I think you've been handling this situation with grace and integrity. Good job! Please let us know what happens.

 

[Pompal 09.]

Pelvic Floor Treatment

BCM and others,
This is a very interesting discussion. I've had a similar situation with a female client several years ago. I found a female pelvic floor PT and she is great for referrals. I have wondered about working the pelvic floor as an issue for MTs. Many of the Orthopedic Massage Classes I've attended: Lowe and Waslaski don't address this issue.
So if I got the call I'd refer the client out to an appropriate PT.
Just my 2c.
Rubmyster

 

[loh m]

"Pelvic Floor" treatment

Are there any updates?

 

[BAPS]

"Pelvic Floor" treatment

No updates other than I referred the client elsewhere ... a nebulous type of "elsewhere." I tried to refer to the female apprentice under the nearby Ortho therapist, and all I got back from their office was an unpleasant note from the Ortho therapist saying, "Surely you're kidding with this guy, right? If you're not, we're not interested." Made me feel about two inches tall for even trying to refer to them, but in the end I decided it was their attitude problem.

I did however ask James Waslasky at a subsequent Lower Body Orthopedic Massage class about pelvic floor injuries. He'd dealt with them, but his response was essentially, "It's a case by case basis and I'd have to know the particulars."

Wish I could provide more info...

Best,
Marlene

 

[school]

"Pelvic Floor" treatment

I tried to refer to the female apprentice under the nearby Ortho therapist, and all I got back from their office was an unpleasant note from the Ortho therapist saying, "Surely you're kidding with this guy, right? If you're not, we're not interested." Made me feel about two inches tall for even trying to refer to them, but in the end I decided it was their attitude problem.

Maybe we should try to put together an awesome reply for you to return to them.

 

[Saliva Man]

"Pelvic Floor" treatment

I tried to refer to the female apprentice under the nearby Ortho therapist, and all I got back from their office was an unpleasant note from the Ortho therapist saying, "Surely you're kidding with this guy, right? If you're not, we're not interested." Made me feel about two inches tall for even trying to refer to them, but in the end I decided it was their attitude problem.

:evil:
ugggh. Why did they even bother, you know? That's terrible.

I have appreciated this thread, FWIW. Just wanted to say thanks to you for bringing it up, & those who have responded. Hopefully anyone else with experience can chime in, at least.

 

[take it or leave it]

"Pelvic Floor" treatment

Barnes offers some internal pelvic floor work training that is amazing stuff, I got to experience some of it during my apprenticeship last June in Sedona. Maybe next time you can refer them to the site http://www.myofascialrelease.com and they can see if there is someone who does internal pelvic work in their area. And, that's the thing, in most states in the U.S.(I don't know about all the states) internal work is illegal for massage therapists but there are physical therapists who do it although I don't know what the specific laws are for PT's.