Pelvic pain progress sitting but standing pain...

[Jamesrec55]

Taking on Dan bulgio's approach of graded exposure to the posture where the brains learned pain alongside messages of safety and just behaving in a way in which tells the subconcious its not in danger has completely got rid of my sitting pelvic pain basically. I stopped doing belly breathing somatic tracking stuff which got me nowhere. This is after 10 years of struggling, endless physio, endless massage stuff even bought my own tools for it, finally getting an improvement and a big one at that.
Anyways issue right now is i actually started out with standing pelvic pain and maybe minor sitting pelvic pain at best. I just havent been in a situation where i've had to stand for long in the last 5-6 months since adopting Dan's approach. I've sort of adapted my desk to a standing desk, perhaps not at the perfect height, but man standing is tiring, forget the pain aspect like standing and doing work is just urgh makes it that much more dull/tiring. Im doing leg training at the gym now again so hoping that will improve my standing endurance.

With sitting i basically just made a point to sit for long periods, like 8/10 hours gaming and doing messages of safety it has completely changed it. Standing for this long though i mean, i dont have a standing job like bartending or shop work. Doing computer work standing is as i said makes it much more a chore. Dont really want to game and stand either. My question is like with this graded exposure stuff do i need to do long duration exposure to prove to my brain i can stand like i did with sitting. Or is frequeny small moments of 5 minute standing 10-15 times throughout the day just as effective?

With my sitting pelvic pain the way i experienced pain was the longer i sat my pain would get exponentially worse. So by me sitting for long periods i was proving i was fine. Dont really want to stand for 3-8 hours unless ive got some purpose/engaging thing im doing. Like standing just feels tiring, more so then walking to be honest. I'd rather walk for 3 hours then stand for 3 hours but walking has never given me pelvic pain so its not challenging my brains learned pain response.

Im also hoping by fixing the standing pain my hard flaccid and urinary issues(often comes with pelvic pain) will also fully resolve. I hoped they'd improve since me fixing my sitting pain but they didnt really. But if im still not able to technically stand for long and clearly bracing my pelvic floor when standing even if im not standing much i think it make sense that other smyptoms wont fully go until i challenge all postures sitting and now standing.

EDIT: maybe for work i should get some kind of leaning stool thing so im still standing posturally but not getting as tired. 'Werkfox® Standing Stool' - this one looks like you'd still mostly be standing but have something to lean against

 

[BloodMoon]

Hi @Jamesrec55. Some people go all gung-ho or hell for leather when challenging their brain/symptoms (like suddenly standing for many hours a day, as you're suggesting), and that has apparently worked out well for them. For many others, like me, it doesn't, because it scares the brain too much and it ramps symptoms up to an unbearable level. A gradual, "baby steps" approach has worked much better instead; you can 'fly under the radar' with your brain regarding your activity if you do that.

Most people probably spend more time sitting than standing during the day (unless, as you say, our job requires us to be on our feet) so, as I'm gathering that applies to you, I'd gradually introduce your brain to spending more time standing by just weaving it more naturally into your life, e.g. if you'd normally sit down at a kitchen table to peel and chop vegetables for dinner, instead stand to do it. Now that you can sit for however long you like, you can choose to alternate between sitting and standing.

When I started my mind-body journey, I was bedridden and couldn't stand for more than two or three minutes without excruciating pain. By taking a gradual approach, I'm now living a relatively normal life and can stand for long periods. That said, I can't honestly say whether my brain would let me stand for 4–8 hours without it asking, "Are you sure this is safe?" and producing some symptoms, simply because I haven't tried it (and I don't plan to!).

Personally, I think doing lots of shorter periods—say, five minutes of standing 10–15 times throughout the day—would likely be just as effective for you (albeit possibly a slower process than if you took a more 'unnatural' forced gung ho approach and it were to work for you and not frighten your brain). I remember that, at one point, I'd just been standing for a maximum of 35 minutes in one go each day... Then circumstances suddenly meant I needed to stand for a couple of hours a day, and I was able to do it with no problem. I remember being quite amazed and, of course, pleased by that!

The fact that you don't want to stand unless you have a purpose or something engaging to do is actually a positive. In my experience, the brain is much more accepting of increased activity—or of being in a position it's previously decided is "unsafe"—when you're also showing it that everything is fine/safe because you're simply getting on with normal life, like answering emails or doing another everyday task...

For example, I stand in my living room while watching TV, frequently breaking it up with a bit of light exercise every so often—walking on the spot, hip circles, arm circles, that sort of thing. I still do that every day for a couple of sessions of around 35 minutes. In fact, once I've finished writing this post, I'm going to watch some of the men's tennis singles final at Wimbledon on TV while standing. I've just made standing a bigger part of my life than it used to be, but not excessively so. To me now, a cue to get up and stand for a while is the TV being put on. It's become a habit and one that has the bonus of being generally good for my health.

I've not used one, but I think the standing stool for your desk is likely to be a good idea too. I'd just introduce it gradually so your brain is less likely to rebel.

 

[Adam Coloretti (coach)]

Dont really want to stand for 3-8 hours unless ive got some purpose/engaging thing im doing.

I don't think you should either, because where does it end? I can't remember the last time I had to stand for 8 hours consecutively, so whilst I could assume that it wouldn't cause my pain to return, I couldn't be sure (and if I tried it, my brain would think what on earth is he doing? I would have more of a chance of inferring something is wrong by trying it). It worked for you as you said because you had another purpose, I'd let life dictate your exposures. Don't restrict yourself (don't say no to things that would mean you would have to stand), but at the same time there's no need to seek it out/artificially create it because being natural and living your life is the best way to send safety in my opinion (i.e. the best way to prove to your brain that nothing is wrong is to act like nothing is wrong, which means living naturally and normally)

 

[Jamesrec55]

I don't think you should either, because where does it end? I can't remember the last time I had to stand for 8 hours consecutively, so whilst I could assume that it wouldn't cause my pain to return, I couldn't be sure (and if I tried it, my brain would think what on earth is he doing? I would have more of a chance of inferring something is wrong by trying it). It worked for you as you said because you had another purpose, I'd let life dictate your exposures. Don't restrict yourself (don't say no to things that would mean you would have to stand), but at the same time there's no need to seek it out/artificially create it because being natural and living your life is the best way to send safety in my opinion (i.e. the best way to prove to your brain that nothing is wrong is to act like nothing is wrong, which means living naturally and normally)

Thanks a lot for the responses guys. Thing is i think have been largely living my life normally the last 5 months while making a point to sit a lot which has as mentioned removed my sitting pain. I'd say i didnt go gungho per say, like if pain got bad i'd allow myself to stop, i just was consistent and my pain improved quite quickly. I never allowed my pain to get really bad. Also i was keen to play pc games again so i was motivated.

Its only recently when ive been in a position where ive needed to stand mostly still for so long watching football games at the pub. So it would seem the last 5 months hasnt changed how my brain percieved longer durations of standing, and i think my body does brace when standing in the pelvic floor, lower abs when i felt them for the first time in standing i was like damn those are clenching. And i think while i dont have to stand long often i think it still might be effect the hard flaccid/urination/ED thing because sincce trying to stand more thats actually been getting better whereas i hit a real dead end with that. Going to the gym and going full out lower body wise seems fine.
I think my brain/if this is how it works... has learned through reptition in the past that standing for long periods causes the pain, so even though ive not thought or worried about it and of course not been exposed to it not through avoidance either, suddenly then going into that scenario again its going back to what it knows. I think i will adopt Bloodmoon's approach - thanks for sharing that it makes sense why it would work... of not limiting myself to having to do long one off periods and just doing it maybe frequently but in shorter burst windows of 30ish minutes a couple of times throughout the day. Just actually getting comfortable with the position itself because i think i avoid standing subconciously because i find it tiring but i need to build some sort of healthy endurance i reckon for it.

I also shared this hopefully as some hope for others because i cant tell you how much better things are and how effective the approach with sitting was. Perhaps i'll tune it down for standing make it more measured/gradual. Or become a Kings Guard or something lol.

 

[cafe_bustelo]

Thanks a lot for the responses guys. Thing is i think have been largely living my life normally the last 5 months while making a point to sit a lot which has as mentioned removed my sitting pain. I'd say i didnt go gungho per say, like if pain got bad i'd allow myself to stop, i just was consistent and my pain improved quite quickly. I never allowed my pain to get really bad. Also i was keen to play pc games again so i was motivated.

Its only recently when ive been in a position where ive needed to stand mostly still for so long watching football games at the pub. So it would seem the last 5 months hasnt changed how my brain percieved longer durations of standing, and i think my body does brace when standing in the pelvic floor, lower abs when i felt them for the first time in standing i was like damn those are clenching. And i think while i dont have to stand long often i think it still might be effect the hard flaccid/urination/ED thing because sincce trying to stand more thats actually been getting better whereas i hit a real dead end with that. Going to the gym and going full out lower body wise seems fine.
I think my brain/if this is how it works... has learned through reptition in the past that standing for long periods causes the pain, so even though ive not thought or worried about it and of course not been exposed to it not through avoidance either, suddenly then going into that scenario again its going back to what it knows. I think i will adopt Bloodmoon's approach - thanks for sharing that it makes sense why it would work... of not limiting myself to having to do long one off periods and just doing it maybe frequently but in shorter burst windows of 30ish minutes a couple of times throughout the day. Just actually getting comfortable with the position itself because i think i avoid standing subconciously because i find it tiring but i need to build some sort of healthy endurance i reckon for it.

I also shared this hopefully as some hope for others because i cant tell you how much better things are and how effective the approach with sitting was. Perhaps i'll tune it down for standing make it more measured/gradual. Or become a Kings Guard or something lol.

Watching football at a pub seems like a great way to challenge this conditioning, though something that's helped me with similar things is to always have an out; i.e. be fully comfortable with excusing myself from the situation so I never feel trapped or like I have to be in an uncomfortable situation for longer than I want. Oftentimes when I know I can leave I end up staying longer and having less (or no) symptoms than I might have if I had the mindset "I have to get through this or else."

I would also suggest—and I think this is advice I received from @Adam Coloretti (coach) —that you don't actually focus on the physical symptoms; perhaps don't even name them. They really are just signals your brain is sending and I've found it better to react to them in the abstract kind of, like, ok, this is happening, but I know it's not a physical problem so I'm not going to worry about it and moreover I'm going to act as normally as if it weren't happening at all instead of physically cringing away from the feeling or trying to manually relax my muscles. It's more likely that your brain is actually sending the physical sensation of tightness as a warning signal than that there's actually dysfunction with the muscles in your lower abs/pelvic region. I have felt this same discomfort and I find that it really is just a matter of getting my attention off of it and then it often disappears (easier said than done at first, but also not that hard once you get the hang of noticing and not reacting).

I've come to think of it like this where there are MANY sensations I can feel in my body if I really focus on them, like tension in my shoulders, tension in my legs, tension in my jaw, my breathing, my heartbeat, whether my nose is stuffy or not, the dryness of my eyelids, etc etc I'm just coming up with examples. What's going on with TMS is that any of these normal sensations in a certain area are being amplified or sent by the brain when there's no need for them, like in this case having to pee or feeling like your abs are cramping (I've had both of these and am well on my way to getting over them), and this is mainly conditioning left over from when you were afraid that something was wrong with your body, plus any emotional triggers (like social pressure to act a certain way).

At the end of the day your symptoms are the same as anyone else's symptoms in that they are your brain trying to keep you safe, emotionally, and focusing on any physical cause will not get you anywhere. I found Claire Weeke's advice to "not be bluffed by any symptom or feeling" that you have; however unpleasant it feels, it doesn't actually mean anything is wrong with you, despite what 99% or 100% of what, say, pelvic floor physios will tell you. The proof of this is in the success stories for various pelvic symptoms where as far as I've read the only people who have 100% recovered have done it through TMS work. I think the PT approach is complicated and hard, whereas by comparison the TMS approach is almost too easy (or if you don't think it's easy, it's at least simple as Dan Buglio is often saying).

Edit: And one more note that in my view at this point "hard flaccid" is basically just the latest mindbody boogeyman symptom (like ulcers back in the day, or back pain of course) in that it's a normal physiological/stress-based response to being in a situation of danger or being in the cold. i.e. to use the classic analogy for our primitive nervous systems if you did a cross section on a caveman fighting a sabre tooth tiger in the freezing cold I bet for sure his testicles and penis would be shriveled up! The only thing that's going on with anyone who has this symptom is that their brain just got scared and has received no new evidence that you're not in danger, because you're still focused on the symptom. Once you get your attention off of it and focus on living life and not reacting to sensations/symptoms, even visible ones, it'll go away on its own, probably without you noticing. The name is something that scared people who aren't doctors invented, and succeeded in spreading this fear to a larger number of people (and now there's even some medical interest because where there's a critical mass of scared people, there's profit to be made). I can sympathize on some level, but in any case this explanation that it's a natural bodily response to a higher level of fear in the autonomic nervous system makes wayyyy more sense than anything structural or any muscular weakness or dysfunction.

 

[Diana-M]

@Jamesrec55
There’s this app I use to remind me to stand up. It’s called, “Stand Up” (no surprise in the name!) It’s free. You can set how frequently you want to be reminded; how long you want to stand before you’re reminded to sit; the hours of the day you want the reminders to start and stop; and the little sound it will play. It’s pretty helpful on days I’m in the mood to stand and annoying on the days when I’m not. But needless to say— you might like it.

 

[Jamesrec55]

“instead of physically cringing away from the feeling or trying to manually relax my muscles.”

I defintely a gree with avoiding this, and its a huge thing in the pelvic floor space especially from the actual practioners/specialists. I was never able to consciously ‘relax’ my pelvic muscles, they’d try and get me to do reverse kegels, feel the pelvic floor drop...belly breathing, trying relaxing it in a stretch, I’d never feel some magical release. It never reduced pain either. And I think its counterintuitive because your bringing fear and attention to it. Your saying this area is dysfunction please let up, please relax and it just doesnt work. Like right now i dont have any sitting pelvic pain, i couldnt tell you if my pelvic floor is feeling more relaxed/released then it used to when i had really bad pain, its just not painful.

I also agree with the hard flaccid take, i've recently changed how i view it, i dont think hard flaccid is an abnormal state of the penis like you said, all men have it when lifting heavy weights or if they are doing something in which the body is going to prioritise pushing blood elsewhere. I found whenever I was on a plane flight or socialising with mates outside the house or even when sitting and gaming talking to mates my hard flaccid would go because my brain wasn’t focusing on it or with the brain my brain was more focused on being at altitude in a large metal bird. And I have since adopted a policy of just not giving it attention and checking it, there was a guy in Dan Buglio's YT channel that said his hf went away in weeks when he stopped paying it attention. And yeah its been better. I do think improving my standing pain will further improve it. I mean my hard flaccid has always been worse when standing, it would often go from normal to hf as i get up in my room. Im confident that will improve.

I agree with the take on hf too with what you said at the end. I honestly think hard flaccid is just the male form of vaginismus. The penis is in a continual protected state - not a damaged state. I had no pelvic or penis injury, no sudden moment of ouch or anything. (Warning dick/sex talk skip paragraph to avoid) I think I just among stomach issues and anxiety in my youth and doing too much rough masturbation, the penis went into a protected state. Sorry to give such details but this might be helpful for those reading with this issue, to improve hard flaccid I’ve also switched to only using this rubber sleeve for masturbation it basically mimics vaginal penetration which is what the penis is designed for - not for a what often defaults to a rough grip. In hindsight is it any wonder the penis retracts and stays in a scared state when doing that, I used to kegel during sexual practise excessively while watching porn, which already puts the nervous system on edge beyond what regular sex does. With typical hand grip masturbation you are tugging more on the internal structures linked to the pelvic floor versus penetration.

I also totally got rid of the fear of thinking as you say anything is wrong with my pelvic floor. I totally ditched stretching and physiotherapy I got nowhere despite getting stronger and more flexible. I think people get stuck because maybe their brain does reduce pain when people proactively work on doing something to fix it and believe it will work. At one point my pain did get a bit better from a routine I did but it then got worse again for many years and I never got back to where I was despite getting stronger and more flexible. I once did DCT where you were told strength training puts tension into the body and you need to resistance stretch it out... back then even body weight stuff massively flared my pain. Now i can deadlift with full effort no issue. It was all about what i believed that resulted in whether i got flares in pain. It just took graduated exposure.

I think im just going to do spells of standing throughout the day when i can, when it suits. Thanks for the suggestion Diana, i think i might avoid timing it for now, as i dont know if by tracking it im sort of putting too much attention on foxing it per say. Thanks for the responses!

 

[Adam Coloretti (coach)]

It never reduced pain either. And I think its counterintuitive because your bringing fear and attention to it. Your saying this area is dysfunction please let up, please relax and it just doesnt work. Like right now i dont have any sitting pelvic pain, i couldnt tell you if my pelvic floor is feeling more relaxed/released then it used to when i had really bad pain, its just not painful.

Same and I completely agree. My sitting pain is all but gone but I couldn't tell you if I am more or less tight, odds are I'm more tight in that area than I used to be (so it clearly wasn't that).