Ok so i have pelvic floor dysfunction (painful muscle spasms in my lower pelvis) and pudendal neuralgia. I DO see a pelvic floor physical therapist, and yes i know some of ya'll might think that's a bad thing, but i'll explain why in a minute. First of all, she does believe in TMS and mind/body approaches (she's seen it in action with her own neck pain) but at the same time, when she does internal pelvic work, she feels all the tightness and triggerpoints that squash the sensitive nerves, so i guess you could say she's into both the physical and mental side of things. I know that going to her will not cure me, but it seems to stop me from getting worse. Mainly because i will sometimes get a horrid muscle knot/trigger point right on top of the nerve and i cannot break it up myself. She said that not all triggerpoints cause pain. People can have many triggerpoints that are not symptomatic at all. however, they almost never just go away on their own. I understand some people here might argue with this, because now we're talking a "physical" issue. But i know my brain is creating this tension in my pelvic floor, and creating the knots. She agrees with this. So anyway i was doing so well for a while. Not pain free, but my baseline pain was down and i was managing it well and feeling hopeful. Then about a month ago, i had a fight with the boyfriend, did a long bike ride (remember, i have PN, and bikes can be quite irritating, even though with mind/body techniques i have gotten back into casual riding), and a stressful work week, i started getting severe pain. I was even waking up in the middle of the night with pain, and that NEVER happens. Also, i would wake up in the morning with almost immediate pain, which also never happens. Generally my nervous system is calm when i've been sleeping (also a clue that it's TMS) so the fact that i now had 24hr pain made me assume it had to be a bad knot. I called the PT and when she did an internal exam, she immediately said "WOAH! this is the biggest knot i've ever felt on you, and it's right on top of the nerve". She broke it up, and i only felt a bit better, but the pain returned very quickly. I waited an agonizing week to see her again, and she said the knot was back in the exact same spot, but smaller. She broke it up, and same thing, i felt better for a short bit, but the pain returned with a vengeance and i'd go back only to be told the knot was back in the exact spot, but a bit smaller. This has been going on about 4 times now. I asked her, "why does this knot keep coming back in the same spot? and will it ever stop?" She said it's probably a muscle memory thing at this point, but luckily it keeps getting smaller so we may be beating it. She also said that my brain probably thinks the area is in danger, and it's upping the sensitivity of the nerves and the muscles are tightening and acting accordingly. Naturally, i'm beside myself because i fear the knot coming back every time she releases it. I know it's my brain doing this, creating this tension that knots up the muscle, but of course that doubt is creeping in that "you have a physical problem". Seriously, i was doing so well. i dont know how to use my brain to stop this muscle from doing exactly what it wants to do, and that is create a giant knot in the same place about 1-2 days after it has been worked out. I try to be calm, i try to listen to meditative videos and breath, but i'm losing this battle. Any advice? I try not to think about the knot coming back, but all it takes is one little stressful event about 1-2 days after the triggerpoint release, and boom, severe pain that wont stop (the knot forms). Please dont tell me that PT is a crock, because this one actually believes in mind/body approaches and i am very aware she will not cure my TMS. I always knew this. It's a matter of breaking up problematic knots that i use her for.