Possible treatments

General relaxation

Relaxation is an important part within treatment. When you are relaxed, your muscles are looser, you breathe more calmly and you also feel better. But if you have pain and symptoms, your body may not feel comfortable at all. This makes it more difficult to relax.

To help you relax, within our clinic we primarily use "paradoxical relaxation" as developed by Dr. David Wise. You learn to accept that your body feels the way it feels. If you can do that, it is easier to let go of tension in your body: you start to de-stress.

Towards relaxed breathing

When we breathe in, the lungs fill up with air. The abdomen bulges and especially the lower ribs move apart. On the exhale, the abdomen and ribs return to neutral position. This is relaxed breathing.

When under stress, tension and pain, muscles can tense up. Perhaps without you noticing it. If the muscles in the torso are tense, the abdomen cannot bulge. And some people don't want their belly to bulge; they like to hold their belly in. But the lungs do need room to fill with air. If the abdomen doesn't give space because of tense muscles, the upper ribs in particular expand. You then feel and see breathing at chest level, or higher. Sometimes the muscles around the chest and shoulders are also tense. Then relaxed breathing may seem impossible.

But with patience and attention, you will learn how to relax tense muscles. This gives space and peace of mind. It immediately helps reduce pain, as the pressure in your body decreases with each relaxed inhalation and exhalation.

Damping the pain

Muffling the pain is the most important thing; all treatments aim to make you experience less pain and thus make it easier to do what you want.

Pain and your daily life

Those who often have a lot of pain want to avoid the pain being there or getting worse. As a result, many people start moving differently or they prefer not to move at all. Pain can affect sleep, pain can cause stress and make you feel lousy, it can affect what you eat. In short, pain can have a huge impact on your daily life.

How is that with you?
You can tell us. Then together we can see what you can do about it. We advise you based on the latest scientific insights and from our years of experience. If you wish, we will give advice with or on behalf of you to your employer or family members.

The Wise-Anderson Protocol (Stanford Protocol).

Years ago, Fetske Hogen Esch was the first European pelvic physiotherapist to be trained in the Wise-Anderson Protocol. She treats you according to this protocol and teaches you what you can do yourself at home. The interpretation of the protocol differs per person; it is tailor-made.

Did you learn the Wise-Anderson Protocol in the US? We can guide you through your self-help program.

The Wise-Anderson Protocol was developed in America by urologist Rodney Anderson and psychologist David Wise(www.pelvicpainhelp.com).

Pelvic physiotherapy

Physical therapy for the pelvic floor, pelvis, low back and lower abdominal-bill region is called: pelvic physical therapy [LINK to movie?]. You will learn, for example, to feel when a muscle is tense or relaxed. And you will learn how to tighten or relax a muscle yourself. Pelvic physiotherapy is also about how you sit, stand, walk, lie and move. A small change in how you sit, walk, lie, stand or move can already affect your (pain) symptoms.
If, after our examination, we believe that pelvic physical therapy is right for you, we will be happy to refer you. It is very important that the pelvic physiotherapist you see specializes in treating chronic pelvic pain and has experience with our treatment plan.

You can also choose our own practice Bekkenfysiotherapie Hogen Esch. If you do not live in (the vicinity of) Enkhuizen, we are happy to refer you to a pelvic physiotherapist with special attention and interest in pain treatment in your own region.

Treatment of joint pain in the back, pelvis, hips and tailbone

If a joint isn't working properly, muscles can't do their job properly either. Or there may be pressure on a nerve. The result: pain and/or movement problems.

If the examination shows that you have joint pain, we can treat it. We treat the joint, the tissues around it (joint capsule) and the muscles around the joint. You can exercise yourself at home.

For a crooked tailbone, we use the NIMOC, a new treatment option. You can see an explanation in this broadcast of One Today The treatment goes as the gentleman in this video says: one hand under the butt and turn the torso so that it comes back above the tailbone.

Good to know: we work with other back pain practitioners such as manual therapists, manual practitioners, chiropractors and osteopaths

To relaxed and supple muscles

In many people with chronic pelvic pain, the muscles in the pelvic floor or abdomen are painful and tense. Other muscles around the pelvis may also be tense: back muscles, the muscles of the diaphragm, gluteal muscles and leg muscles. It is nice when the tension in these muscles returns to normal. If you have painful muscle knots (trigger points are called them), we treat these as well.

Do you know what it feels like when a muscle is tense or relaxed?

During treatment, you will practice this. 'This is what it feels like when a muscle is tense. And now the muscle is relaxed. What is the difference? How can I myself make sure that that muscle stays relaxed if I want to?'
You get to know your body better. And you know better what you can do to relax.
For these exercises we use methods that allow you to see the difference. With an ultrasound, for example, you not only see how your muscles look when you tense or relax them. You can also see the effect on the surrounding tissues and organs.

Many people find this very instructive to see.

We treat the muscle knots by making sure they get good blood flow. The muscle can then relax. We use pressure massage, special needles (dryneedling) or active cell therapy.

In addition, stretching exercises are very good. We will do these with you and you will learn how to do the exercises yourself.
Stretching exercises are also good for the muscles of the pelvic floor. You will learn to stretch these muscles with a rod because the muscles are hard to reach [LINK]. This may be weird to do the first few times, but it helps a lot.

It is important to keep moving. Walk, bike, swim, dance ... do what you can and what you enjoy. Exercise circulates the muscles and helps you relax.

All muscles in balance

When it's good, muscles work together. But sometimes there is no balance. Then one muscle does too little and the other muscle has to work harder. That muscle can then become overloaded and can no longer relax.

We are going to train the muscles that need to become more active again. We do that with exercises.
When those muscles can do more, the overworked muscles can take it easy. Those muscles learn to relax again. You also practice this.

In these exercises, you will learn to feel the difference between a muscle that is working and not working.

In doing so, we also show you what the difference is. With an ultrasound, for example, you can see what your muscles look like when you tighten or relax them. You can also see the effect on the surrounding tissues and organs.

Many people find this very instructive to see.

Good to know: it can take quite a long time to rebalance all muscles. It's not a quick fix; be patient!

Room for irritated nerves

When a nerve is under pressure, it feels like pain. A tense muscle can push on a nerve. Or there is a thickening in connective tissue, such as scar tissue after abdominal surgery. With our treatment, we make sure that the nerve is free again. This involves exercises to relax the muscles or to use muscles in a slightly different way. Massage can help make scar tissue more flexible. We also use techniques to make the nerve movable; neurodynamics is called that. Sometimes this also means we treat a joint.

You will learn exercises that you can do yourself at home.

Scars without pain

When a wound heals, a scar may appear. Almost everyone has a scar on his or her skin. When a wound heals ín the body, such as after surgery, a scar can also form. Such a scar can be "too tight"; then tension or irritation develops. Targeted scar massage improves circulation and makes the scar more supple. Active cell therapy and dryneedling have the same effect.

Better circulation

The blood in our body carries oxygen and nutrition to every cell. And it carries away waste products. So good blood flow to all parts of our body is important. This also applies to all parts and structures where you experience pain or reduced function. To improve blood flow, we treat with massage, exercises, electrotherapy (tens), active cell therapy, heat or ice.
Keep moving yourself, because that helps too!

Balancing the nervous system

After a long period of pain, the nervous system and our brain process pain stimuli differently. Stress also affects this.

We will give you many explanations about how chronic pain occurs and why you may feel pain in places where there are no abnormalities at all. If you understand this, you will also deal with the pain differently. For this part of the treatment, we work closely with psychologists specializing in pain.

Coordinating care (case management).

For many people, it is better if they have multiple practitioners, each with their own specialty. It is important that these practitioners complement each other. They need to know from each other what they are doing and with what results. If you wish, we will coordinate this coordination for you.

Digital coaching

As you begin to work on your treatment plan independently, you may need some remote support. Especially in the first few weeks, you may feel uncertain. Am I doing the exercises right? Am I doing too little or too much? I notice some changes: is that the intention?'
We can guide you through a Skype or FaceTime consultation.

F-active All-in-One Program

We developed this program for patients who come to us from abroad. But many Dutch patients also like this compact program.

It is effective to have the diagnostic consultation followed by individual treatment in our clinic. We treat you, explain your complaint, and we instruct you on how to treat the symptoms yourself. You will learn exercises from us that you can properly and safely do yourself at home.

With patients who have to travel far, we schedule this program on three consecutive days. With patients who do not have to travel as far, we schedule more widely. You may first come for a few hours to learn what you can do on your own. Then you will start working on your own. After a few weeks, we discuss how things are going. If necessary, we can adjust your program.

The F-active All-in-one Program is spread over three days:
Day 1: Diagnostic consultation (4 hours).
Day 2: 4 hours of individual treatment and instruction to treat your symptoms yourself.
Day 3: 2 hours of individual treatment and instruction to treat your symptoms yourself.

For patients from the Netherlands, we have adapted the F-active All-in-One program. The program of 6 hours of individual treatment is divided into 3 consultations of 2 hours of individual treatment with 3 weeks in between. You start working on your own for 3 weeks each time after two hours of treatment. You learn what you can do yourself and we offer you a framework with which you can continue treatment with a specialized pelvic physiotherapist in your area with whom we have short lines of communication. It is of course always possible to come three days apart.