hi® massage protocols to potentially enhance the effects of therapeutic agents for bladder and urinary tract infection.

Contents:

Medical disclaimer and use statement

Rationale for these techniques

Contraindications – when hi® should not be used

Turning hi® on and off, and controlling the settings

hi® Protocols for Female Anatomy

Example routines for using the 3 hi® techniques for female anatomy

hi® Applications for Male Anatomy

Example routines for using the 5 hi® techniques for male anatomy

Overview of the hi® massage system

Educating the patient

hi® online training and live web classes

Medical disclaimer and use statement

Please note:  the techniques referenced in this document are provided as suggestions for qualified healthcare providers to consider as a possible way to enhance the effects of therapeutic agents used to treat chronic bladder infection and urinary tract infection.  This document is not making any medical claims or statements of the efficacy of this protocol.  It is offering it as an option to consider using in conjunction with other currently used protocols.  It also is not meant to diagnose any condition.

If you are a patient, please review this with your health care provider before applying the techniques to make sure they are appropriate for your situation.

If you are a health care provider we ask you to please carefully consider if this approach would be appropriate for your patient’s particular situation.  Please contact us if you have any questions.  We can’t provide medical advice but are happy to share any experiences or technical details.  As well we can refer you to other medical professionals who have experience with this approach.

The massage techniques differ depending on the gender/anatomy of the person receiving the treatment.  Also, please carefully review the potential contraindications for use.

The rationale for these techniques

Bladder and urinary tract infections are a major challenge for men and women.  These infections can often become a chronic, recurring problem because the pathogens that cause these infections often form protective biofilms.  These biofilms can prevent antibiotics and related agents from reaching some of the underlying bacteria.  After the course of antibiotics finishes, the surviving bacteria cause a new infection.  Over time this repeating cycle of infection, antibiotics, and then reinfection increases the chances of antibiotic resistance.

The rationale for these protocols is simple, the percussive and vibratory massage transfers kinetic energy deep into the bladder, urethra, and related areas allowing better exposure of therapeutic agents in the urine and or tissue.  As well it appears in some cases to assist with helping disrupt and break down bacterial biofilms.

Mechanical disruption has traditionally been the only effective solution in other areas dealing with biofilms, such as dentistry.  We are applying that concept to the bladder and urethra via external combined percussion and vibration.

Percussive massage and vibratory massage, combined with postural drainage is an effective, widely used technique for thinning chest mucus, particularly for cystic fibrosis.  As well, a study showed that high-frequency vibration in fluid significantly assists an antibiotic (Tobramycin) killing a particularly aggressive biofilm-forming bacteria (Pseudomonas aeruginosa).

This protocol uses a combination of high amplitude, low-frequency percussive stimulation, and vibratory stimulation in a manner that it is transferred externally into the bladder and urethra.  The goal is to enhance the effectiveness of the antibiotic and related therapies they are currently taking to hopefully end the infection.  

This is of importance since UTI leading to hospitalization and frequently sepsis-related morbidity/mortality has dramatically increased.

The goals of the hi® massage protocols are:

1. To increase the kinetic interaction of the urine/antibiotic mixture with the bacteria and biofilm, hopefully increasing the exposure of the antibiotic with the bacteria.
2. To mechanically disrupt the biofilm, further exposing more bacteria to the antibiotic.
3. To increase the penetration and exposure of the urine/antibiotic mixture to areas of tissue it might not get to otherwise.  For instance, folds and creases of the bladder, and related mucosal tissue may not be fully expanded and thus don’t have contact with the urine/antibiotic.  The goal is that the fluid pressure waves and vigorous mechanical massage will allow the urine/antibiotic mixture to reach deep into these areas.  This can be of more importance with a patient is sedentary or bedridden.
4. To hopefully improve the health and muscle tone of the area by promoting circulation, and in some cases inducing myotatic reflex contractions in the muscles to stimulate growth.  This also can be of importance with a patient is sedentary or bedridden.

The outcome we are seeking is to more thoroughly expose the infected areas to the antibiotics and related therapeutic agents – resulting in completely clearing all of the infection – so it does not return.

Contraindications – when hi® should not be used

hi® is a powerful, percussive, and vibratory massage system.  Percussive massagers have been used in the physical therapy, sports massage, and the consumer markets for decades.   However, like all percussive massage systems, there are some areas where it shouldn’t be used.  

Below are some areas and situations where hi® shouldn’t be used by the general public.  Please note that when a healthcare provider is suggesting using hi® for their patients, an extra review is needed to ensure it is safely used.  This is of particular importance if the patient has an active infection in their bladder, and or urethra.  It’s up to the judgment of the healthcare provider to ensure the patient is a good candidate for using hi®, and that they will understand how to use it properly.

In general, do not use hi® if:

• You have any type of deep vein thrombosis, artificial joints, or related situations where you should avoid vigorous stimulation
• Have any type of abdominal or pelvic mesh, or implant surgery that should not have vigorous stimulation the abdominal and pelvic region
• You are pregnant or think you might be pregnant
• During your period if you have endometriosis, or other conditions were vigorous pelvic massage might not be helpful
• Have high blood pressure where your health care provider advises you not to use hi®
• Are wearing any genital piercings (remove them first)
• Have any type of cancer or unknown tumors
• Have any active infections, open wounds, or bruised areas, or if you have any type of clotting disorder
• Have possible fistula running into your bladder from your bowel.
• Are not in good enough physical health for a vigorous massage
• Have had surgery in the past 6 months, or longer depending on your condition – check with your healthcare provider
• Have any condition or concern you think you should discuss with your health care provider first – particularly for receiving a very intense massage
• Please refer to our user manual for additional areas to consider
• Also do not use the percussive heads of hi® on the sides or front of the neck.  On the face, in front (or behind joints), on the spine or any area that has bones on the surface.  Do not use hi® if you are intoxicated or not able to clearly understand the instructions.

Turning hi® on and off, and controlling the settings

Using hi®:

This video explains how to plug in & turn on/off the hi® unit, plus the speed controls for the percussion and vibration:

To operate the hi® massager:

Plug the AC power supply power connector into a power outlet.  Note that you need to use the appropriate power connector that is compatible and approved for the region you are in.

Connect the DC side of the power connector into the corresponding hi® massager power connector cable by gently inserting the connector so the groves of the power supply side line up with the openings of the massager side connector.

Once inserted gently rotate the AC power supply side of the connector ¼ turn (90 degrees) clockwise until it stops.

To unplug the power from the hi® massager first, unplug the AC power supply from the power outlet and then remove the DC power connection by reversing the above process.

After the hi® massager is connected to power it will beep once.

To turn on the hi® massager, hold the power button down for 4 seconds.  At that time it will beep and the power button will light up.

To increase the percussive speed, press the “+” button to increase percussive speed up 7 steps.  Press the “-” button to decrease the speed.

To increase the vibrating guide speed, press the “+” button to increase percussive speed up 7 steps.  Press the “-” button to decrease the speed.

To turn off the hi® massager, hold the power button down for 4 seconds again after it is turned on.  At that time it will beep and the power button will go off.

For different sensations, you can change out the percussive heads with different stimulation styles. Two extra sets of percussive heads come with the hi® massager.  To change them out, gently pull rubber edge of each percussive head up with your fingertip and “peel it” away from the inner hard plastic percussive head.

To add the new percussive head, first line up the square area on the upper inside of the percussive head to match and fit into the square slot in the inner hard plastic percussive head.  Once it’s aligned press down from the top of the percussive head, then around the outer edges of the percussive head to “snap” it into place.

The carrying bag has a zippered pouch on the outside for the extra percussive heads, a larger zippered space in the bag for the hi® massager.  A zippered pouch on the inside holds the power supply.

For general massage, experiment with the percussive heads and or the vibratory guide.  Specific massage sequences and techniques are available in the optional hi® massager training programs.

Don’t spend more than 3 minutes on any particular spot.  Don’t use the percussive heads on any sensitive parts of the body such as, but not limited to, the sides of the neck, throat, face, eyes, skull, back of knees.  Don’t use directly on any bony or hard parts of the body such as joints, the spine, tailbone, etc.

Make sure to understand the previously mentioned health and safety considerations for when people should not use the hi® massager.

After using the hi® massager for a maximum of 20 minutes, turn it off to let it cool down.

Make sure to keep the hi® massager dry and away from any water or liquids.

hi® Protocols for Female Anatomy

These protocols are intended to help with the following areas:

• Increasing the kinetic interaction of therapeutic agents (such as antibiotics) in the patient’s urine with the mucus membrane in the bladder and urethra.
• Potentially disrupt the infection’s biofilm (if present).
• The percussive motion also may help push urine into folded or creased areas of the bladder, urethra, etc., that urine might regularly reach in sedentary patients.
• Increase general pelvic circulation (which may increase antibiotic exposure to the tissue), while improving tissue health and muscle tone.

The protocols consist of 3 techniques for the hi® unit:

• Lower abdominal massage
• Upper pelvic massage
• Middle pelvic massage

Each technique is performed approximately 3-5 minutes.  We recommend not holding the hi® unit for more than 3 minutes in a specific location, so if the technique is held longer than 3 minutes the unit should be moved slightly.

The techniques should be done minimally once a day.  If the healthcare provider thinks it is beneficial, they should be done twice or three times over the day.  Ideally, the bladder should be as full as possible, allowing it to be expanded with the antibiotic-containing urine.  If needed the patient can wear a thin absorptive napkin for possible urine leakage.

If the patient’s bladder and, or urethra are extremely inflamed or sore due to the infection, care should be taken that the stimulation isn’t too intense.  If the patient feels any pain or discomfort they should try moving the position of, or slowing the speed of the percussive heads.  If the pain continues they should discontinue using hi® and contact their health care provider.

If bladder irrigation is recommended for the patient, the healthcare provider may want to consider having the hi® placed on the lower abdomen intermittently during the process.  The time duration hasn’t been established, but in experimental situations, a patient alternated using the hi® unit for 3 minutes, then pausing for 3 minutes.  This cycle would be repeated during the session.

Please reference this video for the basic operation of hi®.  Once you are familiar with starting and stopping hi®.  Please review the three techniques for female applications.

Position #1  lower abdominal area

hi® is placed sideways on the lower abdomen, just above the pelvic bone.

The diagram below provides an overview of the technique.

Place the hi® on your lower abdomen just above the pelvic bone.  Turn on the percussive heads and increase the percussive speed as high as comfortable.  If anything feels uncomfortable, move the hi® unit to a different location, or decrease the speed.  If there is any pain or significant discomfort, stop using hi®, and contact your healthcare provider to get their input before continuing.

After hi® is turned as high as comfortable, move it around slightly and notice how the feeling changes.  There will be a location that for many people makes them feel like they have to urinate.  Try holding it there for at least a minute.  A light absorptive napkin can be worn if you are concerned about urine leakage.  Then try moving hi® around to different locations on your lower abdomen.   

Your healthcare provider can offer more details on this in your live training session.  Also please note that if you have significant abdominal fat, this position may not work optimally.  However, there are some alternate techniques your healthcare provider may suggest trying.  Please ask them if you have any questions about this.

Position #2 – upper pelvic area

hi® is placed on the pelvis above and below the pelvic bone (pubic symphysis) with, or without the lower blue vibrational guide turned on.

The upper percussive head applies percussive stimulation above the pubic symphysis (pelvic bone), resulting in a compression wave traveling into the lower abdomen directly above the bladder.

Simultaneously the lower percussive head applies percussive stimulation below the pubic symphysis, sending a compression wave into the mons pubis.  This compression wave travels directly through the area of the urethra and urethral sphincter.

The diagram below provides an overview of the position for the technique (without the blue vibratory guide turned on).

To do this, place the upper percussive head (near the handle) of hi® just above your pelvic bone on your lower abdomen.  The lower percussive head (close to the blue vibe guide) is under the pelvic bone on the mons pubis area.  Turn on the percussive heads and increase the percussive speed as high as comfortable.  If anything feels uncomfortable, move the hi® unit slightly to either side or decrease the speed.  Then turn on the blue vibratory guide and increase the speed to as much as is acceptable.  Our observation has been that the combined percussion and vibration stimulate the entire region, as well the vibration appears to activate the bulbocavernosus reflex causing contractions in the urethra. 

The diagram below provides an overview of the position for the technique with the blue vibratory guide turned on.

If there is any pain or significant discomfort, stop using hi®, and contact your healthcare provider to get their input before continuing.

After hi® is turned as high as comfortable, move it around slightly and notice how the feeling changes.  There will be a location that for many people makes them feel like they have to urinate.  Try holding it there for at least a minute.  A light absorptive napkin can be worn if you are concerned about urine leakage.

Make sure the percussive heads are not on the pelvic bone, as this isn’t comfortable and can hurt. 

Sometimes this can be done better sitting on the edge of a bed and then leaning back, as in this image below.

Also if the patient is significantly obese, the angle of the hi® must be changed so it isn’t as parallel with the body.  This reduces some of the bladder stimulation but still allows stimulation to the pelvic region.  However, there are some alternate techniques your healthcare provider may suggest trying.  Please ask them during the live training session if you have questions about this.

A video demonstrating the upper pelvic massage is here

Another position that can be tried is doing this technique on the side of a bed.  Shifting the angle of the hips can alter the angle of how percussion is transmitted.

Position #3 – middle pelvic area

hi® is placed on the pelvis with the upper percussive head just below the pelvic bone (pubic symphysis) and the lower percussive head on the rectum.

The upper percussive head applies percussive stimulation just below the pubic symphysis (pelvic bone), resulting in a compression wave traveling into the mons pubis region.  This causes compression waves to travel directly through the path of the urethra and urethral sphincter, back towards the bladder.

Simultaneously the lower percussive head applies percussive stimulation around the anus.  Please NOTE – do not apply the lower percussive head on the tailbone (coccyx), instead make sure it is above that area. 

This appears to strongly stimulate puborectalis, pubococcygeus, and iliococcygeus muscles, while also very rapidly triggering the bulbocavernosus reflex.

The diagram below shows the general placement for this technique.

The vibratory guide can also be turned on to further stimulate the region.  If anything feels uncomfortable, move the hi® unit slightly to either side or decrease the speed.  Then turn on the blue vibratory guide and increase the speed to as much as is acceptable. 

The diagram below shows the placement with the vibratory guide turned on.

  Our observation has been that the combined percussion and vibration stimulate the entire region, as well the vibration appears to further activate the bulbocavernosus reflex causing contractions in the urethra.  These internal contractions may help increase possible antibiotic exposure.  If there is any pain or significant discomfort, stop using hi®, and contact your healthcare provider to get their input before continuing.

After hi® is turned as high as comfortable, move it around slightly and notice how the feeling changes.  There will be a location that for many people makes them feel like they have to urinate.  Try holding it there for at least a minute.  A light absorptive napkin can be worn if you are concerned about urine leakage.

Also, this position works well if the patient is significantly obese, the angle of the hi® must be changed so it isn’t as parallel with the body.  This reduces some of the bladder stimulation but still allows stimulation on the pelvic region.  However, there are some alternate techniques your healthcare provider may suggest trying.  Please ask them during the live training session if you have questions about this.

This transfers percussive stimulation to the entire pelvic floor region.  The urethra and vaginal canal are directly stimulated by this rapid compression, but at a more direct angle than the upper pelvic massage technique.  This also appears to improve circulation, and over time tissue integrity in the entire region.

The lower vibrating guide is bent outward and behind the coccyx and is optional.

Please note that the legs don’t have to be lifted, this was to help demonstrate the position

Example routines for using the 3 hi® techniques for female anatomy. 

If possible, have the bladder partially full or fully with urine (assuming the patient is also taking antibiotics or related agents).

1. Provide lower abdominal stimulation for at least 3 minutes.
2. Then provide upper pelvic stimulation for at least 3 minutes
3. Then provide middle pelvic stimulation for at least 3 minutes.
4. Then urinate (if possible only ½ the bladder volume) and repeat the above 3 techniques
5. Then urinate the remaining amount and repeat the above 3 techniques again.

If possible, do the above procedure twice daily, in the morning and evening.  Or if recommended by your healthcare provider, perform the routine additional times.

Assuming the health care provider thinks this is a good option, you may want to include D-mannose supplementation also with their antibiotic or similar medical prescription.   Then for a month after the end of the antibiotics, and the end of the symptoms, continue taking the D-mannose supplementation and performing the daily hi® protocols.

hi® Applications for Male Anatomy

Below is an interview with Dr. Andy Davis discussing his personal experience using hi when he had a chronic bladder and Urinary Tract Infection.