The Makous Protocol

Course Objectives:

• Describe why a therapist should choose the Makous Protocol.

• Describe the Makous Protocol progression, compliance, and relapse.

• How I determined the parameters of the Makous Protocol.

• Describe traditional IES Protocols and Parameters based on literature and textbook reviews.

• Describe my theory of how traditional protocols and parameters were developed.

• Present Research Indicating the ineffectiveness of traditional IES Parameters.

• Bonus section: Describe my clinical approach to using Internal and External ES for pelvic as well as head and neck cancer patients.

• Describe the factors that facilitate the clinical effectiveness of the Makous Protocol.

• Describe how to determine which patient is appropriate for the Makous Protocol.

• Relative Contraindications and Contraindications to using the Makous Protocol.

• Describe therapist requirements:

• Ability to make an accurate physical therapy diagnosis

• Sound clinical reasoning skills

• Ability to be creative with wisdom

• Provide extensive clinical examples of the power of the Makous Protocol to be creative in meeting the needs of many patient populations.

• Summarize my theories of why the Makous Protocol works.

• Provide a video demonstration presenting details of how I educate my patients to use The Makous Protocol at home.

• Case Studies

Case Descriptions:

Two cases will be presented to help the therapist understand the power of using the Makous Protocol to strengthen the entire pelvic floor vaginally or rectally.

One case study will be of an 84-year-old female with severe Grade 3 Cystocele (Stage IV based on POP-Q) causing urinary urge incontinence (UUI) and hesitancy with retention if she does not strain the get urine out.

The second will be of an 80-year-old male with severe urinary incontinence (UI), chronic urinary tract infections (UTIs), and erectile dysfunction (ED) caused by a Transurethral Resection of the Prostate (TURP) performed three years prior. The patient uses a penile clamp, condom catheter or adult diaper at all times. Other complicating factors include history of open heart surgery, hernia repair, and chronic pain and constipation due to Rheumatoid Arthritis

His current medications include methotrexate, prednisone, daily baby aspirin, vesicare, and hydrocodone.

I will describe in detail how my protocol is used in each case to resolve the patient’s symptoms.

Case Outcomes:

In Case 1, the patient reported complete resolution of urinary symptoms and a 75% reduction in prolapse (Grade 1 or Stage II) after only 8 sessions of almost once a week therapy, and the Makous protocol of IES at home.

In Case 2, the patient reported total remission of urinary incontinence with only 2 to 3 drops of urine leakage a day, elimination of recurring UTIs, and regaining of erectile and ejaculatory function with ongoing use of anal IES using the Makous Protocol. This only required 11 treatment sessions and 11 weeks of the Makous Protocol with significant improvement after only 9 weeks.

• Need for Future Studies discussed.

• Peer Reviewed References. Posted at the end of the lessons in the Additional Comments section