Physio for PN

[ChrisUK]

Hi, I read how physio is recommended for Pn but at same time have not heard from anyone who has had pn who got better by physio. Am due to have nerve block in 2 weeks but wanted to try physio with a pn aware therapist before embarking on non conservative treatment. Have appt next week but means a flight and couple of nights away. Would welcome opinions, thankyou. Chris

[helenlegs 11]

In my opinion physio can work IF there is no actual entrapment. Conversely it will not help any nerve entrapment long term, but then neither will botox.
It;s a good idea to try it tho' Chris, almost a right of passage. . . I hope you don;t need to go any further on this journey and the conservative treatment works for you.

[Violet M]

Chris, some people have gotten better from physio but I think you are likely to know fairly soon if it's going to help. A good physio may also be able to tell you if there are other underlying issues contributing to your PN such as SI joint dysfunction, pelvic misalignment, etc. Hopefully it will be a worthwhile experience for you but as is always the case with PN -- you won't know until you try it.

[JeanieC]

Chris,

A person who lives in the UK with the screen name birdlife has on their history that they are doing well from trigger point injections. Try sending a PM, I just noticed this a couple of days ago. Hope it helps!

[pomegranate]

Hi Chris,

I got better with conservative treatment, physical therapy being one of those treatments. I'm not "cured" by any means, but consider myself pretty functional, as long as I know my limitations. I work as a teacher, travel, and am socially active.

I've seen four pelvic floor PT's (two of them being Liz Rummer and Stephanie Prendergast--some of the TOP US PT's). For me, PT helped me to "peel back the layers of the onion" of my pain and find possible causes of the pudendal irritation, in additional to bringing physical benefits.

Let me know if you have questions.

Lauren

[Lernica]

Lauren,

Nice to hear from you! Sounds like your recovery from your hip surgery is going well. Good for you!

Lernica

[birdlife]

Hi Chris,

I've had a great deal of success with triggerpoint massage (not injections though, JeanieC, see a bit further down ) until I recently well overdid things digging the garden up (am such an idiot ). But for 7months i was virtually painfree and able to sit and drive for several hours.

2yrs back I'd been diagnosed with PN and possible entrapment at the ischial spine, and underwent two x-ray guided double nerve blocks ~ got half an hour's relief on the first double block, and nothing on the second. I was to be offered a 3rd block, CT-guided this time, but didn't see the point. Strong medication just left me flat on my back with the room spinning, so with nothing else on offer to me I researched online for a non-invasive alternative treatment. I came across mention of TP massage on a site unrelated to the pudendal. I liked the sound of being able to do this massage yourself and eventually found a cross-link between TP massage and the pudendal nerve: if the piriformis muscle (in the buttock) is contracted out of shape due to triggerpoints (knots of waste material) in the muscle, then this will not only affect the sciatic nerve but can also put pressure on an already irritated pudendal nerve laying beneath.

I reasoned that if my pudendal pain was eased on standing, then I'd not reached the stage of entrapment due to scarring (as Helen has already mentioned). So, if I worked hard on the muscles I knew were tight in my lumbar, buttocks and thighs, I must gain some relief of pressure on the pudendal.

Initially I used a sports physio masseur for 4 sessions on the piriformis, as it lays under your glutes and is more difficult to reach and self treat when really tight. Mine was so tight it was pulling my right side up very slightly and pushing my pelvis forward. After deep massage by him I continued to treat myself at home. It was a painful process, I had so many points of pain from triggerpoints (knots of waste material) in all my lumbar muscles and my legs that I was in tears at the beginning. After 2wks of working on my legs I was able to sleep the night through for the first time in 2yrs. But the piriformis muscle took 3 months of daily self treatment before I was at the stage where I was just doing top-up massage to keep latent triggerpoints from becoming active. Then I ruined all this work with digging the d*mn garden .

I can highly recommend a book I got from Amazon called The Triggerpoint Therapy Workbook by Clair and Amber Davies. It deals with triggerpoints anywhere in the entire body. You won't find the pudendal nerve specifically addressed, but I bought it to show me how to release the lumbar muscles that were keeping up the pressure on the pudendal. My sports physio actually had the same book (much larger edition) on his desktop. You don't need prior medical knowledge to follow it either, its all set out in sections and you look up where your pain is then follow the treatment page to see which muscle is your current problem. Then it clearly shows you how to self-massage properly, either using your thumbs or a tennis ball to roll away the pain. Clair Davies does mention triggerpoint injections but says the injection itself can set up its own triggerpoint, so always try massage first.

Hope this info helps absolutely anyone and feel free to message me, I don't mind! Take care,

[ChrisUK]

Thanks for all your responses. Really helpful info that's convinced me to try physio before sgy. Chris

[helenlegs 11]

Thanks for that informative post birdlife, fantastic, and good for you. You deserve an award for endurance !! I know how painful the piriformis massage can be!
I can do a similar thing as you describe, with my left side to some extent as I'm sure there is no scar tissue there as it's not as bad, but then the right hand side 'tricks' it into tightening up all the time. I spend the evenings 'rubbing my bum', well kneeding my p muscles with my knuckles, hell it hurts! but does help eventually
Physio is ALWAYS worth a try, as are any and all conservative treatments.
How are you at the moment? have you got to grips with the post gardening episode at all? I do hope the trigger point massage is helping.
Take care
Helen

[birdlife]

You deserve an award for endurance !! I know how painful the piriformis massage can be!

Thanks Helen, I humbly accept your nomination

Definitely its painful! But like you say, the more it's done the less it hurts and the quicker the result.
Also the more often you do it, the deeper into the muscle you can get. You can do the massage often in every day if you need to, but you shouldn't do it for very long at any one session. Clair Davies in his book recommends a max of 1min x12 times per day on any muscle you massage. Don't forget to always kneed in the same direction so that you massage the 'knot' away out of the muscle, otherwise you're just shoving the knot backwards and forwards without dissipating it. For the piriformis, I always massage mine out towards the hipbone as if I do it the other way it becomes tricky with your spine in the way (which should never be massaged).

How wicked of your right side to interfere with your left! The infamous "crosstalk of nerves" . That's where self-massage comes into its own right, you can do it anytime anywhere and whenever you need it. Straight away with no waiting around while it gets worse with the waiting. My sports physio guy said people often give up too soon with TP massage, thinking either they've done enough and don't need it now, or they think its not working because they still have pain. They don't realise that triggerpoints can be soothed into a latent state where they become inactive, rather than eradicated. Once you start doing again the things that set them off in the first place, you can re-activate them if you haven't worked on them long enough. So top-up massage should be done every now and then, even when you've finished with the intensive massage stage. I was doing all that, and was fine, but obviously moving hardcore in the garden was OTT...

I'm back to sitting briefly, and sometimes sideways on this computer chair, and underwear is sometimes a problem too . But the piriformis is still not as tight as last year when it was also pinching the sciatic, giving me electric shocks and going cold. So massage worked before and it'll work again (where's that medal) and I don't expect to be doing it so intensively this time around. Will let you guys know the minute I can sit and type a post again without flinching.

Take care,