tender ischial tuberosity area - massage? ice?

[deBBieW]

In the last couple of weeks, as my PN pain has increased... I have noticed that my ischial tuberosity area (I think that's what it's called) - bilateral is super tender to touch. Now I don't see a PT right now, or I would be asking her about this. Is it ok to sort of do a massage on this area? Sort of hold and press gently, to try to release tension? Like trigger points I guess. I remeber at one point someone told me to sort of sit on a half of a tennis ball etc., but at that time I didn't have evident pain in that area.

Isn't this sort of where that entrance to the Alcock canal is? I just don't want to aggravate the nerve any more than it is. Maybe massage a little and then ice?
Where would I be without ice!

Anyone else have tenderness there, like right between top of back thigh, and your butt - but sort of in towards perinium area.
Whenever I get new symptoms I always like to know if anyone else has them too.
thanks... Debbie

[Faith]

Yes, I have pain in this area. Mine is medial (more to the middle of the body - like toward the perineal area) to the ischial tuberosity "sit bones". Sometimes it is so sore to touch. Sometimes it feels like knives are stabbing me and it burngs. Sometimes my hamstrings are very tight and I burn/ache in the area you described too. Yes, the alcock's canal is more medial to the ischial tuberosities. I think when I have pain more towards the back it is likely coming from nerve crosstalk between the PN and the perineal branch of the posterior femoral cutaneous nerve/inferior cluneal nerve (you can search these nerves on the forum here. I've posted a couple of articles about them).

Sometimes I worry because technically the sit bones are outside of the distribution of the PN, but there have been many people with diagnosed PNE (in surgery) who also have sit bone pain so it's not uncommon. For me sometimes it is the most debilitating pain because I can't sit at all. If your sit bones, hamstrings, and perineum can't touch a chair when sitting you pretty much can't sit!

I do a lot of ice (sometimes internally which helps, with a test tube filled with I think 1 part alcohol to 2 parts water). I will sometimes lightly massage the area with my hands, but I think a tennis ball might be aggressive. Now, if it's the back of my upper thigh where the hamstrings meet the sit bones I will sometimes have my husband rub that area with a massager "knobby" thing (you know what I'm talking about?).

Sorry you have this new symptom. My sit bone pain came on hard about 6 months after my PN symptoms really hit full force. From that point on I have struggled majorly to sit. Hopefully you can get some relief soon. (Side note: my sit bone pain has varied intensity levels over the last year. Some months it's horrible and other months it's not so bad. Ever since my botox injections 3 months ago it's been horrible though )

[deBBieW]

Sounds like we have the same pain in the you know what! Ok, I'll keep massaging, and icing. The test tube idea is a good one, I have slushy condoms, but that's not good for internal use.
Faith, may I ask why you got Botox injections? Pelvic floor too tight? Were these all internal?

I'm going for my first block next Friday, so we'll see what happens. (CT guided at least)
When you got your blocks, may I ask where did they insert the needle? I hear about many different doc protocols, so I'm curious. This doctor I'm seeing uses the Mayo Clinic protocol. First two in the ischial spine I think, then the last one into the alcock canal - but I will confirm all of that Friday. I don't put much hope in any long term relief, and I'll be happy just to not get a flare from it.

Thank you
Debbie

[helenlegs 11]

I have ischeal tuberosity pain (right side worst). The more I rub it the more painful it is, the same with sitting. I wouldn't try a tennis ball as faith said probably too aggressive. Mine only aches independently with prolonged rubbing and/or sitting, pressure on that spot I guess, so if those things are avoided I can only feel any pain with pressure. Any extra pain does disappear after a couple of days but I try and avoid any pressure there if possible.
I have a similar problem at my illiac crest too, of course there isn't any pressure there to cause ongoing problems but a good rub will take a while for pain to dissipate. I was diagnosed with gross enthesitis http://en.wikipedia.org/wiki/Enthesitis of gluteus minmus an medius (from a pelvic MRN) which no one mentions much except me and I often wonder if enthesitis can be a problem with quite a few people as it's where the muscle meets the bone and as our muscles are prone to spasm this area must be affected to some degree. I know we keep going on about the ligaments to the ischeal tuberosities but thigh muscle originate at this point too and many of us (including me) have thigh pain.
thttp://www.getbodysmart.com/ap/muscularsystem/ ... orial.html

Achilles tendonitis and enthesitis

What is tendonitis and enthesitis?
Every muscle in the body attaches to a bone at both ends. However muscle does not attach directly to bone. Instead muscle firstly attaches to tendon tissue and then the tendon attaches to the bone. Using the word “attach” is actually a little misleading. In reality the small cells of a muscle amalgamate with tendon cells at what is called the musculotendinous junction (pictured right) and at this point, the tissue is a composite of both muscle cells and tendon cells – this is a common site of muscle injury. The tendon cells then amalgamate with the bone/periosteal cells – this site of connection is called the enthesopathic junction (where the tissue is a composite of both bone and tendon).

In medicine the suffix “itis” is used to imply “inflammation” – appendicitis (inflammation of the appendix), meningitis (inflammation of the meninges – the lining of the central nervous system) or bronchitis (inflammation of the ‘bronchi’ – the airways that make up the lungs). Tendonitis therefore implies inflammation of the tendon tissue. The term ‘achilles tendonitis’ is generally used to describe inflammation of the tendon itself or inflammation of the sheath of tissue that surrounds the tendon (the paratendon). For purposes of this article it is unnecessary to differentiate whether the tendon and/or the paratendon is involved as the physiotherapy treatment for both is almost identical.

Enthesitis therefore can be thought of as inflammation at the enthesopathic junction (the site of bone and tendon union). In normal situations the enthesopathic junction a very small region of tissue and is defined using microscopy. It is only when we see enthesopathic inflammation that this region may become visible and osseous (bony) change may even show up on x-ray.

[deBBieW]

Helenlegs... I have nerver heard about your condition, sounds pretty complicated. Whichever doctor diagnosed that, must really know his/her stuff - and it sounds like you have an excellent understanding of it.

I'm with you, avoid what hurts - but I do think a gentle massage of tissue is good as it gets blood flow into the area too.
Any day I'm not too sore, I try a 20-30 walk.
I can really feel the "sore spot" when I squat down, which I try not to do, but sometimes you just do it without thinking.

Debbie

[Lernica]

I was recently told I had ischial bursitis on the left side. Maybe that's your dx too?

[helenlegs 11]

Quite a few people (athletes?) can develop ‘achilles tendonitis’ which is a similar thing (I think) and because some of my pelvic muscles have gone berserk! it seems to have developed at the enthesis, the site of bone and tendon union.
I had never heard of it either. . . and had to look it up. I was lead to believe that normal enthesitis was fairly common ? especially as you get older.
Not sure about the burstis being similar? ? so complicated isn't it!! but saw this
http://www.ncbi.nlm.nih.gov/pubmedhealt ... objectonly
We have to be our own pelvic detectives, get sleuthing

[Faith]

Sounds like we have the same pain in the you know what! Ok, I'll keep massaging, and icing. The test tube idea is a good one, I have slushy condoms, but that's not good for internal use.
Faith, may I ask why you got Botox injections? Pelvic floor too tight? Were these all internal?

I'm going for my first block next Friday, so we'll see what happens. (CT guided at least)
When you got your blocks, may I ask where did they insert the needle? I hear about many different doc protocols, so I'm curious. This doctor I'm seeing uses the Mayo Clinic protocol. First two in the ischial spine I think, then the last one into the alcock canal - but I will confirm all of that Friday. I don't put much hope in any long term relief, and I'll be happy just to not get a flare from it.

Thank you
Debbie

Hi Debbie,

Dr. Hibner uses Botox a lot as a diagnostic tool in people who have had blocks/PT (with no relief). If the botox helps the pain then the pain might be caused from muscle spasm and not a true nerve entrapement. Yes, my pelvic floor is spasmed and yes the botox was internal. Dr. Hibner does the botox injections (it's about 20 small injections-at least it was for me) under general anesthesia because it is so painful. It did not help me and has only made me worse.

My PN block was done through the buttocks and I was injected at the ischial spine level. I did have flares with all my blocks but usually within 2 weeks I am starting to get back to my pre-block pain level.

I hope it goes well!