Thoughts on PN from one MD and 2 PT's

[Violet M]

We've updated the homepage with some thoughts on PN/PNE from Dr. Vancaillie, Peter Dornan, and Sherin Jarvis. Thanks to all 3 of them for replying to our director, Catherine, with questions from HOPE. Thanks Catherine for your work on this!

http://www.pudendalhope.info/

Violet

[Faith]

I found it really interesting what Peter Dornan said about the relationship between SIJD and PN. He said:

"The working theory is as the innominate bone (pelvis bone) posteriorly rotates on the sacrum, it causes adverse neural tension to the pudendal nerve as the nerve passes around various structures – particularly sacrotuberous and sacro-spinous ligaments and Alcocks canal."

I don't quite understand how a posteriorly rotated SIJ would cause PN. If the SIJ is rotated posteriorly then wouldn't the ligaments not be as strained thus not putting more tension on the PN? It's always been my understanding that most PNers with SIJD are anteriorly rotated (to the front of the body) thus causing the ST ligament to be pulled forward more tightly and compressing the PN. Or it may not be the ligamets so much as the muscle imbalances in general that is causing pelvic floor dysfunction as would be the case in lower crossed syndrome where the pelvis is anteriorly rotated
You can read more about that here: http://www.muscleimbalancesyndromes.com ... -syndrome/

Often I think it is much more invovled that just an anteriorly/posteriorly rotated SIJ as the sacrum and pubis symphysis can be out of alignment, and of course hip joint pathology could be causing the SIJD as well.

[Jackson]

I found it really interesting what Peter Dornan said about the relationship between SIJD and PN. He said:

"The working theory is as the innominate bone (pelvis bone) posteriorly rotates on the sacrum, it causes adverse neural tension to the pudendal nerve as the nerve passes around various structures – particularly sacrotuberous and sacro-spinous ligaments and Alcocks canal."

I don't quite understand how a posteriorly rotated SIJ would cause PN. If the SIJ is rotated posteriorly then wouldn't the ligaments not be as strained thus not putting more tension on the PN? It's always been my understanding that most PNers with SIJD are anteriorly rotated (to the front of the body) thus causing the ST ligament to be pulled forward more tightly and compressing the PN. Or it may not be the ligamets so much as the muscle imbalances in general that is causing pelvic floor dysfunction as would be the case in lower crossed syndrome where the pelvis is anteriorly rotated

Hi Faith,
The following is what I've found on Peter Dornan's website in relation to this : "the putative reasoning suggests that if physical stress causes the sacrum to nutate or the ilium to posteriorly rotate tension is placed on the nerve as it moves between the sacrospinous and the sacrotuberous ligaments"
The definition I've found for nutate is "rotation of the sacrum forward". I'm not sure if this adds any light to the situation. You can read the full article at http://www.perterdornanphysio.com.au/pudendal

[Karyn]

Thank you very much Catherine and Violet for your hard work! Great info to present.
Also - thanks to Dr. V, Peter Dornan and Sherin Jarvis for responding and contributing to the HOPE community!
Best,
Karyn