MEN! pelvic pain, time to treat them right.

[helenlegs 11]

http://www.pelvicpainrehab.com/blog/201 ... men-right/

From Stephanie Prendergast and Elisabeth Rummer's blog on pelvic rehab.

[Violet M]

Thanks, Helen.

Well......I have mixed feelings about the article. I realize that Stephanie is considered the PT guru when it comes to men's pelvic pain and I have great respect for her but I find the article a bit misleading for the following reasons:

1. I'm not sure what online information she was referring to but certainly on our forum/website we never advise jumping immediately into surgery. We have spent many hours updating our list of PT's who treat chronic pelvic pain and recommending people go see them. I've read a lot of online information about PNE and I would not have come away with the impression she describes below.

Unable to find any answers from the doctors he visited, he turned to the Internet. That’s when the fear and panic set in. After spending hours online, he discovered that his symptoms were a match with a disorder called “pudendal nerve entrapment”or “PNE.”

After reading a litany of stories about PNE, he was convinced that he needed surgery as soon as possible to free his entrapped pudendal nerve. Otherwise, according to the information he was uncovering, his symptoms would continue to worsen. He even contacted one of the doctors mentioned in the online forums who performed the surgery. The doctor encouraged him to fly out and schedule the surgery with him right away.

2. Secondly, there are people who have tried her protocol who don't get well. In all fairness to the physician who may have recommended surgery to the guy, it's entirely possible he has seen and done surgery on patients who have not responded well to the protocol she recommends.

Don't get me wrong -- I am not criticizing her treatment protocol. I think everyone should try something similar before surgery. I just feel like the blog is a bit misleading. Tony in the article is very lucky. Unfortunately, not everyone is that lucky and I think that reality should have been pointed out in the article.

Violet

[helenlegs 11]

Agreed Violet. The trouble being that as that 'pelvic guru,' while managing to help such a lot of people with pelvic physiotherpy, it should be realised that this therapy isn't always enough for everyone, unfortunately.
In an earlier blog she also stated that true entrapment could be as a result of surgical trauma or anatomical variation but made no mention of any other traumatic causal onset. I asked a question about this on the blog and she did reply but still didn't seem to accept that injuries like ours for instance, could cause actual entrapment. While Dr Greensalde did note that my sciatic nerve does run through my piriformis muscle and therefore it looks like I do have an anatomical variation, making me more prone to a nerve problem at this level, I would not be in this position without falling and injuring that muscle, anatomical variation or not. I didn't pursue the matter as I realise that her forte is the pelvic floor and I do absolutely appreciate the work she does, but the blog was about PN as opposed to PNE and it didn't have all of the facts quite correct. We are both testament to that fact.
Now that I have had the nerve conduction studies done, it is quite clear that I have a pelvic entrapment even without having had anyone take a look inside on the operating table.
The trouble is that no physiotherapy in the world is going to help injuries like yours, mine and quite a few others who have not had any previous pelvic surgical intervention. Any anatomical variation will not help the matter BUT the only reason I have this problem is the fact that I fell on my bum 5 years ago.
Just as well we have HOPE to address these small erroneous points. They may be small but they are certainly not at all inconsequential to those that are proof of the whole truth.

[ezer]

I have been treated by 7 pelvic floor physical therapists and everyone of them was against PNE surgery. To be fair it is seen somehow as a personal failure when one of their patients considers surgery. I have experienced the same anti-surgery slant from physiatrists that are MDs and trained to offer conservative modalities.

[helenlegs 11]

I know I have a continual good nature'd debate with my nephew who also thinks EVERYTHING can be fixed with diet, exercise and body balance (I'm sure there's more on his list)
If only that were the case, although I think I would struggle with his regime on a full time basis, regardless.
I accept that this lifestyle choice is definitely going to be of benefit, some things are beyond a cure or even partial fix; although advantages will always be enjoyed when employing a 'healthy life choice'. I also admire the passion and dedication to this more natural and holistic approach but I would hope that other proven ideas would be considered and recognised when pontificating upon a subject to give the whole true picture.
They have the added advantage of being body beautiful with glowing perfect skin, so should help the rest of us out by eating chocolate and ice cream by the bucket full every now and again and getting all of the facts correct.
The problem with my nephew is that he did sever his cruciate ligament playing footy (soccer) hasn't had surgery and has managed to compensate for this injury, which still shows as severed, with imaging, by building up muscle group, which I'm sure is a fantastic effort. This doesn't mean that the scar tissue, lesions and entrapment mess in my right piriformis muscle can be dealt with in a similar manner though. I know he is only concerned and trying to help but a tub of ice cream would be more gratefully received as I do feel as if I am letting him down, being this fed up failure.
It is admirable being so focused and passionate about a subject that resistance to it's benefits can be seen as a personal failure but that is very preferable to being the subject of that failure and still being in pain, and looking for answers that don't easily present themselves because the whole picture hasn't been addressed properly.
MEN!!!