How does weight lifting affect the pudendal nerve?

[HerMajesty]

Thanks Celeste, that is interesting. Just from following some of these cases I guess I have a double impression:

1. Some of what Dr. Potter is found has been confirmed during decompression surgery; I believe there have been 2 cases of this at least with members of this forum?

2. Some of what Dr. Potter has found I think might be artifact, and this could only be checked if she were to do a double-blind study in which she examines her images of pelvic pain patients vs. her images of people with no complaint, without being told which is which. I don't know if she has done this (???) It seems like something basic one would do.

I think the imaging tests (MRN and 3T) are great proof of pudendal pathology. Before the MRN confirmed that my pudendal nerves are inflammed I was getting frivilous denials from my insurance company and encountering local Docs that would argue with me about my diagnosis just to mess with my head. It makes life easier to be a confirmed pudendal neuralgia patient. Otherwise while I do not think the imaging is useless, I do think it is still in a somewhat experimental phase and needs to be taken with a grain of salt.

[Celeste]

HM, I agree with you on the grain of salt, but I don't think anybody else does.

So far everyone is clinging to the two cases where their 3T MRI was an indication to go forward and "prove" the MRI results. Nobody is willing to "disprove" the 3T MRI and go forward with surgery even though they have pain in the path of the pudendal nerve. These results would be very important, but we aren't going to get them. No one is going to do a study on them.

In any case, people most definitely do get well from PNE surgery without having had the 3T MRI.

[shljk]

Well, I guess I will be one person who is willing to "disprove" it...hopefully.

I've had PN/PNE symptoms for just over two years, starting from a foreign object sensation progressing to rectal muscle spasms then vulvar burning and finally clitorial hyperarousal/hypersensativity now as well, with a history of IC/PBS and vestibular pain for 16 years. I was unofficially dx-ed by a well-respected pelvic pain PT in DC and then officially dx-ed by Dr. Marvel and confirmed by Dr. Antolak. I've had 2 nerve blocks, 1st gave me great relief for nearly a month and the 2nd nothing. I've had two rounds of pelvic PT, the first time 1xweek for over a year and the second 2xweek for 4 months, with no sustained improvement at best and an fairly severe increase in symptoms at the worst. I've tried all the drug combo with the exception of the hardcore pain meds.

I'm currently pursuing surgery with Dr. Hiber although he isn't convinced I have PNE. He sent me to have a MRI with the radiologist at St. Joseph's; the MRI came back negative as far as I understand (was told this by Dr. Hibner but haven't seen the official report yet). Hibner then gave me his series of Botox shots in the hope that my issues were caused by PFD.....that was three weeks ago and I haven't felt any improvement.

So it's my belief that I have PNE and that while the MRI technology is a great tool for providing us and our doctors with more information, it shouldn't be used a criterion for surgery by either group.....or atleast not yet. From what Dr. Hibner told me, this is his belief as well. The MRI can give us more information, but, as he said to me, it does not/will not change his treatment plan for me.

[paulette]

shljk,
I agree with you. If I go with the first interpretation of my 3t MRI, which is that it is normal, then I will have to resign myself to reclining on the couch for the rest of my life. I was just hoping that it would show entrapment and save me from injections. If I accept the MRI as the sole criteria for determining PNE, then I will have to resign myself to reclining on the couch for the rest of my life. paulette

[Celeste]

Well, I guess I will be one person who is willing to "disprove" it...hopefully.

I'm currently pursuing surgery with Dr. Hiber although he isn't convinced I have PNE.

So it's my belief that I have PNE and that while the MRI technology is a great tool for providing us and our doctors with more information, it shouldn't be used a criterion for surgery by either group.....or atleast not yet.

I think you're doing the right thing; so many people have been relieved of symptoms by surgery, and you've tried everything there is. I think you'd be making a big mistake not to try surgery just because of what an MRI said. To me, the pain speaks louder than the MRI.

Wishing you all the best, S.

[paulette]

Since Dr. Ansell is one of the topics of conversation here, can anyone tell me if his method of surgery is the same as Dr. Antolak and Dr. Shobeiri?

[scaredgal]

My understanding is that Dr. Ansell does the original TG surgery learned by the Nantes team in France - anyone correct me if I'm wrong.

[Violet M]

Since Dr. Ansell is one of the topics of conversation here, can anyone tell me if his method of surgery is the same as Dr. Antolak and Dr. Shobeiri?

It's my understanding the Dr. Ansell completely severs the sacrotuberous ligament but Dr. Antolak spares some of it. It's debatable as to which method is best. The surgeon who severs the ligament will probably tell you that you can't adequately decompress the nerve without full visualization. The surgeon who spares part of the ligament will probably tell you he can adequately visualize the nerve and he is trying to not to destabilize the pelvis. Both Antolak and Ansell learned from Robert in France and I think Shobieri learned from Antolak.

[pianogal]

back to why does weight lifting cause pne.... i am recently theorizing that instabilities can cause spasm of muscles to compensate and create structure which puts friction on the nerve in one place or another. And over time, the friction and spasm can lesson blood flow to the nerve, which can in turn create scar tissue and fibrosis. This theory is building b/c I am learning that pne can also be tied to labral hip tears. and I theorized with my pt julie sarton and with stacy fetterman at beyond basics, and they didn't balk the suggestion but seemed to think it was plausible.

about the 3t mri... celeste, you may have a good point. Onl time will tell if the 3t will show us why some people don't respond well to surgeries (b/c maybe they are approaching the wrong area) or if the 3t is negligible and we should look more at symptomology.

if the nerve is tensioned anywhere with scar tissue, in some cases relieving the tension even at the wrong spot could create enough laxness in the nerve to take it off tension and provide relief, theoretically... theoretically...

[scaredgal]

Hi Pianogal,

Sounds like a good theory, but this is what is puzzling to me. There are hundreds of thousands of avid exercisers, from recreational to professional - most of which never develop PN. Also, PT facilities are full of patients with one biomechanical issue or another. I went on and off for years to PT's for SIJD. I would be a millionaire if I could count the times that the PT's told me so many of their patients had pelvic issues, including the infamous one longer/shorter leg. I just know there are so many athletes with pelvic issues, who never go on to develop PN. What makes us so unlucky? What is it in our pathology? And how many people develop PN that's idiopathic (unrelated to surgery, or other proven causes)?

I think the only sport that I can really tie directly to the possible development of PN are those where continual pressure is exerted on the nerve - ie., bicycling and horseback riding. And even if you look at that - how few of those that participate in these sport even develop PN - a very few. I really don't think weightlifting causes PN (IMHO), but the million dollar question is, what does?