Health Organization for Pudendal Education

My PT is having me do some "Amy Stein" stretches to loosen my tight pelvic muscles. I have questions about the Hip Rotator Stretch and the Hamstrings Stretch. I have a VERY tight left buttock (same side as PN ano-rectal symptoms). My PT thinks it is a tight piriformus muscle and encourages me to stretch it out AND to massage the trigger point in the buttock with a therapeutic ball (like a tennis ball, but bigger). I have been doing this for a couple of weeks and while it feels good to do it, I wonder whether I'm not putting too much pressure on the piriformis muscle/pudendal nerve by doing so. Any thoughts?

Thanks.

Lernica

Hi Lernica,
I would say if you can handle it and especially if it "feels good", Keep on doing it. The piriformis muscle can sometimes get tight or even spasm (as can other pelvic muscles of course) when there is a pelvic nerve entrapment due to the bodies natural reaction to 'gaurd' agaist the pain The more relaxed and plyable the muscle(s) is the less likelyhood of tension and cyclical pain.
The sciatic and pudendal nerve are fairly close together usually running under the piriformis muscle at the sciatic notch, so any 'bunching' or tightness in that muscle can result in sciatica and PN at that point.
Basically thats what I've got from a fall, subsequent haematoma which progressed to scar tissue in the muscle iself
In 17% of the population the sciatic nerve runs through the P muscle (as mine does) so resulting sciatica is almost a given if this muscle ever has problems.
Obviously don't over do it, nice easy stretches and 'bum rubs' but try and keep this muscle as supple as possible.
Take care
Helen

Sorry, I realize that this is an older post, but I just wanted to chime in as I was curious in stretching as well. Thanks for answering and helping, Helena. It sounds like when it comes to stretching, there isn't really any sort of innovative treatment, just to don't over-do it and stretch as long as it "feels good." Those are actually probably good tips for anyone who is stretching!

Very new to this, not even sure this is what I have. Do kegel exercises help or make this worse.... it's making it worse for me! (female, 55, left groin pain for 20 years, last two years intense pain and most of the symptoms mentioned on this page have set in). Help!

Madjugar - I am just writing a more extensive reply to your post in the Welcome Centre - but you need to know that if PN issues are involved, doing kegels exercises will invariably make things worse. A PN-aware physiotherapist would not be recommending them to you.

Lernica,
The only thing I worry about is that the SS/ST ligaments are deep in those buttocks and I wouldn't want you to flare anything up. I guess if you haven't felt a connection between your "bum rubs" and increased pain, you aren't upsetting the PN.

birdlife wrote:
How have you got on with the stretches and the massage, have they worked for you in loosening your tight pelvic floor?

Yes, I have been stretching and massaging and things are much looser, thanks. I no longer feel like my legs and buttocks are two tree trunks.

Thanks Lernica for asking about stretching. I'm going to pick up a copy of that book.

I too have to be very careful with any stretching type of movements. My PN is right-sided and there is a whole lot of pelvic floor tightness. This was confirmed recently when I went for an assessment appt with a pelvic floor therapist. I don't know yet if I can tolerate those treatments. I expected that the initial assessment would stir things up a bit and it did start a bad 2 week pain flare that I'm now starting to get better control of (with pain meds).

I've started using a more targeted yet gentle "butt rub" as a result of this thread and am seeing some loosening up effects. Thanks to the suggestions provided here there is a noticeable improvement in my stride and with basic pelvic movements.

Any improvement is ALWAYS a great thing.

Thanks to everyone for their input.

And the great thing about the butt-rubs is that you can also do it on doorknobs when you're not home and you don't have the ball (and no one's looking!!!) My mother-in-law once caught me doing it and she said I looked like a cat!!