Health Organization for Pudendal Education

I have nerve pain in my buttocks, legs, scrotal area when sitting. My pelvic muscles are in spasm, I'm trying to address this through physio.

But I also get tingling in my lower back sometimes, can trapped nerves in the pelvis cause tingling in the lower back?
Or does nerve pain start at the spine and move down?

It can definitely be a whole body thing, depending on your pathology.
Both sources of my pelvic pathology had a head-to-toe effect. The 1st was SIJD, which is a misalignment of the pelvic joints, and this causes compensation further up in the spine often as far as the neck: If your pelvis is unbalanced and twisted to one side, you are not going to walk sideways, you are going to unconsciously compensate by creating a twist in the opposite direction someplace further up the chain.
My other pathology was tarlov cysts in the sacrum putting pressure on the sacral nerve roots: these or other spinal pathology should be ruled out if you have neuropathies in the feet and legs as well as pudendal, and / or sacral pain. Spinal cord pathology can change cerebrospinal fluid pressure and hence cause symptoms even in the brain.
As a result, although pelvic pain is my main issue I have experienced head to toe symptoms; the "upper" symptoms being migraines, frequent episodes of vertigo, neuropathy in my fingers and hands, and muscle trigger points not confined to the pelvic region but throughout my entire body.
If Physio is working for you - which would indicate your main problem might be simple pelvic floor dysfunction - the problem with your back might even just be muscular tension created in compensation to the issues with your pelvic muscles - musculoskeletal issues in general tend to cause "chain reactions" in the body. So I am not suggesting you have the same pathology as me, just giving examples. But if Physio is not helping your muscles relax, you have to look at underlying pathology and any other symptom you have is a possible clue, whether it is "up" or "down". Hope this helped.

Thanks for the reply. Yes my Pelvis is rotated, I remember waking up in the middle of the night once and feeling a bad ache in the back. This is what I'm trying to correct at the moment.

Do you thing tight pelvic floor muscles can cause a rotated pelvis? Or is it usually the other way around?

Hi reckless,
Must say that I have wondered this such a lot myself, although more to do with actual nerve pain itself. As usual HM's answer was educational showing that the body does need to be treated holistically, simply because things ARE all connected. I have also often wondered if SIJD is the problem in my case or does it just run along side the piriformis issues. It is the chicken and egg question although that can develop into chicken, egg and chips? The perpetual pelvic conundrum, although as HM said if something is working treatment wise, say physio, that can often give an answer.
I do get your wondering about the tingling above your more? apparent pelvic problems. Obviously tingling can be nerve thing and by now you will definitely know the difference between tingling caused by blood flowing back into say a 'dead leg' through sitting strangely and a nerve tingle. If I HAD to answer this question for money or honour say my answer would be no, but not a very emphatic no!
I have (as many do) absolutely tons of shooting nerve pains and they always seem to travel away from nerve origin, so distal (just checked, and looked it up AGAIN!! definitely distal ) Of course some nerves run kind of horizontally, although most are more down. (In fact, part of the course of the pudendal nerve is across, isn't it)
I know that a lot of people have also said that their pain follows a path which is the pathway of the nerve. I'm pretty sure that I could point out the almost exact route of a fair bit of my pudendal (and PCFN) nerve because of this 'pain path'. Therefore we do get a good idea of how the nerve pain does travel and almost without exception for me it is down, sorry distal I would like to know if this is the same for others actually.
I do have one strange exception, which makes a complete mockery of what I have just said, although I would reiterate that my pudendal and sciatic nerve pain symptoms demonstrate this above distal theory dramatically.
I do however, also get a shooting pain along the top back of my thigh, this one is the exception. I though this was the perineal branch of the post femoral cutaneous nerve as shown here http://en.wikipedia.org/wiki/File:Gray832.png but to be honest the pain travels a longer pathway than this branch shows on here and travels towards the outside of my thigh which would be back UP the nerve in theory, which judging from the rest is completely wrong???
The fact that this one is a longer path could just be down to people being different of course but I still can't get my head around it going the 'wrong way!' Maybe it is another nerve entirely ?? Maybe I'm just weird wired weird ?
I would like a consensus on this question please. All of us nervy people must be able to answer it, well better than most anyway.
I would have to add though that any 'nerve crosstalk' may alter that statement reckless. This 'crosstalk' was not something I would have agreed really did exist one time being of a more practical nature (my husband would laugh uproariously at that) I am not talking about crosstalk in a nerve wind up kind of way (I think nerve wind up would involve additional, nearby muscle impairment, and then a possible 'knock on' effect) More like a zapping over nerve signal (sounds ridiculous, right ?) but I can honestly say that my back of the thigh thing, does seem to 'web out', once the travelling pain gets to the outer side of my thigh. Unless this is just a nerve branching out at that point?
Anyone else get the web/branching thing?
Anyway, until I discover conclusively otherwise I would still say that nerve pain travels down. (even though I may be testament to that theory being completely wrong)
I would therefore postulate that your nerve tingle may be from a separate nerve problem at a higher point.
OR perhaps in very extreme cases where a nerve is so entrapped and tethered the whole nerve is under tension above and below the entrapment point?? Not even sure that this can happen as nerves are usually free to glide and in fact probably do still glide (so I have read) to an extent, even if in scar tissue or whatever. After all they are not rigid structures and can take a bit of hammer (or so I have read), So this absolute tension would be very unusual or improbable.
Going to stop whittering on now, but I would love to know the answer too. What do others think? Where is a good peripheral neuro person when you need one eh?
Take care,
Helen

reckless wrote:
Do you thing tight pelvic floor muscles can cause a rotated pelvis? Or is it usually the other way around?

For me with the "chicken and egg" thing, the problem was an injury to the pelvic joints and not the other way around. I did 4 months of pelvic floor PT which focused on muscular issues (trigger point release, stretching of the overly tense muscles and core excercises). The PT immediately recognized that my pelvis was twisted and was having me do stretches specifically to address that issue right from the start. I made initial rapid progress with some of my symptoms and then stalled: That is, I kept the symptom improvements but wasn't making any more progress, and my pelvis definitely was not any straighter. There were a few temporary improvements in alignment that could be made by stretching, but if I walked around for a few minutes it would be as poorly aligned as ever. After 4 months the PT referred me to a PT Manual Therapist, which is a PT specialty that directly manipulates joints. He got my pelvic permanently aligned in two sessions.
Later I got a better understanding about why the muscle work was not going to work for me: I had certain "hypermobilities" of the pelvis, that is, certain joints had excess motion in them, which is why every time I stretched to correct the position of the pelvis, the correction would "fall out" again in a little while. The work to relax my muscles was meant to prevent tight muscles from pulling the loose joints out of place, and the core excercises were meant to strengthen the larger muscle groups which support the pelvis, to better hold the pelvis in proper alignment. However, the Manual Therapist was not interested in chasing my hypermobilities - he found them to be secondary and compensatory to the fact that other pelvic joints were "hypomobile", that is, stuck or jammed out of place - and those needed to be directly adjusted so that they were freed up / released. As I said, getting that done aligned my pelvis permanently.
The problem is, I see you are in London and I am not sure about UK access to practitioners who do direct pelvic Joint work. I know there are some in the USA and Australia, but I haven't seen anyone from the UK post about this. You have to be careful to find a gentle practitioner to manipulate pelvic joints: Some PT Manual Therapists and most Chiropractors do high-velocity joint manipulations - I would describe "high velocity" as the rough twist n crack method you will often see used to adjust the spine. There is at least one patient on this board who was injured and her symptoms permanently exacerbated by going to Manual Therapists who did rough adjustments on her pelvis. So while in my own experience it was a good thing to give up on the muscle work and get my pelvis directly adjusted, you have to go with what is accessible in your area, in terms of competent care.

I'm actually seeing an osteopath who massages the muscles and also tries to realign me. I previously saw a chiropractor who was a complete quack.

I just don't understand why I'm getting the sharp tingling in the lower back as well. One thing's for certain, I do have tender pelvic floor muscles that I need to massage. I'll try with my crystal wand tomorrow.

I definitely think the cutaneous nerve is involved, because if I lay on my stomach then the front of my thigh will start to burn, basically any part of my lower body burns after making contact with a chair or bed.

Still on the subject of nerve pain travelling up. . . .I often get a shooting sciatic pain down my leg; if it is particularly 'violent' it terminates in very distinct areas. When it is my whole leg, it shoots to either side of my heel bone just behind my ankle, but more often to the inside (tibial nerve).
I nettled myself ridiculously (only I could do this, I know) picking blackberries in capri pants and could not find a dock leaf, well, there were FAR too many blackberries for that
In my vain attempts to stop scratching I have been 'pressing' my ankles, one squeeze at the inside of my heel didn't shoot up from that spot, but jumped straight to the back of my thigh and 'zinged'!! It went no higher however. I am putting it down to the nerve, tibial end of the sciatic in this case, being too tort overall because of entrapment in my pelvis (piriformis level) Still a theory but this does fit in with my other one that zings along the top back of thigh too.
This is something Paulette suggested to me a little while ago,so she may well be right
Blackberry crumble later,MMm Mmm Mmmmm, just need to ponder on custard or ice cream (both?)
Take care,
Helen

Hi Helen
I'm not ignoring you BTW, I don't get shoot-type pain, but I think you are a very observant person because I was getting sciatica on and off before my surgery and I cannot for the life of me remember in which "direction" it travelled...or maybe it didn't feel like it was "travelling", maybe it was just "there" along the length of the leg...anyway always nice to hear from you but I'm clueless as to whether or how / why nerve pain would feel like it is moving towards or away from the CNS

helenlegs 11 wrote:When it is my whole leg, it shoots to either side of my heel bone just behind my ankle, but more often to the inside (tibial nerve).

Me, too, Helen!!!!!

helenlegs 11 wrote:I nettled myself ridiculously (only I could do this, I know) picking blackberries in capri pants and could not find a dock leaf, well, there were FAR too many blackberries for that

Yes, very unfortunate! But what's a dock leaf?

helenlegs 11 wrote:In my vain attempts to stop scratching I have been 'pressing' my ankles, one squeeze at the inside of my heel didn't shoot up from that spot, but jumped straight to the back of my thigh and 'zinged'!! It went no higher however. I am putting it down to the nerve, tibial end of the sciatic

Hmmmm ... I'll get a reaction in my feet if I press certain areas of the posterior thigh, but that real zinging, electric shock pain to my ankles comes from the lateral and posterior sides of my calves. It's so strange! You know what's even stranger? Do you ever get the "bug sensation???" This is really beginning to freak me out. For the longest time, well, since last October, it was restricted to the calcaneus bone only. Then this summer, it progressed to various, random places all along my legs, hips, sacral area, butt and mons pubis . It can alternate between feeling like ants or wasps, or both. Very disturbing!!!!!

helenlegs 11 wrote:Blackberry crumble later,MMm Mmm Mmmmm, just need to ponder on custard or ice cream (both?)
Take care,

Helen ... get your small pleasures when and where you can. Go for BOTH custard and Ice Cream!!!!
Hugs,
Karyn

So HM has the sciatica disappeared altogether with tarlov removal? Wonderful if so

I have decided that a CNS shooting pain that the body,or rather brain instigates shoots down. However by touch press on a nerve is 'self inflicted' it can shoot up. Until I find out differently I'm sticking to that anyway. Although, problem solved if you don't bother to investigate and self inflict.

Karyn wrote:[Yes, very unfortunate! But what's a dock leaf?

Karyn wrote:
Sorry apparently it's western European but an excellent remedy for a nettle sting http://en.wikipedia.org/wiki/Rumex_obtusifolius
You have them in America too now says wikipedia

You know what's even stranger? Do you ever get the "bug sensation???" This is really beginning to freak me out. For the longest time, well, since last October, it was restricted to the calcaneus bone only. Then this summer, it progressed to various, random places all along my legs, hips, sacral area, butt and mons pubis . It can alternate between feeling like ants or wasps, or both. Very disturbing!!!!!


Yes, Yes! Karyn, I know that my piriformis (plural? piriformii ) do this, so when other bits of me 'jump' under the skin (oooh! just happened in my leg ) I put it down to muscles as they can feel like real 'bug' movement. I had an idea that it is the muscles relaxing slightly? ? un-knotting? Although I think Violet once pointed out that it could be a 'wonky signal' nerve message, which sounds more feasible as I feel no better after or during this episodes and definitely never more relaxed. I don't even feel as if the muscles in my legs where it sometimes happens, are even knotted. I'm sure they are not in fact. Violet wins the prize (again) I think Smaller buzzing and 'ant' behaviour must be nerves and more probably nerve endings?? but still its not just a skin tingle is it. When you look down you really think there should be something to see burrowing about down there. Got to say that this does not happen anywhere on the front of my legs (side and back yes, bum, yes) But the rest of me is completely normal, HONEST! We aren't mad are we Karyn???

helenlegs 11 wrote:Blackberry crumble later,MMm Mmm Mmmmm, just need to ponder on custard or ice cream (both?)
Take care,

Helen ... get your small pleasures when and where you can. Go for BOTH custard and Ice Cream!!!!
Hugs,
Karyn

With you on that one too
Thanks H x