Health Organization for Pudendal Education

Charlie, I'm waiting for you to pounce on this one.

J Can Chiropr Assoc. 2010 Dec;54(4):276-81.
Pudendal nerve entrapment in an Ironman athlete: a case report.
Durante JA, Macintyre IG.

Graduate Student, Sport Sciences, Canadian Memorial Chiropractic College, Toronto, Canada.
Abstract
OBJECTIVE: To present the diagnostic and clinical features of pudendal nerve entrapment and create awareness amongst clinicians of this rare and painful condition.

CLINICAL FEATURES: A 41-year old male ironman athlete complaining of insidious constant penis pain 12-24h after long distance cycling and pain after sexual intercourse. A diagnosis of "cyclist syndrome" also known as pudendal nerve entrapment was made.

INTERVENTION AND OUTCOME: Patient was treated twice a week for four weeks using the soft tissue protocol described by Active Release Technique(®) to the obturator internus muscle. After two weeks of treatment his pain decreased to a 5/10 on the pain intensity scale and he began to cycle again. After four weeks of treatment his pain had decreased to 1/10 in intensity and he continued to cycle. At follow-up, approximately 8 weeks and 12 weeks later the patient communicated that his pain is resolved and he has began to train for Ironman Lake Placid 2010.

CONCLUSION: Pudendal nerve entrapment is a rare, painful condition and is often misdiagnosed due to the fact that the clinical manifestations can mimic other pathologies. It is important to be aware of the clinical features to obtain appropriate diagnosis and treatment of this condition promptly.

http://www.ncbi.nlm.nih.gov/pubmed/21120020

Here's what I don't get -- why is the guy going back for more?

Hey Violet...just noticed this post.

Dr. Andrew, the chiro I went & saw in Cornwall (who's come up w. a non-surgical protocol for PNE...comprised of a mish-mash of therapies, including the ART mentioned in this article), printed this article out for me while I was there actually!

As much as I miss cycling, I can't help but agree w. your sentiment of...

Violet M wrote:why is the guy going back for more?

Was this article really published? Well, at any rate good for him. I'm glad he didn't have PNE!

Faith wrote:Was this article really published?

Why do you say that Faith?

Violet M wrote:After two weeks of treatment his pain decreased to a 5/10 on the pain intensity scale and he began to cycle again.

How could anyone cycle in 5/10 pain???

Pelvis Stressly wrote:

Faith wrote:Was this article really published?

Why do you say that Faith?

Just because they seem to be ill informed about how PNE is diagnosed and I would be embarrased to publish an article that would make me look uneducated. Did the guy have Pudendal neuralgia or neuropathy very possibly, yes. Did he have PNE? We can't know...he hasn't had surgery yet.

MsRivers wrote:

Violet M wrote:After two weeks of treatment his pain decreased to a 5/10 on the pain intensity scale and he began to cycle again.

How could anyone cycle in 5/10 pain???

Amen!

Faith wrote:Just because they seem to be ill informed about how PNE is diagnosed

Are you basing that solely on the abstract though? Because the author goes into much more depth re. the initial diagnosis in the actual article (close to a full page re. case history).

Faith wrote:Did he have PNE? We can't know...he hasn't had surgery yet.

To a certain extent PNE is a diagnosis of exclusion (you rule out that you don't have any of the other conditions that cause similar symptoms, like Prostatitis, then go from there). But that said, there are also lots of non-surgical methods of testing for PNE (beyond just the aforementioned 'order of elimination')...blocks, 3T MRI/MRN, PNMLT, etc. I'd agree that maybe none of these are 100% conclusive, but if they corroborate symptoms, you can get a pretty good pre-surgical picture (crucial, given that no one wants to undergo a procedure as risky as the PN decompression surgery merely for 'exploratory purposes'!).

MsRivers wrote:How could anyone cycle in 5/10 pain???

Raises the interesting point that pain is subjective. What one person considers a '5' might be someone else's '2'. Which leads to the bigger dilemma of how do you accurately measure 'success' of any treatments in this field (surgical or otherwise), when there's nothing really 'tangible' to measure (primarily based on patient feedback, which, as discussed, is, by definition, subjective)?

I don't really have any answers here, just raising some points (this stuff always crosses my mind whenever I read that this or that surgeon is achieving a certain percentage of success...what is that actually based on, and might it not vary wildly depending on which patient is giving the feedback?).

If PT solved his pain, it wasn't PNE. I wonder how this even got published, if the editors did any research into what PNE actually is.

ART is different than PT Celeste. From the ART website...

"Did you know that many common therapies (such as medication, physiotherapy, chiropractic treatment, massage, electrical muscle stimulation, rest, exercise, and surgery) have all failed to effectively resolve repetitive strain injuries."

Pelvis Stressly wrote:ART is different than PT Celeste. From the ART website...

"Did you know that many common therapies (such as medication, physiotherapy, chiropractic treatment, massage, electrical muscle stimulation, rest, exercise, and surgery) have all failed to effectively resolve repetitive strain injuries."

Awesome. I'd much rather have a repetitive strain injury than an entrapment; it sounds like they respond to lesser methods than surgery.