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pain in the perineum

I have a client who, due to a twisting incident has pain in the perineum. Using Myoskeletal Alignment Techniques, I have resolved most issues EXCEPT the pain in perineum. Any ideas of what to do?

Replies to This Discussion

Permalink Reply by Erik Dalton, Ph.D. on February 21, 2011 at 8:12am

Hi Amy:

Is your client a male? Painful perineum swelling (between anus and scrotum) is not uncommon in men due to muscle and fascial tissue that can become injured due to sports injuries, i.e., cycling or, in your case, a twisting incident. I always do pelvic balancing work first and make sure to treat any pubic symphysis dysfunction followed by the sidelying adductor technique (you learrned this in class) around the pubic ramus to release myospasm in the levator ani and other pelvic floor muscles. In many cases, the painful condition can be fixed by release tissue constricting the pudendal nerve. Be sure and ask your client if he's noticed chronic prostate inflammation , i.e., burning on urination, as that condition will often co-present with perineum swelling.

Lower quadrant stretches and functional pelvic floor exercises are usually helpful. If you're having no luck, get a urologist to rule out more serious problems...good luck!

Permalink Reply by Amy Quartermaine on February 21, 2011 at 1:51pm

Yes, the client is male. I will see him next week and ask him. Thanks for your answer.

Permalink Reply by Wilson Jordan on November 15, 2011 at 3:19pm

Twisting indicates a Torking; pain after the twist indicates that the tork has not been fully released! The tork will be held by a cramp and in this case sounds like a sharp cramp. The entire pubic region is not circumspect including cocyccx. The twist could be anywhere but it somewhere specifically traveling downward into this region. Removing all upper adductors out of play (Satorious, Brevis & ; Ligaments going from ASIS to Pub bone. If cramp persist after releasing Coccyx with lower lumbar verterbras then you know that the twist originated higher than thought; now you must look elsewhere. the ribs are usually and idea place to start looking for twist because they naturally have that twisting action; so we tend not to think of then getting twisted. Is there any tenderness in the abdominal region upon palpation?

Permalink Reply by Jerry Hesch, MHS, PT on February 21, 2012 at 2:19pm

Hi Amy,

I discovered a pattern that correlates with mechanical pudendal neuropathy. It has 6 components. Check the tone of the sacrospinous and sacrotuberous ligaments just like you would test muscle tone. Check both ischia (flat portion just ~2" above the tuberosity) in prone to see if one is prominent. Check lower 1/3 of the symphysis pubis; symmetrical going from right to left? Check the medial portion of the ischia just above the ischial tuberosity and compare left to right in relation to the midline gluteal crease. This is an advanced Hesch Method AKA The Method pattern. More info can be found at ww.HeschInstitute.org

I hope this is helpful. Also i just posted a detailed review of Chronic Pelvic Pain: A Physical Medicine Approach by Chaitow and Logrove