A Dancers Tail - The case of unexplained Pelvic pain.

When I met this female dancer she was complaining of IBS (irritable bowel syndrome). As usual I asked her not to tell me anything else so that I could read her body without thinking in terms of what other people had told her.
When doing a general evaluation, her body led me  to the lower left side, more posterior than anterior. So I asked her to lie down on the treatment table. I started to listen at the legs and although looking at her right leg it was obviously restricted at the knee, It was slightly in flexion, it was the left leg that was attracting my hand. I did a very gentle mobility test for the hips. They were as stiff as a board. Despite being a dancer he rotation was very limited. I asked her is she had problems with her legs and she told me she had a problem with her right leg.  But I followed the listening up the left leg and by a process  of prioritisation I was led to an area above the superior to the pubic bone. The listening pulled me deep into the body; very posterior. It was so posterior I was let to ask the dancer to lie face down and checked the tailbone. The tailbone was tender when she sat for a longer time. As I palpated it I felt it was under quite a lot of tension and as she told me she had had quite of lot of bumping on her bottom while dancing it also seemed pragmatic to engage it. There was also an attraction to the Sacrum at around S4. This happens to be the level where the Pudendal nerve.​

At this point I would like to start the atmospheric music. The villain just walked in….or danced in! In this case he’s a strong suspect for being a villain. Actually in the working healthy body he’s a superhero. The pudendal nerve as a superhero does so many great things for us. It is very connect to the autonomic function of the of the body. Known as the “Peepee, pooh pooh, sex nerve” by anatomy teachers. You just never forget that expression. It runs deep inside the pelvis and runs a gauntlet of confided spaces. It even has its on canal (thank you Mr Alcock for naming the canal). It gives tension to the urogenital diaphragm. 


So there’s a kind of Nexus of problems here. The tiny Ligament  from the ischial spine to the sacrum forms two holes (foramen) though which neves and arteries for bottom and legs pass. The  superior hole is the piriformis (it’s infamous for imitating a spinal disc prolapse). It presses on the pudendal nerve nerve, ischial nerve and inferior gluteal nerve from above. 


The function of the pelvic nerve:

• the majority of the pelvic floor muscles,
• the perineum,
• the perineal area,
• the distal third of the urethra
• part of the anal canal
• the skin of the vulva, the clitoris, portions of the labia in women,
• and the penis and scrotum in men.

So let’s just look at the symptoms of an entrapment of the pudendal nerve. It’s like a way story:

• The suprapubic or perineal region, testis, tip of the penis, and low back area may be painful
• Pain in the genital area
• Bladder incontinence and pain
• Anorgasmia 
• Urinary symptoms

Autonomic Nerve dysfunction symtoms:

• Sexual dysfunction
• an increase in heart rate,
• a decrease in the mobility of the large intestines,
• a constriction of blood vessels,
• pupil dilation,
• perspiration,
• a rise in blood pressure
• goosebumps, and
• sweating, agitation, and anxiety.

Well some of those look very general but that’s often the problem.

Back to my dancers tail. My hand was also attracted to the tailbone of the dancer. The tailbone has a muscle called the Coccygeus - going from the tailbone and sacrum to the ischial spine. So after doing an external release of the tailbone and pelvic floor I rechecked the tailbone and it was fine. However when I checked from the front there was still a strong attraction from above the pubic bone deep inside the body. So I released this.


Now here’s something interesting. The coccygeus is enmeshed in the Sacrospinous ligament which is in turn enmeshed in the Sacrotuberal ligament. When one is damaged it can affect them all. Theses ligaments are essential for spinal health as a whole. The pelvis which locks up here cannot roll easily and allow the rotations of the spine which we all need for our health. 

My lovely dancer led me to research all this. Also she told me she’s suffered very very regular bouts of bladder infections (pudendal nerve - is my suspect). It was a first treatment. I am sure it will not be fully treated in one treatment, but she already said she notices a difference.

If you have "piriformis syndrome" or above symptoms you can now suspect the pudendal nerve. 

References:
https://www.pelvicpainrehab.com/male-pelvic-pain/male-pudendal-neuralgia/726/how-do-i-know-if-i-have-pudendalneuralgia-or-pudendalnerveentrapment/
Wikipedia
https://blogs.webmd.com/womens-health/2008/11/i-have-pelvic-pain-is-it-cancer.html

---