Selbourne wrote:HerMajesty wrote:Selbourne,
There are a ton of conservative treatments and diagnostic tests to try between what you have done, which is basically some strategies to mask symptoms but no actual treatments, and surgery. Is there Pelvic floor PT available in your area?
Sorry to sound stupid,, but can you please list the treatments and tetst so I can chase them all down ? Thanks !!
Selbourne, The important thing is to get some kind of a grip on your underlying pathology. I could write a book here and not be done telling you about all possible tests and interventions for all individuals. You could narrow it down quite a bit if you could identify your precipitating cause or event. Any that you know of? Traumatic injury? Surgery? Sports participation such as weight lifting or cycling? Do you have a Morton's toe, self-diagnosis of which can be made easily by scrolling down this page:
http://whyyoureallyhurt.com/home/#tp , or for that matter do you have any other known gait abnormality due to any kind of foot or leg issue? Any known misalignment, such as something you would see a chiropractor for?
Tests would include: Standard screening tests (CAT, MRI) of thoracic, lumbar, sacral, and pelvic regions; specialized pelvic scans such as 3T or MRN, hands-on assessment by a pelvic floor PT both of soft tissues and alignment of the bony pelvis, internal manual palpation of the inguinal canal to rule out involvement of the nerves that run through there, conduction tests specifically for the pudendal to confirm whether this nerve is involved, and/or diagnostic nerve blocks. This is by no means an exhaustive list, just off top of my head. You can probably find much more on the informational sections of this site.
Treatments should in my opinion not just be "tried", unless they are relatively non-invasive and reasonably priced. For example it may be reasonable to try something such as accupuncture, yoga, or massage, for a couple of visits to see if they help, just as something to do in the interim while dealing with diagnostics. And of course, medication management to mask symptoms is generally necessary for humane reasons. Treatment decisions should be made based on known underlying pathology. There is pathology that can respond to PT, pathology that needs surgery, pathology that can respond to various minor procedures such as injections performed by an Anesthesiologist.
You have to approach the pelvis logically. The pelvic structure is made up of bones / joints, tendons, ligaments, mucles, connective tissues, and nerves, and organs. Any pathology in one pelvic structure will tend to in turn pull traction on, or otherwise impact, other pelvic structures, causing a kind of domino effect or cascade or interconnected pathologies. In my case for example I had a joint dysfunction, which was secondary to gait issues from morton's toe. The joint displacement pulled traction on surrounding muscles, leading to spasticity and trigger points. Muscle spasticity caused nerve feedback to the bladder leading to interstitial cystitis, the pain of which caused more muscle tension. Muscle tension and joint displacement of course caused a drag on tendons and ligaments. If you look at the base of the spine in a cadaver, you will see that various nerves including the pudendal feed out in a large bundle like the cords at the back of your computer. The pelvic structures form a kind of a criss-cross pattern which makes snagging one of these nerves a very likely scenario with any kind of pathology. A nerve can get caught between two structures, or pulled into a state of tension by the misplacement of pelvic structures. An individual with appropraitely positioned pelvic structures may instead have physical impingement or chemical radiculopathy of a nerve root. Or, a person with a history of pelvic surgeries, traumatic pelvic injury, pelvic inflammatory disease, endometriosis, congenital abnormality, or a cause of injury such as cycling, might have a nerve entrapped within scar tissue.
In each case the underlying cause must be addressed, and this cannot be done until it is identified. I therefor would not encourage you to chase down any treatment at all, until you have a sense of what you are treating.