Steve Middleton1,2 and James E Leone3,4
Scientific Tracks Abstracts: J Sports Med Doping Stud
Objective: To present the case of a male who presented with inflammatory pelvic pain consistent with pudendal neuritis. Background: A 49-year-old male machinist presented to the sports medicine staff with chronic testicular and rectal pain of 10 years duration. Subsequently, he was diagnosed with pudendal neuritis and referred for physical rehabilitation. Differential Diagnosis: Epididymitis, pudendal neuritis, sacroiliac joint dysfunction, athletic pubalgia, testicular tumor. Treatment: Post-isometric relaxation and muscle energy techniques were used to correct a left-sided sacroiliac joint dysfunction. The patient was then progressed to therapeutic activities to restore normal mechanics to lumbo-pelvic-hip complex. Several flare-ups have occurred in the 24 months since initial treatment; however, they have been of short duration (< 2 days) and less intense. Uniqueness: Pudendal neuritis tends to affect females more than males. Typically, males with testicular pain suffer from epididymitis or some type of testicular torsion, which was not the situation in this case. Compression also is a common cause of pudendal neuritis, which did not factor in this case, making identification and treatment a complex challenge. Conclusions: The pudendal nerve passes between the sacrospinous and sacrotuberous ligaments. When there is dysfunction of the sacroiliac joint, said ligaments can cause compression of the pudendal nerve manifesting with diffuse pelvic pain and dysfunction. Many pain syndromes can be treated via the removal of the original stimulus; however, recognizing the contributing factors of the pain and dysfunction in pelvic pain in males can be a challenge for the sports medicine professional. A vigilant and unassuming approach to male pelvic pain is warranted.
Steve Middleton, MS, ATC, CSCS, CES, CKTP, FMT serves as the Director of Rehabilitation and Sports Medicine at Assess, Treat & Condition, an outpatient clinic in Carbondale, Illinois. He has 15 years experience in a combination of roles treating a variety of patients. He has treated with athletes from high school to college as well as professional athletes in the NFL and Olympics. He has also instructed over 1000 clinicians in continuing education courses emphasizing Fascial Movement Patterning and manual interventions. His treatment and teaching approach is very hands-on from performing manual therapy techniques to corrective exercises. Mr. Middleton earned a Bachelor of Science-Athletic Training from Southern Illinois University. He holds a Master of Science in Exercise Science & Health Promotion from California University of Pennsylvania. He is currently pursuing a Doctor of Physical Therapy degree at the University of St Augustine. In addition to his academic degrees, he holds additional certifications from the National Academy of Sports Medicine, National Strength & Conditioning Association and the International Kinesio Taping Association.
Journal of Sports Medicine & Doping Studies received 657 citations as per Google Scholar report