Objective: To describe the course of chiropractic management for an adult male experiencing chronic pelvic pain due to Pudendal Neuralgia.
Clinical Features: A 25-year-old male sought chiropractic care for a 10-year history of persistent pelvic pain following unsuccessful treatment that included physical therapy, avoidance of irritating activities, gabapentin medication, and various supplements including Vitamin B12 and alpha lipoic acid. The pain began as tingling, numbness, and a stabbing sensation in the left gluteal region and extended to his anus and left scrotum. He also reported experiencing constipation that appeared to coincide with an exacerbation of his symptoms. This condition initially worsened following repetitive activities associated with salsa dancing, which included lifting dance partners. Furthermore, ongoing aggravating factors included all core exercises, running, salsa dancing and playing soccer. Avoidance of irritating activities, short bouts of walking, and low intensity exercises offered limited and short-term relief.
Intervention and Outcome: Multimodal chiropractic care involved high-velocity low-amplitude lumbosacral spinal manipulation, multiple forms of manual therapy, (e.g., instrument assisted soft tissue mobilization and neuromobilization), as well as rehabilitation exercises. Goals of treatment included symptom reduction and increased tolerance for daily exercise, in particular return to dance. The main focus of treatment was to perform manual therapy over the soft tissue structures of the perianal region, an area that the Pudendal Nerve travels through. The main structure that was treated was the obturator internus.
Conclusion: This case describes a course of chiropractic care for the management of an adult male with Pudendal Neuralgia. In this case, treatment involved a combination of soft-tissue treatments combined with lumbopelvic spinal manipulation, which was associated with resolution of the patient’s Pudendal Neuralgia symptoms and a return to normal activities.
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