Our Patient
A male cyclist came to us with erectile dysfunction and pelvic pain. He was being treated elsewhere with manual therapy, with no signs of improvement.
The Challenge
The therapist who had been treating the patient was using internal manual therapy to address tight pelvic floor muscles, when in fact the muscle tension was a symptom secondary to the actual mechanism of injury.
Our Diagnostic Approach
After a thorough health history and clinical exam, we used diagnostic ultrasonography to visualize the structures of the patient’s pelvis. We discovered that the pudendal nerve had been injured by repetitive trauma related to the patient’s cycling activity.
Our Treatment Approach
To promote healing of the injured nerve, we applied nano-energy focused shockwaves along the course of the pudendal nerve where it comes in contact with the bicycle seat.
Our Results
After just seven shockwave sessions once a week, our patient showed a 90% improvement in his erectile dysfunction.
Conclusion
Contrary to current treatment trends, not all pelvic pain and dysfunction is related to pelvic muscle tension. Unless there is a specific mechanism of injury, nearly all pelvic issues are multifactorial. Most physical therapists address pelvic pain from inside the pelvic floor, when in fact pelvic pain is most often secondary to other issues that originate above or below the pelvic floor.
Pelvic pain often arises from dysfunctional breathing, spinal instability, hip dysfunction, foot problems, fascia dysfunction, autonomic dysregulation, nerve entrapment and other issues that have been ongoing, and eventually spread to the pelvic floor. Prior to treating tight pelvic floor muscles, practitioners should seek to diagnose other issues that eventually lead to pelvic pain, and address them.
Related Research
Lee, K. C. J., et al. “Extracorporeal Shockwave Therapy of the Perineum for male patients with chronic pelvic pain syndrome: A Pilot Study.” Prostate International (2023).
https://www.sciencedirect.com/science/article/pii/S2287888223000582
Request Telehealth 
