Nerve Pain (Neuralgia)



Neuralgia is the term for nerve pain.  Nerve pain can present in several ways in the pelvis.  Frequently, people do not realize it is nerve pain.  The great news is that Nari has been trained in neural manipulation, so we can work to take pressure off the nerve.  When a nerve is compressed along its path from the spinal cord or between organs or in a tunnel (foramen), it can generate a pain signal.  By working with key points along the pathway of the nerve, we can decompress that structure and allow symptom relief.  Neural manipulation can help all these conditions in most cases.  See below for details on pudendal nerve, lateral femoral cutaneous nerve, obturator neuralgia, and genitofemoral nerve.  Most nerves can be treated with these techniques.

Lateral femoral cutaneous nerve pain :  the lateral femoral cutaneous nerve can become entrapped around the inguinal ligament.  This is especially problematic in long distance runners and those who have had surgery across the inguinal canal.  Often this causes an overactive and painful IT (Iliotibial Band), as well as a vague groin and thigh pain.  No worries, we can mobilize it!

Obturator nerve pain:  The obturator nerve travels from the lumbar (low back) plexus, through the psoas, by the ureters, through the obturator foramen (a body tunnel and common place of compression), where it then divides into an anterior (front) and posterior (back) branch.  It is responsible for sensation in the middle of the inner thigh, and can create a sensation of skin itching or irritation or vague pain here.  It can also create excessive tone in the adductor muscles, which is frequently misdiagnosed as a chronic groin strain, especially in elite athletes.  Keep in mind the muscles of the deep inner thigh are just muscles, so they are controlled by this nerve.  So, if they will not quiet down with endless muscle work, it may be the nerve that needs addressing.  We can help you out with that here, with very specific techniques to the nerve.

Genitofemoral nerve:  That persistent or intermittent burning sensation in the vulva or penis, that shooting pain in the front of the privates that feels intense or deeply achy:  that could well be your genitofemoral nerve.  The genitofemoral nerve travels through the inguinal canal.  With suprapubic incisions or hernia repairs, it can easily become entrapped, compressed or restricted in its path.  With specific neural mobilization of the nerve and the canal, these issues can be helped in very few visits.

Pudendal Nerve/ Pudendal Neuralgia:  The pudendal nerve takes a twisted, long route through the pelvis, around the sacrospinous and sacrotuberous ligament. The pudendal nerve passes between two of the deep hip rotator muscles: the piriformis and coccygeus.  This is one possible site of compression.  It then travels through the greater sciatic foramen (an anatomic tunnel of sorts), where it can also be compressed.  It then crosses over a large ligament (the sacrospinous ligament) and goes back into the pelvis in another anatomic tunnel, the lesser sciatic foramen. It then divides into three branches with distinct function.  These three branches can become compressed in pelvic fascia.

  • The dorsal branch is called the dorsal nerve to the clitoris in women and the dorsal nerve of the penis in men.  It can create a feeling of hypersensitivity, burning, intense itching, or a nervy, irritated sensation in the genitals when compressed, as well as pain with orgasm.  It is responsible for penile and clitoral erection and ejaculation.
  • The perineal branch goes to the perineum, the space between the testes and anus in men and the space between the vaginal opening and the anal opening in women.  When this branch is compressed the perineal region or between the perineum and there is a burning sensation in the lower “saddle” area, and this pain is often increased with sitting.  The pain can be quite intense and can feel like burning, pinching, or tightness.
  • The rectal or inferior hemorrhoidal branch innervates the rectal area.  This can cause rectal pain or itching, even the condition proctalgia fugax, as well as a general achy and crampy saddle region.   Again, sitting and biking can increase or bring on these symptoms

The Pudendal Nerve is also responsible for innervation of several pelvic floor muscles from the superficial bulbocavernosus to the deeper, powerful levator ani.  Spasm, pain or hypertonia causing the muscles to have difficulty releasing can be an early sign of pudendal entrapment.

Nari knows specific techniques to mobilize the pudendal nerve, the sacral plexus it comes from, the space between the sacrospinous and sacrotuberous ligaments, as well as doing fascial releases along the sciatic foramen.  We do have success reducing pain in these patients.  Occasionally patients come who have had surgery to decompress the pudendal nerve.  Often, they did not have follow up surgery, so the adhesions from surgery can cause repeat pain down the road.  We do find specific manual therapy techniques help in this case, also.

It is common for this clinic to have patients from out of town come in for treatment.  We will work with you in advance to allow treatment.  Please see the information for out of town patients in the FAQ section.