I am well known in my field for treating back pain, and I have treated a lot of people with serious back problems. But the second most common complaint I hear from both women and men is pelvic pain.
The pelvis is largely misunderstood, and sadly, many men and women suffer from obscure or idiopathic pelvic pain—that is, pain of unknown cause that arises spontaneously. Unfortunately, after many trips to the doctor, too many people are told that it is “in their head” and are even prescribed an antidepressant medication.
The fact is that the muscles of the pelvic floor do not get the same respect and care that the quads, pecs and abs receive for two reasons: (1) The muscles can’t be seen or flexed in the mirror, and (2) most people in the rehabilitation and fitness world just don’t truly understand their anatomy and function.
To make this simple, the obturator internus, piriformis, levator ani and coccygeus form the pelvic diaphragm and are intimate with the organs and glands of the pelvis. These muscles also play an important role in sports performance by stabilizing the pelvis–and in pelvic pain.
The Obturator Internus: A Critical Function
The obturator internus is a fan-shaped muscle that originates on the medial surface of the pubis around the obturator foramen, runs posterior-lateral and attaches to the inner surface of the greater trochanter of the femur—and it has many important fascial connections that are often overlooked. The obturator internus and five other muscles known together as the “deep six” govern external rotation, flexion or extension, and abduction of the hip, and they work together as an important stabilizer of the hip joint.
The Pudendal Nerve And Alcock’s Canal
The internal pudendal vessels and pudendal nerve cross the obturator internus and are enclosed in a special canal called Alcock’s canal formed by the obturator fascia. The pudendal nerve is from the branches of the S2, S3 and S4 nerves. It provides motor innervation to the muscles of the perineum and is the primary sensory innervation to the genitalia. The pudendal nerve often gets “trapped” by the fascia of the obturator internus, causing all sorts of strange pelvic symptoms. You may be having one of those “Aha!” moments now.
The Pudendal Nerve’s Role in Neuralgia
To respect the obturator internus as well as the pudendal nerve and how it can cause pelvic symptoms, we need to take this further. The pudendal nerve branches into three smaller nerves:
- The inferior rectal nerve, supplying sensation to the rectum, skin and anal sphincter,
- The perineal nerve, supplying sensation to the perineum, vagina, urethra, male scrotum and labia, and
- The dorsal nerve, supplying sensation to the clitoris or penis.
Sensory symptoms could manifest as itching, burning, tingling or cold sensations in these areas or shooting pains into the groin, abdomen, legs or buttocks. The pudendal nerve is the only nerve that has both somatic (body) and autonomic fibers—meaning that the person may not just suffer these sensory issues, but also things like increased heart rate and blood pressure, constipation or an overall sense of malaise.
Exercises for the Pelvic Floor
Getting to a pelvic floor specialist quickly could be difficult at best in these times of Covid, and that is one of the reasons I created H3TV. H3TV is my On-Demand Channel with exercises in several categories. Essentially, I have put my expertise online for subscribers to use at their convenience. One of the categories that I think differentiates H3TV from other online “fitness” offerings is “Targeted Therapy,” in which I lead exercises designed to target issues with specific parts of the body, like the shoulder, lungs, cervical spine—and yes, the pelvic floor.
At present I have two videos with exercises designed specifically for the pelvic floor, and a third one is on the way. The exercises are not for any one specific pelvic floor pathology, but as I like to tell my clients, YOU are always your own best therapist. These exercises have historically brought my clients good results, and if you follow them as instructed and listen to what your body tells you, you will feel healthier and experience diminishing discomfort.
Look at H3TV‘s advantages.
Please take a look at H3TV and see the unique advantages it offers to anyone who wants to stay healthy, mobile and strong. Go here to access H3TV directly and receive your 3-day free trial. Membership includes a monthly free coaching call and unlimited email support, so you will never be on your own.
Better Body. Better Life.
Dan Hellman, MSPT