PNE Ironman athlete

[PN-SufferVT]

I believe this a case proving that one can have Pudendal Neuralgia and not necessarily have PNE.

The above scenario may be true, but don't think it's what this particular article is saying. In the 'Case' section of the paper, the authors clearly state, "Palpation in this area reproduced the 9/10 pain in his penis and perineum and caused fasciculations in the surrounding buttock musculature. A working diagnosis of pudendal nerve entrapment was reached."

And the title of the article itself is, "Pudendal nerve entrapment in an Ironman athlete: a case report"!

Pelvis Stressly,
I understand what you are saying, but I think there is a very fine line between PNE and just Pudendal Neuropathy or Neuralgia. It is my believe that one can never fully know if they have actual entrapment without very clear images of the area. That being said I do believe that PNE exist, but I do not necessarily think the protocol for diagnosis of it in this case is a clear cut as this article makes it sound.... I mean in PNE what causes the pain? The compression of the nerve, correct? Which in turn causes a neuropathy or (damage of) thus causing the neuralgia (pain). That being said, I do not think one has to have true PNE to have the neuralgia, and furthermore I highly doubt that true entrapment (ligament compression) could be healed with ART that quickly or maybe at all. Now I do believe that a irritation of the nerve, by a tight or injuried muscle, which in turn causes the nerve to swell slightly with inflammation, thus starting the PN pain cycle, which reinforces the guardian mechanism of the muscle causing a pain feedback loop.......etc. I believe in cases like this techniques such as ART, Shockwave, CounterStrain, Myofacial Release, Dry Needling, Calmare, (here is a new one to research) Magnetic Brian Stimulation, cold laser, and maybe even injections have value.... but in true PNE my guess would be that it would be very rare for a patient to heal this quickly from such therapy. Pelvis... your post are some of the best on this forum, and I definitely am not trying to contradict you, but I think we as a group need to be very careful of assuming the true PNE diagnosis as the writer of this article did.

[PN-SufferVT]

Charlie, I'm waiting for you to pounce on this one.

Hi Violet

I have only just seen this. Nice of you to think of me.

Firstly let me say I have never said Physical therapy does not work. What I have said is that there is no credible evidence that myofascial PT can resolve pelvic pain. Patients should be aware of that before they spend money on it. I have also never personally known anyone to recover from it.

After looking at the above I still stand by it. Firstly maybe we should look at the source of this report.

Sport Sciences, Canadian Memorial Chiropractic College, Toronto, Canada

It has been done by a Sport's study student at a Chiropractic College. Chiropractic treatment is generally categorized as complementary and alternative medicine (International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds0 ). So it has been published by an alternative medicine college. Alternative medicine is a lovely euphmism for unproven. I know we are all aware of what alternative medicine is but I wanted to post this clip as I agree with this very brief summary of it.

http://www.youtube.com/watch?v=IZLKKW2SQoc ( Dawkins can't resist in having his usual dig at religion at the end of this clip so ignore that bit)

Like many studies that suggest the benefit of an alternative treatment we have no control group as the video explains. In fact this is not even a study, it is not even a group of patients being assesed. It is a single case study, an anecdote.

I think it is healthy to be skeptical of all studies , often the stamp of Peer reviewed can be meaningless. What is important is how the study is designed.

Now I appreciate that many Chiropracters would reject the claim that they practice alternative medicine. However chiropracters have made some pretty dubious claims in the past. In fact there is a whole series of articles about Chiropractic treatment on the website Quack Watch a website which exposes medical quackery. Here are some quotes below and I have provided a link to the Quack watch articles.

Chiropractic's educational system has continued to improve but remains significantly inferior to medical training . In addition, many schools still imbue their students with "philosophy" that leads them astray

Studies conducted by chiropractors and published in "peer reviewed" chiropractic journals often recommend treatment for such conditions as infantile colic and asthma. A study published in the Journal of Manipulative and Physiological Therapeutics for example, concluded that "Spinal manipulation is effective in relieving infantile colic" —a conclusion not confirmed with reliable, unbiased research and recently refuted by a well designed study by a Norwegian research team .

If you cannot find a chiropractor who is a neuromusculoskeletal specialist or who works in a back-pain clinic as a member of a back-care team, you have to be on guard as an informed consumer if you are to protect yourself from the nonsense associated with chiropractic treatment. There are many chiropractic procedures and techniques you should avoid—some of which are dangerous as well as a waste of time and money

http://www.quackwatch.com/search/webgli ... iropractic

So I think there is some basis to be skeptical.

I appreciate they used the technique of ART. Another alternative medicine technique. I am always a bit concerned when a technique is patented. (®) . Art is apparently a relatively new massage technique.

If I posted a single case study from the American Medical Association Of Homeopathy explaining how a single person was cured of pudendal nerve entrapment would we take that seriously?

That is not to say the patient in this instance did not get better. Maybe they massaged his OI muscle which relieved pressure on his alcocks canal. It is definitly possible.

However this report is not credible scientific evidence. It is not much different from reading a post on a message board. Call me a cynic but I would argue that what it definitly is is a fantastic advert for Art (®)

Charlie,
I find your post both cynical and somewhat ill informed. Your definition of "alternative medicine" is very short sighted.... For instance, did you know that for a large majority of drugs (modern medicine, right?) the mechanism in which they work is unknown. I would call this a little alternative..... Secondly, about the article.. yes it was produced by a student, but did you know one can be a research fellow with many years of education under their belt and be considered a student? Do you feel that osteopathic physicians are quacks too? Who are you to say that this study that has a University's name on it is not credible? It is ok to be skeptical but pretty ignorant to ignore the fact that this student even knew what this little known condition of PNE is. Lastly, who are you judge the training the chiropractors get? I am sure that you could try to contact this student an talk nerve conditions with him.... but I think unless you are medically trained you might have some problems keeping up. I am not trying to be an A hole, but come on.... don't discount everything so quickly.

[Charlie]

PN-SufferVT

I have no problem with you disagreeing with me but I have responded to your points.

Charlie,
I find your post both cynical and somewhat ill informed.

Cynical perhaps but ill informed, no. I used a video from Richard Dawkins to explain my thoughts on alternative medicine. Dawkins is an ethologist and evolutionary biologist. He was the University of Oxford's Professor for Public Understanding of Science from 1995 until 2008. Is he ill informed?

Your definition of "alternative medicine" is very short sighted.... For instance, did you know that for a large majority of drugs (modern medicine, right?) the mechanism in which they work is unknown. I would call this a little alternative....

.

As I said I used a video from Richard Dawkins. Is he short sighted also? I feel your example is irrelevant and does not support your argument. Those drugs you refer to have been proven to work under controlled studies. Who cares how the drugs work. It is nice to know but if they work, they work. Alternative medicine as the video explained has either not been subjected to these trials or failed them otherwise it would not be classed as 'alternative'. In other words unproven.

I accept that there are lots of treatments we consider mainstream/modern medicine which have not been subjected to to controlled trials.

It is ok to be skeptical but pretty ignorant to ignore the fact that this student even knew what this little known condition of PNE is.

Could you point me to the part of my post where I said the student knew nothing about PNE? Sorry but you accuse me of making judgements but I think you are the one doing that.

Lastly, who are you judge the training the chiropractors get?

I made no individual judgement. I know very little about Chiropracters but what I did do is provide sources. For the statement ''Chiropractic treatment is generally categorized as complementary and alternative medicine'' I provided a source. Also for the articles on Chiropracters I linked to an external website, Quackwatch.com. Quackwatch.com is run by a medical Doctor. You can email the website if you disagree with the articles.

Why after posting these sources do you also ask me if I believe osteopaths are quacks?

I also made a point of mentioning the fact that Chiropracters would disagree with their treatment being described as alternative.

I am sure that you could try to contact this student an talk nerve conditions with him.... but I think unless you are medically trained you might have some problems keeping up. I am not trying to be an A hole, but come on.... don't discount everything so quickly.

Why would I contact the student? I have no problem with what he has done. I even explained in my post how I felt it was plausible.

As I also explained in my post it provides no proof that the treatment is effective.

If I posted a single case study explaining how homeopathy was effective in treating a PNE patient conducted by a student from a homeopathy college would you take that as credible evidence that homeopathy could treat PNE?

[Pelvis Stressly]

Hey guys, I'm aching to respond in this thread but I'm off to New Zealand for a month tomorrow, so am racing around trying to tie up loose ends before I leave. I'll definitely get back to this over the next few weeks though.

Just a few quick points however...

Art is apparently a relatively new massage technique.

Much like it's not PT (as I pointed out to Celeste), ART is definitely not massage! Aside from the fact that it's hands-on-body, it's actually about the furthest thing from massage you could possibly imagine!! (I speak as someone who's had it...not at all pleasant, but necessarily so in order to eliminate any adhesions present). I mean, boxing is also hands-on-body but it's obviously a mistake to categorize it as 'massage'!! I'm happy to debate the finer points of this article w. anybody, but I insist they at least READ THE FULL ARTICLE FIRST so there's a baseline of understanding of the concepts involved (sorry, not trying to be an ass!).

It is not much different from reading a post on a message board.

This is a stretch. Look, I'm pretty skeptical about chiropractic myself. But that said, chiropractors (at least here in Ontario, where the paper was written) are considered full doctors (see below from Wiki)...

"In Canada, Chiropractors must generally have a 4 year undergraduate degree before starting chiropractic school, then they must complete a 4 year, post graduate, doctorate in chiropractic (8 years total). In 2005, the province of Ontario granted the Canadian Memorial Chiropractic College (CMCC) the right to offer a professional health care degree under the Post-secondary Education Choice and Excellence Act. This decision was based on a thorough review by the government of the curriculum taught at CMCC, and the knowledge that its graduates have upon completion of the program. This degree granting right sets the program at CMCC within the hierarchy of education in Ontario as comparable to that of other primary contact health care professions, such as medicine, dentistry, and optometry. As such, in Canada, chiropractors are indeed doctors, doctors of chiropractic. "

Dr. Andrew (chiro I saw in Cornwall, who did the ART on me) told me that Chiropractors (again, at least here in Canada) have to take as many hours of anatomy as MDs. And this becomes very apparent after even a short convo w. Dr. Andrew on the subject of PNE...he obviously has much greater knowledge of the condition than an average forum-posting layperson (myself included), which makes sense given that he's a doctor! Refer to any of the quotes I've posted of his on this board for examples (I'm no doc, but I've done enough research on this condition over the last 4 years to at least know when somebody knows what they're talking about!).

I should also add that ART, much like it's not massage or PT, is also not traditional chiropractic (in the sense of sharp 'adjustments').

Quack Watch a website which exposes medical quackery

You don't have to look very far on this site to find patients who have been made much worse by the actions of (non-chiropractic) doctors/specialists. Point being, I'm sure there are quacks in any profession...leap though to then say the entire profession is therefore quackery!

I highly doubt that true entrapment (ligament compression) could be healed with ART that quickly or maybe at all.

Ligament compression isn't the only form of 'true entrapment' though VT. ART targets fibrosis (ie. scarring) which is another form...one that seems particularly prevalent in our community these days, according to all the Potter scans everybody's getting.

I can't think of one person I've ever met on these forums who has rushed into surgery, myself included.

Yeah, I certainly didn't mean to label anyone who's opted for surgery already a fool Celeste! As I said, if my pain levels were higher, I might have gone that route myself much earlier. It's just a saying, and I still think the key sentiment has some merit...namely, that, if possible, sometimes the best course of action is just to wait until there's a better/less risky option available.

Thanks for reading...hope everyone's having a good day!
PS

[Charlie]

It is not much different from reading a post on a message board.

This is a stretch. Look, I'm pretty skeptical about chiropractic myself. But that said, chiropractors (at least here in Ontario, where the paper was written) are considered full doctors (see below from Wiki)...

Why ? It is a single case study? An anecdotal report. If a person comes on and says so and so surgeon cured me why is that so very different?

Never once have I labeled Chiropracters quacks. I am sure they are very professional. I merely stated there are many articles about chiropractic treatment on Qauckwatch.com. I think there is reason to be skeptical as I said in my earlier post.

This is the definition I found about Art on the following website - http://www.aetna.com/cpb/medical/data/300_399/0388.html

Active release technique (ART) is a patented soft tissue system that treats problems with muscles, tendons, ligaments, fascia and nerves (e.g., headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow). These conditions have one important commonality -- they often result from injury to over-used muscles. Each ART session is a combination of examination and treatment. The ART provider uses his/her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements. These treatment protocols - over 500 specific moves - are unique to ART. They supposedly allow providers to identify and correct the specific problems that are affecting each individual patient. Active release technique is similar to some massage techniques, albeit more aggressive.

The same website states :

Aetna considers the following alternative medicine interventions experimental and investigational, because there is inadequate evidence in the peer-reviewed published medical literature of their effectiveness:

and then lists ART.

I am not saying alternative treatments don't work. I am not saying ART does not work and I wish you all the best with your treatment. I just feel people should be skeptical of the claims alternative treatment makes. Personally I don't consider a single case study very strong evidence.

[ezer]

Many PNE sufferers embraced ART around 2004. It was the upcoming treatment. People flew to Colorado to get treatment. It just did not work that well for PN. A few months later, cold laser was the revolutionary technology. Once again, it did not pan out.
Then it was Rolfing, Alexander technique, Botox.
Sure some of those treatments have helped some but having tried a lot of them without success I am justifiably a bit skeptical...

[Pelvis Stressly]

It is a single case study? An anecdotal report. If a person comes on and says so and so surgeon cured me why is that so very different?

Again, really don't have time at the moment to respond properly to this, but just quickly...a single case study is not at all the same as anecdotal report on a message board. The latter isn't peer reviewed & published in a medical journal. Many of the early PNE papers by Shafik were discussing less than 10 patients...same for Dellon & Aszmann's paper that's provoked so much discussion in the behemoth 'Dorsal Branch' thread.

I'm not sure about the site you linked. Here's a quote from the official ART site though...

"Most healthcare providers use techniques of massage, trigger point, electrical modalities and ultrasound with varying degrees of specificity to treat soft tissue problems. These all provide reasonable results but there is a much better way." (so clearly they don't consider what they're doing to be massage)

By all means, I agree w. staying skeptical though (not saying this article is the end all, be all of PNE research...just something to be filed away at the back of the brain, and not dismissed automatically w.out properly looking into it).

It just did not work that well for PN. A few months later, cold laser was the revolutionary technology.

Dr. Andrew is finding that the key is the combination of the above elements along with the ESWT (+ a few other elements)...he's been getting some promising, early results w. his protocol.

Gotta go!

[Charlie]

Here is another article on ART.

http://chirobase.org/06DD/art.html

A review published in 2004 noted that many case studies had been published but (a) no studies had compared whether different practitioners would agree on what tissues were affected, and (b) treatment outcome had not been assessed in controlled studies [6]. Since that time, two pilot studies have been published. One found that that ART protocols did not reduce inhibition or increase strength in the quadriceps muscles of athletes with anterior knee pain [7]. The other found that a single ART session had lengthened hamstring muscles of healthy males, but there was no follow-up to see how long the effect lasted [8].

Aetna's chiropractic clinical policy bulletin classifies ART as "experimental and investigational" because there is inadequate evidence of effectiveness in the peer-reviewed published medical literature . It remains to be seen whether its advocates can produce publishable results that will establish it as effective. Practitioner Web sites state that many other insurance plans cover ART.

My purpose in writing this article is to describe what ART involves. I have no opinion about whether or not it works.

Here is another article regarding Chiropractic treatment.

http://www.guardian.co.uk/commentisfree ... nce-health

[Pelvis Stressly]

The great thing about the internet is there's info about everything on it. The bad thing is, there's so much info available, you can inevitably find something to back up any point you're trying to make.

The page you linked is not an objective site Charlie...their mandate is clearly stated as being, "Your Skeptical Guide to Chiropractic History, Theories, and Practices". However, as already demonstrated earlier in this thread, I can also easily pluck quotes & stats...from the ART site itself, or from other sources (such as the orig. paper linked in this thread)...that counter what's being presented as fact on the pages you presented. I'm not really trying to get into a copy and paste war though.

I mean, the decompression surgery that's generally seen on this forum as the 'be-all, end-all' treatment for this condition, is looked at just as skeptically by many elsewhere, as 'alternative treatments' are here. Believe the following has already been posted... http://www.chronicprostatitis.com/pne.html Perfect example of an unobjective site, with a clear anti-PNE/decomp. surgery slant (article is presented as fact, but, based on what we know here, there's obviously a lot of exaggerated fear-mongering sprinkled liberally throughout).

[Charlie]

The page you linked is not an objective site Charlie...their mandate is clearly stated as being, "Your Skeptical Guide to Chiropractic History, Theories, and Practices".

Pelvic Stressly I accept that http://www.chirobase.org is a biased source. I think some of the arguments on there should be considered but I accept it is anti-chiropractic treatment. When assessing bias I would not put it in the same league as chronic prostatitis which is a for profit, sales site. Chirobase does not sell any products or treatment.

The second article I linked to was posted from the British Newspaper The Guardian. What is interesting about that article is that the British Chiropractic Organisation attempted to sue the Journalist who wrote the article. In the end the British Chiropractic Association had to drop their case as they could not prove the article was libel. This can be seen from the 2 articles below.

http://www.badscience.net/2010/04/libel ... he-public/

The great thing about the internet is there's info about everything on it. The bad thing is, there's so much info available, you can inevitably find something to back up any point you're trying to make. I'm not really trying to get into a copy and paste war though.

I disagree with you here. This is not a for and against debate. The debate is about the validity of the case study to show ART as an effective treatment for PNE. The fact is it cannot be considered evidence which proves the case for ART being an effective treatment for PNE. Yes a case study is better than nothing however you will find case studies by homeopaths who claim to have cured all kinds of ailments published in homeopathic journals. Homeopathy though is the equivalent of drinking water.

There is a very easy way to silence the doubters. Simply perform a controlled study. You say ART is not a new treatment, my question would be then why have they still not got around to performing a controlled study? My assumption would be is that the practioners themselves suspect it would not stand up to a controlled trial.

The same happend with Myofascial PT. For years no controlled study was performed. Then when they finally did get around to a study for patients with IC and announced the results last year they found the results were not significantly better than a regular full body massage. This nugget of information has of course dropped like a stone in the pelvic pain world as it is not exactly good news for myofascial PTs.

In the case of PNE I fully accept more studies are needed but there has been a controlled study for the surgery. It is not a perfect study by any means and it is possible to point out flaws in it however it is none the less a controlled study.

http://www.ncbi.nlm.nih.gov/pubmed/15716208

Yes many alternative treatments may work. ART may be highly effective however it is also an unproven treatment and patients deserve to be aware of that before they spend money on it.

The burden of proof lies with the practioners making the claims not the people questioning the treatment as we saw in the UK libel case.