Log In

Contact Us

Monday to Friday: 8am-8pm
Saturday: 9am-1pm
020 7937 8978
Feedback
FAQs

Testimonials

Read our latest Patient Testimonials

Read testimonials from our coccyx pain patients on www.coccyx.org

what clinic 2013

Pelvic and Coccyx Pain

Unsure which appointment to book? Call us on 020 7937 8978


Pelvic and Coccyx Pain 

Sayer Clinics - the leading pelvic pain clinics in London are the world's leading Coccyx pain, Pelvic Floor Pain and Pudendal Nerve pain specialist musculoskeletal treatment Clinics.

We specialise in the diagnosis and treatment of Coccyx pain, Pelvic Girdle Pain (PGP), Pelvic Floor Pain and dysfunction, Pudendal Neuralgia (PN) and Pudendal Nerve Entrapment (PNE) in our three specialist clinics located in West London: Kensington W8, in Central London W1 off Wigmore Street West End and in East London at Moorgate in the City of London EC2..

Neuromusculoskeletal coccyx expert and London's leading pelvic pain specialist Michael Durtnall leads, practises and liaises closely with his exceptionally skilled Pelvic Pain Physiotherapy Team of Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves who are not only excellent pelvic therapy specialist physical therapists but also the most, caring, experienced and highly recommended for successful treatment of pelvic pain and Pudendal neuralgia. Sayer Clinics are clearly the leading coccyx / tailbone pain, pelvic pain and sacroiliac pain manual Physical Therapy specialists in London, UK.

Dr Michael Durtnall is uniquely experienced as a chiropractor, acupuncturist and musculoskeletal pelvic pain specialist in spinal, sacroiliac and sacro-coccygeal digital radiological (x-ray) and pelvic diagnostic ultrasound diagnosis as well as pelvic joint, internal and external pelvic muscle, ligament, fascia and nerve pathway manipulation, medical acupuncture and physical therapy modalities, making Sayer Clinics the leading non-surgical treatment clinics to painlessly resolve chronic and acute musculoskeletal coccyx and pelvic pain. 

Read the 130 coccyx testimonials for Michael and his team at http://www.coccyx.org/treatmen/docsuk.htm and www.coccyx.org as well as pelvic pain patient reviews for Michael Durtnall and his team on the UK and Ireland forum of www.Pudendalhope.info.

Michael and Sayer Clinics' physical therapists are the world's foremost coccyx and pelvic pain diagnostic and manual treatment specialists with www.pelvicpain.org, www.pudendalhope.info and www.coccyx.org listings for their specialist diagnosis and manual treatment of musculoskeletal tailbone-coccyx dislocation and dysfunction, pudendal neuralgia, pudendal nerve compression and entrapment, pubic symphysis, pelvic girdle pain and referred groin, hip and pelvic floor pain.

Read here 10 years of Michael's research on coccyx.org at 'Chiropractic and Acupuncture works for acute & chronic Coccyx pain/dislocation and read his 2012 statistics on his treatment of 87 consecutive coccyx and pelvic pain patients and http://www.coccyx.org/medabs/durtnall.pdf on http://www.coccyx.org/medabs/durtnall.htm

Michael has conducted extensive research into effective pelvic pain manual treatment as well as quantitative and qualitative analysis of post-partum coccyx pain (coccyx pain after childbirth). He has successfully treated multiple cases of coccyx dislocation and reset sacral fractures following ventouse and forceps deliveries in London hospitals.

Michael Durtnall's Pelvic Pain knowledge progressed when he studied with New Yorker Dr Amy Stein (author of 'Heal Pelvic Pain') at her workshop at the World Congress of Lower Back and Pelvic Pain in Barcelona in 2007. Dr Stein was adamant that all pelvic pain patients must first have their pelvic joints examined and adjusted by a chiropractor. Amy Stein had herself learned from the leading pioneers of the profession as a physical therapy graduate, studying with Holly Herman who with Kathe Wallace had founded the Herman & Wallace Pelvic Rehabilitation Institute in Seattle, USA.

Michael next decided to study 'hands-on' with the American pelvic pain guru Dr Rhonda kotarinos at St George's Hospital in London and went on to treat their mutual pelvic pain patients together at Sayer Clinic: Kensington.

We are pleased to report that over the last 10 years countless patients with severe and acute as well as chronic musculoskeletal pelvic pain are deeply grateful for the dramatic and sustained improvement in their pelvic function along with the ability to live a normal pain-free life following a course of manipulation and physical therapy with Michael, Sofia, Marta, Karolina and Katy at Sayer Clinics.

Many doctors have not heard of pelvic-floor physical therapy. Pudendal neuralgia, coccydynia and vulvodynia can be excruciatingly painful and chronic, yet surprisingly the majority of people who suffer neuro-musculoskeletal referred pelvic pain are still treated with surgery, nerve cauterisation, cortisone injections, painkillers, anti-epileptic and antidepressant drugs. 

GP's can best help these patients by referring them first to Sayer Clinics' experienced pelvic-floor manual physical therapists for a thorough examination and clear diagnosis curative pelvic rehabilitation therapy instead of 'cut-it' or 'cover-up the pain' treatment.

Healthy connective tissues cushion and protect blood vessels and pelvic nerves from compression.

Our manual therapy works on connective tissue restrictions caused by dysfunction or injury in muscles, pelvic nerves and joints or which develop as a reflex from malfunctioning abdominal and pelvic organs. Connective tissue which has thickened over time, reduces local blood flow and entraps or sensitises nerve endings, causing pain. When we manually release connective tissue restrictions we relieve trigger point activity and pain referred from bladder, uterus, prostate and other tissues and organs. We manually perform the pinch-roll test of the pelvis, abdomen, buttocks and thighs to finely assesses for painful tissue thickening or panniculosis and our pelvic physiotherapists use skilled connective tissue manipulation to mobilise, improve circulation, desensitise and remove negative reflex effects on muscles, nerves, organs which are ubiquitous in pelvic and coccyx syndromes in women and men.

Men and women who suffer chronic pelvic floor pain with sitting typically have widespread connective tissue thickening of their pelvic floor tissues, pubis, perineum, inner part of the sitting bones (ischial tuberosities) buttocks, groins and inner and rear-thighs. We also examine for tissue restrictions and postural contractions of the chest, pectorals, intercostals, upper abdominal and diaphragm.

Our low-dose, standing x-rays often detect significant leg-length difference and compensatory scoliosis with pelvic asymmetry and sacroiliac joint torsion which is often seen in patients with pubis, coccyx and pelvic pain. Tissue manipulation normally causes pain and soreness for several days after treatment, but after a few treatment sessions, the connective tissue manipulation pain diminishes and finally disappears both during and following treatment.


Sayer Pelvic Physiotherapy Team

Sayer Clinics' specialist pelvic physiotherapists, Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves, are rare hands-on experts as most NHS and private physiotherapists have not been taught these manual techniques even at post-graduate level. Successful treatment depends on experienced therapists with expert connective tissue evaluation and individualised courses of treatment.

Michael Durtnall presented the world-first workshop lecturing on Coccyx and Pelvic pain at the 8th World Congress of Low Back and Pelvic Pain in Dubai in 2013 and at the world's first Coccyx Symposium in Paris in July 2016 as the world expert in coccyx manipulation and rehabilitation to international medical audiences of doctors, therapists, specialists and professors to begin the process of educating the medical profession how to properly diagnose and effectively treat musculoskeletal coccyx and pelvic pain without mind-altering drugs, steroid injections or invasive surgery.

Sayer Clinic chiropractors and physiotherapists are also highly experienced in working with pregnant women. We understand the demands placed on the body during the different phases of pregnancy with many pregnant women experiencing neck pain, headaches, low back pain and leg pain. We clearly understand and expertly treat postural changes, sacroiliac, SPD or PSD pubic symphysis joint dysfunction and PPGP pregnancy-related pelvic girdle pain.  Dr Allison Hyman is expert in Webster technique to help realign breach babies and optimise the health of the mother before birth.

Causes of chronic & acute pelvic pain and coccyx pain - coccydynia - tailbone pain.

Neuro-musculo-skeletal disorders

Abdominal muscle pain (trigger points)

Nerve entrapment in Caesarian (c-section) or episiotomy scar tissue.

Spondylolisthesis - forward slippage of one lumbar vertebra on another – treated by regaining mobility/normal function of joints above and below, strengthening core muscles to minimise strain on a spondylolisthetic joint and postural changes.

Poor posture – caused by normal postural adaptation to pregnancy which is unresolved following birth - caesarian section - weak abdominals - obesity, sedentary occupation - sitting at computers - wearing high-heels.

Mechanical low back pain – lumbar facet joint pain or sacro-iliac joint pain and dysfunction - sciatic referred leg pain - athrosis - leg-length difference, muscle spasm or joint locking.

Sacrococcygeal syndrome – chronic or acute coccygeal pain – coccyx hypomobility (stiffness), minor dislocation or arthrosis causing muscular pain, spasm or weakness to coccygeus, gluteal, obturator externus / internus with typically unilateral Arcus tendinosus tension, piriformis, gluteus minimus, quadratus femoris muscle spasms as well as internal hip rotators, gluteus medius, adductor longus and brevis, pectineus, tensor fascia lata and medial hamstrings.

Coccygeal, sacral or pudendal nerve referred pain - pelvic pudendal neuralgia or pudendal nerve entrapment PNE: 

In women -rectal or perineum pelvic floor pain, pain in the labia, internal vaginal wall muscle pain with trigger points, burning clitoris pain and persistent hypersensitivity genital arousal disorder (PGAD) or clitoral hypo- sensitivity and numbness, lower abdominal and inner thigh pain. 

In men, chronic referred pain to the inner thigh, groin, pelvic floor, testicles or penis.

Muscular strains and injuries of gluteal medius, gluteus minimus or maximus muscles with hip or buttock pain or piriformis spasms may entrap the pudendal nerve or sciatic nerve. Coccygeus muscles spasm can compress the rectal branch of the nerve causing proctalgia fugax, fleeting, agonising and occasionally long-term rectal spasm and pain.

Fractures of the sacrum or coccyx following trauma or childbirth - especially after obstetric intervention with Ventouse or forceps delivery in childbirth.

PPGP, SPD OR PSD - Pubic Symphysis Diastasis causing severe pain at the symphysis pubis in the later stages of pregnancy linked to sacroiliac joint dysfunction or subluxation is only effectively, easily and efficiently treated with chiropractic sacroiliac joint specialist manipulation.

Sayer Clinics chiropractors in London and our leading pelvic pain physiotherapists in London are the real experts in treating the agony of sacroiliac - SI joint or SIJ dysfunction - PPGP (pregnancy-related pelvic girdle pain) SPD (symphysis pubis diastasis or PSD (pubic symphysis dysfunction) and are able to treat this disabling condition very safely, swiftly and effectively - without pelvic belts, oral analgesics, injections or other largely ineffective conventional and outdated therapies.

Piriformis syndrome

Rectus Femoris tendon strain.

Disc bulge / herniation.

Compensatory Scoliosis associated with significant leg-length difference

Help during Pregnancy

Tailbone Mobility versus Position - We are frequently asked: Can you manipulate my coccyx back into the right position?

'It's not about a 'right position' but about regaining a pain-free, fully-functional 'range of movement' which also allows the pelvic floor and spine to function properly again and free you from the grip of nerve-pain and protective muscle spasm.

If you suffer debilitating tailbone pain, it is not unusual for a hospital specialist to tell you there is nothing wrong after an x-ray or MRI. Most doctors are not trained to, and do not, examine the coccyx properly for tailbone injuries and having seen a radiology report which says there is no fracture, tumour or cancer often dismiss or misdiagnose it and label the problem as psychosomatic.

Static x-rays and MRIs show coccyx position, but not the fixed, limited or disturbed range of motion which causes coccyx pain. At Sayer Clinics, we properly examine and, in conjunction with our digital coccyx x-rays, treat you to restore coccyx mobility and achieve excellent function of the coccyx and pelvic joints, muscles, posture and fitness.

Contact us to ask any questions or just Book online for painless treatment to regain pain-free health at our West London, Central London and City of London coccyx and pelvic pain clinics.

Sayer Pelvic & Coccyx Pain specialists

Our chiropractors, osteopaths and physical therapists are all highly qualified and fully registered health practitioners who diagnose using neurological and orthopaedic tests, chiropractic or osteopathic spinal examination and digital radiology and treat patients with safe and effective manipulation, physical therapy modalities and postural rehabilitation.

Sayer Women's Health Physical Therapy

Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves are exceptionally skilled specialist Pelvic Pain Physical Therapists with expertise in trigger point and myofascial release for coccyx - tailbone pain, pudendal neuralgia and pelvic floor rehabilitation. We treat women from teenagers to post-menopausal. Treatments are conducted in private treatment rooms with focused hands-on therapy. Our specialist women's health physical therapists evaluate and treat pelvic pain and dysfunction with the active participation of the patient through their treatment and healing process.

We are specialised in rehabilitation treatment programmes for pelvic floor pain, abdominal muscle diastisis, incontinence, pre-natal and post-partum pelvic girdle pain, pelvic organ prolapse, sexual pain and dysfunction.

Symptoms of Musculoskeletal Coccyx and Pelvic Pain we routinely successfully treat at Sayer Clinics London.

Our patients typically suffer from 2 or more of these symptoms: 

Coccyx - tailbone pain

Low back pain

Sacroiliac pain

Pain with sitting

Urinary Frequency - Urgency - Hesitancy

Rectal / Perineum pain

Male Genital Pain or parasthesia / numbness - gluteals, buttocks, pelvis,   perineum, testicles or penis, lower abdomen or inner thighs

Female Genital Pain or parasthesia / numbness - gluteals, anal pain buttock pain , pelvic floor muscle tightness or tension or weakness , perineal burning nerve pain, vulval and labial  inflammation , one or both sides internal vaginal muscle contraction or weakness , clitoral hypersensitivity, PGAD or insensitive / loss of clitoral sensation or clitoris pain with anorgasmia / inability to climax, lower abdomen or inner thigh pain or altered sensations.

Lower abdominal pain - parasthesia - tingling altered sensations in lower legs

Pelvic pain during or after sex

Pain or relief after bowel movement

Stress increases pain

Hot showers baths or heat helps

Depression or anxiety about chronic pain

Medical tests find no pathology or disease

Drug treatments ineffective + miserable side effects

Reduced quality of life

We describe and list below in specific detail the initial real-life experiences and symptoms of Sayer Clinics' coccyx and pelvic patients successfully treated at our clinics in London. It will help you to see and begin to understand how it feels to suffer these musculoskeletal coccyx and pelvic pains syndromes. 

If you suffer the symptoms below then please ask for our help at Sayer Clinics:

Sitting pain

Almost everyone sits constantly throughout every day in cars, trains, all day at work and then socialising or at home for most waking hours. Sitting can trigger or aggravate coccyx and pelvic pain discomfort and flare all pain symptoms which worsen through the day. Travelling, flights and driving aggravates coccyx and pelvic pain.

Coccyx Pain - Tailbone pain - Coccigodynia - Coccydynia

Tailbone / coccyx pain is the most common cause of pelvic floor pain and typically refers sharp or burning pain to the anal area via the rectal nerve branch, and / or via the labial and clitoral branches and also potentially to the lower abdomen and inner thigh via the sacral or coccygeal branches of the compressed, entrapped or inflamed pudendal nerve. 

The simple mechanism of pelvic pain progression is that almost everybody with coccyx pain or musculoskeletal pelvic pain sits sideways long-term to avoid the primary pain which then causes thickening and spasm of the pelvic muscles through which the pudendal nerves pass with chronic compression of the pudendal nerve/s with the whole gamut of potential and secondary referred pain along the pudendal nerve pathway. 

Coccyx pain is often associated with bowel movement pain.

Low back pain is a normal part of the whole scenario in patients with pelvic pain as they all typically sit or lie awkwardly and twisted sideways on one or other buttock to avoid their pain in the pelvic floor or coccyx. This creates a torsion and imbalance with asymmetrical tension in the pelvic muscles and the lumbar spine which often leads to sacroiliac-iliac pain, facet joint pain, compensatory spinal curvature and poor posture with nerve root irritation.  

Coccyx nerve irritation can make the sufferer feel the need to defecate many times a day without resolution of the sensation. This is curable by regaining coccyx function along with coccygeal and sacral nerve function. 

We heal pelvic pain at Sayer Clinics by assessing and treating the body's entire musculoskeletal structure which includes, posture, mobility, symmetry, tone and strength. We teach and help every patient perfect the unique 'Sayer Clinics perfect Posture' method of sitting and standing for lifelong postural perfection .

Genital pain 

Males: pain in the perineum and at the tip and shaft of the penis or testicular pain felt in one or both testicles.

Females: pain superficially or deep inside the vagina, vestibulitis, vestibulodynia, labial-vulvar pain on both or one side or Clitorodynia, clitoral burning pain or altered sensation, parasthesia or numbness.

Pain is commonly felt along with urinary frequency and urgency.

Coccyx /pelvic muscle trigger points may refer as perineum, pelvic floor, rectal, inner thigh and lower abdominal pain.

Patients also frequently suffer thigh, calf and foot pains or paraesthesia as altered sensation - formication - like ants crawling or a sensation of water trickling on the skin. These symptoms are usually the first to go once treatment has started.

Genital pain is best resolved using a combination of specialist manipulation to correct pelvic or coccyx joint torsion or dislocation. We treat muscle / nerve compression using specialist physical therapy stretches, trigger point therapy or medical acupuncture. 

Groin, pelvic, hip or abdominal pain

Groin pain needs to be diagnosed accurately and not confused with a hernia, muscle, tendon-bone insertion inflammation or hip joint CAM or PINCER pain.

Bowel movement pain

Relief after a bowel movement is experienced when tight pelvic muscles relax but often pain after a bowel movement may be stronger for many hours afterwards.

The need to defaecate sends a nerve impulse to the internal anal sphincter and puborectalis muscles to relax, triggering a bowel movement. Once the stool passes through the relaxed anal sphincter the internal anal sphincter may reflexively ‘over tighten' into painful spasm.

After-bowel-movement pain occurs less if you can learn to relax and usually resolves fully with specialist pelvic physiotherapy and pelvic muscle tension releases.

Pain symptoms can move or migrate to different parts of the pelvis as the condition progresses with pain and altered sensation in the pelvic floor, genitals, lower abdomen, inner thighs and legs.

Hot baths, showers or heat packs help whereas cold can aggravate symptoms.

Urinary frequency 

Urinary frequency can range from a worry to an overwhelming urge.

A feeling of a constant subtle ache in your bladder/urethra/genitals, not feeling 'empty’ after urination and feeling a need to urinate again despite an empty bladder. The relaxed resolution normally felt after urination is often absent with pelvic pain.

Urgency - difficulty 'holding' once urge starts.

Frequency/urgency means constant worry and planning ahead to be near a toilet for fear of leaking or loss of control when the urge comes.

Urinary urgency and frequency can cause sleep deprivation with frequent waking to urinate throughout the night.

Dysuria

Burning or pain with urination, often with pelvic floor weakness.

When the chronic spasm and myofascial contraction of the pelvic muscles is resolved, in most of our patients, dysuria is also resolved

Pain during or after urination - Dysuria can be severely painful which refers a variety of acute pelvic pains.

Nocturia causes disturbed sleep which quickly impacts on chronic tiredness and exhaustion, irritability with increased stress, tension, guarding and anxiety.

In men a reduced stream or urinary flow may be due to prostate enlargement or neuro-musculoskeletal conditions.

Hesitancy of initiating urination can be worsened when urine is held longer than comfortable and can be a contributory symptom to low self-esteem and hypochondriasis particularly in younger males.

When urinary symptoms are muscular in origin, after relaxing the pelvic floor, the flow of urine usually improves.

Those with neuro-muscular pelvic pain may have to consciously focus on muscle relaxation until urinary flow can start.

Perineum 

Chronic pain in the perineum is very common in females especially after episiotomy where scar tissue is trapping nerves.

The perineum is the focal point of many pelvic floor muscle attachments and may be the endpoint or the source of referred pain.

The perineum is often injured by prolonged cycling with saddle pain and compression of the pudendal nerve/s.

Perineal pain is usually aggravated by sitting but also by standing.

Abdominal and pelvic muscles can refer pain to the perineum (rectus abdominus, adductor magnus, and coccygeus).

Irritation of the perineum and anal sphincter can feel like you're “sitting on a golf ball".

Increased discomfort for hours or even the next day after sexual activity is common as orgasm causes strong contractions of the pelvic, prostate and seminal vesicle muscles with significant nervous system arousal which tightens pelvic muscles, pushing the patient above the symptom threshold.

Dyspareunia 

Pain with sexual activity either during or after sex -pain is felt on the outside of the vagina, inside or both with potential clitoral hypersensitivity or complete insensitivity or numbness.

Pelvic examination in which trigger points are palpated can recreate symptoms of pain during sex but are resolved by trigger point release physical therapy.

Libido 

Reduced or a total lack of interest in sex is common with chronic pelvic pain.

In musculoskeletal pelvic pain, there is dysfunction but rarely any pathology of the anatomy involved in sexual activity.

Low libido is often associated with anxiety, low self-esteem and pain in the pelvis which reduces sexual arousal and interest.

Effective physical treatment of pelvic pain and dysfunction of the pelvic muscles usually resolves low libido. 

Anxiety

When sex is chronically painful, fear and avoidance of sex follows.

Pain can cause difficulty with erection which worsens already low esteem and confidence. Anxiety with pain and sex is a major reason for performance anxiety and is ‘medicalised’ as erectile dysfunction.

Resolution of pelvic pain usually cures the anxiety and erectile dysfunction normalises.

Pelvic and coccyx pain patients are usually worried that they will never improve and catastrophise, fixate and over-focus on the pain which leads to an increasingly powerful and chronic 'centralisation of pain in the brain' which is harder to cure, needing a great deal of practitioner support and focus to break through the fear-pain cycle.

Depression 

Experiencing severe chronic pelvic pain leads to depression, low esteem and hopelessness, with helplessness and the inability to act to move forward, research, find the right treatment and follow through to resolution.

Sexual and social withdrawal with chronic coccyx or pelvic pain is common and also affects their partners who suffer the loss of sex, socialising, holidays and travel. Preoccupation with pain kills any fun and social enjoyment.

Disturbed Sleep with frequent waking during the night to pee or from pain and anxiety means each day starting with tiredness and anxiety.

Normal daily activity as well as unexpected stresses, specific physical activities such as bowel movements or orgasm can initiate severe pain flares with deep pelvic muscle protective spasms for many hours after the initial stress has passed. Long term these protective spasms make muscles fibrotic and hypersensitive to pain.

Helplessness naturally follows the seemingly permanent lack of control of the chronic pain which makes you feel hopeless, demoralised, fearful and banishes most of your enjoyment of life. 

Drug treatments 

Benzodiazepines are associated with an increased risk of Alzheimer’s disease while tricyclic antidepressants like Amitryptalline and neural drugs called Gabapentin, Neurontin or Pregabalin have potentially disturbing side effects and when used regularly for chronic pelvic pain, become less effective with time and can cause tiredness, lethargy and large weight gain.


Causes
Orgasms are a complex reaction to multiple physical and emotional factors:
Simple physical pelvic conditions.
Simple neuromusculoskeletal nerve compression and muscle spasm due to pelvic joint and muscle asymmetry may compress or constrict the blood and nerve supply to the pelvis leading to pudendal neuralgia or neuropathy 
as one of many pelvic symptoms or signs of pudendal neuralgia.
Spinal nerve compression or irritation in the lumbosacral spine may also cause pelvic neuralgia and impede orgasm. 
Hormonal disorders such as hypothyroidism, Addison disease, Cushing syndrome, hyperprolactinemia, hypopituitarism, decreased oestrogen and androgen levels and a whole host of commonly prescribed medications commonly negatively affect libido.
Gynecological factors.
Climax may be impacted by pregnancy, gynecologic surgeries and hysterectomy. Anorgasmia can result from painful intercourse as well as female genital mutilation (FGM), pelvic trauma, hormonal imbalances, vulvodynia, and childbirth trauma. 
The following pelvic disorders may also give rise to anorgasmia:
Vaginal dryness occurs in menopause due to lowered estrogen level with poor lubrication and the side-effects of commonly-prescribed medications which can inhibit arousal and making intercourse painful.
Vaginismus – is painful spasm and tightening of muscles at the vaginal opening which prevents or make penetration extremely painful. Vaginismus may also follow surgical scars or injury, abuse, chronic infection, childbirth trauma, anxiety and fear.
Nerve damage following surgery 
During pelvic surgery and hysterectomy, small nerves will be cut which may decrease sexual response and sensation.
Prescription drugs.
Many prescription medications impede orgasm. These include drugs for blood pressure antihistamines, anxiolitics, anticonvulsants and barbiturates, Venlafaxine and many antidepressants especially selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. 
Post-SSRI sexual dysfunction causes up to 41% of women taking SSRIs to experience lowered libido up to anorgasmia. 
Research has shown a sexual and orgasm dysfunction rate of 
16-27% for quietiapine, aripiprazole, ziprasidone and perphenazine with 
40-60% for haloperidol, clozapine, olanzapine, thioridazine and risperidone. 
Decreased libido and anorgasmia are reported for beta-blockers as well as carbamazepine, benzodiazepines, phenytoin, gabapentin, pregabalin and topiramate. 
Alcohol and Drugs
Excessive alcohol, cocaine, marijuana, amphetamines, opiates, heroin, street drugs and tobacco cause vascular and neurological damage which affects sexual function and ability to orgasm.
Aging
Ageing gradually changes neurological, hormonal and circulatory systems which impact sexuality leading up to menopause with lowering of oestrogen causing reduced sensation of nipples, clitoris and reduced blood flow to clitoris and vagina.
Psychological Causes
Psychological factors can cause anorgasmia.
Performance anxiety
Embarrassment
Cultural beliefs
Religious 'shame or guilt'.
Stress, relationship, work or money problems
Fear of pregnancy or sexually transmitted diseases.
Dysfunctional pubococcygeus (PC) muscles inhibited by coccyx pain or sacroiliac joint and pelvic muscular dysfunction.
Sexual abuse 
Depression.
Emotional Causes
Disagreements about money, childcare or control and issues including infidelity and lack of trust, unresolved conflict, loss of emotional connection with partner, poor communication of sexual preferences and needs and sexual boredom can often lead to chronic sexual dysfunction and anorgasm

Anorgasmia - Total inability to orgasm or difficulty achieving orgasm is a complex reaction to multiple physical and emotional factors:


Simple physical pelvic conditions.

Simple neuromusculoskeletal nerve compression and muscle spasm due to pelvic joint and muscle asymmetry may compress or constrict the blood and nerve  supply to the pelvis leading to pudendal neuralgia or neuropathy as one of many pelvic symptoms or signs of pudendal neuralgia.Spinal nerve compression or irritation in the lumbosacral spine may also cause pelvic neuralgia and impede orgasm. 


Hormonal disorders

Hypothyroidism, Addison disease, Cushing syndrome, hyperprolactinemia, hypopituitarism, decreased oestrogen and androgen levels and a whole host of commonly prescribed medications commonly negatively affect libido.


Gynecological factors.

Climax may be impacted by pregnancy, gynecologic surgeries and hysterectomy. Anorgasmia can result from painful intercourse as well as female genital mutilation (FGM), pelvic trauma, hormonal imbalances, vulvodynia, and childbirth trauma. 

The following pelvic disorders may also give rise to anorgasmia:
Vaginal dryness occurs in menopause due to lowered estrogen level with poor lubrication and the side-effects of commonly-prescribed medications which can inhibit arousal and making intercourse painful.
Vaginismus – is painful spasm and tightening of muscles at the vaginal opening which prevents or make penetration extremely painful. Vaginismus may also follow surgical scars or injury, abuse, chronic infection, childbirth trauma, anxiety and fear.
Nerve damage following surgery 
During pelvic surgery and hysterectomy, small nerves will be cut which may decrease sexual response and sensation.


Prescription drugs.

Many prescription medications impede orgasm. These include drugs for blood pressure antihistamines, anxiolitics, anticonvulsants and barbiturates, Venlafaxine and many antidepressants especially selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. 

Post-SSRI sexual dysfunction causes up to 41% of women taking SSRIs to experience lowered libido up to anorgasmia. 
Research has shown a sexual and orgasm dysfunction rate of 16-27% for quietiapine, aripiprazole, ziprasidone and perphenazine with 40-60% for haloperidol, clozapine, olanzapine, thioridazine and risperidone. Decreased libido and anorgasmia are reported for beta-blockers as well as carbamazepine, benzodiazepines, phenytoin, gabapentin, pregabalin and topiramate. 

Alcohol and cocaine, marijuana, amphetamines, opiates, heroin, street drugs and tobacco cause vascular and neurological damage which can affect  sexual function and ability to orgasm.


Ageing

Ageing gradually changes neurological, hormonal and circulatory systems which impact sexuality leading up to menopause with lowering of oestrogen causing reduced sensation of nipples, clitoris and reduced blood flow to clitoris and vagina.


Psychological causes of sexual  dysfunction and anorgasmia.

Performance anxiety Embarrassment Cultural beliefs Religious 'shame and guilt'. Stress, relationship, work or money problems Fear of pregnancy or sexually transmitted diseases. Dysfunctional pubococcygeus (PC) muscles inhibited by coccyx pain or sacroiliac joint and pelvic muscular dysfunction.• Sexual abuse  Depression.


Emotional Causes

Disagreements about money, childcare or control and issues including infidelity and lack of trust, unresolved conflict, loss of emotional connection with partner, poor communication of sexual preferences and needs and sexual boredom can often lead to chronic sexual dysfunction and anorgasmia.


Physical treatment

In our opinion, drugs, injections and chemical or electrical burning of nerves (radio frequency ablation) is not a good way to treat chronic neuromusculoskeletal conditions. They suppress and cover up pain symptoms, allowing the patient to continue being trapped in a pain-generating cycle with continued inactivity, overweight, poor posture and progression of the condition. The patient will lose control over their health under the influence of these drugs. We help by educating you to understand how to reduce pain logically and to physically regain control and fitness.

FIRST choose Neuromusculoskeletal Pelvic Pain assessment, treatment and advice at Sayer Clinics - London and Europe's leading pelvic pain clinics. The musculoskeletal system is most commonly the cause of chronic and severe pelvic pain  and sexual dysfunction so use Sayer Pelvic Pain Clinics physical Neuromusculoskeletal manual therapy treatment FIRST for male or female pelvic pain or sexual dysfunction.

Common Symptoms of pelvic pain include:

Vulvar, vaginal, clitoral, perineal or anal pain

Dyspareunia - pain during sex - pain after sex

Labial, vulvar or genital pain, altered sensation - burning pain or itching

Pain on urination, urinary hesitancy, urgency and/or frequency

Lower abdominal, groin, inner thigh pain or altered sensation

Sacroiliac joint pain, locking or instability

Constipation

Painful periods

Pain on wearing jeans or underwear

Pain with sitting

Muscular pelvic pain with exercise

Associated or alternate Diagnoses:

Interstitial Cystitis - Painful Bladder Syndrome

Vulvodynia - Vestibulitis - Vestibulodynia

Clitorodynia, clitoral burning pain or altered sensation, parasthesia or numbness

Persistent Genital Arousal Disorder (PGAD)

Proctalgia Fugax - stabbing or shooting rectal pain

Irritable Bowel Syndrome

Tailbone pain - Coccydynia

Sacroiliac Joint Dysfunction

Pelvic Girdle Pain

Endometriosis

Evaluation and Treatment at Sayer Clinics:

During your first "evaluation appointment,” a therapist will take your extensive medical history and will then perform a thorough musculoskeletal examination. Your initial evaluation includes:

-- Postural, pelvic joints, spinal and structural assessment

-- Evaluation of fascia and connective tissue in the abdomen, back, pelvis and lower extremities

-- Myofascial evaluation of the pelvic girdle muscles

-- Examination to identify myofascial trigger points in the pelvic girdle and pelvic floor muscles

-- Pelvic floor examination by gently assessing muscle tone, motor control and tenderness.

-- Evaluation of pelvic floor muscle strength

-- Pelvic skin inspection

Following your physical examination, our therapist discusses your physical findings, assesses and explains the treatment frequency and probable duration of therapy.

Initially, treatments are 60-90 minutes long over eight weekly sessions. We then re-evaluate, and set further treatment plans and goals depending on progress. Patients with pelvic pain are typically seen for a minimum of 12 visits but the duration may vary based on the severity and chronicity of the problem. 

Treatment at Sayer Pelvic Pain Clinics is one-on-one manual physical therapy with a multidisciplinary treatment approach with email access to your therapist to answer questions, address your concerns and provide you with ongoing support. We are committed to ensure that you receive the best treatment possible to help you to get well.

Sayer Clinics Manipulation and Pelvic Physical THerapy Treatments include: 

Trigger point release

Myo-fascial manipulation

Musculoskeletal pelvic joints manipulation

Dry needling, Medical or Japanese Acupuncture

Scar massage, mobilisation & de-sensitisation

Re-education of pelvic floor and nerve  function

Restoring tone and function of abdominal core muscles

 

Sayer Clinics Physiotherapists are HCPC registered with Health & Care Professions Council and registered with most insurers.

Dr Michael Durtnall is registered with Bupa, BUPA International, Aviva and most international insurance companies.

Please check with us and with your insurers before starting treatment.

Please choose from the three Sayer Clinics in London W8, W1 or EC2, research and choose your practitioner/s, choose dates and times and then book and pay online at www.sayerclinics.com for your treatment appointments. We will email you a confirmation email and issue you receipts to help you to reclaim from your insurers.

Book Online 24/7 here  for Sayer Clinic Kensington W8, Moorgate EC2 in the City or Welbeck Street W1

Please call Alexandra or Lucie on 020 7937 8978 from 8am-8pm Monday to Friday and Saturdays 9am-2pm or email mail@sayerclinics.com to ask us any questions.


Sayer Pelvic Pain Clinics' unique neuromusculoskeletal approach to Pelvic pain.

 

Pelvic pain is often the result of nerves becoming chronically irritated and inflamed. This is most commonly due to long-term, slumped sitting positions, compressing nerve pathways where they exit the lower sacrum and coccyx, with burning nerve pain into the deep and superficial pelvis, which is served by a multitude of nerves including the rectal, perineal and pudendal nerves. This nerve damage instructs the coccygeus, piriformis and deep gluteal muscles to contract to protect the nerves with resulting self-perpetuating, deep muscle spasms deep in the ischium or “sitting bones” area of the pelvis. Chronic referred pain or neuralgia may be felt in the genitals, perineum, abdomen and buttocks. Pain is increased by sitting, usually onesided but often both sides are involved. Symptoms may include pain, burning, numbness and paraesthesia in the pelvis near the sacrum and coccyx, which can radiate throughout the pelvic floor, inner thigh, lower abdomen and groin.

 

The first step, in consultation with your GP, is obviously to exclude any previous pathological, urological or gynaecological causes of your pelvic pain.  Once these have been eliminated as a source or cause of the problem, the persistent symptoms of pelvic pain can be examined and often successfully treated by a multi-disciplinary team of manipulation therapists and physiotherapists.

Diagnosis depends on a thorough history and physical examination of the complex interaction between all structures leading inevitably to complex dysfunction throughout the body. Leg-length differences of a centimetre or more, for example, can cause significant pelvic tilt and shearing forces at the sacro-iliac and hip joints which in time can cause degenerative changes in these joints. We can address this with graduated heel-lifts to balance the leg-length and spine.

Following a thorough initial chiropractic musculoskeletal evaluation and digital standing x-ray's to confirm your diagnosis we use specific connective tissue manipulation, acupuncture or myofascial release to reduce muscle spasm and nerve compression and consequent inflammation. Specific joint manipulation, physical therapy ‘nerve tissue tension releases’, neural mobilisation and local medical acupuncture can help regain function. Misalignment or fixation of the pelvis, sacro-iliac joints, facet or sacro-coccygeal joints with muscular spasms are usually interrelated factors.


The compression or irritation of obturator, ilioinguinal or genito-femoral nerves can cause intermittent and poorly localised shooting or burning pain in the pelvis, front and inner thighs aggravated even by light touch in the nerve distribution. Treatment with pelvic joint mobilisation, deep muscle trigger points and acupuncture, stretches and exercises help to resolve this nerve irritation. Referral for surgery to release a trapped nerve is extremely rarely necessary.

 

A variety of medical terms exist to describe Chronic Pelvic Pain Syndromes (CPPS):  these include Pudendal Neuralgia; Pudendal Nerve Entrapment; Chronic Prostatitis; Interstitial Cystitis; Proctalgia fugax, Levator Ani syndrome, as well as Vulvodynia and Clitoral pain, hypo-sensitivity or hypersensitivity. However, these pain syndromes are often over-confidently and simplistically labelled yet poorly understood with vague diagnostic tests and pain-masking treatment. 

   



Sufferers seek out urologists, neurologists, gynaecologists, dermatologists, proctologists, rheumatologists and orthopaedic surgeons to treat their symptoms which are in most cases secondary to inter-dependent neuro-musculoskeletal causes. As a result, symptoms almost always return in some form or are never completely eliminated.  Urinary symptoms, for example, are often treated with antibiotics, despite no positive culture, but symptoms will return if they are secondary to biomechanical, neurological or visceral dysfunction.  


A diagnosis of pudendal nerve entrapment (PNE) by a neurologist usually leads to nerve block injections and drugs to dull the brain's perception of pain. This will temporarily mask symptoms yet allow the patient to keep compressing and damaging their nerves, while unaware of the pain. Invasive surgery may cause fibrotic scar tissue in skin, muscle and fascia and cutting of pelvic ligaments can permanently lessen pelvic stability. There are multiple entrapment sites within the pelvis which cannot all be addressed by surgery.

 

Our unique clinical experience over the years has shown us that these pelvic pain conditions are very closely interrelated and associated with often simple factors such as: connective tissue, fascia and ligament laxity; prolonged sitting and physical inactivity (due to job/lifestyle); pelvic asymmetry; previous (forgotten) falls and other injuries from years before. Biomechanical muscular imbalance from prolonged slumped, asymmetrical sitting, cycling, weight-training and repetitive strains to the pelvic floor, sacroiliac and coccygeal joints can cause muscular spasm, hypertonicity and painful thickened, fibrotic myofascial adhesions with the potential to trap the pudendal and perineal nerves within these deep pelvic muscles. The Pudendal nerve is extremely specialised, controlling a complex web of urogenital sexual sensation and function, control of bladder and pelvic floor muscular function plus fascial connections to pelvic and abdominal viscera. The pudendal nerves as well as the urethra pass through pelvic fascial structures and may be compressed or irritated if pelvic fascia, internal pelvic muscles or ligaments to the bladder, prostate, urethra, rectum, anus, pubis, sacrum and coccyx are in pain and spasm.

 

We have found that complex and varied pelvic pain syndromes respond best when each and every patient is treated individually and differently at each treatment visit according to their current situation. Some need very specific manipulation of the sacroiliac and coccyx joints, others need firm external treatment to regain flexion of their almost fused and extended sacro-coccygeal joint. Most also need very deep tissue trigger point work to usually one-sided gluteal, coccygeus and deep pelvic muscles which have thickened and are compressing pelvic nerves. These muscles have usually become deeply fibrotic and pain sensitive, after years or decades of sitting sideways (usually on the same side). Some are so exquisitely painful that they can hardly be touched, so we start using light medical acupuncture, gradual and super-gentle soft tissue work and, finally,  progress to internal or external pelvic joint, muscle and ligament manipulation.

 

We use a flexible, inquiring approach in our clinical practice without preconceptions or foregone conclusions about how treatment has to be. Our treatment is based on clear musculoskeletal findings following experienced physical examination and digital standing x-rays. We treat in a multi-disciplinary way, with a combination of chiropractic, acupuncture, osteopathy and pelvic physical therapy. We use localised medical acupuncture with very specific, frequent and increasingly intensive rehabilitation exercises. 

For example, we recommend specific active movement every half hour throughout each day to regain fitness of joints, muscles, ligaments, tendons and nerves. We ask patients to stand and move while working, to adapt so that they stop sitting so much for prolonged hours. “Sofa surfing” after work is discouraged, as is taking prescription drugs to mask pain, putting on weight, becoming morbidly inactive and losing hope.

 

Our experience over 35 years allows us also to use words, ideas and motivation - what some would now call “mindfulness” - to increase confidence and fitness by degrees, empowering our patients to become pain-free and regain control over their bodies and general well-being.  We certainly do not believe in covering or blocking pain as a short-term goal for short-term pain relief.

 

Patients describe pelvic pain as like being in an abyss; it is very dark, deep and depressing but the need for mental clarity to climb out of this is an imperative. Our role as therapists is to help in this struggle for recovery. I ask my patients why they think we are successful in treating their pelvic and pudendal pain. They tell me that Sayer Clinics are incredibly “hands-on”; that we are comprehensive in our musculoskeletal diagnostics; that we ceaselessly re-examine and reappraise the symptoms of joint locking, muscle spasms, asymmetry and range of movement of the pelvis and coccyx; and that we search out and firmly tackle poor health behaviour and bad ergonomics that largely cause the maelstrom of pelvic pain.


Everybody who suffers from pelvic pain is overwhelmed with diagnostic words: pudendal neuralgia, interstitial cystitis, proctalgia, vulvodynia. Let's keep it simple: the pelvis is a basin, served by nerves and blood vessels and moved by muscles with complex stresses shared between joints and ligaments. There are only so many things that can cause pain; if it isn’t infection, if it isn't a skin disorder and if it isn't cancer then the chances are that it has a neuro-musculoskeletal basis. This means that most pelvic pain can be physically solved and effectively treated.

 

                                                                 

Michael Durtnall DC MSc (UCL) FRCC (Orth)

Chairman Sayer Clinics: London 

Fellow Royal Society of Medicine

www.sayerclinics.com

 


Sayer Clinics Summary of Intense Treatment

Generally, patient treatment may range from daily or 2-3 visits per week if fairly local to those who visit weekly, fortnightly or monthly.

Our intense protocol condenses therapy traditionally spread over the course of months into 1-3 weeks, to keep it practicable for those travelling from very distant locations and reducing the need for subsequent trips. The initial intense treatment protocol comprises one to three weeks of daily therapy for those travelling from afar with:

• Spinal and Pelvic Manipulative Therapy 5 days/week, depending on patient response and tolerance.

• Manual Physical Therapy and  Pelvic Active Release Techniques 5 days/week, depending on patient response and tolerance.

• Lifestyle Modifications.

• Exercises and Dietary Interventions.

• Education of causes, aggravating factors, strategies for management and prevention.

• Biomechanical Correction of lower limb, spinal and pelvic biomechanical gait anomalies.

Each of the above therapies follow scientific evidence in the treatment of pelvic pain syndromes, however none have been combined in such an intensive, focussed way which we find to be extremely successful in patient pain scores and improvement of tissue and joint function outcomes.

Sayer Clinics are world leading London Pudendal Neuralgia, Coccyx pain and Pelvic Pain Specialist Clinics


First book at Sayer Clinic: Kensington W8 to see Dr Michael Durtnall for your initial consultation, x-rays, diagnostic tests and to start effective treatment. Michael combines specific rehabilitation with our highly skilled specialist pelvic and coccyx pain Physical Therapists, Sofia Ornellas Pinto, Katy Goncalves, Karolina Krzaczek and Marta Dias de Oliveira at Sayer Clinics EC2, W1 or W8.


If you suffer coccyx or musculoskeletal pelvic pain or sexual dysfunction our specialist clinics with Michael Durtnall will help you. We successfully treat patients every day who travel to us from all over the world.


We are sure the sooner you start treatment and change your flexibility, posture, mentality, lose pain, gain positivity, exercise and fitness the sooner you will  achieve and maintain great future health!

Book online 24/7 here  or email mail@sayerclinics.com or call Alexandra or Lucie on 0207 937 8978.  

 🌞We are here to help you 🌞

 

Help with infertility

Myofascial restrictions or adhesions of the ovaries, uterus and fallopian tubes can contribute to infertility.

Pelvic, sacrum, coccyx, and/or spinal joint misalignment may compromise normal physiological processes necessary to facilitate pregnancy.

Your comprehensive evaluation helps diagnose myofascial adhesions or joint dysfunctions. Studies have shown that myofascial assessment and release of pelvic and abdominal structures and acupuncture can help fertility and successful IVF outcomes.

Specific and careful abdominal massage and acupuncture help you to prepare for successful pregnancy.

Scientists from the USA and Holland analysed seven clinical trials, involving a total of 1,366 women, and showed that women trying to get pregnant using IVF treatment could significantly improve their chances by 65% with fertility acupuncture.

Michael Durtnall helps patients with acupuncture and abdominal myofascial therapy to achieve successful pregnancy.

Pregnancy Testimonials

I have been treated by Michael Durtnall since 1998 for headaches and severe low back pain. Michael was the only medical professional who found the rare diagnosis and treated the source of my problem which was a huge relief as my daily activities had been severely limited by my back pain.

Naturally I have developed a very trusting relationship with Michael over the years and I shared with him that my husband and I had been thinking about starting a family. We were preparing ourselves for some challenges getting pregnant as I have Polycystic Ovarian Syndrome (PCOS).

However Michael assured me that he could assist me in getting pregnant using fertility acupuncture to help prepare the body for conception. Also the success rate of acupuncture has been closely researched recently and is achieving favourable results. Since I had everything to gain by trying acupuncture I underwent a few sessions performed by Michael.

Shortly thereafter I became pregnant and we have just had a beautiful baby girl. The acupuncture was certainly a substantial contributing factor to my successful pregnancy and I will certainly be employing Michael’s services when we are trying for more children.

Sarah

I went to see Michael Durtnall after suffering severe coccyx pain. After regular treatment I am now pain free. Before I visited Michael I saw numerous chiropractors and osteopaths, none of whom could help me.

Having tried to get pregnant for many months, I succeeded once starting fertility acupuncture with Michael. As a result of Michael’s treatment I no longer suffer from coccyx pain and I have a wonderful baby boy. I would recommend anyone to visit him based on my experience.

Ali

I had been seeing my chiropractor Michael Durtnall for a while and when I told him my husband and I were trying for a baby, Michael got out his needles and we never looked back. I had acupuncture as part of my weekly treatments and was soon pregnant. I’m a firm believer in acupuncture and truly credit the ancient medicinal art as having helped me conceive. While I was pregnant I continued to see Michael and I never suffered any further back pain or sciatica. I am constantly referring friends to him and have nothing but the utmost respect for his talent and his compassion for his patients.

Mommy in London

Call Ines on 020 7937 8978 – Book an appointment between 8am to 8pm – We are here to help you.

Conditions

Symphysis Pubis Disorder – SPD.

The Symphysis Pubis joint between the pubic bones at the front of the pelvis may become separated or twisted due to ligamentous laxity during pregnancy causing SPD with pain and difficulty on walking, climbing stairs, dressing, turning in bed and getting in and out of a car.
 Pain can be severe in the sacro-iliac joints and sometimes in the groin, inner thigh, hips or buttocks.

SPD can be surprisingly easily and rapidly improved by careful, experienced and skillful unlocking of the sacroiliac joints, thus instantly reducing the torsional strain at the pubis. Acute SPD patients, usually referred by their midwife or obstretician, often in tears, hobbling and supported by friends at their first visit to us, walk out smiling within the hour!

Our specialised treatment tables have adjustable abdominal sections for maximum comfort during treatment allowing you to lie face-down comfortably. Treatment with manual therapy eases painful muscles, decreases oedema and swelling and increases joint motion and flexibility. Post-pregnancy Core stabilisation, pelvic floor exercises and postural re-education are addressed.

Help with Pelvic Pain originating from the Musculoskeletal System

Musculoskeletal pathologies that can cause pelvic pain include sacroiliac dysfunction, symphysis pubis and sacrococcygeal joint dysfunctions, coccyx injury or subluxation and neuropathic structures in the lower thoracic, lumbar, and sacral plexi. The thoracic and lumbar spine, as well as sacro-iliac and hip joints, are linked due to pain-avoidance posture and mobility, and must be considered in the differential diagnosis of pelvic pain.

Pudendal Nerve Entrapment – PNE

The Pudendal nerve can become compressed or inflamed as it passes from the sacral and coccygeal nerve branches within self-perpetuating, deep muscle spasms close to the ischium or “sitting bones” area of the pelvis. Chronic referred pain or neuralgia may be felt in the perineum, abdomen and buttocks. Many patients have increased pain on sitting which is usually one-sided but both sides can be involved.

Symptoms may include pain, burning, numbness and parasthesia in the pelvis near the sacrum and coccyx which can radiate throughout the pelvic floor, inner thigh, lower abdomen and groin.

After a thorough evaluation to confirm your diagnosis we use specific connective tissue techniques, acupuncture or myofascial release to reduce muscle spasm and nerve compression and, therefore, inflammation. Specific physical therapy techniques called ‘nerve tissue tension releases’ and neural mobilisation or acupuncture can help decrease and regain reduced coccygeal range of motion by internal mobilisation to reduce coccyx/spinal cord meningeal tension. Misalignment or fixation of the pelvis, sacro-iliac joints, facet or sacro-coccygeal joints and muscular spasms are usually interrelated factors. We may use acupuncture, manipulative techniques and exercises prescribed with instruction.

It is very important to previously exclude, in consultation with your GP, urological and other potential medical causes of your pain.

Groin Pain in Sportsmen and women

The Groin is anatomically complex, highly mobile and vulnerable to significant stresses generated in sport through the legs, abdomen and pelvis.

Pain can originate from the lumbar spine, sacroiliac joints, hip joints and/or symphysis pubis.

Muscles involved include the hip adductors, hip flexors, gluteal, abdominal and lumbar extensors.

The obturator nerve, ilioinguinal nerve and genitofemoral nerve are potentially involved.

Diagnosis depends on a thorough history and examination of the complex interaction between them all with dysfunction of one structure leading inevitably with time to a multipartite dysfunction throughout the body. Leg-length differences of a centimetre or more can cause significant pelvic tilt and shearing forces at the sacro-iliac and hip joints which, in time, cause degenerative changes in the joints. We address this with graduated heel-lifts to balance the leg-length and spine.

Our aim is to give the athlete a realistic framework for rehabilitation and return to sport.

Adductor Tendinosis

Pain and inflammation at the insertion of the adductor tendons onto the pubic bones causes pain with running and kicking with tightness and tenderness on resisted adduction of the hip.

Adductor tendon injuries are treated with soft-tissue physical therapy, ultrasound or laser with gradual strengthening of the adductor muscles.

Osteitis Pubis and Pubic Symphysis Diastasis - PSD

The symphysis pubis joint at the front of the pelvis has adductor muscles attaching on either side and abdominal muscles attaching to the top of the pubic bones. The symphysis can shear with sudden and repeated changes of direction during running and kicking and especially if the sacro-iliac joints at the back of the pelvis have sheared or twisted following a fall on the side of the pelvis or due to a significant leg-length difference, often of only a centimetre or so.

PSD pain typically radiates to the inner thigh and lower abdominal region often with clicking at the pubis.

Our digital x-rays may show degeneration at the pubic symphysis due to chronic inflammation of the joint.

Treatment includes mobilisation of the sacro-iliac joints and deep massage and acupuncture to the muscles of the pelvis, hips and lumbar spine.

Hip Labral Tears

The hip joint is a common source of groin pain. The labrum is the cartilage lip of the acetabulum or hip socket, adding stability to the joint. A labral tear can cause clicking and pain on flexion and rotational hip movements with pain at the front of the hip which may radiate to the front of the thigh.

Examination can show decreased range of abduction and of internal rotation with the hip flexed at 90° and positive grinding tests. There may be associated spasm and pain in Iliopsoas, piriformis, gluteal and lumbar spinal muscles.

Hip and groin conditions can sometimes cause knee pain due to somatic referral of nerve pain from hip to knee.

Treatment of hip labral tears may involve referral to an orthopaedic surgeon for MRI and arthroscopic surgery.

Pelvic Nerve Entrapments

Compression or irritation of obturator, ilioinguinal or genitofemoral nerves within a self-perpetuating, deep muscle spasm can cause intermittent and poorly localised shooting or burning pain in the pelvis or inner thighs aggravated even by light touch in the nerve distribution. Treatment with pelvic joint mobilisation, deep muscle trigger points and acupuncture, stretches and exercises may help to resolve nerve irritation .

Referral for surgery to release a trapped nerve is occasionally necessary.

N.B. There has been very limited large-scale, clinical research carried out in the physical treatment of coccyx and pelvic pain and therefore limited evidence of the efficacy or otherwise of manual and acupuncture treatment for these conditions.

Call Ines on 020 7937 8978 – Book an appointment between 8am to 8pm – We are here to help you.

Dr Michael Durtnall's Research

Currently involved in 7 years of PhD research at the UCL Institute of Orthopaedics & Musculoskeletal Science, RNOH, Stanmore with Professor Gordon Blunn and with Mr Andreas Roposch FRCS Paediatric Orthopaedic Surgeon and epidemiologist of the Institute of Child health (ICH), Great Ormond Street Hospital, London

Researching involves my original idea for stimulation and equalisation of long-bone growth in children with a leg-length-difference before cessation of growth and to minimise compensatory scoliosis.

PhD Research will further perfect the system of measurement researched during his MSc to accurately measure the leg-length of growing children with LASER & Ultrasound, and therefore avoid the repeated use of x-rays. Research will involve monthly measurements and assessment of children’s leg-lengths using this safe and accurate LASER/US while actively accelerating and equalising growth in length of lower-limb long-bones of the significantly shorter leg by physical measures before cessation of growth.

Current surgical shortening by stapling the long-bone growth plate of the longer leg or lengthening the shorter leg by Ilizarov (painful, risk of side effects and injury) or Dr Paley internal methods (effective but extremely high cost).

He plans further research into sacroiliac and coccyx joint dysfunction and treatment.

Michael presented the world-first whole-day Coccyx, Sacroiliac and Pelvic Pain Diagnosis & Treatment Workshop to professors, consultants, therapists and doctors at the 8th Interdisciplinary World Congress on Low Back & Pelvic Pain, in DUBAI, on November 2nd 2013. This unique conference is held every three years around the globe. Previously held in Los Angeles in 2010 and Barcelona in 2007.

Michael practises full-time, treating coccyx and pelvic pain patients as well as back pain and neck pain at Sayer Clinic Kensington: London W8.

N.B. There has been very limited large-scale, clinical research carried out in the physical treatment of coccyx and pelvic pain and therefore limited evidence of the efficacy or otherwise of manual and acupuncture treatment for these conditions.

Research analysis of 87 of Michael's consecutive coccyx and pelvic pain patients has shown that 73% of the coccyx patient treated achieved 70-100% improvement in pain and symptoms and the average number of treatments to achieve this was seven.

These conditions have so far been researched by a few clinicians and with small patient numbers. However, Coccyx.org lists available research papers which are well worth reviewing at www.coccyx.org/medabs/

Call Ines on 020 7937 8978 – Book an appointment between 8am to 8pm – We are here to help you.