London UK Pelvic Specialist manual therapy for Vaginismus, Clitoral pain, Pudendal neuralgia, Coccyx - Tailbone pain, Persistent genital arousal disorder (PGAD), Vestibulodynia, Vulvodynia, Women's Pelvic health and Men's Pelvic health.
Our specialist pelvic manual treatment team at Sayer Clinics: London UK offers efficient diagnosis and effective treatment for vaginismus & complex pelvic and coccyx pain.
Sayer Clinics practitioners can also help with pregnancy symphysis pubis dysfunction (SPD) pelvic girdle pain, pelvic floor pain and dysfunction, pudendal neuralgia PN and pudendal nerve entrapment PNE.
Sayer Clinic Kensington, West London, W8 6PX
Sayer Clnics has vast clinical experience in spinal and pelvic manipulation using spinal, sacroiliac and sacro-coccygeal radiology or diagnostic ultrasound.
The Sayer Coccyx and Pelvic team is able to successfully treat Symphysis pubis Dysfunction (SPD), Sacroiliac and Coccyx pelvic joints, external and internal muscles, ligaments, fascia and nerve pathways using joint manipulation and myofascial mobilisation.
Our practitioner's continuing professional development focus has been on the pelvis and coccyx and we have been leading listed practitioners with www.coccyx.org and the International Pelvic Pain Society (IPPS) since 2006.
Our founder and mentor, Michael Durtnall (now retired), was an International and UK leading specialist in Symphysis Pubis Diastasis (SPD) pubic joint pain and associated pelvic floor pain and sacroiliac pelvic pain before, during and after pregnancy with extensive specialist postgraduate training with the leading USA pelvic pain physical therapy experts, Dr Amy Stein (author of 'Heal Pelvic Pain'), Dr Rhonda Kotarinos and Dr Stephanie Prendergast. Michael also learned with esteemed French gynaecologist Dr Eric Bautrant at courses and international Coccyx and Pelviperineal conferences where they have both presented.
Michael, has shared his knowledge and expertise with Specialist Physical Therapist Maria-Madalina Grigore, who practices at Sayer Clinic: Kensington. Madalina uses Michael's uniquely effective techniques to resolve chronic (long-term) and acute (short-term) musculoskeletal pudendal, pelvic and coccyx pain.
Michael has passed on his vast knowledge and experience by lecturing at University College London (UCL) on MSc Masters courses and to AECC University College students as well as doctors, therapists, specialists and professors at conferences and symposia in many countries focussed on musculoskeletal and pelvic nerve-related pelvic and coccyx pain providing efficient diagnosis, effective hands-on manual treatment with intelligent exercise and lifestyle changes without resort to steroid injections, invasive surgery or dependence on opioid prescription drugs.
He presented 10 hours of unique specialist expertise on pelvic and coccyx pain to the 8th World Congress of Low Back and Pelvic Pain in Dubai in 2013, and then at the 1st Coccyx Symposium in Paris in July 2016, 2nd Coccyx and Pelvic Pain Symposium in Dordrecht, Holland in July 2018 and at the 3rd international Coccyx Symposium held in Munich in June 2021 and was invited by Dr Jean-Yves Maigne to give a presention on 'Effects of Posture on Pelvic and coccyx pain' at the 4th Symposium in Paris in June 2023.
Michael has also, for over a decade, conducted ground-breaking research into effective pelvic and coccyx pain manual treatment as well as post-partum coccyx pain (coccyx pain after childbirth). He has advised major London teaching hospitals on the mechanism of multiple cases of coccyx dislocation and distal sacral fractures following hospital deliveries particularly when Ventouse (a cup-shaped suction device) and forceps were used and which he successfully diagnosed and treated. Michael has led the field in manipulation treatment for mechanical, musculoskeletal, asymmetrically and posturally-induced chronic pelvic pain (CPP) and tailbone pain / coccyx pain.
Under Michael's leadership Sayer Clinic clinicians have successfully treated countless patients from UK, EU, United States, Canada, Australia, the Middle East and around the globe who have suffered coccyx dysfunction, pudendal nerve compression and entrapment, pudendal neuralgia and pelvic pain.
Read more than 230 patient coccyx.org testimonials for Sayer team here: https://www.coccyx.org/personal/index.htm
Read 40+ pudendal neuralgia patient success stories on http://www.pudendalhope.info/forum/viewforum.php?f=27&sid=ce49e35b78cf11f92f5790bcd2f17efe
Sayer Clinics Pelvic Pain Physiotherapy.
Sayer Clinics specialist physiotherapy team are London’s leading pelvic pain specialists with expertise in trigger point* and myofascial release** for coccyx pain, pudendal neuralgia and pelvic floor rehabilitation.
Sayer Clinics specialist pelvic pain physiotherapists evaluate and treat pelvic pain and pelvic floor dysfunction with ongoing written and constant verbal consent and active participation of patients throughout the treatment and healing process.
We are trained in the diagnosis and rehabilitation treatment for pelvic floor pain, abdominal muscle diastasis (muscle separation), urinary urgency, urinary frequency, urinary incontinence, pre-natal and post-partum pregnancy pain, pelvic girdle pain, PSD, pubic symphysis diastasis, pain or dysfunction, pelvic organ prolapse, dyspareunia, vestibulodynia, clitorodynia, PGAD (persistent genital arousal disorder), vaginismus, sexual pain and dysfunction.
Treatments are conducted in private treatment rooms with focused hands-on specialist manual pelvic techniques that NHS and most private physiotherapists are not taught, even at post-graduate level. Our team are not only excellent specialist pelvic therapists but also the most caring, experienced and effective in manual and bio-psycho-social treatment of pelvic pain.
* A trigger point is a small knot in your muscle that can cause pain where it originates or further away in another part of the body.
** Myofascial release is an effective manual technique that involves applying gentle, sustained pressure into the myofascial connective tissue to reduce pain and restore motion.
About pelvic and coccyx pain
The pelvis is effectively a basin, served by nerves and blood vessels and moved by muscles with complex stresses shared between joints and ligaments.
Within the pelvic region is the coccyx or tailbone at the bottom of the spine of three to five, often mobile, coccygeal vertebrae or spinal bones. The coccyx is connected to the sacrum by a synovial joint and is an attachment site for tendons, ligaments, gluteal and levator ani pelvic floor muscles. It is also connected to many of the muscles of the pelvic floor where its function is to flexibly support and protect pelvic organ function and help stability in the sitting position.
This complex neuromusculoskeletal region of the body is a hugely neglected area of clinical research, yet more of us are suffering pelvic and coccyx pain and dysfunction due to our increasingly sedentary and stressful 21st century lifestyles.
Coccyx pain – also known as tailbone pain, coccydynia or coccygodynia
Coccydynia is the most common type of pelvic floor pain. It often occurs when you misalign, injure or strain your coccyx or the surrounding muscles and ligaments. The result is pain and discomfort felt at the base of your spine that is worse when sitting and often aggravated on standing up from sitting if the top Sacrococcygeal joint is straightened like a spike or dislocated backwards.
In some cases, the pain disappears within a few days but it can last for months and years and become permanent, severely impacting your ability to sit, drive, travel and perform daily activities.
Low back pain and sacroiliac pain is common in patients with pelvic and coccyx pain as they 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 months of torsion and imbalance with asymmetrical pressure and tension in the pelvic muscles and the lumbar spine which often leads to disc degeneration, sacroiliac pain, facet joint pain, compensatory spinal curvature and painful, poor posture.
Pudendal neuralgia (PN)
Pudendal neuralgia is a long-term chronic pelvic pain where the pudendal nerves become stretched, compressed, damaged or irritated.
The pudendal nerves are the main nerves of pelvic floor control and function, conducting autonomic as well as motor control of the pelvic floor and sexual function and transmitting sensation from urogenital system with bladder, clitoral pain, vaginal pain, labial pain, pelvic floor pain, perineal pain, ischial sitting-bone burning pain and coccyx and anal pain with sitting.
Pudendal nerve entrapment (PNE)
We are expert at manually treating Pudendal nerve entrapment which causes chronic pelvic pain when pudendal nerves are compressed by over-tight, torsioned or asymmetrically contracted pelvic obturator internus pelvic muscles or entrapped Pudendal nerves between the sacrotuberous and sacrospinatus ligaments inside the pelvis at Alcock’s canal.
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Cluneal nerve entrapment
Sayer Clinics are specialists in manually treating Cluneal Neuralgia.
The cluneal nerves are nerves of the buttocks. Entrapment or compression of these nerves can cause a miserable and intense burning sensation in the upper (superior cluneal nerve compression) or lower buttock and pelvic floor (inferior cluneal nerve compression) with sitting.
To read more about nerve entrapment conditions, scroll to the further reading section at the bottom of the page.
Pregnancy related pelvic girdle pain (PGP)
Pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD) is usually caused by a locking or subluxation of your sacroiliac joints or by torsional joint dysfunction with uneven mobility at both sacroiliac joints posteriorally with resulting pubic symphysis joint strain at the front of your pelvis.
Pelvic girdle pain usually occurs with gradually worsening pelvic-postural changes in the later stages of pregnancy as the symphysis relaxes and widens under the influence of pregnancy hormones as well as for many months post-partum which can cause severe pubic and clitoris, groin, hips, inner thighs and buttock pain.
Sayer Clinics are leading specialists for effective pelvic joint manipulation treatment with good long-term outcomes in pelvic girdle pain.
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
What causes pelvic and coccyx pain?
If you are experiencing pelvic or coccyx pain, the first step is to visit your GP to rule out serious conditions such as an infection or – in rare cases – cancer.
Most often, this type of pain is neuromusculoskeletal, which means that it can be effectively treated and physically resolved using our hands-on expertise, without the ineffective and temporary cover-up of drugs or injections.
Pelvic pain and coccyx pain may be chronic or acute and there are several possible causes:
Fracture of the sacrum or coccyx: This usually occurs following trauma, such as a fall or childbirth. Fractures from childbirth happen more frequently following intervention using a ventouse (cup-shaped suction device) or forceps with poor technique and excess force. We can visualise sacral and coccygeal fractures, even hairline coccyx fractures on our super-advanced, high-definition, low dosage x-ray system.
Poor posture: This can be caused by obesity, weak abdominals, having a sedentary occupation, sitting slumped on sofas and poor quality office and home-work seating, postural adaptation in pregnancy and after Caesarean section (C-section).
Surgical procedures during childbirth: Having a C-section or episiotomy (surgical cut at the back of the vagina) can lead to scar tissue which may result in nerve entrapment, leading to pelvic pain. Our skilled Manual therapy helps to resolve painful scar tissue and the sooner treatment is started the more effective the result.
Spondylolisthesis: This happens when a vertebra, usually at the base of the spine, slips forwards over the vertebra below. It is essential to mobilise and optimise the movement of the sacroiliac joints, reduce swayback, improve core and lower abdominal muscle tone and permanently improve whole-body posture to reduce and minimise long-term lower lumbar joint and disc degeneration.
Muscular strains and injuries: Strains or injuries of the gluteal muscles, or glutes (the muscles in your buttocks) may entrap the pudendal nerve or sciatic nerve. Similarly, spasm of the coccygeus muscle (a muscle of the pelvic floor) can compress the rectal branch of the pudendal nerve causing fleeting, agonising and occasionally long-term rectal or pelvic floor spasm and pain (proctalgia fugax). Chronic pelvic muscle spasm or levator ani muscle tightness is often implicated in vaginismus, PGAD, vulvar pain, reduced clitoral sensation and lack of orgasm.
Mechanical low back pain: This may result from postural sway-back, lumbar facet or sacro-iliac joint pain and dysfunction, lumbar-disc-referred sciatic leg pain, arthrosis, significant leg-length difference (over 10 mm), muscle spasm or joint locking.
What are the symptoms of pelvic and coccyx pain?
Patients typically experience two or more of these symptoms:
Pain when sitting: Sitting can trigger or aggravate pelvic, pudendal and coccyx pain, particularly at work, when driving or travelling. Sometimes, this pain can be made worse by wearing tight jeans or underwear.
Pain or difficulty with bowel movements: In some cases the pain is relieved by a bowel movement, while for others the pain feels worse afterwards. The pain is felt as a result of spasms in the surrounding muscles. You may also feel the need to go to the toilet more often or experience constipation.
Pain or difficulty with urination (dysuria): This is usually a result of spasms in the surrounding pelvic muscles. If urinary symptoms are muscular in origin, relaxing the pelvic floor, improves the flow of urine but worsens when urine is held for longer than comfortable.
Needing to urinate more frequently: This can range from a worry to an overwhelming urge. There may be a constant subtle ache in your bladder, urethra or genitals. You may not feel 'empty’ after urination and feel a need to urinate again despite an empty bladder. You may also need to urinate often during the night – this is known as nocturia.
Thigh, calf or foot pain: Some people may feel pain or paraesthesia (a burning, prickling or itching sensation) in the pelvis. inner thighs, down the legs and to the feet referred through nerves from the pelvis or via the brain as ‘central sensitisation’.
Groin, hip or abdominal pain: Groin pain needs to be diagnosed accurately as a hernia, muscular, bursitis or tendon-bone insertion inflammation or hip joint labral pain.
Genital pain (in males): This is felt at the tip and shaft of the penis or as testicular pain felt in one or both testicles and may be referred via pudendal nerve compression.
Genital pain (in females): Females may experience pain, paraesthesia or numbness superficially or deep inside the vagina, on one or both sides of the vulva (vulvodynia) or in the clitoris (clitorodynia) and may be referred via pudendal nerve compression most typically between the coccyx and sitting bone.
Perineal pain: The perineum is the area between the genitals and the anus. Chronic pain in the perineum is common in females especially after episiotomy when scar tissue is trapping nerves. In both males and females the perineum is often injured by prolonged cycling with saddle pain and compression of the pudendal nerve. This type of pain is aggravated by deep-squatting exercises, sitting or standing with increased flares of pain for hours or even the next day or after sexual activity as orgasm causes strong contractions of the pelvic muscles.
Pain during or after sex (dyspareunia): This pain may be felt on the outside as vulvar pain or as vestibular pain just inside the vagina. In some cases there will also be clitoral hypersensitivity or complete insensitivity or numbness.
Loss of interest in sex (low libido): This is common in cases of chronic pelvic pain which may be caused by low sex hormone levels, which need to be assessed.
In males low libido causes difficulty with erection resulting in anxiety and low self-esteem, reducing sexual arousal and interest. In females low libido causes difficulty with clitoral erection, arousal and inability to orgasm.
Persistent Genital Arousal Disorder (PGAD): This is a spontaneous, persistent, unwanted and uncontrollable state of genital arousal in the absence of any sexual stimulation or desire. PGAD may be linked with neurological, vascular, physiological, pharmacological and psychological factors. It may follow trauma or surgery, pudendal nerve entrapment, spinal disc bulges or compressed nerves and pelvic blood vessels.
Sayer Clinic's PGAD specialist team in London are effective in manually treating persistent genital arousal disorder (PGAD). Maria-Madalina Grigore mobilises and frees pudendal nerve branches and deep pelvic nerves trapped or compressed within myofascial tissues often due to trauma and pelvic asymmetry.
CLITORAL PAIN
Clitoris pain may be sudden sharp stabbing pain or a constant raw scratchy irritation of the clitoris from touch, certain movements or underwear.
Our patients experiencing PGAD report unwanted genital arousal with tingling, throbbing, swelling and lubrication and feeling on the verge of orgasm, without sexual desire. In our experience at Sayer Clinic we find that PGAD involves overactive deep or superficial pelvic floor muscles, especially ischiocavernosus and obturator internus muscles as primary contributors to PGAD and clitoral pain via constriction of pelvic and pudendal sensory nerves with reduced blood flow through hyper-contracted pelvic floor muscles.
Pelvic diagnosis and manual treatment specialist Dr Michael Durtnall expertly examines the pelvic floor. He has found that many of his patients with chronic pelvic floor and clitoral pain have a severely contracted and immobile clitoral hood which traps hardened sebum grit under the tight clitoral hood. We mobilise the clitoral hood and carefully remove any accumulation of hard gritty, sand-like sebum or keratin pearls. These irritant, gritty pearls are often the source of years of clitoral pain and PGAD or, conversely, eventual loss of clitoral sensitivity with inability to reach full orgasm, due to the constant sharp irritation deep under the hood against an over-sensitive clitoral head.
Dr Durtnall with his unique and long experience lecturing internationally on neuromusculoskeletal pelvic, coccyx and clitoral pain has concluded that clitorodynia commonly occurs via superficial compression or stretch injury along the pudendal nerve pathway or locally via adhesions around the dorsal clitoral nerve branch of the pudendal nerve. In Michael’s experience it is rare to find pudendal nerve compression within Alcock’s canal between the sacrospinous and sacrotubrous ligaments, However when this occurs Michael swiftly refers for expert surgical pudendal nerve release to the few excellent pudendal surgeons in UK, Europe or USA.
Pelvic asymmetry due to a shorter leg (significant leg length discrepancy of a centimetre or more) or twisted pelvic joints following birth injury or falls, coccyx and sacroiliac joint dysfunction or spinal scoliosis may all be potentially involved in asymmetrically compressing nerves, muscles and pelvic pudendal nerve pathways with a, broad spectrum of sensory motor and autonomic dysfunctional pelvic floor symptoms, including clitorodynia.
TREATMENT
Dr Michael Durtnall’s treatment protocol for clitorodynia depends on the specific diagnosis and origin of the clitoral pain.
Treatment for hard gritty, sand-like sebum or keratin pearls is to expertly, painlessly and carefully manually tease the granules from beneath the clitoral hood until the clitoris is clear and free from constant irritation with uninterrupted blood-flow and rapid return to a healthy pink. We mobilise any network of fine clitoral hood adhesions until the hood or prepuce can once again easily and freely open or retract when aroused or contract to flexibly protect and cover the clitoris to reduce touch-sensitivity from clothing throughout the day.
He examines and frees-up all pudendal nerve pathways by manually mobilising any involved sacroiliac joints, sacrum, coccyx and pelvic intramuscular pathways to normalise pudendal nerve neuromusculoskeletal function which typically cause symptoms of pelvic floor, anal and vaginal spasm (usually 2 contractions / second, lasting minutes, days or months) with coccyx pain, anal pain, perineal pain, clitoris hypersensitivity or loss of sensation until unable to achieve full whole-body orgasm as well as bladder symptoms such as urinary urgency, urinary frequency, incomplete voiding and nocturia. Sayer Clinics team includes specialist pelvic physical therapists and expert massage therapists.
Michael Durtnall and Sayer Clinics’ do not advocate antidepressants, gabapentin, amitriptyline and numbing drugs which partially cover-up symptoms but ensure that loss of pelvic floor function becomes chronic as the root causes are not properly addressed.CLITORAL PAINOur patients experiencing PGAD report unwanted genital arousal with tingling, throbbing, swelling and lubrication and feeling on the verge of orgasm, without sexual desire.In our experience at Sayer Clinic, we find that PGAD involves overactive deep or superficial pelvic floor muscles, especially ischiocavernosus and obturator internus muscles as primary contributors to PGAD and clitoral pain via constriction of pelvic and pudendal sensory nerves with reduced blood flow through constantly hyper-contracted pelvic floor muscles.Pelvic diagnosis and manual treatment specialist Maria-Madalina expertly examines the pelvic floor. We have found that many of our patients with chronic pelvic floor and clitoral pain have a severely contracted and immobile clitoral hood which traps hardened sebum grit or pearls under the tight clitoral hood. We mobilise the clitoral hood and carefully remove any accumulation of hard gritty, sand-like sebum or keratin pearls. These irritant, gritty pearls are often the source of years of clitoral pain and PGAD or, conversely, eventual loss of clitoral sensitivity, due to constant sharp irritation deep under the hood against an over-sensitive clitoral head.
Our unique and long experience on neuromusculoskeletal pelvic, coccyx and clitoral pain has shown that clitorodynia commonly also occurs via superficial compression or stretch injury along the pudendal nerve pathway or locally via adhesions around the dorsal clitoral nerve branch of the pudendal nerve. In our experience it is relatively rare to diagnose pudendal nerve compression within Alcock’s canal between the sacrospinous and sacrotubrous ligaments however when this occurs we swiftly refer for expert surgical pudendal nerve release to the few excellent pudendal surgeons in UK, Europe or USA.
Pelvic asymmetry due to a shorter leg (significant leg length discrepancy of a centimetre or more) or twisted pelvic joints following birth injury trauma, falls, coccyx and sacroiliac joint dysfunction or spinal scoliosis may all be potentially involved in asymmetrically compressing pelvic nerves, muscles pudendal nerve pathways with a broad spectrum of sensory, motor and autonomic dysfunctional pelvic floor symptoms, including clitorodynia which may be itchy, burning or aching pain.
PGAD TREATMENT
Our PGAD treatment protocol depends on the specific diagnosis and origin of the clitoral pain or dysfunction.
Effective treatment for dense sebum or smegma build-up or hard gritty, sand-like sebum or keratin pearls is to expertly, painlessly and carefully manually remove the granules from beneath the clitoral hood until the clitoris becomes clear and free from constant irritation with uninterrupted blood-flow and rapid return to mobility with a healthy pink colour. We mobilise a network of fine clitoral hood adhesions until the hood or prepuce can once again easily and freely open, retract or contract to flexibly protect and cover the clitoris to reduce touch-sensitivity from clothing throughout the day.
Maria-Madalina Grigore frees-up pudendal nerve pathways by expertly mobilising sacroiliac joints, coccyx and pelvic intramuscular pathways to normalise pudendal nerve neuromusculoskeletal function. Her expert treatment often quickly relieves the demoralising symptoms of chronic pelvic floor, anal and vaginal spasm (usually at a frequency of two contractions per second) which have in most cases persisted for many months or years.
PGAD is often associated with tailbone, anal and perineal pain or spasm, clitoris hypersensitivity or loss of sensation along with bladder symptoms such as urinary urgency, urinary frequency, incomplete voiding and nocturia.
Sayer Clinics do not advocate antidepressants, gabapentin, amitriptyline, anti-inflammatory, painkilling and numbing drugs which only partially cover-up symptoms, undermining pelvic floor function which then becomes chronic, as the root causes are not properly addressed.
Vaginismus / Levator Ani Syndrome / Hypertonic pelvic floor muscle dysfunction / Hyper-contracted or Shortened pelvic floor linked with Coccyx dislocation and dysfunction.
Hypertonic pelvic floor muscle dysfunction or called Levator ani syndrome or Vaginismus is a common cause of pain in the vestibule / vestibulodynia and dyspareunia / painful sex.
Pelvic floor muscles of the posterior part of the vestibule - pubococcygeus, puborectalis and transverse perineal muscles become constantly and painfully contracted. When these muscles contract this reduces the normal blood flow through them with lower oxygenation to cells resulting in an increase in Lactic acid with a raw feeling of burning, throbbing, scratching, episodic sharp stabbing pains.
Women with levator syndrome also experience intense tenderness with reddening of the posterior vestibule where it joins the perineum and may also suffer urinary frequency, urgency and incomplete voiding as well as constipation, hemorrhoids and rectal fissures. Vaginismus is linked with low back pain and groin, hip and buttock pain often following coccyx injury years before.
Vaginismus Treatment.
Maria-Madalina Grigore is experienced in vaginismus treatment.
Her pelvic floor dysfunction treatment involves gentle manual pelvic therapy, pelvic floor relaxation exercises, vaginal dilators and rectal or vaginal trigger point manual release therapy.
Effective Vaginismus Treatment at Sayer Pelvic Pain Clinic in Kensington, London, W8
Specialist Vaginismus Treatment
One in 500 women experience vaginismus, but likely far more as so many sufferers don’t get the right help and receive an incorrect diagnosis.
Vaginismus is involuntary, constant or intermittent super-contracted vaginal and anal levator ani musclular spasms, with moderate to severe pain making vaginal examination, tampon insertion and sex extremely uncomfortable or impossible.
Common causes of pelvic floor muscle contraction or tightness and tension include:
1. Misaligned coccyx and sacroiliac joints, hip and spine which is often due to leg length difference of 1-2 cms creating asymmetry and tension in deep and external pelvic and spinal muscles or following previous falls and injuries to your tailbone / coccyx.
2. Straining due to chronic constipation, inflammatory pelvic or urinary tract infection (UTI) or gastrointestinal dysfunction and pain can cause permanent tension in your pelvic floor muscles. Chronic straining can also cause severe damage to the rectum with intussusception, Anismus and Rectal Dyssynergia.
Pelvic and Spinal Alignment Affects Your Pelvic Floor:
Your entire body is interconnected and misalignment affects pelvic floor muscle (PFM) dysfunction:
Dyspareunia - pain with sex
Interstitial cystitis - painful bladder syndrome
Chronic or frequent yeast infections
Chronic urinary tract infections (UTI)
Coccyx pain with sitting
Chronic constipation
Irritable Bowel Syndrome
Stress aggravates PFM spasm
Childbirth Trauma
Vulvodynia
Vestibulodynia
Levator ani syndrome
Other symptoms of vaginismus include:
Episodic, pelvic floor muscle (PFM) spasms lasting several hours of frequent anal, perineal and vaginal spasms at a frequency of 1-2 spasms per second.
Constipation
Difficulty Urinating
Urinary hesitation, frequency and / or urgency
Pain with urination
Pain with pelvic exam
Feeling of vaginal or rectal fullness or pain with sitting
Low back, hip & groin pain
Sacroiliac (SI) joint dysfunction
You may feel like you have a urinary tract infection (UTI) or yeast infection which always tests negative but inflammation and urinary burning is a potential symptom of chronic pelvic floor asymmetry, pain and spasm.
Specialist Manual Therapy at Sayer Clinic W8 for Vaginismus:
Sayer Clinics’ Specialist Manual therapy releases the tension in deep pelvic floor muscles. If your body has been out of alignment for months or years, your pelvic musculature will be out of balance and asymmetrically contracted.
Our specialist manual therapy team help realign muscles and joints along with complete rehabilitation of your posture, balance and overall efficient body function and movement.
If muscles have compensated for a long time, they become fibrous, contracted, gnarly and extremely painful and need specialist physiotherapy medical massage to regain proper function once your pelvic tension is released.
Sayer Clinics Specialist Manual Pelvic Therapy addresses internal as well as external muscles and fascia of the pelvis, abdomen, hips, buttocks, thighs and low back, gradually improving internal myofascial pelvic floor tension and spasm using specialist pelvic stretching therapy and our unique and extremely effective broad trigger point sweep techniques.
Sayer Clinics’ unique and highly effective approach to postural rehabilitation includes deep releases to diaphragm, pectoral and intercostal muscles to release the chest to open and free-up breathing, flexibility in the middle back and to regain elegant, tall, functional pain-free, upright posture. This deep diaphragmatic stretch-massage frees your breathing which works synergistically with and links directly to the internal pelvic floor diaphragm which supports your rectum, vagina, uterus and bladder.
Email mail@sayerclinics.com to book your initial consultation and treatment with Maria-Madalina Grigore our senior specialist pelvic physiotherapist.
Inability or difficulty to achieve orgasm (anorgasmia):
Anorgasmia is a complex reaction to multiple physical, neurological and emotional factors. Simple neuromusculoskeletal nerve compression and muscle spasm due to pelvic joints and muscle asymmetry can compress or constrict the blood and nerve supply to the pelvis, leading to pudendal neuralgia or neuropathy. Spinal nerve compression or irritation in the lumbosacral spine can also cause pelvic neuralgia and impede orgasm.
We have successfully treated many women suffering anorgasmia and clitoral dysfunction who responded well following a course of pelvic structural manipulation and pudendal nerve pathway mobilisation treatment.
Anxiety and depression:
Experiencing chronic pelvic pain can lead to depression, low self-esteem and feelings of hopelessness.
As a result, sexual and social withdrawal with chronic pelvic or coccyx pain is common and people experiencing pain have less desire to have sex, socialise, go on holiday or travel. In addition, problems with sexual performance, worries about needing the bathroom and feeling unable to control the situation leads to anxiety.
Anxiety and depression can make it hard to move forward, find the right treatment and follow through to resolution. Pelvic and coccyx pain patients are often worried that they will never improve and catastrophise, fixating on the pain which leads to an increasingly powerful and chronic 'pain centralisation in the brain' which is much harder to treat. Patients suffering 'central sensitisation' are a real challenge to treat and also need bio-psycho-social practitioner support and focus to break through the fear-pain cycle.
How is pelvic and coccyx pain treated?
Self-care advice and measures provide important relief. These include avoiding long periods of sitting, using a specially-designed coccyx cushion, applying cold packs to the pelvic area and wearing loose clothing, avoiding straining during defecation or urination, stopping the cycle of trying to control autonomic pelvic function by controlling and overstressing.
GPs and specialists may prescribe pain medication, gabapentin, pregabalin, amitriptyline and even opioids such as codeine phosphate, Co-codamol or Co-dydramol for pelvic or coccyx pain, or injections of anti-inflammatory drugs (corticosteroids) and painkillers into the coccyx or surrounding area. We do not advise this approach which covers-up the pain just to a limited extent, with side-effects, but without resolving the underlying neuromusculoskeletal condition which needs addressing with specialist mobilisation treatment.
In extreme, yet fortunately extremely rare cases, a patient may need to be referred by us to the best surgeon for the coccyx to be surgically removed – a procedure known as coccygectomy.
In our experience, prescription drugs, injections and chemical or electrical burning of nerves (radio frequency ablation) are not effective treatment for 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, weight-gain, poor posture and progression of the condition.
We help by educating you to understand how to reduce pain logically and to physically regain control and fitness.
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Our manipulation and physcial therapy methods include the following clinical techniques:
• Pelvic skin inspection
• Trigger point release
• Myofascial manipulation
• Musculoskeletal pelvic joints manipulation
• Dry needling, acupuncture
• Scar massage, mobilisation & desensitisation
• Re-education of pelvic floor and nerve function
• Restoring tone and function of abdominal core muscles
• Spinal, pelvic, coccyx mobilisation or manipulation
• Manual pelvic physical therapy over several days, depending on tolerance
• Lifestyle modifications
• Exercises and dietary interventions
• Education of causes and strategies for management and prevention
• Biomechanical correction of lower limb, spinal and pelvic gait anomalies
What will happen during my treatments at Sayer Clinics?
The first step is to consult your GP 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 our unique multidisciplinary approach of chiropractic and physical therapy.
We're committed to give the best treatment to help you become well.
During your first appointment we take your extensive medical history and perform a thorough musculoskeletal examination which may include high definition digital x-rays and/or colour diagnostic Doppler ultrasound examination.
Sayer Clinics' therapists always first obtain specific valid consent in writing as well as verbally at each stage of treatment for specialist coccyx or pelvic manipulation or internal mobilisation, if diagnostically indicated, which is fully discussed with benefits and any risks as well as the expected timescale to regain pain-free coccyx and pelvic-floor function.
We answer all your questions and will only proceed with coccyx or pelvic treatment with your written consent as well as your repeated valid verbal consent at each visit and at every stage of treatment.
We advise you how to sit uniquely without pain, how to stand to minimise aggravation of tailbone or pelvic pain and the best coccyx cushion for your coccyx or pudendal pain. We also give you effective physical and mental strategies to cope with tailbone pain with our unique and specific exercise programme to help maximise your effective, successful rehabilitation from coccyx or pudendal burning sitting pain.
Your initial evaluation may include:
• Postural, pelvic joints, spinal and structural assessment
• Evaluation of fascia of abdomen, back, pelvis and lower extremities
• Myofascial evaluation of the pelvic girdle muscles
• Examination for myofascial trigger points of pelvis and pelvic floor muscles
• Pelvic floor examination assessing muscle tone, motor control and tenderness
• Evaluation of pelvic floor muscle strength
Treatment may, if required, begin during your first appointment and is geared towards resolving all dysfunction noted. You will be provided with feedback regarding home management, exercises, and behavioural and lifestyle changes as needed.
When you are our patient, you are always in control and receive your physical therapist's undivided attention for the appointment. You may choose to have one or more different therapists who work with you to learn what your body needs and how your body best responds to treatment.
Our therapists work in partnership with you and liaise with each other, with your consent, via shared medical notes.
We allow sufficient treatment time to provide you with optimal results. We are specialists with experience in the field of pelvic floor physical therapy. We have a high level of education and attend national and international conferences to stay on top of the latest research to better help our patients.
Your length of treatment varies based on the severity and length of time you have had your symptoms, any previous treatment you have received, and your adherence to self-management and home exercise programmes which we will provide for you. It is imperative that you are committed to actively participating in your treatment.
Patients are usually seen for 60-90 minutes of pelvic physical therapy each week for between 8 and 12 weeks, depending on severity and length of time of their condition. In partnership and consultation with you, we re-evaluate every 10 visits to determine if there has been adequate improvement in your symptoms to justify continued therapy. Once you have achieved 75% to 80% improvement in your symptoms your treatments may be reduced to once every 2 weeks. On achieving 90% to 95% improvement in your symptoms, your treatments will be reduced to once a month until you are discharged from therapy.
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
The hypertonic pelvic floor
What is a hypertonic pelvic floor?
When pelvic floor muscles are too tense and can’t relax you may start to feel pelvic symptoms such as regular pelvic muscle spasms, constipation, painful sex, urinary urgency and pelvic pain. A hypertonic pelvic floor also affects surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
What causes a hypertonic pelvic floor?
Certain specific activities cause pelvic floor muscles to tighten:
Heavy repetitive weight-training and deep squats in the gym while over-contracting core muscles can, over time, tense and cause pelvic floor dysfunction where pelvic muscles become permanently contracted and unable to relax and contract normally. Habitual holding on to bladder and bowels generates tension in pelvic floor muscles to avoid loss of control.
An environment of permanent stress, fear and anxiety makes muscles contract reflexively with resulting hypertonic pelvic floor muscles. Pelvic floor muscles are also known as the PC or pubococcygeus muscles which attach to your pubis at the front of the pelvis and at the back to your tailbone or coccyx. Shortened pelvic floor muscles held in contraction and can compress Pudendal Nerves, inferior cluneal nerves and posterior femoral cutaneous nerves as well as coccydynia or coccyx pain with sitting.
Chronic pelvic pain conditions such as endometriosis, irritable bowel syndrome, interstitial cystitis, pudendal neuralgia vestibulodynia and vulvodynia can cause reflex pelvic floor muscle pain, cramps and spasms. Traumatic child birth and episiotomy with deep vaginal and perineal scar tissue can damage pelvic floor muscle function.
A functional pelvic floor nervous system enables getting through the day without suddenly peeing, pooing or passing wind expectedly by maintaining control of your pelvic floor muscles.
Your ‘abdominal brain’ or enteric nervous system (ENS) controls peristalsis in the gut, fluid balance and blood flow and communicates with your immune system and microbiome. Constant ‘head-brain’ interference dominates and overrides your normal pelvic function and can permanently damage the ability of the pelvis autonomic nervous system to function and automatically control urination, defecation and sexual function.
Signs and symptoms of a hypertonic pelvic floor.
The typical signs of a hypertonic or non-relaxing pelvic floor are pelvic muscle pain along with:
- constipation and straining
- incomplete emptying of bowels
- pelvic pain
- perineal pain
- low back pain
- hip groin and gluteal buttock pain
- coccyx pain
- vaginal pain and painful sex
- vaginismus
- urinary incontinence
- incomplete bladder emptying
- urinary urgency, frequency, nocturia
- obsessive, controlling or perfectionist personality.
Sayer Clinics’ hypertonic pelvic floor treatment
If you suffer signs or symptoms of a hypertonic pelvic floor we take a detailed medical history, discuss with you all your symptoms, use diagnostic ultrasound or low-dose x-ray scanning as necessary to find the root cause of your hypertonicity and provide you a simple treatment plan to regain normal function.
- pelvic floor muscle relaxation techniques
- advice to stop over-controlling pelvic function.
- breathing techniques
- advice on bladder and bowel habits
- pelvic floor and abdominal massage techniques
- vaginal dilators to treat vaginismus
- pelvic and hip mobilisation
- sacroiliac, coccyx joint manipulation
- postural rehabilitation
- scar tissue massage techniques.
Frequently asked questions
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 to free sufferers from the grip of nerve-pain and protective muscle spasm.
What do X-rays and MRIs show?
If you suffer debilitating tailbone or pelvic pain, it is not unusual for a hospital specialist to tell you there is nothing wrong after an X-ray or MRI. Many clinicians are not trained to, and do not, examine the coccyx properly or at all for tailbone injuries and having seen a radiology report which says there is no fracture, tumour or cancer, often dismiss it and label the problem as psychosomatic.
Static X-rays and MRIs, with the patient prone, show coccyx position, but not the fixed, limited or disturbed range of motion which causes coccyx pain.
At Sayer Clinics, we properly examine and, where indicated with digital coccyx x-ray, diagnose and treat you to restore coccyx mobility and normal function of the coccyx, pelvic joints and muscles, together with better posture and fitness.
Are you able to treat patients from abroad?
Yes, many of our patients come from abroad.
The initial intense treatment protocol for patients travelling from overseas may comprise a few days or a week or more of careful daily therapy which is constantly reassessed. If there are early signs of a flare, the frequency and type of therapy is moderated accordingly.
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Will the treatment work?
Due to the complexity of these conditions a rapid cure, during a limited treatment time-frame, should not be anticipated as your body and mind always need time to respond to your long-term specific treatment and exercise plan with our biopsychosocial input where we guide you to move, act and think differently to optimise your eventual outcome.
While 100% cure may never be guaranteed, we are pleased to report that over the decades patients with severe, acute and chronic neuro-musculoskeletal pelvic pain have reported sustained improvement in pelvic function along with the ability to live a more normal pain-free life following a course of treatment with our physical therapy team at Sayer Clinics.
To read more than 200 testimonials for our team, follow this link: https://www.coccyx.org/personal/index.htm
Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com
Book your first appointment now - We are always here to help you
Book your appointment 24/7 here or email mail@sayerclinics.com
For your first appointment we recommend you book first with Maria-Madalina Grigore at Sayer Clinic Kensington, West London.
Book an initial consultation to see Dr Ed Timings or Dr Marek Gibson if standing (and seated if required) digital X-rays, are needed, and for examination and treatment with musculoskeletal coccyx, sacroiliac, postural and pelvic manipulation in combination with our specialist pelvic physiotherapists.
Following your initial consultation with x-rays if required, you should book with our specialist pelvic physiotherapist Maria, Madalina Grigore. It is this combination of treatment that is unique in the world and a hugely significant factor in Sayer Clinics’ global success in pelvic & coccyx pain.
Articles and news
A guide to how scar massage can help C-section, episiotomy and general wound healing By Midwives Cathy Tabner and Karen McEwen
https://myexpertmidwife.com/blogs/my-expert-midwife/massaging-scars
2022
Immediate stop to NHS mesh operations
http://www.bbc.co.uk/news/health-44763673
09 July 2018
TVT trans-vaginal tape and plastic mesh implants were used to support a prolapsed uterus but this caused severe problems in many women who suffered compression or cutting-in to nerve pathways and other tissues in the pelvis. Sayer Clinics’ pelvic physiotherapists are experienced in improving your pelvic floor strength and function to try to obviate the need for this type of surgery and to rehabilitate healthy pelvic function.
Find out more: The Operation that Ruined My Life
www.bbc.co.uk/programmes/b09jl9dd
16 December 2017
Taking the shame out of Pudendal Neuralgia! – by Violet Matthews RN, moderator on www.pudendalhope.info
www.obgyn.net/pelvic-pain/taking-shame-out-pudendal-neuralgia
Interstitial cystitis and pelvic floor dysfunction - by Stephanie Prendergast
https://www.youtube.com/watch?v=J4J4UsMExcg&__s=jsczy3fq5sjkmnsznjse
Dr Stephanie Prendergast is one of our three USA Pelvic Pain gurus, along with Dr Amy Stein and Dr Rhonda Kotarinos, who all brilliantly teach how to treat pelvic pain.
Stephanie explains interstitial cystitis treatment and functional rehabilitation so clearly in this video.
In addition, we discovered, over decades of treating thousands of extremely difficult cases, how coccyx dysfunction and its inhibition of complex pelvic floor muscular function, often with pudendal nerve branch compression from sitting, can contribute to interstitial cystitis, clitoral hypersensitivity (PGAD) or loss of sensation and vaginal pain.
Our team, with full written and verbal consent from the patient continuously throughout therapy, treat pelvic pain and pudendal neuralgia and coccydynia with a unique combination of sacroiliac, coccyx and pelvic floor mobilisation and manipulation, major postural changes and simple postural advice, teaching 'how to sit', 'how to stand' with frequent specific and original rehabilitation exercises.
Read about Sayer Clinics research into coccyx and pelvic pain: https://www.coccyx.org/treatmen/michael.htm
Read our medical statistics on 87 consecutive coccyx and pelvic pain patients at: http://www.coccyx.org/medabs/durtnall.pdf
"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 address this with graduated heel-lifts to balance the leg-length and spine.
Following a thorough initial musculoskeletal evaluation and, where necessary, digital standing x-rays and sitting /seated x-rays to diagnose your problem, 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 help regain function. Misalignment or fixation of the pelvis, sacro-iliac joints, facet or sacro-coccygeal joints with associated 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 rarely necessary:
A variety of medical terms 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, Vulvovestibulitis, Clitoral pain and PGAD, 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 consult urologists, neurologists, gynaecologists, dermatologists, proctologists, rheumatologists and orthopaedic surgeons to treat their symptoms which can often be secondary to inter-dependent neuro-musculoskeletal causes. As a result, symptoms almost always return in some form or are never completely eliminated. Patients report that urinary symptoms are often treated with antibiotics, despite no positive culture, so symptoms return if 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 are not best addressed by surgery but by expert manual therapy.
Our clinical experience over the years has shown us that these pelvic pain conditions are closely interrelated and associated with often simple factors such as:
Connective tissue, fascia and ligament laxity; prolonged sitting and physical inactivity (due to illnesses/ 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 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 or levator ani muscles supporting the bladder, prostate, urethra, rectum, anus, pubis, sacrum and coccyx are in painful 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.
In partnership with you, the patient, 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, if necessary, digital standing x-rays. We treat in a multi-disciplinary way, with a combination of manipulation, acupuncture 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 43 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 as pain-free as possible 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 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.
We ask our patients why they think we are successful in treating their pelvic and pudendal pain. They reply that Sayer Clinics are incredibly “hands-on and 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 neuromusculoskeletal basis. This means that a large proportion of pelvic pain may be physically resolved and effectively treated."
Michael studied with Dr Amy Stein DPT at the World Congress of Lower Back and Pelvic Pain pelvic pain workshops in Barcelona in 2007. Dr Stein was clear that pelvic symmetrical function was critically important and that all pelvic pain patients should first have their pelvic joints examined and, if necessary, manipulated by a specialist chiropractor.
Michael also studied 'hands-on' with USA pelvic pain therapy expert Dr Rhonda Kotarinos and was instrumental in inviting her to London to lecture over several days at an intensive specialist workshop at St George's Hospital in London and afterwards they continued professional development holding consultations and together treating some of their mutual pelvic pain patients at Sayer Clinic: Kensington.
Dr. Kotarinos has had a vital and profound influence on our understanding and treatment of pelvic pain and we pay tribute to her expertise, knowledge and teaching.
For world-leading Specialist Coccyx pain and Pelvic Pain treatment
Email us at www.sayerclinics.com - we really help.