Neuropathic Pain - Sciatic & Pudendal Problems: Episode 118 with Thomas Dekkers

Hello and welcome to today's episode, where I'm discussing neuropathic pain, particularly the Sciatic & Pudendal nerves, with Thomas Dekkers - Tom's background includes his 18-year clinical experience as a spine specialist physiotherapist, his PhD research on athletic back pain, and current role as a clinical specialist in neurosurgery at Cork University Hospital.

In our conversation today, we explored how dermatomes can be unreliable for diagnosis, particularly with pelvic pain conditions, and discussed the role of neuroinflammation in persistent pain states.

Tom shared his approach to managing neuropathic pain, emphasizing the importance of first avoiding activities that aggravate symptoms before gradually reintroducing movement and exercise.

We also discussed the problematic nature of the "core stability" terminology in physiotherapy and the need for more biopsychosocial approaches to patient care.

The conversation highlighted the challenges of managing chronic pain conditions and the importance of proper patient education and goal-setting in treatment plans, including neuroinflammation, when compression can lead to inflammation throughout the nervous system, including glial cell activation in both the dorsal horn and thoracic spinal cord.

We talked about that when patients completely color in body maps, it raises concerns about nociplastic pain, particularly given the anatomical proximity of nerve roots and the potential for irritation to spread.

Tom explained how he helps patients understand that pain can be influenced by multiple factors beyond just anatomy, including sleep, stress, and social aspects, and described his process of developing individualized treatment plans with patients, setting realistic expectations about pain management over 6-12 months, and focusing on improving functionality rather than achieving complete pain elimination.

We also covered:

Sciatic vs Pudendal Pain

Neurodynamics Testing and Applications

Nerve Glide Pain Management Discussion

Nerve Pain Management Approach

Core Stability Terminology Discussion

While pain knowledge has advanced significantly, treating chronic pain patients remains challenging due to the complexity of widespread pain patterns and the need to identify key contributing factors rather than addressing every symptom - I hope this conversation has given you some food for thought and some actionable steps to steer away from overwhelm when you're working with people with persistent pain.

You can find Tom on instagram @tdekkersphysio and info about his courses at thomasdekkers. com

Want to learn more about managing female pelvic pain? My online course, Female Pelvic Pain Rehab course is going through a major overhaul, update and expansion. Already enrolled? you'll get access as the new modules are available - the vulvar and sexual pain modules are available now, and you can look forward to new modules on endometriosis associated pain, bladder pain syndrome, pudendal and other neuralgias and more, through an up to date evidence based framework, that takes you from understanding pathophysiology, assessment and treatment strategies. Want to learn more? All of the course info is at CelebrateMuliebrity.com

Until next time, Onwards & Upwards, Mx! #celebratemuliebrity