J.P. (47y/o, Male) Initial visit 10/20/23
Extremely athletic: CROSSFIT 5 times a week, in addition to Pilates, yoga, and running several times a week. Clean living, no medications reported, no drugs/alcohol prescribed or recreational.

CC: 5/10 Right side nerve pain and groin pain, “constant, tingling, stabbing, spasming, shooting” in abdominals with rotation (both sides same) radiating down into R thigh, stopping above the knee, wrapping around medially into adductors, also along IT Band. Feels the sensation all the time, especially at night. Worse with lying supine and no knee support. Feels better when he “digs into his groin” and demonstrates using deep palpating. 

Txt history: Has had several months of Pelvic Floor (PF) PT and was referred by PF PT specifically to address an abundance of trigger points in the rectus abs. Patient hit a plateau with PT.

They also report perineum pain, and “urethral discomfort”. No noticeable difference in symptoms with ejaculation and intercourse. 

Surgical history:
Varicocele Repair - 2007 Vasectomy - 2016
Bladder Neck incision - 2021 Inguinal hernia repair (tissue repair, no mesh) - beginning 2024

Physical Exam:
VISUAL: VERY LOW BODY FAT, very faint visible hernia scar lower RIGHT inguinal region, very defined quadriceps, and visible adductor longus tendon.
PALPATION: HYPERTONIC right abdominal muscles, internal and external obliques, iliacus, adductor longus, TFL, quadriceps (lateralis, rectus femoris), biceps femoris and obturator internus, transverse perineum, upon deep palpation at scar, can feel tension lines along length of scar/tissue, scar tissue is very tight with very little movement while fascial gliding.

Tx: Using multiple needle lengths and gauges: Trigger point and myofascial dry needling. Muscles treated:

R: Multiple dramatic fasciculations in abdominals (also around surgical site) pain refers to anterior thigh, and adductors longus, brevis and magnus treated, quads, pectineus.

R: Obturator internus and perineum reproduces urethral discomfort. Dramatic work in glutes and piriformis, Obturator internus tendon. Obliques internal and external.

Manual work: Simple soft tissue myofascial manipulation in along adductors longus and magnus to attachments on pelvis; soft tissue work along ischial rami area right side.

Follow Up visit:  11/28/23

CC: Slight numbness and tingling in R femoral triangle, symptoms have SIGNIFICANTLY improved 2/10.

No more burning, nervy, stabbing pain into the thighs.

Patient has more ROM with hip flexion and extension, also rotation of the trunk without eliciting symptoms. He is “blown away” about how effective this treatment is, and wants to know “why isn't everyone trying this?”

No pain with ejaculation/intercourse. Feels some tension in the inguinal region, like a pronounced pulling. Skin is gliding more in abdominals, zero urethral discomfort.

Palpation: tightness along R inguinal ligament, especially with heavy palpation, adductor longus tight, but much better than initial visit.

Tx:  lliacus, iliopsoas (psoas through rec abs and below inguinal ligament). Pectineus, adductor longus, brevis, and magnus. Obliques, rec abs, TFL, Vastus lateralis. Local area right of xiphoid process

Results:  After two more repeat visits of “cleaning up” the remaining trigger points and fascial tension, the patient is no longer feeling any symptoms other than “tightness” in the inguinal ligament.

The goal of the treatment is to continue to loosen up the fascial adhesions, resulting in reduced tension and properly functioning myofascial and muscular systems.

Darren O'Rourke LAc is an Acupuncturist practicing in Dublin, Ireland. Darren specializes in musculoskeletal conditions and orthopedics, utilizing physical assessment, electro- acupuncture, dry needling, and soft tissue manipulation in his treatments. He treats athletes as well as everyday soft tissue and MSK injuries. In addition to practicing, Darren has presented and taught at the 2023 and 2024 ASE Acupuncture Symposium, Lower Body Dry Needling in Tampa, FL, and assisted in numerous EXSTORE and Pelvic Floor seminars since 2021.