Is Your Deadlift Causing Perineal Pain?

Perineal pain, characterized by discomfort in the area between the anus and genitals, is often a complex and frustrating condition to diagnose and treat. For many individuals, the root cause remains elusive despite consulting multiple specialists. This article explores a real-life case of a young male struggling with persistent perineal pain linked to his gym workouts—particularly deadlifts—and provides insights into potential musculoskeletal triggers and solutions.

Understanding Perineal Pain

The perineum, also known as the “saddle area,” is a crucial region of the body that includes muscles, nerves, and connective tissues. Pain in this area can stem from various causes, such as infections, nerve entrapments, or muscular dysfunction. For this individual, the pain felt like “a fist on the inside of the pelvis pushing down onto the perineum,” causing immense discomfort and a heavy sensation throughout the day.

Common Symptoms of Perineal Pain

• Persistent or intermittent pressure
• Heaviness in the rectal or pelvic region
• Pain exacerbated by sitting
• Associated discomfort in nearby areas, such as the prostate or lower back

Case History: A Patient’s Journey

The young male in question, in his mid-30s, experienced these symptoms for years, with the onset dating back to a workout session in 2019. Here’s a detailed account of his journey:

Initial Symptoms and Interventions

• Onset: The pain began during a gym workout, described as a fist-like pressure in the rectal and perineal areas.
• First Steps: His primary doctor prescribed antibiotics, which temporarily alleviated the symptoms. However, the discomfort returned soon after stopping the medication.
• Worsening Symptoms: Over time, the pain extended to what felt like prostate issues. Consultations with a urologist and further courses of antibiotics yielded little to no improvement.

Exhaustive Diagnostics and Treatments

The patient underwent extensive medical evaluations, including:

• Imaging: Pelvic and lumbar MRIs revealed no abnormalities.
• Specialist Consultations: He saw multiple doctors and specialists, each offering different treatments:
  • Pelvic Floor Therapy: Included internal therapy, stretches, and breathing exercises, but results were minimal.
  • Nerve Medications: Gabapentin and later Duloxetine provided limited relief.
  • Injections: Several nerve blocks targeting the pudendal nerve were ineffective.
  • Other Interventions: Muscle relaxants and a “chromosome shot” also failed to alleviate symptoms.

Despite these efforts, no definitive cause or lasting solution emerged.

A Breakthrough: Linking Pain to Deadlifts

Through a comprehensive consultation, it became clear that the pain originated after a gym workout. A deeper dive into the patient’s exercise routine revealed a possible connection between the symptoms and specific movements, particularly deadlifts.

Why Deadlifts Could Be the Culprit

Deadlifts engage multiple muscle groups, including:

• The glutes
• The hamstrings
• The pelvic floor muscles
• The lower back

Improper technique, overloading, or muscle imbalances can lead to strain or dysfunction in these areas. For this patient, it was hypothesized that specific muscle groups, potentially underworked or overworked during deadlifts, were mimicking the described perineal pain.

The Importance of a Thorough Evaluation

This case underscores the critical role of a detailed history and physical examination. While the patient had previously undergone physical therapy, it lacked a targeted focus on specific muscle groups and movements associated with his symptoms.

Steps for Identifying the Root Cause

1. Review Exercise History: Understanding the mechanics and intensity of gym routines can pinpoint triggering movements.
2. Targeted Muscle Testing: Evaluating the strength, flexibility, and activation of muscles like the pelvic floor, glutes, and lower back.
3. Functional Assessments: Observing how certain exercises, such as deadlifts, impact symptoms in real time.

Potential Solutions

For individuals experiencing similar issues, focusing on musculoskeletal factors can be transformative. Below are strategies that might help:

Refining Exercise Technique

• Ensure proper deadlift form to avoid undue strain on the pelvic floor and lower back.
• Work with a fitness professional or physical therapist knowledgeable about biomechanics.

Strengthening and Balancing Muscles

• Pelvic Floor Training: Strengthen and relax the pelvic muscles with targeted exercises.
• Core Stabilization: Strengthen the transverse abdominis and other core muscles to support the pelvis.
• Flexibility Routines: Address tightness in the hamstrings, hip flexors, and glutes.

Seeking Specialized Care

• Consult a pelvic floor physical therapist experienced in treating gym-related injuries.
• Work with a musculoskeletal specialist who can assess subtle imbalances and prescribe a tailored rehabilitation plan.

Lessons Learned from the Case

This patient’s journey offers valuable insights for anyone grappling with unexplained perineal pain:

1. Exercise Connection: Don’t overlook the potential link between gym activities and symptoms.
2. Comprehensive Diagnostics: While medical imaging and tests can rule out severe conditions, they may not identify musculoskeletal issues.
3. Persistent Exploration: If traditional treatments fail, revisiting the history and consulting specialized practitioners can make a difference.

Is Your Deadlift Causing Perineal Pain? – Conclusion

Perineal pain, especially when triggered by gym activities like deadlifts, can be a perplexing and debilitating condition. However, as this case demonstrates, understanding the musculoskeletal underpinnings of the pain can lead to effective solutions. If you’ve been struggling with similar symptoms, consider revisiting your workout routines, seeking targeted evaluations, and exploring specialized care to uncover the root cause and regain your quality of life.

Also Read: How to Reduce Pain from Sitting with Head and Neck Stretches

About:

I’m Hina Sheth. I have been treating complex orthopedics, sports and pelvic floor physical problems for over 25 years with amazing results. Now I want to bring my knowledge to the global community so I can spread my knowledge to you.

Our bodies are complex systems of 600 muscles and organs intertwined in a fascial system that all work together. Imbalances in this system such as trigger points, visceral and myofascial restrictions can lead to joint, pelvic, and organ issues.

Factors like nutrition, exercise, sleep, and stress play a crucial role. Unfortunately, our current healthcare model does not look at our bodies as a whole and oftentimes compartmentalize musculoskeletal injuries and dysfunctions.

At Rebalance, our goal is to holistically treat this complex system to restore harmony in the body.  By addressing these imbalances, we help clients improve their overall health and well-being.  Our vision is to empower individuals to create a healthier lifestyle for themselves.