The Institute of Clinical Excellence has released a new episode of its #PTonICE Daily Show podcast, focusing on tips for dry needling in the management of pudendal neuralgia. This episode, aired on March 10, 2026, addresses assessment and treatment approaches for this condition, which originates from the sacral plexus and often presents with symptoms such as burning or sharp pain in the perineum.
Pudendal neuralgia affects individuals with pain aggravated by sitting, along with potential genital numbness, hypersensitivity, and impacts on sexual function or bowel and bladder control. The episode outlines strategies for evaluation, including the use of a symptom behavior model that incorporates subjective reports and objective measures like sitting tolerance, hip range of motion—particularly internal rotation—and pelvic floor tone. Palpation of key areas, such as the alcox canal between the levator ani and obturator internus muscles, helps identify irritation points along the nerve pathway.
Dry needling emerges as a central treatment modality in the discussion, with guidance on progressing from proximal targets, including sacral nerve roots and multifidus muscles, to more peripheral sites like the obturator internus and pudendal nerve via the ischial cavernosus muscle. The approach emphasizes respecting the level of irritability, beginning with peripheral interventions for highly symptomatic cases and advancing to direct nerve targeting as symptoms subside. Retesting within the session, through measures like pelvic floor tone and hip range of motion, allows clinicians to gauge immediate effects.
The episode also integrates mobility and exercise components to reinforce treatment gains. Techniques such as pelvic floor down-training, using an A-frame analogy, banded hip mobilizations, and 90-90 hip internal rotation exercises are highlighted. Follow-up assessments within 24 to 48 hours focus on subjective improvements, with an overarching emphasis on incorporating load-based exercises to support long-term outcomes.
This content aligns with the Institute of Clinical Excellence's broader educational framework, which includes a range of Physical Therapy CEU's & Courses designed to enhance clinical skills in areas like dry needling and pelvic health. The organization offers certifications in dry needling, including upper body, lower body, and advanced programs, as well as specialized training in pelvic floor dry needling. These courses provide hands-on instruction to build competence in managing complex conditions.
Upcoming sessions include a lower body dry needling course in Raleigh, North Carolina, at the end of March 2026, which is nearing capacity. An advanced dry needling course follows in Longmont, Colorado, in April 2026, alongside a pelvic floor dry needling session in the same location. These offerings complement the podcast by providing in-depth, practical training that extends the concepts discussed in episodes like this one.
Beyond dry needling, the Institute of Clinical Excellence delivers courses on topics such as persistent pain management, primary care physical therapy, rehabilitation of injured runners, and care for older adults. Online options, spanning eight weeks, cover areas like lumbar and cervical spine management, while live sessions occur in various locations across the United States, including Bellingham, Washington; Portland, Oregon; Salt Lake City, Utah; and Ridgeland, Mississippi.
The organization's mission centers on developing Physical Therapist 2.0, a concept that promotes proficiency in foundational skills alongside specialized expertise. Through one-year specialization programs, clinicians gain the ability to deliver targeted interventions that address patient needs effectively. Certifications enable participants to become ICE Physio Trained Specialists in fields such as pelvic health, fitness athletes, older adults, endurance athletes, dry needling, and orthopedics.
Resources extend to the ICE Physio Podcast, which includes the #PTonICE Daily Show, delivering weekday content on clinical topics. Additional support comes from the Hump Day Hustle weekly email, featuring research articles and insights. Testimonials from clinicians across the country underscore the value of these educational tools in updating practices and enhancing patient care.
"The number one key feature that you’ll see with pudendal neuralgia is pain that is aggravated by sitting," said Alan Fredendall, faculty member at the Institute of Clinical Excellence.
"We want to make sure that we are testing, retesting, respecting irritability, and then always ending with Load is our love language at Ice Physio. So we want to make sure that all roads lead to load," said Dr. Ellison Melrose, lead faculty with the dry needling division at the Institute of Clinical Excellence.
The Institute of Clinical Excellence provides continuing education for physical therapists and rehabilitation providers, with a focus on fitness-forward approaches. It offers live and online courses, certifications, and free resources to support professional development in evidence-based care.
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For more information about Institute of Clinical Excellence, contact the company here:
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