{"id":8116,"date":"2026-02-05T11:07:18","date_gmt":"2026-02-05T10:07:18","guid":{"rendered":"https:\/\/blueportance.com\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/structural-functional-triage\/"},"modified":"2026-10-25T22:43:41","modified_gmt":"2026-10-25T21:43:41","slug":"structural-functional-triage","status":"publish","type":"page","link":"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/structural-functional-triage\/","title":{"rendered":"KB_Pudendal Neuralgia_04 : SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms"},"content":{"rendered":"\n\n\n<style>\n  .bp-bdc-wrap {\n    max-width: 980px;\n    margin: 0 auto;\n    padding: 0 16px 48px;\n    color: #222;\n    line-height: 1.65;\n  }\n\n  .bp-bdc-breadcrumb {\n    max-width: 900px;\n    margin: 0 auto;\n    padding: 20px 16px 0;\n    font-size: .85rem;\n    color: #6b7280;\n  }\n\n  .bp-bdc-breadcrumb a {\n    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href=\"\/en\/\">Blue Portance<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">Knowledge Base<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/\">Sitting-Related Pain<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/\">Pudendal Neuralgia<\/a> \u2192 SBNFA\u2122 Triage\n<\/nav>\n\n<section class=\"bp-bdc-wrap\">\n\n  <header class=\"bp-bdc-hero\">\n\n    <h1>\n      SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms\n    <\/h1>\n\n    <p>\n      In pudendal neuralgia, the challenge is not only to identify\n      <em>where<\/em> the pain is located. It is also to determine which\n      mechanisms may contribute to its onset, its persistence, or its\n      worsening.\n    <\/p>\n\n    <p>\n      SBNFA\u2122 triage offers an interpretive framework designed to distinguish,\n      without setting them against each other, situations in which an anatomical\n      abnormality can be objectively demonstrated from those in which symptoms may\n      arise from functional interactions among mechanical stresses, tissues,\n      muscles, and the nervous system.\n    <\/p>\n\n    <p>\n      This distinction does not constitute a validated medical diagnosis. Nor\n      does it allow the conclusion that pain without a visible abnormality is\n      necessarily fascial or mechanical in origin. Its purpose is to organize\n      clinical reasoning and to avoid confusing the absence of a visible lesion\n      with the absence of real pain.\n    <\/p>\n\n    <p>\n      Triage therefore does not sort patients into two mutually exclusive boxes.\n      It examines three dimensions that may coexist: the presence of a\n      structural factor, the weight of functional mechanisms, and the adaptive\n      reserve still available. Its aim is to prioritize hypotheses and\n      investigative needs, not to assign a single cause.\n    <\/p>\n\n    <div class=\"bp-bdc-meta\">\n      Blue Portance Knowledge Base \u00b7 Non-commercial reproduction permitted with\n      citation of the source\n    <\/div>\n\n  <\/header>\n\n  <nav class=\"bp-bdc-toc\" aria-label=\"Table of contents\">\n\n    <h2>Contents<\/h2>\n\n    <ul>\n      <li>\n        <a href=\"#enjeu\">\n          1. Why triage is decisive\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#structurel\">\n          2. Structural factors: when an abnormality can be objectively demonstrated\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#fonctionnel\">\n          3. Functional mechanisms: when visible anatomy does not explain everything\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#reserve-adaptative\">\n          4. Adaptive reserve and tolerance threshold\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#indicateurs\">\n          5. SBNFA\u2122 triage indicators\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#resume-comparatif\">\n          6. Structural, functional, and adaptive reserve\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#implications\">\n          7. Clinical implications and understanding the transition to chronic pain\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#references\">\n          Scientific references\n        <\/a>\n      <\/li>\n    <\/ul>\n\n  <\/nav>\n\n  <article class=\"bp-bdc-content\">\n\n    <section id=\"enjeu\">\n\n      <h2>1. Why triage is decisive<\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">ESTABLISHED CLINICAL FRAMEWORK<\/span>\n        <span class=\"bp-bdc-level\">SBNFA\u2122 INTERPRETIVE GRID<\/span>\n      <\/p>\n\n      <p>\n        The diagnosis of pudendal neuralgia is primarily clinical. The Nantes\n        criteria provide a reference framework, but imaging, neurophysiological\n        testing, and diagnostic blocks may also play a role in the overall\n        assessment of the patient.\n      <\/p>\n\n      <p>\n        Normal imaging therefore does not mean that the pain is imaginary or\n        lacks a mechanism. It only means that no structural abnormality likely\n        to explain the symptoms was identified with the examination\n        performed.\n      <\/p>\n\n      <p>\n        The essential Nantes criteria include pain located in the territory of\n        the pudendal nerve, worsened by sitting, not usually waking the patient\n        at night, with no objective sensory deficit, and relieved by a\n        diagnostic pudendal anesthetic block\n        (Labat et al., 2008).\n      <\/p>\n\n      <p>\n        SBNFA\u2122 triage thus seeks to avoid two opposite errors: regarding all\n        pudendal pain as the consequence of a demonstrated anatomical\n        compression, or considering that normal imaging rules out any\n        functional impairment and any clinical reality of the symptom.\n      <\/p>\n\n      <p>\n        It adds a third point of vigilance: not mistaking a visible abnormality\n        for a sufficient explanation. A person may simultaneously present with\n        a structural factor, nerve hypersensitivity, a protective muscular\n        response, and reduced sitting tolerance. Triage aims to clarify the\n        probable contribution of each of these levels and how they interact.\n      <\/p>\n\n    <\/section>\n\n    <section id=\"structurel\">\n\n      <h2>2. Structural factors: when an abnormality can be objectively demonstrated<\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">OBJECTIVELY DEMONSTRABLE DATA<\/span>\n      <\/p>\n\n      <p>\n        A structural factor corresponds to an identified anatomical abnormality\n        judged potentially relevant in light of the clinical picture. Depending\n        on the context, it may be a post-traumatic lesion, a surgical sequela,\n        a mass, a bony abnormality, a pathological scar, or a zone of\n        mechanical interference.\n      <\/p>\n\n      <p>\n        The anatomical work of Robert et al. described several potentially\n        compressive anatomical relationships along the course of the pudendal nerve,\n        notably between the sacrotuberous and sacrospinous ligaments, within\n        Alcock&#8217;s canal (pudendal canal), and at the falciform process\n        (Robert et al., 1998).\n      <\/p>\n\n      <p>\n        These potential zones of mechanical interference are analyzed in\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/mechanical-locks\/\">\n          Mechanical Vulnerability and Pudendal Nerve Entrapment Mechanisms\n        <\/a>.\n      <\/p>\n\n      <p>\n        These observations establish anatomical zones that may be involved in\n        certain forms of entrapment. They do not demonstrate that a\n        pathological compression exists in every patient presenting with\n        pudendal pain.\n      <\/p>\n\n      <p>\n        The clinical relevance of an abnormality must therefore be assessed\n        according to its concordance with the pain distribution, the history of\n        the symptoms, the clinical examination, and the other available data. An\n        abnormal image is not automatically the cause of the pain.\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n\n        <strong>Key point<\/strong>\n\n        <p>\n          A structural abnormality may contribute to pain, but its discovery\n          must be interpreted within its clinical context. Conversely, the\n          absence of a visible structural abnormality does not call into\n          question the reality of the symptom.\n        <\/p>\n\n      <\/div>\n\n    <\/section>\n\n    <section id=\"fonctionnel\">\n\n      <h2>\n        3. Functional mechanisms: when visible anatomy does not explain everything\n      <\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">MECHANICAL INTERPRETATION<\/span>\n        <span class=\"bp-bdc-level\">NEUROMUSCULAR REGULATION<\/span>\n      <\/p>\n\n      <p>\n        Pain can be severe and persistent even when no sufficiently explanatory\n        structural lesion is identified. This situation may involve several\n        factors: nerve sensitivity, nociceptive modulation, mechanical stresses,\n        muscle tension, protective behavior, sleep disturbance, and psychosocial\n        context.\n      <\/p>\n\n      <p>\n        From a biomechanical perspective, posture, duration of exposure, and\n        repetition of stresses may alter tissue tolerance.\n        Sitting may, in particular, aggravate symptoms in some\n        patients, which is also one of the essential Nantes\n        criteria (Labat et al., 2008).\n      <\/p>\n\n      <p>\n        \u201cFunctional\u201d here describes a change in how the system works or in its\n        tolerance: relative mobility between the nerve and its interfaces,\n        stress distribution, the ability to vary points of support, protective\n        muscle activity, and modulation of the pain signal. These mechanisms\n        can be real and disabling without corresponding to a tear or a\n        mass visible on standard imaging.\n      <\/p>\n\n      <p>\n        This dependence on posture does not, however, on its own, allow the\n        conclusion that there is fascial densification, a loss of nerve\n        gliding, or compression of the nerve. It only indicates that\n        posture-related stresses may play a part in modulating\n        symptoms.\n      <\/p>\n\n      <p>\n        The concept of fascial entrapment neuropathy proposes that a change\n        in the connective tissues surrounding a nerve may influence its relative\n        mobility and its mechanical environment. This model is general and must\n        be distinguished from a specific demonstration concerning the pudendal nerve\n        (Stecco, Pirri &amp; Stecco, 2019).\n      <\/p>\n\n      <p>\n        For a closer look at tissue interfaces and nerve gliding, see\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/fascia-neural-gliding\/\">\n          Fascia, Nerve Gliding, and Tissue Densification\n        <\/a>.\n      <\/p>\n\n      <p>\n        In the SBNFA\u2122 framework, the issue is therefore not to choose between \u201cmechanical\u201d\n        and \u201cneural.\u201d Repeated mechanical stress may alter the neuromuscular\n        response; protective hypertonia may in turn reduce the\n        possibilities for movement and redistribution; and heightened sensitivity\n        may finally lower the level of stress that can be tolerated. This loop is\n        a coherent functional hypothesis, but its presence and weight must\n        be assessed on an individual basis.\n      <\/p>\n\n      <p>\n        Likewise, the distinction between fascial densification and fibrosis may\n        help structure thinking about changes in tissue\n        interfaces. It does not allow the conclusion that densification is\n        present in a given patient without an appropriate assessment method\n        (Pavan et al., 2014).\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--warning\">\n\n        <strong>Terminological caution<\/strong>\n\n        <p>\n          \u201cFunctional\u201d means neither imaginary, nor benign, nor necessarily\n          reversible. Here, the term means that the presumed mechanism does not\n          rest on an anatomical abnormality that is objectively demonstrable or\n          sufficient to explain the symptoms.\n        <\/p>\n\n      <\/div>\n\n    <\/section>\n\n    <section id=\"reserve-adaptative\">\n\n      <h2>4. Adaptive reserve and tolerance threshold<\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">SBNFA\u2122 HYPOTHESIS<\/span>\n      <\/p>\n\n      <p>\n        The SBNFA\u2122 framework uses the notion of <strong>adaptive reserve<\/strong>\n        to describe the functional margin a system has to absorb,\n        redistribute, and recover from stresses before they become\n        symptomatic or before symptoms persist.\n      <\/p>\n\n      <p>\n        It resides neither in the nerve alone nor in an isolated tissue. It depends on\n        the relative mobility of interfaces, the possibility of varying\n        postures and points of support, stress redistribution, the neuromuscular\n        response, nerve sensitivity, and recovery. Sleep, general health,\n        and emotional context may also modulate it. It is a functional\n        notion intended to organize the analysis, not a quantity measurable\n        by a single clinical test.\n      <\/p>\n\n      <p>\n        This reserve can be described in terms of four capacities:\n        <strong>accepting a variation in load<\/strong>, <strong>changing\n        configuration<\/strong>, <strong>redistributing stresses<\/strong>, and\n        <strong>recovering before the next exposure<\/strong>. Its reduction\n        therefore does not necessarily mean that a tissue is \u201cexhausted\u201d: it indicates\n        that the available options are becoming insufficient in the face of the current\n        load.\n      <\/p>\n\n      <p>\n        As long as adaptive capacity remains sufficient, a stress can\n        be tolerated without causing persistent symptoms. When several\n        factors combine, the same stress may become painful or\n        lead to slower recovery.\n      <\/p>\n\n      <p>\n        Symptoms may then fluctuate according to sitting duration, activity,\n        fatigue, psychological stress, sleep, or the possibility of changing position.\n        This variability is compatible with a functional mechanism, but it\n        does not constitute specific proof of fascial involvement.\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n\n        <strong>Key point<\/strong>\n\n        <p>\n          The functional nature of a clinical picture does not mean that the symptoms\n          are necessarily transient. Functional pain can\n          persist when maintaining factors continue or when the\n          nervous system becomes more sensitive.\n        <\/p>\n\n      <\/div>\n\n      <p>\n        Repeated exposure to an aggravating posture may help maintain\n        symptoms in some people. However, it has not been demonstrated\n        that prolonged sitting systematically leads to densification,\n        fibrosis, or a measurable biological depletion of the adaptive reserve.\n      <\/p>\n\n      <p>\n        In the SBNFA\u2122 framework, exceeding the adaptive reserve therefore refers to\n        a <strong>functional tolerance threshold<\/strong>. It corresponds to the\n        point at which mechanical load, nerve sensitivity, and protective\n        responses become significant enough to sustain the\n        symptoms. This notion remains an interpretive framework specific to the\n        SBNFA\u2122 framework.\n      <\/p>\n\n      <p>\n        The threshold is neither fixed nor exclusively quantitative. A moderate\n        but prolonged and minimally varied demand may become less tolerable than\n        a stronger but brief demand that is alternated and followed by recovery.\n        This distinction links symptoms not only to the intensity\n        of a pressure, but also to its duration, its repetition, and the scope\n        for adjustment left to the body.\n      <\/p>\n\n      <figure class=\"bp-figure\">\n\n        <img decoding=\"async\"\n          src=\"https:\/\/blueportance.com\/wp-content\/uploads\/IMG_FI_Adaptaive-Reserve.jpg\"\n          alt=\"Conceptual evolution of the adaptive reserve under prolonged stresses\"\n          loading=\"lazy\">\n\n        <figcaption>\n          <strong>Conceptual evolution of the adaptive reserve.<\/strong>\n          The same stress may be tolerated differently depending on the level of\n          nerve sensitivity, recovery, muscle tension, and\n          postural exposure. The diagram presents a functional model of\n          reduced tolerance, not a validated biological measurement of\n          tissue exhaustion.\n        <\/figcaption>\n\n      <\/figure>\n\n    <\/section>\n\n    <section id=\"indicateurs\">\n\n      <h2>5. SBNFA\u2122 triage indicators<\/h2>\n\n      <p>\n        SBNFA\u2122 triage relies on a convergence of clues. No single element\n        can distinguish with certainty structural factors from\n        functional mechanisms.\n      <\/p>\n\n      <p>\n        These clues do not produce a binary verdict. They serve to answer\n        three questions in turn: Is there a structural factor to\n        investigate or monitor? Does the variability of symptoms reveal\n        a modifiable functional component? Which signs suggest that the\n        margin for adaptation is shrinking or being restored?\n      <\/p>\n\n      <h3>5.1 Findings compatible with a structural investigation<\/h3>\n\n      <ul>\n        <li>\n          Clearly identified trauma, surgery, or local event.\n        <\/li>\n\n        <li>\n          Pain that appeared suddenly after that event.\n        <\/li>\n\n        <li>\n          Anatomical abnormality concordant with the territory and profile of the pain.\n        <\/li>\n\n        <li>\n          Objective neurological deficit or focal clinical sign requiring\n          specialist evaluation.\n        <\/li>\n\n        <li>\n          Stable course, little influenced by variations in posture or load.\n        <\/li>\n      <\/ul>\n\n      <p>\n        These findings do not prove that an abnormality is responsible for the symptoms.\n        They indicate that a targeted structural or neurological investigation\n        may be relevant.\n      <\/p>\n\n      <h3>5.2 Findings compatible with a functional or mixed mechanism<\/h3>\n\n      <ul>\n        <li>\n          Symptoms that fluctuate with posture, sitting duration, or load.\n        <\/li>\n\n        <li>\n          Partial improvement with changes of position or during off-loading phases.\n        <\/li>\n\n        <li>\n          No sufficiently explanatory structural abnormality on the available imaging.\n        <\/li>\n\n        <li>\n          Perineal pain associated with urinary, sexual, or rectal\n          manifestations, without a single identified local lesion.\n        <\/li>\n\n        <li>\n          Symptoms that vary with fatigue, psychological stress, sleep, or recovery.\n        <\/li>\n      <\/ul>\n\n      <p>\n        These findings point toward a functional or mixed analysis, but they\n        do not allow the conclusion of an exclusively mechanical,\n        fascial, or muscular origin.\n      <\/p>\n\n      <h3>5.3 Clues related to adaptive reserve<\/h3>\n\n      <ul>\n        <li>\n          Time to symptom onset that shortens with successive exposures.\n        <\/li>\n        <li>\n          Slower recovery after a comparable sitting duration.\n        <\/li>\n        <li>\n          Fewer positions or points of support still tolerated.\n        <\/li>\n        <li>\n          Conversely, improvement in tolerance time or recovery\n          when points of support and positions can be varied.\n        <\/li>\n      <\/ul>\n\n      <p>\n        These changes describe a functional variation in tolerance. They\n        do not directly measure a biological reserve and do not prove a\n        structural restoration or deterioration.\n      <\/p>\n\n      <h3>5.4 Situations requiring particular vigilance<\/h3>\n\n      <p>\n        Certain symptoms should not be attributed outright to a simple\n        functional mechanism. Medical evaluation should be sought\n        particularly when any of the following appear: progressive neurological weakness,\n        saddle anesthesia, new sphincter disturbances, fever,\n        unexplained weight loss, unusual night pain, or rapid\n        worsening.\n      <\/p>\n\n    <\/section>\n\n    <section id=\"resume-comparatif\" class=\"comparison-section\">\n\n      <h2>6. Structural, functional, and adaptive reserve<\/h2>\n\n      <p>\n        The following table presents the predominant features of each reading. In practice,\n        the structural, functional, and adaptive dimensions may\n        overlap. This grid is not a validated diagnostic tool and\n        replaces neither the clinical examination nor the medical interpretation of\n        additional diagnostic testing.\n      <\/p>\n\n      <p class=\"bp-note\">\n        <em>\n          On mobile, scroll the table horizontally.\n        <\/em>\n      <\/p>\n\n      <div class=\"comparison-table\">\n\n        <table>\n\n          <thead>\n            <tr>\n              <th scope=\"col\">Criterion<\/th>\n              <th scope=\"col\">\n                <span class=\"icon-structurel\">\ud83c\udfd7\ufe0f<\/span>\n                Possible structural factor\n              <\/th>\n              <th scope=\"col\">\n                <span class=\"icon-fonctionnel\">\ud83c\udf0a<\/span>\n                Possible functional mechanism\n              <\/th>\n            <\/tr>\n          <\/thead>\n\n          <tbody>\n\n            <tr>\n              <td>Definition<\/td>\n              <td>\n                Identified anatomical abnormality, potentially concordant\n                with the symptoms.\n              <\/td>\n              <td>\n                Symptoms without a sufficiently explanatory structural abnormality,\n                which may involve several mechanical,\n                neuromuscular, or neurophysiological mechanisms.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Possible triggers<\/td>\n              <td>\n                Trauma, surgery, scar, mass, bony abnormality, or\n                local mechanical interference.\n              <\/td>\n              <td>\n                Prolonged sitting, repeated stresses, variations in load,\n                muscle tension, and nerve sensitivity factors.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Relationship to imaging<\/td>\n              <td>\n                An abnormality may be visible, but its relevance must be\n                confirmed by its clinical concordance.\n              <\/td>\n              <td>\n                Normal imaging is possible. It does not always identify\n                functional mechanisms or variations in sensitivity.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Symptom profile<\/td>\n              <td>\n                Symptoms sometimes more stable and associated with an event or\n                a specific anatomical region.\n              <\/td>\n              <td>\n                Symptoms often variable with posture, duration of exposure,\n                fatigue, psychological stress, or recovery.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Possible dominant mechanism<\/td>\n              <td>\n                Mechanical interference, local irritation, or compression associated with\n                an identifiable structure.\n              <\/td>\n              <td>\n                Interaction among mechanical load, nerve sensitivity,\n                muscular protection, and functional adaptation.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Interpreting the absence of a lesion<\/td>\n              <td>\n                An abnormality may not be visible with the examination used or\n                may be insufficiently characterized.\n              <\/td>\n              <td>\n                The absence of a visible lesion may be compatible with a functional\n                mechanism, but does not prove a fascial origin.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Adaptive reserve<\/td>\n              <td>\n                It may be reduced by an anatomical source of stress, but its\n                level cannot be inferred from imaging alone.\n              <\/td>\n              <td>\n                In the SBNFA\u2122 framework, it refers to the margin of tolerance to\n                stresses before symptoms appear or intensify.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Clinical example<\/td>\n              <td>\n                Pain that appeared after surgery with a concordant scar\n                abnormality, to be confirmed by specialist evaluation.\n              <\/td>\n              <td>\n                Pain aggravated by sitting and fluctuating, without a sufficiently\n                explanatory structural abnormality.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Possibility of a mixed profile<\/td>\n              <td>\n                A real abnormality may be amplified or sustained by\n                functional mechanisms and reduced tolerance.\n              <\/td>\n              <td>\n                Disturbed function does not rule out an associated anatomical\n                vulnerability or structural sequela.\n              <\/td>\n            <\/tr>\n\n            <tr>\n              <td>Key references<\/td>\n              <td>\n                Robert et al. (1998); Labat et al. (2008).\n              <\/td>\n              <td>\n                Labat et al. (2008); Pavan et al. (2014);\n                Stecco et al. (2019).\n              <\/td>\n            <\/tr>\n\n          <\/tbody>\n\n        <\/table>\n\n      <\/div>\n\n    <\/section>\n\n    <section id=\"implications\">\n\n      <h2>\n        7. Clinical implications and understanding the transition to chronic pain\n      <\/h2>\n\n      <p>\n        The absence of explicit triage can encourage a succession of tests\n        and interventions without a shared hypothesis. Conversely, an overly\n        hasty functional reading can lead to overlooking a lesion, a neurological\n        deficit, or another medical cause.\n      <\/p>\n\n      <p>\n        The objective of SBNFA\u2122 triage is therefore to uphold two\n        requirements at the same time: looking for findings that warrant a structural\n        investigation, and recognizing that pain can be real and disabling\n        in the absence of a visible abnormality.\n      <\/p>\n\n      <p>\n        The transition to chronic pain may result from interactions among repeated exposure\n        to stresses, sensitization, protective strategies, activity\n        limitation, sleep disturbance, and psychological or\n        social factors. The persistence of symptoms does not prove progressive\n        anatomical deterioration.\n      <\/p>\n\n      <p>\n        Within this framework, the notion of adaptive reserve can help describe a\n        possible functional trajectory: a previously tolerated stress\n        becomes progressively less well tolerated when several vulnerability\n        factors combine. This notion belongs to the SBNFA\u2122 framework\n        and must be presented as an organizing hypothesis, not as\n        a validated clinical variable.\n      <\/p>\n\n      <p>\n        Triage therefore does not involve artificially opposing \u201cstructural\u201d\n        and \u201cfunctional.\u201d It involves determining whether a structural abnormality\n        is objectively demonstrable and clinically concordant, while evaluating the\n        functional mechanisms likely to contribute to the symptoms.\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n\n        <strong>The output of triage is not a label<\/strong>\n\n        <p>\n          It takes the form of a hierarchy of hypotheses: structural findings\n          to rule out or document, plausible functional mechanisms, factors\n          that reduce the adaptive reserve, and signs that call for medical\n          referral. This hierarchy may evolve with testing, observation,\n          and the response to changes in context.\n        <\/p>\n\n      <\/div>\n\n    <\/section>\n\n    <section id=\"references\">\n\n      <h2>Scientific references<\/h2>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n\n        <ol>\n\n          <li>\n            Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J.\n            Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment\n            (Nantes criteria).\n            <em>Neurourology and Urodynamics<\/em>.\n            2008;27(4):306\u2013310.\n            doi:\n            <a\n              href=\"https:\/\/doi.org\/10.1002\/nau.20505\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1002\/nau.20505\n            <\/a>.\n          <\/li>\n\n          <li>\n            Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R,\n            Leborgne J.\n            Anatomic basis of chronic perineal pain: role of the pudendal nerve.\n            <em>Surgical and Radiologic Anatomy<\/em>.\n            1998;20(2):93\u201398.\n            doi:\n            <a\n              href=\"https:\/\/doi.org\/10.1007\/BF01628908\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1007\/BF01628908\n            <\/a>.\n          <\/li>\n\n          <li>\n            Pavan PG, Stecco A, Stern R, Stecco C.\n            Painful connections: densification versus fibrosis of fascia.\n            <em>Current Pain and Headache Reports<\/em>.\n            2014;18(8):441.\n            doi:\n            <a\n              href=\"https:\/\/doi.org\/10.1007\/s11916-014-0441-4\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1007\/s11916-014-0441-4\n            <\/a>.\n          <\/li>\n\n          <li>\n            Stecco A, Pirri C, Stecco C.\n            Fascial entrapment neuropathy.\n            <em>Clinical Anatomy<\/em>.\n            2019;32(7):883\u2013890.\n            doi:\n            <a\n              href=\"https:\/\/doi.org\/10.1002\/ca.23388\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1002\/ca.23388\n            <\/a>.\n          <\/li>\n\n        <\/ol>\n\n        <p class=\"bp-reference-note\">\n          These references respectively support the clinical framework of the Nantes\n          criteria, the anatomical basis of the pudendal course, and certain\n          general models concerning fascial interfaces and pain. They do not\n          demonstrate that a fascial or functional mechanism alone explains\n          every case of pudendal neuralgia.\n        <\/p>\n\n      <\/div>\n\n      <div class=\"bp-bdc-box bp-bdc-box--warning\">\n\n        <strong>Blue Portance internal reference<\/strong>\n\n        <p>\n          The SBNFA\u2122 framework \u2014 notably the notions of triage, adaptive\n          reserve, and tolerance threshold \u2014 is a proprietary framework\n          developed by Blue Portance. It must be presented as an internal\n          conceptual model and not as a validated medical classification.\n        <\/p>\n\n        <p>\n          The following internal references may be cited separately\n          from the scientific publications:\n        <\/p>\n\n        <ul>\n          <li>\n            Blue Portance. SBNFA\u2122 framework \u2014 <em>Neuro-anatomie, partie IV :\n            triage structurel\/fonctionnel<\/em> [Neuroanatomy, Part IV:\n            Structural\/Functional Triage]. 2026.\n          <\/li>\n\n          <li>\n            Blue Portance. SBNFA\u2122 framework \u2014 <em>Neuro-anatomie, partie IV :\n            errance diagnostique et chronicisation<\/em> [Neuroanatomy, Part IV:\n            Diagnostic Odyssey and Transition to Chronic Pain]. 2026.\n          <\/li>\n        <\/ul>\n\n      <\/div>\n\n    <\/section>\n\n    <div class=\"bp-bdc-navigation\">\n      <strong>Pudendal Neuralgia pathway<\/strong>\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/pudendal-nerve-anatomy\/\">1. Functional Anatomy and Neuromechanics of the Pudendal Nerve<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/mechanical-locks\/\">2. Mechanical Vulnerability and Pudendal Nerve Entrapment Mechanisms<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/referred-pain-trident\/\">3. Referred Pain and the Pudendal Trident: Understanding Symptom Territories<\/a><br>\n        <strong>4. SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms<\/strong><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/fascia-neural-gliding\/\">5. Fascia, Nerve Gliding, and Tissue Densification<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/wandering-central-sensitization\/\">6. The Diagnostic Odyssey and Central Sensitization in Pudendal Neuralgia<\/a>\n      <\/p>\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/referred-pain-trident\/\">\u2190 Previous article<\/a> \u00b7\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/fascia-neural-gliding\/\">Next article \u2192<\/a>\n      <\/p>\n    <\/div>\n\n    <div class=\"bp-bdc-navigation\">\n\n      <strong>Navigation<\/strong>\n\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/\">\n          \u2190 Back to the Pudendal Neuralgia hub\n        <\/a>\n        <br>\n\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/\">\n          \u2190 See the topic: Sitting-Related Pain\n        <\/a>\n        <br>\n\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">\n          \u2190 Explore the Knowledge Base\n        <\/a>\n      <\/p>\n\n    <\/div>\n\n    <footer class=\"bp-bdc-footer\">\n\n      <strong>Note:<\/strong>\n      this content aims to present an anatomical, clinical, and functional\n      interpretive framework. It constitutes neither a medical diagnosis, nor a therapeutic\n      recommendation, nor a scientific validation of the SBNFA\u2122 framework.\n\n    <\/footer>\n\n    <p class=\"bp-bdc-copyright\">\n      \u00a9 Gil Ayache. The concepts, diagrams, terminology, and principles presented on this page constitute a work protected by copyright. They are made available to Blue Portance under an intellectual property license agreement, without transfer of economic rights or of authorship.\n    <\/p>\n\n  <\/article>\n\n<\/section>\n\n\n\n","protected":false},"excerpt":{"rendered":"<p>Blue Portance \u2192 Knowledge Base \u2192 Sitting-Related Pain \u2192 Pudendal Neuralgia \u2192 SBNFA\u2122 Triage SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms In pudendal neuralgia, the challenge is not only to identify where the pain is located. It is also to determine which mechanisms may contribute to its onset, its persistence, or its worsening. SBNFA\u2122 [&#8230;]\n","protected":false},"author":6,"featured_media":0,"parent":8099,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_yoast_wpseo_title":"Structural vs Functional Pudendal Neuralgia | Blue Portance","_yoast_wpseo_metadesc":"SBNFA\u2122 triage in pudendal neuralgia: telling structural factors from functional mechanisms, which can coexist.","footnotes":""},"pathologie_secondaire":[],"effet_positif":[],"class_list":["post-8116","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.7 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Structural vs Functional Pudendal Neuralgia | Blue Portance<\/title>\n<meta name=\"description\" content=\"SBNFA\u2122 triage in pudendal neuralgia: telling structural factors from functional mechanisms, which can coexist.\" \/>\n<meta name=\"robots\" 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