Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women
- Rhonda K Kotarinos, DPT, MS
Rhonda K Kotarinos, DPT, MS
- Kotarinos Physical Therapy, Ltd.
- Urogynecology Clinical Assistant Professor
- University of South Florida, Tampa
Pelvic floor physical therapy is the general term used to describe a variety of treatments utilized by physical therapists with advanced training for the management of pelvic floor dysfunction. Pelvic floor dysfunction is a global term used to describe conditions such as pelvic organ prolapse, fecal or urinary incontinence, and chronic pelvic pain. Myofascial pain syndrome is a potential etiology of chronic pelvic pain that can be associated with urinary and bowel symptoms.
For women with pelvic organ prolapse and incontinence issues, the therapist develops a treatment program that addresses the weakness of the pelvic floor and related structures, including but not limited to the abdominal wall and hip girdle musculature . This program may include pelvic floor muscle training, biofeedback, and electrical stimulation. (See "Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management" and "Treatment of urinary incontinence in women" and "Fecal incontinence in adults: Etiology and evaluation".)
Many experts believe that many, if not most, women with chronic pelvic pain have some degree of myofascial pelvic pain syndrome, a disorder in which pelvic pain is attributed to short, tight, tender pelvic floor muscles, usually with myofascial trigger points. (See "Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women".)
Management of myofascial pelvic pain syndrome may also utilize pelvic floor muscle training, biofeedback, and electrical stimulation. However, additional forms of pelvic floor physical therapy may be employed secondary to the unique pathophysiology of this syndrome, which involves changes in the length tension relationship of the muscle, as well as changes in neural function. These may also be related to a visceral pathology. (See "Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women", section on 'Pathogenesis'.)
This topic provides an overview of the conceptual framework from which pelvic floor physical therapists approach the myofascial component of pelvic pain syndromes. It is intended to inform clinicians who refer patients for this intervention. An overview of multimodal treatment approaches to this disorder is presented separately. (See "Treatment of myofascial pelvic pain syndrome in women".)
- FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:261.
- Cantu, RI, Grodin, AJ. Myofascial Manipulation Theory and Clinical Application, Aspen Publication, Gaithersburg 1992.
- King, PM, Myers, CA, Ling, FW, Rosenthal, RH. Musculoskeletal factors in chronic pelvic pain. J Psychosom Obstet Gynaecol 1991; 12:87.
- Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res 1994; 43:352.
- Mense, S, Simons, DG. Muscle Pain Understanding Its Nature, Diagnosis, and Treatment, Lippincott Williams & Wilkins, Philadelphia 2001. p.211.
- Butler, DS. The Sensitive Nervous System. Noigroup Publications, Australia 2000.
- FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:269.
- Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct 2002; 13:125.
- Langford CF, Udvari Nagy S, Ghoniem GM. Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain. Neurourol Urodyn 2007; 26:59.
- Mitchell, FL. An Endocrine Interpretation of Chapman's reflexes. Academy of Applied Osteopathy, 1963.
- Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001; 166:2226.
- FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 2009; 182:570.
- Payne CK. Randomized multicenter clinical trial shows efficacy of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome (IC/PBS) (abstract). J Urol 2010; 183:e402.
- Adams SR, Dessie SG, Dodge LE, et al. Pelvic Floor Physical Therapy as Primary Treatment of Pelvic Floor Disorders With Urinary Urgency and Frequency-Predominant Symptoms. Female Pelvic Med Reconstr Surg 2015; 21:252.
- CAUSES OF MYOFASCIAL PELVIC PAIN
- REFERRAL TO PHYSICAL THERAPY
- PATIENT EVALUATION
- Pain mapping diagrams
- Range of motion
- Abdominal and pelvic musculature
- Soft tissue assessment
- Trigger points
- Peripheral nerves
- General approach
- - Connective tissue manipulation
- - Release of scars
- - Transvaginal release of trigger points
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS