CHRONIC PELVIC PAIN

Can myofascial pain be treated?

Physical therapy has moved enthusiastically into the area of pelvic pain in general. Many clinicians and physical therapists have begun to look beyond the pelvic floor and recognize contributions from the hip external rotator muscles (piriformis, obturator), the sacroiliac joints, and the abdominal wall muscles. These muscle groups seem to communicate with each other at times. For example, palpation of the pelvic floor may refer pain to the ipsilateral lower abdominal wall, and palpation of the sacroiliac joint, which may be painful itself, may also refer pain to the corresponding anterior lower quadrant. The gynecologist can readily screen for these dysfunctions, with treatment provided by the physical therapist. Follow-up by the gynecologist then permits integration of all medical, surgical, and physical therapy.

Systematic studies are needed

At present, comparisons across treatment centers are complicated by variations in clinical assessment techniques. For example, the literature describing how the bladder contributes to pelvic pain often fails to describe assessment techniques for disorders in other systems (gastrointestinal, pelvic floor, etc). When increased bladder sensitivity is then demonstrated, the reader is left to wonder whether it is the prime mover in the problem or an epiphenomenon, secondary to some other disorder.

Dr. Steege reports no financial relationships with any company whose products are mentioned in this article.