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Chapter 20 - Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain

Published online by Cambridge University Press:  08 March 2021

Michael Hibner
Affiliation:
St Joseph’s Hospital & Medical Center, Phoenix, AZ
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Summary

Pelvic floor muscle spasm is one of the most common reason for pelvic pain, and it often coexists with other pelvic pain conditions. Oral muscle relaxants do not seem to be helpful in these patients and vaginal suppositories seem to relax muscles much better. A combination of diazepam 5 milligrams placed vaginally, baclofen 4 milligrams, and ketamine 15 milligrams used before bedtime works well on pelvic muscle spasm. The mainstay of treatment of pelvic floor muscle spasm is pelvic floor physical therapy. It is best done by Women’s Health physical therapists who are specifically trained in pelvic floor dysfunction. Patients who fail physical therapy may be candidates for injections of botulinum toxin into pelvic floor muscles.

Type
Chapter
Information
Management of Chronic Pelvic Pain
A Practical Manual
, pp. 207 - 222
Publisher: Cambridge University Press
Print publication year: 2021

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References

Haynes, RB, Sackett, DL, Gray, JM, Cook, DJ, Guyatt, GH. Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. ACP J Club. 1996;125(3):A1416.CrossRefGoogle ScholarPubMed
Lee, D, Lee, L-J. The Pelvic Girdle. Edinburgh: Elsevier; 2011.Google Scholar
Faubion, SS, Shuster, LT, Bharucha, AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Paper presented at Mayo Clinic Proceedings2012.CrossRefGoogle Scholar
Bo, K, Berghmans, B, Morkved, S, Van Kampen, M. Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice. Philadelphia: Elsevier Health Sciences; 2014.Google Scholar
Irion, JM, Irion, G. Women’s Health in Physical Therapy. Philadelphia: Lippincott Williams & Wilkins; 2010.Google Scholar
Padoa, A, Rosenbaum, TY. The Overactive Pelvic Floor. Cham, Switzerland: Springer; 2016.CrossRefGoogle Scholar
Weiss, JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001;166(6):2226–31.Google Scholar
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(4):269–75; discussion 275.Google Scholar
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;182:570–80.CrossRefGoogle ScholarPubMed
FitzGerald, MP, Payne, CK, Lukacz, ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–18.CrossRefGoogle ScholarPubMed
Oyama, IA, Rejba, A, Lukban, JC, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862–5.CrossRefGoogle ScholarPubMed
Pastore, EA, Katzman, WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680–91.Google Scholar
Barnes, JF. Myofascial Release: The “Missing Link” in Your Treatment. Norfolk, VA: Rehabilitation Services; 1995.Google Scholar
Laan EvL, RHW. Overactive pelvic floor: Sexual functioning. In Padoa, A, Rosenbaum, TY (eds), The Overactive Pelvic Floor (pp. 1729). Cham, Switzerland: Springer; 2016.Google Scholar
Barral, J-P, Mercier, P. Manipulations viscérales, Vol. 1. Paris: Elsevier Masson; 2004.Google Scholar
Goats, GC, Keir, KA. Connective tissue massage. Br J Sports Med. 1991;25(3):131133.Google Scholar
Jones, LH, Kusunose, R, Goering, E. Jones Strain-Counterstrain. Boise, ID: Jones Strain Counterstrain Incorporated; 1995.Google Scholar
Huffman, LB, Hartenbach, EM, Carter, J, Rash, JK, Kushner, DM. Maintaining sexual health throughout gynecologic cancer survivorship: a comprehensive review and clinical guide. Gynecol Oncol. 2016;140(2):359–68.CrossRefGoogle ScholarPubMed
Murina, F, Bernorio, R, Palmiotto, R. The use of Amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: an observational multicentric study. Medscape J Med. 2008;10(1):23.Google ScholarPubMed
Sorensen, J, Bautista, KE, Lamvu, G, Feranec, J. Evaluation and treatment of female sexual pain: a clinical review. Cureus. 2018;10(3):e2379.Google Scholar
Glazer, HI, Rodke, G, Swencionis, C, Hertz, R, Young, AW. Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. Obstet Gynecol Surv. 1995;50(9):658–9.CrossRefGoogle Scholar
Hay‐Smith, J. Therapeutic ultrasound for postpartum perineal pain and dyspareunia. Cochrane Database Syst Rev. 1998;(3).Google Scholar
Murina, F, Bianco, V, Radici, G, Felice, R, Di Martino, M, Nicolini, U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG. 2008;115(9):1165–70.CrossRefGoogle ScholarPubMed
Waldinger, MD, de Lint, GJ, Venema, PL, van Gils, AP, Schweitzer, DH. Successful transcutaneous electrical nerve stimulation in two women with restless genital syndrome: the role of adelta- and C-nerve fibers. J Sex Med. 2010;7(3):1190–9.CrossRefGoogle ScholarPubMed
Alappattu, MJ, Bishop, MD. Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain. Physical Therapy. 2011;91(10):1542–50.Google Scholar
Peters, KM, Carrico, DJ, Diokno, AC. Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Urology. 2008;71(4):634–40.Google Scholar
Persson, AL, Veenhuizen, H, Zachrison, L, Gard, G. Relaxation as treatment for chronic musculoskeletal pain: a systematic review of randomised controlled studies. Phys Ther Rev. 2008;13(5):355–65.Google Scholar
Bertisch, SM, Wee, CC, Phillips, RS, McCarthy, EP. Alternative mind–body therapies used by adults with medical conditions. J Psychosom Research. 2009;66(6):511–19.CrossRefGoogle ScholarPubMed
Conrad, A, Muller, A, Doberenz, S, et al. Psychophysiological effects of breathing instructions for stress management. Appl Psychophysiol Biofeedback. 2007;32(2):8998.Google Scholar
Hodges, PW, Sapsford, R, Pengel, LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26(3):362–71.Google Scholar
Talasz, H, Kremser, C, Kofler, M, Kalchschmid, E, Lechleitner, M, Rudisch, A. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing: a dynamic MRI investigation in healthy females. Int Urogynecol J. 2011;22(1):61–8.Google Scholar
Bump, RC, Hurt, WG, Fantl, JA, Wyman, JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165(2):322–7; discussion 327–9.CrossRefGoogle ScholarPubMed
Neumann, P, Gill, V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):125–32.Google Scholar
Bo, K, Talseth, T, Holme, I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318(7182):487–93.Google Scholar
Herderschee, R, Hay-Smith, EJ, Herbison, GP, Roovers, JP, Heineman, MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011(7):CD009252.Google ScholarPubMed
Dumoulin, C, Lemieux, MC, Bourbonnais, D, Gravel, D, Bravo, G, Morin, M. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2004;104(3):504–10.Google Scholar
Bo, K, Talseth, T. Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(1):36; discussion 67.Google Scholar
Sapsford, RR, Hodges, PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil. 2001;82(8):1081–8.Google Scholar
Vleeming, A, Stoeckart, R, Volkers, A, Snijders, C. Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine. 1990;15(2):130.CrossRefGoogle ScholarPubMed
Haugstad, GK, Haugstad, TS, Kirste, UM, et al. Posture, movement patterns, and body awareness in women with chronic pelvic pain. J Psychosom Res. 2006;61(5):637–44.CrossRefGoogle ScholarPubMed
Sapsford, RR, Hodges, PW, Richardson, CA, Cooper, DH, Markwell, SJ, Jull, GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):3142.Google Scholar
Collie, M, Harris, B. Physical therapy treatment for diastasis recti: a case report. J Sect Women’s Health. 2004;28:1115.Google Scholar
Spitznagle, TM, Leong, FC, Van Dillen, LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18(3):321–8.Google Scholar
Hunskaar, S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn.2008;27(8):749–57.CrossRefGoogle ScholarPubMed
Latthe, P, Mignini, L, Gray, R, Hills, R, Khan, K. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006;332(7544):749–55.Google Scholar
Maserejian, NN, Kupelian, V, Miyasato, G, McVary, KT, McKinlay, JB. Are physical activity, smoking and alcohol consumption associated with lower urinary tract symptoms in men or women? Results from a population based observational study. J Urol. 2012;188(2):490–5.CrossRefGoogle ScholarPubMed
Abrams, P, Andersson, K-E, Birder, L, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40.CrossRefGoogle ScholarPubMed
Charach, G, Greenstein, A, Rabinovich, P, Groskopf, I, Weintraub, M. Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology. 2001;47(2):72–6.Google Scholar
Emmons, KM, Rollnick, S. Motivational interviewing in health care settings: opportunities and limitations. Am J Prev Med. 2001;20(1):6874.Google Scholar

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