Matrix Radiofrequency Combined with Myofascial Manipulation in the Treatment of Myofascial Pelvic Pain: A Retrospective Study.

A total of 87 patients were enrolled in this study. The observation group consisted of 42 patients, aged 23–53 years, with a mean age of 45.67 ± 5.11 years. The disease duration ranged from 6 to 24 months, with a mean duration of 12.43 ± 3.14 months. The number of deliveries ranged from 1 to 4, and the mean BMI was 25.13 ± 2.37 kg/m 2 . The control group included 45 patients, aged 22–55 years, with a mean age of 44.73 ± 5.82 years. The disease duration ranged from 7 to 28 months, with a mean duration of 13.00 ± 2.78 months. The number of deliveries ranged from 1 to 3, and the mean BMI was 24.98 ± 3.14 kg/m 2 . No statistically significant differences were observed between the two groups in terms of age, disease duration, number of deliveries, or BMI ( p  > 0.05; Table  1 ). Table 1 Comparison of general clinical baseline data of the two groups Observation group ( n  = 42) Control group ( n  = 45) t /χ 2 p value Age (years, mean ± SD) 45.67 ± 5.11 44.73 ± 5.82 0.792 0.430 BMI (kg/m 2 , mean ± SD) 25.13 ± 2.37 24.98 ± 3.14 0.250 0.803 Disease duration (months, mean ± SD) 12.43 ± 3.14 13.00 ± 2.78 0.901 0.370 Delivery method ( n ) 0.112 0.802    Caesarean section 9 11    Natural birth 33 34 Operation history ( n ) 15 14 0.207 0.658 Comparison of general clinical baseline data of the two groups Before treatment, the VAS score in the observation group was 5.55 ± 1.04, whereas in the control group, it was 5.51 ± 1.03. There was no statistically significant difference in VAS scores between the two groups at baseline ( p  = 0.870). After the treatment course, the VAS score in the observation group decreased to 1.21 ± 0.95, and in the control group, it decreased to 2.76 ± 0.80. Within-group comparisons showed that the VAS scores in both groups were significantly lower than those before treatment, with the differences being statistically significant ( p  < 0.001). Between-group comparisons revealed that the VAS score in the observation group was significantly lower than that in the control group, with a statistically significant difference ( p  < 0.001; Table  2 ). Table 2 Comparison of VAS scores between the two groups of patients (mean ± SD) Before treatment After treatment t p value Observation group 5.55 ± 1.04 1.21 ± 0.95 24.174  < 0.001 Control group 5.51 ± 1.03 2.76 ± 0.80 20.348  < 0.001 t 0.164 8.191 p 0.870  < 0.001 Comparison of VAS scores between the two groups of patients (mean ± SD) Before treatment, there were no statistically significant differences in any of the Glazer assessment parameters between the two groups ( p  > 0.05). After completing the treatment course, within-group comparisons revealed that both groups showed significant improvements in rapid contraction myoelectric values, sustained contraction myoelectric values, and durable contraction myoelectric compared with pre-treatment levels, with statistically significant differences ( p  < 0.001). Conversely, both pre-resting and post-resting amplitudes decreased significantly compared with pre-treatment levels, with statistically significant differences ( p  < 0.001). Between-group comparisons demonstrated that the observation group exhibited significantly higher rapid contraction myoelectric values, sustained contraction myoelectric values, and durable contraction myoelectric than the control group after treatment. Additionally, the observation group showed significantly lower pre-resting and post-resting amplitudes than the control group, with statistically significant differences between the groups ( p   0.05; Table  3 ). Table 3 Comparison of Glazer assessment indicators between the two groups of patients (mean ± SD) Observation group Control group t p value Pre-resting potential (μV)    Before treatment 5.68 ± 1.42* 5.70 ± 1.31* 0.058 0.954    After treatment 3.83 ± 0.50 4.21 ± 0.66 2.989 0.004 Rapid contraction myoelectric values (μV)    Before treatment 31.69 ± 10.68* 32.16 ± 7.99* 0.236 0.814    After treatment 37.78 ± 5.42 35.07 ± 4.98 2.425 0.017 Sustained contraction myoelectric values (μV)    Before treatment 22.67 ± 6.99* 23.40 ± 5.69* 0.534 0.595    After treatment 29.18 ± 8.75 26.29 ± 3.67 2.032 0.045 Durable contraction myoelectric values (μV)    Before treatment 19.85 ± 6.79* 20.61 ± 5.85* 0.557 0.579    After treatment 26.41 ± 7.06 23.84 ± 4.35 2.061 0.042 Post–resting potential (μV)    Before treatment 5.49 ± 1.40* 5.44 ± 1.15* 0.168 0.867    After treatment 3.77 ± 0.66 4.13 ± 0.63 2.562 0.012 *Comparison before and after treatment within group, p  < 0.001 Comparison of Glazer assessment indicators between the two groups of patients (mean ± SD) *Comparison before and after treatment within group, p  < 0.001 In the observation group treatment was significantly effective in 26 cases, effective in 13 cases, and ineffective in 3 cases, resulting in a total effective rate of 92.86%. In the control group, treatment was significantly effective in 14 cases, effective in 20 cases, and ineffective in 11 cases, yielding a total effective rate of 75.56%. The comparison of total effective rates between the two groups revealed a statistically significant difference ( p  = 0.040; Table  4 ). Table 4 Comparison of outcomes between the two groups of patients n Significantly effective Effective Ineffective Observation group 42 26 13 3 Control group 45 14 20 11 Chi-squared 4.816 p 0.040 Comparison of outcomes between the two groups of patients

We retrospectively analyzed clinical data of MPP patients who were admitted to our hospital between January 2021 and December 2024. All patient identities were anonymized. Based on inclusion and exclusion criteria, a total of 87 patients were ultimately included in the study (Fig.  1 ). Patients were divided into two groups according to their treatment modalities: the observation group (matrix radiofrequency combined with myofascial manipulation) and the control group (myofascial manipulation alone). Fig. 1 Data flow diagram for the study Data flow diagram for the study This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Xi’an Medical University and complied with the ethical standards outlined in the Declaration of Helsinki for medical research involving human subjects. The requirement for informed consent was waived by the committee owing to the retrospective design of the study. Inclusion Criteria : (a) Patients diagnosed with MPP. (b) Patients with complete clinical and imaging data. (c) Patients presenting with symptoms related to pelvic floor dysfunction. (d) Adult female patients (aged ≥ 18 years). Exclusion Criteria : (a) Patients with an identified etiology for MPP, such as interstitial cystitis, irritable bowel syndrome, pelvic inflammatory disease, endometriosis, or pelvic congestion syndrome. (b) Patients who had undergone pelvic surgery within the past three months. (c) Patients with severe cardiovascular or cerebrovascular diseases, poor compliance, or an inability to tolerate examinations. (d) Pregnant women or those without a history of sexual activity. (e) Patients with severe psychiatric disorders or cognitive impairments that hinder cooperation with the study. Patients diagnosed with MPP Patients with complete clinical and imaging data Patients presenting with symptoms related to pelvic floor dysfunction Adult female patients (aged ≥ 18 years) Patients diagnosed with MPP Patients with complete clinical and imaging data Patients presenting with symptoms related to pelvic floor dysfunction Adult female patients (aged ≥ 18 years) Patients with an identified etiology for MPP, such as interstitial cystitis, irritable bowel syndrome, pelvic inflammatory disease, endometriosis, or pelvic congestion syndrome Patients who had undergone pelvic surgery within the past 3 months Patients with severe cardiovascular or cerebrovascular diseases, poor compliance, or an inability to tolerate examinations Pregnant women or those without a history of sexual activity Patients with severe psychiatric disorders or cognitive impairments that hinder cooperation with the study Patients with an identified etiology for MPP, such as interstitial cystitis, irritable bowel syndrome, pelvic inflammatory disease, endometriosis, or pelvic congestion syndrome Patients who had undergone pelvic surgery within the past 3 months Patients with severe cardiovascular or cerebrovascular diseases, poor compliance, or an inability to tolerate examinations Pregnant women or those without a history of sexual activity Patients with severe psychiatric disorders or cognitive impairments that hinder cooperation with the study Before initiating treatment, all patients received health education and behavioral therapy. This included an introduction to the treatment plan and objectives, as well as a detailed explanation of the etiology, high-risk factors, and pathophysiological mechanisms underlying MPP. Patients were educated on self-management strategies, including maintaining a balanced diet while avoiding irritant and allergenic foods, ensuring proper perineal and genital hygiene, and avoiding tight-fitting clothing. Additionally, postural assessments were conducted, and patients were guided in performing corrective exercises to improve pelvic and spinal alignment. They were also trained to establish proper diaphragmatic breathing habits and provided with psychological relaxation and stress reduction techniques. For objective assessments, a biofeedback stimulator (EDAN P4 Pro; Edan Instruments, Shenzhen, China) was used to measure pelvic floor surface electromyographic activity through the Glazer assessment. Pain intensity was assessed using the Visual Analog Scale (VAS). All patients are treated by the same medical team. The procedure was performed by an experienced gynecologist who had undergone specialized systematic training in myofascial manipulation. The gynecologist conducted a comprehensive physical examination of the patient to identify spasmodic muscles and MTrPs. The palpation pressure, applied using a single finger, targeted the pelvic floor MTrPs through stretching, pressing, and plucking techniques. The finger pressure, synchronized with the contraction and relaxation of the affected muscles, was aimed at restoring muscle softness, with a pressure range of 0.4–0.5 kg/cm 2 . Key examination points for pelvic floor muscle pain included 1 cm inside the vaginal introitus for superficial muscles; 2.5 cm inside the vaginal introitus at positions 1 to 5 on the left and 7 to 11 on the right for the pubococcygeus muscle; the vaginal fornix at positions 4 to 8 for the iliococcygeus muscle; the deep vaginal regions at positions 2 and 10, approximately 2–3 finger joints deep, for the obturator internus muscle; and the deep vaginal regions at positions 5 and 7 for the coccygeus muscle. Each treatment session lasted 10–15 min, and was performed twice a week for a total of ten treatments. In addition to the control group's treatment, the observation group received combined matrix radiofrequency therapy. The matrix radiofrequency therapy was performed using a gynecological matrix radiofrequency therapy device (model BBT-RF-C280; Bantiantian Medical Technology Development, Wuhan, China; Fig.  2 ). The pubic hair in the mons pubis area was shaved, and the bladder was emptied, the patient was placed in the lithotomy position, and routine iodine disinfection was performed. Gel was applied intravaginally, and the intracavitary treatment mode was initiated using a vaginal electrode (single-use). The temperature was set at 45 °C, and the power was set at 15 W. Fig. 2 Operating mode diagram of the matrix radiofrequency instrument Operating mode diagram of the matrix radiofrequency instrument For the anterior vaginal wall treatment, the electrode plate was first placed above the pubic symphysis. The treatment electrode was gently pressed against the vaginal wall starting from the 9 o'clock position at the vaginal apex and slid toward the 12 o'clock position. The probe was then retracted by 1.5 cm, and the procedure was repeated from the 12 o'clock to the 9 o'clock position, with 2–3 repetitions. This was followed by repeating the procedure from the 12 o'clock to the 3 o'clock position, also 2–3 times. After completing the anterior pelvic treatment, the electrode plate was moved from the pubic symphysis to the sacrococcygeal region. The treatment electrode was gently pressed against the vaginal wall starting from the 9 o'clock position at the vaginal apex and slid toward the 6 o'clock position. The probe was retracted by 1.5 cm, and the procedure was repeated from the 6 o'clock to the 9 o'clock position, with 2–3 repetitions. This was followed by repeating the procedure from the 6 o'clock to the 3 o'clock position, also 2–3 times. The entire process was repeated until reaching the vaginal introitus, with a total treatment duration of approximately 50 min. During the procedure, areas causing pain or discomfort were specifically targeted and treated with an additional three repetitions. The first four treatments were administered at 7-day intervals, whereas the last two treatments were administered at 28- to 30-day intervals, completing a total of six sessions as one treatment course. The evaluation criteria included pain intensity measured by the VAS and pelvic floor muscle function evaluated through Glazer surface electromyography (EMG). The parameters recorded included pre-resting potential (μV), rapid contraction myoelectric values (μV), sustained contraction myoelectric values (μV), durable contraction myoelectric values (μV), and post-resting potential values (μV). These measurements were collected before treatment and 1 week after the completion of treatment. Efficacy was determined based on pain relief and functional improvement: significantly effective—pain was completely resolved or significantly alleviated and the VAS score decreased by more than 70%; effective—pain was partially relieved with a decrease in VAS score of 50% to 70%; ineffective—pain showed no improvement or worsened and the VAS score decreased by less than 50%. The total effective rate was calculated as (Significantly effective cases + Effective cases)/Total number of cases × 100% Statistical analyses were performed using IBM SPSS Statistics 23.0 (IBM, Armonk, NY, USA) and R software (version 4.3.2). Continuous variables following a normal distribution were expressed as mean ± standard deviation, with independent sample t tests used for between-group comparisons and paired sample t tests used for within-group comparisons. Non-normally distributed continuous variables were presented as median and interquartile range (IQR, 25th–75th percentile) and analyzed using the Mann–Whitney U test for between-group comparisons. Categorical variables were expressed as counts and percentages or composition ratios, and comparisons between groups were performed using the Chi-squared test. A p value < 0.05 was considered statistically significant.

Matrix radiofrequency combined with myofascial manipulation provides a safe and effective treatment option for patients with MPP. Combined application of radiofrequency therapy on the basis of myofascial manipulation can significantly enhance the therapeutic effect of MPP. The combined application of these two treatment modalities not only alleviates patients'pain but also improves pelvic floor muscle function, which is worthy of clinical promotion.

Our study retrospectively analyzed the clinical data of patients with MPP and mainly compared the therapeutic effects of matrix radiofrequency therapy combined with myofascial manipulation therapy with myofascial manipulative therapy alone in patients with patients with MPP. The results demonstrated that both treatments were effective in alleviating the clinical symptoms of MPP. However, compared with myofascial manipulation alone, matrix radiofrequency combined with myofascial manipulation therapy showed better efficacy in pain relief and restoration of pelvic floor muscle function. Myofascial pelvic pain is primarily caused by MTrPs in the pelvic floor muscles or associated fascia. These trigger points are localized sensitive areas within taut muscle bands and are usually accompanied by muscle hypertonia [ 8 , 18 ]. The clinical management of MPP primarily includes physical therapy, pharmacological treatment, psychological and lifestyle interventions, as well as surgical approaches [ 7 , 16 ]. However, to date, there has been no standardized treatment for MPP [ 7 , 19 , 20 ]. Among these, physical therapy is one of the most important treatment modalities for MPP, encompassing myofascial manipulation, pelvic floor muscle training, biofeedback therapy, and more [ 22 , 23 ]. Studies have demonstrated that myofascial manipulation can identify trigger points in patients and employ techniques such as finger pressure, stretching, and plucking to alleviate discomfort in pain-sensitive areas. This approach helps to restore control over the pelvic floor muscles and enhances muscular coordination [ 4 , 22 , 25 ]. Additionally, pelvic floor myofascial manipulation promotes local blood circulation and capillary dilation, thereby reducing pain in patients [ 4 , 15 ]. A randomized controlled trial involving 78 patients with CPP demonstrated that after 6 weeks of myofascial manipulation, the patients'VAS scores significantly decreased from an average of 6.8 to 3.4, whereas the control group only experienced a reduction to 5.5. In the treatment group, 68% of patients reported a pain improvement of over 50%, which was significantly better than the 23% reported in the control group [ 11 ]. Our research demonstrated that myofascial manipulation therapy can not only alleviate clinical symptoms of MPP but also improve the functional status of pelvic floor muscles, with an overall effectiveness rate of 75.56%. In recent years, radiofrequency therapy has been increasingly applied in the treatment of CPP. Several studies have demonstrated that radiofrequency therapy, including both pulsed and continuous radiofrequency, can effectively manage CPP by modulating nerve conduction [ 17 , 26 ]. In cases involving pelvic muscle hypertonicity or pelvic floor myofascial-related pain, radiofrequency therapy targets relevant nerve tissues or pain points, providing effective therapeutic outcomes [ 21 , 27 , 28 ]. Carralero-Martínez et al. [ 28 ] suggested that radiofrequency therapy, as a physical treatment technique, can alleviate pain and improve the quality of life in patients with CPP. Similarly, Ashtiani et al. [ 21 ] demonstrated through a study involving 46 patients with MPP that radiofrequency therapy effectively alleviates symptoms of MPP and promotes the rehabilitation of pelvic floor muscle function. MPP is a common subtype of CPP, yet it is often overlooked. To further improve the clinical efficacy of MPP treatment, we hypothesized that combining radiofrequency therapy with myofascial manipulation may achieve better clinical outcomes. Through the analysis of MPP clinical data, we found that after treatment, the VAS scores significantly decreased in both groups compared to pre-treatment levels. However, the VAS scores in the observation group were significantly lower than those in the control group. In addition, the total effective rate of the observation group was 92.86%, significantly higher than that of the control group. This indicates that matrix radiofrequency combined with myofascial manipulation has a distinct advantage in alleviating pain. Carralero-Martínez et al. [ 29 ] analyzed the clinical data of CPP patients treated with a combination of radiofrequency therapy and myofascial manipulation. The study demonstrated that combining radiofrequency with myofascial manipulation therapy can improve kinesiophobia and pain catastrophizing in patients with CPP syndrome, including fear of movement and catastrophic thinking related to pain. Our findings are consistent with previous research results [ 21 , 27 , 29 ], demonstrating that radiofrequency therapy can be effective in relieving chronic myofascial pain. The underlying reason may be that radiofrequency therapy generates localized thermal effects through the application of high-frequency electrical currents, improving blood circulation, reducing the secretion of inflammatory factors, and modulating pain transmission pathways. This process interrupts the"pain–spasm–pain"vicious cycle [ 30 ]. To further validate the improvement of pelvic floor muscle function by the combination of matrix radiofrequency and myofascial manipulation, this study assessed the pelvic floor muscle function of all patients before and after treatment using the Glazer evaluation. The results revealed that, compared with pre-treatment levels, both groups showed significant improvements in fast-twitch contraction strength, tonic contraction strength, and endurance contraction strength of the pelvic floor muscles after treatment, along with significant reductions in pre-rest and post-rest amplitudes. However, the matrix radiofrequency combined with myofascial manipulation group demonstrated superior improvements in fast-twitch contraction strength, tonic contraction strength, and endurance contraction strength compared with the control group. Additionally, the reduction in resting electromyographic amplitudes was more pronounced in the combined therapy group, with statistically significant differences between the groups ( p  < 0.001). These findings suggest that matrix radiofrequency therapy combined with myofascial manipulation not only directly alleviates local muscle spasms but also enhances muscle fiber metabolism and neural regulation through thermal effects, thereby improving the functional coordination and recovery capacity of the pelvic floor muscles. This study has several limitations. First, this was a retrospective analysis, and the allocation of patients to matrix radiofrequency combined with myofascial manipulation and myofascial manipulation alone therapy groups was based on real-world clinical decisions rather than randomization. Although we statistically adjusted for demographic and baseline clinical variables, unmeasured confounders (e.g., physician preferences, subtle differences in disease severity not captured in our data, or patient-specific factors influencing treatment choice) may have introduced selection bias. Second, a relatively small sample size and the recruitment of participants from a single center may have limited the generalizability and reliability of the results. Third, the study did not include long-term follow-up, making it impossible to evaluate the sustained efficacy of radiofrequency therapy combined with myofascial manipulation in the treatment of MPP. Therefore, future research should involve multicenter, large-sample randomized controlled trials with long-term follow-up data to further validate the efficacy and safety of matrix radiofrequency combined with myofascial manipulation.

Myofascial pelvic pain (MPP) is a significant subtype of chronic pelvic pain (CPP) [ 1 , 2 ], characterized by localized or radiating pain originating from myofascial trigger points (MTrPs) within the pelvic floor muscles and fascia [ 3 ]. Studies have shown that the prevalence of MPP among female CPP patients ranges from 14 to 78%, severely impacting their quality of life and daily functioning [ 4 , 5 ]. The pathophysiology of MPP is complex, primarily involving excessive tension in the pelvic floor muscles and the activation of trigger points [ 7 ]. Trigger points are localized hypertense regions within muscles, often accompanied by local inflammation, and they may contribute to mechanical hyperalgesia and tactile allodynia through central sensitization [ 8 , 9 ]. Moreover, the presence of central sensitization may amplify pain perception in MPP patients, leading to an expansion of pain intensity and distribution [ 10 ]. The treatment of MPP includes pharmacological therapy, physical therapy, and psychological interventions [ 11 , 12 ]. Among these, pelvic floor physical therapy is considered the primary treatment modality for MPP [ 14 ]. Myofascial manipulation, as a key physical therapy approach, involves direct pressure on pain-triggering points and specific muscle groups, combined with slow stretching and sliding techniques to deeply massage tense myofascial tissues. This process helps to reduce muscle tension, improve local blood circulation, relieve pain, eliminate trigger points, and enhance functional recovery [ 15 ]. However, the effectiveness of myofascial manipulation is highly dependent on the therapist’s experience and technical proficiency, and a single physical therapy approach may be insufficient to achieve comprehensive symptom relief in MPP patients [ 16 ]. Radiofrequency therapy (RF) is a non-invasive interventional treatment that utilizes the thermal effects of high-frequency electrical currents to achieve neural blockade and tissue repair, and it has been widely applied in the management of CPP [ 17 ]. RF can interrupt pain signal transmission, alleviate pain, reduce central sensitization, and mitigate local inflammatory responses, thereby promoting the restoration of myofascial elasticity and function. Given the potential synergistic effects of matrix radiofrequency and myofascial manipulation in MPP treatment, their combination may further enhance therapeutic efficacy in patients with MPP. Currently, studies on the combination of matrix radiofrequency and myofascial manipulation for the treatment of MPP remain limited, particularly regarding its efficacy in pain relief and functional improvement, which requires further validation. Based on the limitations of the efficacy of myofascial manipulation in MPP and the therapeutic role of radiofrequency therapy in CPP, we suggest that laser therapy combined with myofascial manipulation might further improve outcomes for patients with MPP. This study is aimed at evaluating the clinical efficacy of matrix radiofrequency combined with myofascial manipulation in the treatment of MPP, providing scientific evidence to support therapeutic strategies and ultimately offering greater clinical benefit to patients.