Physical Therapy for Female Pelvic Pain

The purpose of this chapter is to discuss the role of physical therapy in the management of women with pelvic pain disorders. Pelvic pain is a costly, prevalent, yet poorly understood condition, found to disproportionately affect women 4:1 [1]. Annual healthcare costs in the US are estimated in excess of $880 million for physician visits alone, and nearly three billion when out-of pocket expenses and mental health visits are included [2]. Prevalence of pelvic pain is found to be similar to prevalence rates of asthma and low back pain [3], and the 3-month prevalence of chronic pelvic pain is estimated at 24% [4]. The majority of prevalence studies of pelvic pain have excluded women with vulvar pain disorders, as well as women who were pregnant or who had been pregnant within the past year. Therefore, the prevalence of all pelvic pain conditions is likely greater than that commonly cited in the literature. For example, an investigation by Harlow and Stewart identified a 16% lifetime prevalence of unexplained chronic vulvar pain, equating to approximately 14 million US women; a much higher prevalence than that found in earlier studies [5]. This high prevalence of female pelvic pain and the changing healthcare landscape are contributing to the now widely accepted and promoted concept of a multidisciplinary and collaborative approach to diagnosis and treatment that includes physicians of multiple specialties, physical therapists, and mental health professionals [6, 7]. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Sinaki M, Merritt JL, Stilwell GK. Tension myalgia of the pelvic floor. Mayo Clin Proc. 1977;52:717–22. Mathias SD, Kupperman M, Liberman RF, Steege JF. Chronic pelvic pain, prevalence, health-related quality of life and economic correlates. Obstet Gynecol. 1996;87:332–7. Grace V, Zondervan K. Chronic pelvic pain in women in New Zealand: comparative well-being, comorbidity, and impact on work and other activities. Health Care Women Int. 2006;27:585–99. Zondervan KT, Yudkin PL, Vessey MP, et al. The community prevalence of chronic pelvic pain in women and associated illness behavior. Br J Gen Pract. 2001;51:541–7. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc. 2003;58:82–8. Gambone JC, Reiter RC. Nonsurgical management of chronic pelvic pain: a multidisciplinary approach. Clin Obstet Gynecol. 1990;33(1):205–11. van Lankveld JJDM, Granot M, Schultz WCMW, et al. Women’s sexual pain disorders. Int Soc Sex Med. 2010;7:615–31. Specialty Council on Women’s Health Physical Therapy. Description of Specialty Practice: Women’s Health Physical Therapy. Alexandria, VA: American Physical Therapy Association; 2007. McGowan L, Clark-Carter D, Pitts M. Chronic pelvic pain: a meta-analysis review. Psychol Health. 1998;13:132–44. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. Br Med J. 2006;2:16. doi:10.1136/bmj.38748.697465.55. Stout A, Steege J, Dodson W, Hughes C. Relationship of laparoscopic findings to self-report of pelvic pain. Am J Obstet Gynecol. 1991;164:73–9. Vercillini P, Trespidi L, De Giorgi O, et al. Endometriosis and pelvic pain: relation to disease stage and localisation. Fertil Steril. 1996;65:299–304. Rapkin AJ, Mayer EA. Gasteroenterologic causes of chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:663–83. Summit RLJ. Urogynecologic causes of chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:685–98. Saravelos H, Li T, Cooke I. Adhesions and chronic pelvic pain. Contemp Rev Obstet Gyneacol. 1995;7:172–7. Cheong Y, Stones WR. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gyneacol. 2006;20(5):695–711. Tu FF, Holt J, Gonzales J, Fitzgerald CM. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol. 2008;198:272.e1–e7. Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52:11–6. Baker PK. Musculoskeletal origins of chronic pelvic pain diagnosis and treatment. Obstet Gynecol Clin North Am. 1993;20:719–42. Srinivasan AK, Kaye JD, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Curr Pain Headache Rep. 2007;11:359–64. Chaitow L. Chronic pelvic pain: pelvic floor problems, sacroiliac dysfunction and the trigger point connection. J Bodyw Mov Ther. 2007;11:327–39. Montenegro MLLS, Vasconcelos ECLM, Candido dos Reis FJ, Nogueira AA, Poli-Neto OB. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract. 2007;62(2):263–9. Van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001;39:395–408. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction. J Sex Med. 2008;5:513–23. Rosenbaum TY. Physiotherapy of sexual pain disorders. J Sex Marital Ther. 2005;33:329–40. Fritsch H. Anatomy and physiology of the pelvic floor. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart: Thieme; 2006. p. 1–20. Sapsford R. The pelvic floor: a clinical model for function and rehabilitation. Physiotherapy. 2001;87(12):620–30. Shafik A. The role of the levator ani muscle in evacuation, sexual performance, and pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:361–76. Vleeming A, Stoeckart R. The role of the pelvic girdle in coupling the spine and the legs: a clinical-anatomical perspective on pelvic stability. In: Vleeming A, Mooney V, Stoeckart R, editors. Movement, stability, & lumbopelvic pain: integration of research and therapy. 2nd ed. Edinburgh: Churchill Livingstone/Elsevier; 2007. p. 113–37. Hodges PW, Cholewicki J. Functional control of the spine. In: Vleeming A, Mooney V, Stoeckart R, editors. Movement, stability, & lumbopelvic pain: integration of research and therapy. 2nd ed. Edinburgh: Churchill Livingstone/Elsevier; 2007. p. 489–512. Lee DG. The pelvic girdle. 3rd ed. Edinburgh: Elsevier; 2004. Lee D, Lee LJ. Stress urinary incontinence – a consequence of failed load transfer through the pelvis? In: 5th world interdisciplinary congress on low back and pelvic pain, Melbourne; 2004. Hodges PH, Sapsford RR, Pengel HM. Feedforward activity of the pelvic floor muscles preceded rapid upper limb movements. In: Proceedings of the VI international physiotherapy conference, Sydney; 2000. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehab. 2001;82:1081–8. Pool-Goudzwaard A, van Dijke GH, van Gurp M, Mulder PH, Snijders CJ, Stoeckart R. Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clin Biomech. 2004;19(6):564–71. Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relationship between the transversely oriented abdominal muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27(4):399–485. Smith MD, Coppieters MW, Hodges PH. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurol Urodynam. 2007;26(3):377–85. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transverses abdominus. Spine. 1996;21(22):2640–50. Leinonen V, Kankaanpää M, Luukkonen M, Hänninen O, Airaksinen O, Taimela S. Disc herniation-related pain impairs feed-forward control of paraspinal muscles. Spine. 2001;26(16):E367–72. Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain. 1996;64(2):231–40. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001;26(7):724–30. Hodges P, Moseley L. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361–70. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001;166:2226–31. Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med Hypotheses. 2007;68:74–80. Spitznagle TM. Musculoskeletal chronic pelvic pain. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart, Germany: Thieme; 2006. p. 35–68. Sahrmann SA. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby; 2002. Haugstad GK, Haugstad TS, Kirste UM, et al. Posture, movement patterns, and body awareness in women with chronic pelvic pain. J Psychosom Res. 2006;61:637–44. Prendergast SA, Weiss JM. Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol. 2003;46(4):1–10. Meadows JTS. Orthopedic differential diagnosis in physical therapy: a case study approach. New York: McGraw-Hill, Health Professions Division; 1999. Molloy G. NAIOMT 500 localizing and analyzing the site and source of pain. Eugene, Oregon: NAIOMT, Inc.; 2009. Meadows JTS. Level I differential diagnosis. Eugene, Oregon: NAIOMT, Inc.; 2001. Fitzgerald MP, Kotarinos R. Rehabilitation of the short pelvic floor I: background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:261–8. 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 Dysfunc. 2003;14:269–75. Head H. On disturbances of sensation with especial reference to the pain of visceral disease. Brain. 1893;16:1–13. Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–17. Kendall FP, McCreary EK, Provance GP. Muscles, testing, and function. 4th ed. Baltimore: Williams and Wilkins; 1993. Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–82. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42. Sadowy AM, Brouwer HL, Finseth DL, Hagener KM, Lawrence AE, Hollman JH. Development of a pelvic floor muscle coordination scale. J Women’s Health Phys Ther. 2010;34(3):81–8. Kaltenborn FM, Evjenth O, Kaltenborn TB, Morgan D, Vollowitz E. Manual mobilization of the joints: joint examination and basic treatment; Volume II, The Spine. 5th ed. Oslo: Norli; 2009. Cantu RI, Grodin AJ. Myofascial manipulation theory and clinical application. 2nd ed. Gaithersburg: Aspen Publishers; 2001. Weiss JM. Chronic pelvic pain and myofascial trigger points. Complement Med Pain. 2000;2:13–8. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. J Manual Manip Ther. 2006;14(4):203–21. Vleminckx M. Visceral mobilization. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart, Germany: Thieme; 2006. p. 230–52. Butler DS. Mobilization of the nervous system. Edinburgh: Churchill Livingstone; 1991. Hodges PW. Low back pain and the pelvic floor. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart: Thieme; 2006. p. 81–97. McArdle WD, Katch FI, Katch VL. Exercise physiology: energy, nutrition, and human performance. 5th ed. Baltimore: Lippincott Williams and Wilkins; 2001. Frahm J. Biofeedback and electromyography. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart: Thieme; 2006. p. 203–27. Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J. 2006;17(6): 624–30. Frahm J. Electrotherapy. In: Carriere B, Markel Feldt C, editors. The pelvic floor. Stuttgart: Thieme; 2006. p. 177–203. Janda V, Frank C, Liebenson C. Evaluation of muscular imbalance. In: Liebenson C, editor. Rehabilitation of the spine: a practitioner’s manual. Baltimore: Lippincott Williams and Wilkins; 2007. p. 203–25. Key J. The pelvic crossed syndromes: a reflection of imbalanced function in the myofascial envelope; a further exploration of Janda’s work. J Bodyw Mov Ther. 2010;14(3):299–301. McLaughlin L. Breathing evaluation and retraining as an adjunct to manual therapy. Man Ther. 2009;14(5):S1–54. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2013 Springer Science+Business Media New York About this chapter Cite this chapter McKinney, J. (2013). Physical Therapy for Female Pelvic Pain. In: Bailey, A., Bernstein, C. (eds) Pain in Women. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7113-5_14 Download citation DOI: https://doi.org/10.1007/978-1-4419-7113-5_14 Published: Publisher Name: Springer, New York, NY Print ISBN: 978-1-4419-7112-8 Online ISBN: 978-1-4419-7113-5 eBook Packages: MedicineMedicine (R0)

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