Myofascial Physical Therapy for Chronic Pelvic Pain

Keeping Your Athletic Edge with TeleHealth Physical Therapy

Many athletes of all ages and skill levels rely on physical therapy and chiropractic care to enhance and maintain optimal performance. With recent reductions in team practices, games and competitions, it is more important than ever to find innovative and effective ways to stay in top shape and hang onto your competitive edge. TeleHealth online physical therapy services offer an effective solution for periods of reduced activity, giving you the training and advice you need to stay at the top of your game.

Causes of Pelvic Floor Muscle Pain

Causes of Pelvic Floor Muscle Pain

The structures of the pelvic region are complex, and many things can contribute to CPPS. Some of the most common causes include:

  • Pelvic nerve entrapment or irritation
  • Myofascial trigger points
  • Hypertonic pelvic floor muscles
  • Shortening of the pelvic levator muscles
  • Hip impingement
  • Labral tears
  • Hernia
  • Pelvic floor prolapse
  • Diastasis recti

CPPS can be intensified by other conditions, including:

  • Bladder problems and kidney stones
  • Constipation
  • Prostate problems in men
  • Postpartum problems in women
  • Intestinal problems
  • Constipation

CPPS Symptoms

CPPS Symptoms

Pelvic floor pain can range from mild to severe. Symptoms may include:

  • Pain with sexual intercourse
  • Abdominal pain
  • Genital pain
  • Frequent urination
  • Low back pain
  • Pelvic pain while sitting

In addition, CPPS patients often report psychological distress, anxiety and depression. Chronic pelvic pain can indicate other serious conditions, and therefore should not be ignored.

Myofascial Physical Therapy Treatment for CPPS

Myofascial physical therapy (MPT) involves hands-on techniques performed by a trained MPT specialist that target soft tissues like muscles and fascia. Fascia is a thin tough web of connective tissue that surrounds and connects muscles, bones, nerves, blood vessels, and organs throughout the body. Fascia tissue can become tight, and may form trigger points, tiny spasmodic nodules that can cause pain in neighboring tissues.

MPT involves specific manual maneuvers to help relax and elongate tight tissues. MPT may include stretching and massage, along with the release of trigger points. As an adjunct to myofascial physical therapy, CPPS symptoms like low back pain can be successfully treated by a chiropractor.

A 2019 longitudinal study by Grinberg et al. compared 39 female patients with CPPS who received MPT treatment, to 11 female CPPS patients who went untreated. The study concluded that MPT could be recommended as an effective mechanism-based treatment for patients suffering from CPPS.

MPT Treatment at NYDNRehab

he pelvic pain specialists at NYDNRehab use high resolution diagnostic ultrasonography to visualize the structures of the pelvis to identify the true cause of pelvic pain and discomfort, and rule out more serious conditions.

Once we accurately diagnose CPPS, we proceed with an individualized treatment plan for every patient. Our treatment protocol may include:

  • Manual MTP therapy to relax and elongate the pelvic floor muscles
  • Myofascial trigger point release with ultrasound guided dry needling
  • Therapeutic massage therapy
  • Physical therapy exercises
  • Chiropractic care

In addition to in-person therapy sessions, NYDNRehab now offers TeleHealth services, so you can meet with your therapist online to treat and manage CPPS remotely, from the privacy and convenience of your home, office or hotel room.

Resource:

Grinberg, Keren, et al. “How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?.” Pain Research and Management 2019 (2019).

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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