Chronic pelvic pain (CPP) is a vague and confusing term that generally refers
to noncyclic pain in the abdominal and/or pelvic area, that has been present for
6 months or longer, and that may have a negative impact on activities of daily living
and quality of life. CPP affects predominantly women but men may suffer with pelvic
and/or rectal pain as well.
An initial evaluation will include a thorough musculoskeletal assessment. A Musculoskeletal
evaluation includes posture assessment, gait and transfer analysis, active range
of motion, and strength tests of the extremities and trunk. Patients are also examined for scar tissue on the abdomen and pelvis to determine their mobility
and extensibility. A pelvic muscle examination may be performed and should include grading muscle strength
and coordination of slow-twitch and fast-twitch fibers, overall muscle tone, tissue
sensation and color, location of tender and trigger points, organ descent, perineal
movement, and scarring. Surface electromyographic evaluation of the PFM documents
may be performed to determine a baseline or resting muscle tone and contractility.
During the musculoskeletal assessment particular attention will concentrate
on the hip rotators, hip flexors, hip adductors, hip extensors, sacroiliac joint
function, lumbosacral joint function, leg lengths, upper body position, and general
movement patterns. A comprehensive, therapeutic program targeting the dysfunctions found in
any and all of these musculoskeletal groups is imperative towards attaining complete wellness.
To assist the patient with relaxation techniques, we will work
with breathing techniques, visualization, massage, and progressive relaxation exercises.
Transcutaneous electrical nerve stimulation (TENS) may be effective for treating
patients with chronic pelvic pain. TENS has been used with patients with interstitial
cystitis . Manual therapy is another essential component of the treatment plan for patients
with chronic pelvic pain. Manual therapy may include visceral mobilization of the
pelvic organs and supporting structures, soft tissue massage or myofascial techniques
to pelvic girdle musculature, scar tissue massage, internal vaginal and/or anal work
to muscles and tissues, and joint mobilization to spine and extremities.
