PM&R
Volume 1, Issue 4 , Pages 346-358 , April 2009

Review of Anatomy, Evaluation, and Treatment of Musculoskeletal Pelvic Floor Pain in Women

  • Heidi Prather, DO

      Affiliations

    • Section in Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes Plaza, Suite 11300, St. Louis, MO 63110
    • Corresponding Author InformationAddress correspondence to H.P.
  • ,
  • Sheila Dugan, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Rush University, Chicago, IL
  • ,
  • Colleen Fitzgerald, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL§
  • ,
  • Devyani Hunt, MD

      Affiliations

    • Section in Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO

Received 31 July 2008 ,Accepted 2 January 2009.

References 

  1. Prather H. Pelvis and sacral dysfunction in sports and exercise. Phys Med Rehabil Clin N Am. 2000;11:805–836viii
  2. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 2007;18:477–496ix
  3. Vleeming A, Stoeckart R, Volkers AC, Snijders CJ. Relation between form and function in the sacroiliac joint (Part I: Clinical anatomical aspects). Spine. 1990;15:130–132
  4. Wong CA, Scavone BM, Dugan S, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol. 2003;101:279–288
  5. Bache CE, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B. 2002;11:212–218
  6. Hunt D, Clohisy J, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am. 2007;18:497–520ix-x
  7. Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC. Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res. 2005;441:327–333
  8. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–1457
  9. Santori N, Villar RN. Acetabular labral tears: Result of arthroscopic partial limbectomy. Arthroscopy. 2000;16:11–15
  10. Sady S, Freedson P. Body composition and structural compositions of female and male athletes. Clin Sports Med. 1984;3:755–777
  11. Cirullo J. Lower extremity injuries. In:  Pearl AJ editors. The Athletic Female. Rosemont, IL: American Orthopaedic Society for Sports Medicine; 1993;
  12. Vleeming A, Pool-Goudzwaard AL, Hammudoghlu D, Stoeckart R, Snijders CJ, Mens JM. The function of the long dorsal sacroiliac ligament: Its implication for understanding low back pain. Spine. 1996;21:556–562
  13. Vleeming A, Stoeckart R, Snijders CJ. The sacrotuberous ligament: A conceptual approach to its dynamic role in stabilizing the sacroiliac joint. Clin Biomech. 1989;4:201–203a
  14. Vleeming A, Volkers AC, Snijders CJ, Stoeckart R. Relation between form and function in the sacroiliac joint (Part II: Biomechanical aspects). Spine. 1990;15:133–136
  15. Fitzgerald C. Anatomy and How Things Go Wrong. http://www.disaboom.com/Health/Articles/pelvicpain/anatomy-and-how-things-go-wrong.aspx2006;Accessed January 14, 2009
  16. Schroder HD. Anatomical and pathoanatomical studies on the spinal efferent systems innervating pelvic structures (1. Organization of spinal nuclei in animals. 2. The nucleus X-pelvic motor system in man). J Auton Nerv Syst. 1985;14:23–48
  17. Barber MD, Bremer RE, Thor KB, Dolber PC, Kuehl TJ, Coates KW. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187:64–71
  18. Louis F, Beco J, Biquet J. Comprendre le syndrome du canal d'Alcock et son traitment. L'agenda Gynecol. 2003;32:12–16
  19. Netter FH. Alcock's canal (map 1), In: Netter FH, Craig J, Machado C, eds. Elsevier. p. Alcock's canal. http://www.netterimages.com.
  20. Delaney T, Young DC. Spontaneous versus induced labor after a previous Cesarean delivery. Obstet Gynecol. 2003;102:39–44
  21. Greenman P. Clinical aspects of sacroiliac function during walking. J Man Med. 1990;5:125–130
  22. Fenton BW, Durner C, Fanning J. Frequency and distribution of multiple diagnoses in chronic pelvic pain related to previous abuse or drug-seeking behavior. Gynecol Obstet Invest. 2008;65:247–251
  23. Peters KM, Carrico DJ. Frequency, urgency, and pelvic pain: treating the pelvic floor versus the epithelium. Curr Urol Rep. 2006;7:450–455
  24. Frawley H. Pelvic floor muscle strength testing. Aust J Physiother. 2006;52:307
  25. Isherwood PJ, Rane A. Comparative assessment of pelvic floor strength using a perineometer and digital examination. B J Obstet Gynaecol. 2000;107:1007–1011
  26. 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 Pelvic Floor Dysfunct. 2006;17:624–630
  27. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24:374–380
  28. Tu FF, Fitzgerald CM, Kuiken T, Farrell T, Harden RN. Comparative measurement of pelvic floor pain sensitivity in chronic pelvic pain. Obstet Gynecol. 2007;110:1244–1248
  29. Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8:468–473
  30. O'Sullivan PB, Beales DJ, Beetham JA, et al. Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Spine. 2002;27:E1–E8
  31. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine. 1996;21:2594–2602
  32. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998;79:288–292
  33. Arab Am, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther. 2009;14:213–221
  34. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, Fickenscher TC. The reliability of multitest regimens with sacroiliac pain provocation tests. J Manipulative Physiol Ther. 2002;25:42–48
  35. Robinson HS, Brox JI, Robinson R, Bjelland E, Solem S, Telje T. The reliability of selected motion- and pain provocation tests for the sacroiliac joint. Man Ther. 2007;12:72–79
  36. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10:207–218
  37. 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
  38. Harris G, Horowitz B, Borgida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med. 2007;52:103–106
  39. Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. 1st ed.. St. Louis, MO: Mosby Inc; 2001;
  40. Baker PK. Musculoskeletal origins of chronic pelvic pain (Diagnosis and treatment). Obstet Gynecol Clin North Am. 1993;20:719–742
  41. Spitznagle T. Musculoskeletal chronic pelvic pain. In:  Carriere B,  Feldt C editor. The Pelvic Floor. New York: Thieme Verlag; 2006;p. 35–67
  42. Markwell SJ. Physical therapy management of pelvi/perineal and perianal pain syndromes. World J Urol. 2001;19:194–199
  43. Sinaki M, Merritt JL, Stillwell GK. Tension myalgia of the pelvic floor. Mayo Clin Proc. 1977;52:717–722
  44. Slocumb JC. Neurological factors in chronic pelvic pain: trigger points and the abdominal pelvic pain syndrome. Am J Obstet Gynecol. 1984;149:536–543
  45. Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: A randomized controlled trial. Obstet Gynecol. 2006;108:915–923
  46. Brown CS, Glazer HI, Vogt V, Menkes D, Bachmann G. Subjective and objective outcomes of botulinum toxin type A treatment in vestibulodynia: Pilot data. J Reprod Med. 2006;51:635–641
  47. Maria G, Cadeddu F, Brandara F, Marniga G, Brisinda G. Experience with type A botulinum toxin for treatment of outlet-type constipation. Am J Gastroenterol. 2006;101:2570–2575
  48. Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature. Pain Phys. 2008;11:215–224
  49. Yoon SJ, Ho J, Kang HY, et al. Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome. Pharmacotherapy. 2007;27:657–665
  50. Windisch G, Braun EM, Anderhuber F. Piriformis muscle: Clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29:37–45
  51. Finnoff JT, Hurdle MF, Smith J. Accuracy of ultrasound-guided versus fluoroscopically guided contrast-controlled piriformis injections: A cadaveric study. J Ultrasound Med. 2008;27:1157–1163
  52. Gonzalez P, Pepper M, Sullivan W, Akuthota V. Confirmation of needle placement within the piriformis muscle of a cadaveric specimen using anatomic landmarks and fluoroscopic guidance. Pain Phys. 2008;11:327–331
  53. Dalmau-Carolà J. Myofascial pain syndrome affecting the piriformis and the obturator internus muscle. Pain Pract. 2005;5:361–363
  54. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104:1217–1222tables of contents
  55. Barre L, Lutz GE, Southern D, Cooper G. Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: A retrospective evaluation of long term efficacy. Pain Phys. 2004;7:187–193
  56. Becker C, Heidersdorf S, Drewlo S, de Rodriguez SZ, Kramer J, Willburger RE. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: An investigator-initiated, prospective, double-blind, reference-controlled study. Spine. 2007;32:1803–1808
  57. Cooper G, Lutz GE, Boachie-Adjei O, Lin J. Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy. Pain Phys. 2004;7:311–317
  58. Young IA, Hyman GS, Packia-Raj LN, Cole AJ. The use of lumbar epidural/transforaminal steroids for managing spinal disease. J Am Acad Orthop Surg. 2007;15:228–238
  59. Bryan MB, Lutz C, Lutz GE. Fluoroscopic assessment of epidural contrast spread after caudal injection. J Orthop Med. 2000;22:3–6
  60. Prather H. Sacroiliac joint pain: practical management. Clin J Sport Med. 2003;13:252–255
  61. Slipman CW, Lipetz JS, Plastaras CT, et al. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil. 2001;80:425–432
  62. Martin RL, Irrgang JJ, Sekiya JK. The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy. 2008;24:1013–1018
  63. Laycock J, Brown J, Cusack C, et al. Pelvic floor reeducation for stress in continence: comparing three methods. Br J Community Nurs. 2001;6:230–237

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00024-0

doi: 10.1016/j.pmrj.2009.01.003

PM&R
Volume 1, Issue 4 , Pages 346-358 , April 2009