Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review

Meister, Melanie; Shivakumar, Nishkala; Sutcliffe, Siobhan; Spitznagle, Theresa; Lowder, Jerry L.

doi:10.1016/j.ajog.2018.06.014

Cited by 56 publications

(47 citation statements)

References 55 publications

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“…Overall, published examination strategies were highly variable and had little supporting evidence. 12 Key examination components that were identified through this systematic review were incorporated into the examination protocol. Additional components based on FPMRS surgeon and women's health physical therapy experience were incorporated.…”

Section: Materials and Methods Examination Developmentmentioning

confidence: 99%

“…We recognize that pelvic floor myofascial pain has been associated with trigger points in muscles outside of the OI and LA complex, which include within the coccygeus and piriformis muscles, and that some investigators advocate isolation of these components during the examination. 12 We specified examination of the LA as a muscle group rather than the individual component muscles because of documented difficulties in accurately distinguishing between the individual muscle components on transvaginal examination. 7,25,26 Because our examination was designed as a screening tool, not a comprehensive examination to map all possible muscles associated with pelvic pain, we believed that identification of trigger points within these muscles was sufficient to screen for pelvic floor myofascial pain and representative of the examination that a general gynecologist or urologist may perform to screen the pelvic floor musculature.…”

Section: Commentmentioning

confidence: 99%

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Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain

Meister

Sutcliffe

Ghetti

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Pelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain. OBJECTIVE: The purpose of this study was to develop a simple, reproducible pelvic floor examination to screen for pelvic floor myofascial pain. STUDY DESIGN: A screening examination was developed by Female Pelvic Medicine & Reconstructive Surgery subspecialists and women's health physical therapists at our institution and tested in a simulated patient. We recruited 35 new patients who underwent examinations by blinded, paired, independent examiners. Agreement was calculated with the use of percent agreement and Spearman's rank correlation coefficient.

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Section: Materials and Methods Examination Developmentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain

Meister

Sutcliffe

Ghetti

et al. 2019

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

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“…Furthermore, a detailed physical examination, diagnostic tests, and evaluation for specific causes should be performed. [11] Physical examination should include evaluation of the patient's posture, gait, body, abdomen, lumbar region, hip joint, thigh muscle, and connective tissues as well as bone, pelvic floor muscles and ligamentous structures in the pelvic region. Sensitive and trigger points and reflected pain should be defined, and a thorough neurological examination should be performed.…”

Section: Evaluation Diagnosis and Differential Diagnosis Of Cppmentioning

confidence: 99%

“…Lumbar region, abdomen, pelvis, and thigh muscles should be examined for taut band and trigger points. [11] Pelvic myofascial pain is particularly common in the levator ani, hip internal rotators (particularly obturator internus), and connective tissue. Chronic prostatitis in men, interstitial cystitis/bladder pain syndrome in women and men, and vulvodynia in women may also lead to CPP.…”

Section: Evaluation Diagnosis and Differential Diagnosis Of Cppmentioning

confidence: 99%

“…Furthermore, the development and standardization of reliable and reproducible examination methods is required. [11] The Carnett's sign and cotton swab testing are also helpful, when the pain is caused by trigger points at the abdominal wall, or when evaluating abdominal wall neuropathy. The Carnett's sign is a clinical examination finding that is useful to confirm whether pain originates from the abdominal wall.…”

Section: Evaluation Diagnosis and Differential Diagnosis Of Cppmentioning

confidence: 99%

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Pelvic pain rehabilitation

Vural¹

2018

Turk J Phys Med Rehab

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Chronic pelvic pain is defined as persistent painful condition which lasts for at least six months under umbilicus. Numerous factors are blamed for etiopathogenesis, and quality of life of individuals is adversely affected. Chronic pain as well as functional disorders are accompanied to chronic pelvic pain. The treatment and rehabilitation program should be tailored for specific causes, targeting general pain treatment. Consequently, chronic pelvic pain management can be used to propose personalized treatment options and include patient education, behavioral therapy, and a biopsychosocial approach. Interdisciplinary teamwork and collaboration are essential for facilitating patient-centered rehabilitation.

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Widespread myofascial dysfunction and sensitisation in women with endometriosis‐associated chronic pelvic pain: A cross‐sectional study

Phan

Stratton

Tandon

et al. 2021

European Journal of Pain

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Background Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. Objective Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis‐associated chronic pelvic pain. Methods Cross‐sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain‐focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro‐musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure‐pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. Results All women had a pelvic floor muscle spasm that they self‐identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure‐pain thresholds and trigger points in over two‐thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure‐pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). Conclusions Women with endometriosis‐associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on‐going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. Significance Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On‐going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.

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Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review

Cited by 56 publications

References 55 publications

Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain

Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain

Pelvic pain rehabilitation

Widespread myofascial dysfunction and sensitisation in women with endometriosis‐associated chronic pelvic pain: A cross‐sectional study

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