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

Abstract

The purpose of this review is 2-fold. The first is to provide a review for physiatrists already providing care for women with musculoskeletal pelvic floor pain and a resource for physiatrists who are interested in expanding their practice to include this patient population. The second is to describe how musculoskeletal dysfunctions involving the pelvic floor can be approached by the physiatrist using the same principles used to evaluate and treat others dysfunctions in the musculoskeletal system. This discussion clarifies that evaluation and treatment of pelvic floor pain of musculoskeletal origin is within the scope of practice for physiatrists. The authors review the anatomy of the pelvic floor, including the bony pelvis and joints, muscle and fascia, and the peripheral and autonomic nervous systems. Pertinent history and physical examination findings are described. The review concludes with a discussion of differential diagnosis and treatment of musculoskeletal pelvic floor pain in women. Improved recognition of pelvic floor dysfunction by healthcare providers will reduce impairment and disability for women with pelvic floor pain. A physiatrist is in the unique position to treat the musculoskeletal causes of this condition because it requires an expert grasp of anatomy, function, and the linked relationship between the spine and pelvis. Further research regarding musculoskeletal causes and treatment of pelvic floor pain will help validate these concepts and improve awareness and care for women limited by this condition.

Physiotherapy for Women with Stress Urinary Incontinence: A Review Article

“…The iliococcygeal and pubococcygeal muscles form a horizontal shelf or hammock that spans from one pelvic sidewall to the other and then attaches laterally to the ischial spines and arcus tendineus fascia. The puborectalis muscle arises from the pubic bone on either side and extends into a sling or U-shape around the posterior rectum, which attaches to the walls of the vagina, urethra, and rectum13, 14 ) (Fig. 1

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“…These include the anterior fibers of the LA, the transverses perinea superficialis and profundus, bulbospongiosus, external anal sphincters, and fibers from urinary sphincters13 ) (Fig. 1).…”

Musculoskeletal Causes of Chronic Pelvic Pain

“…13 The use of a clock face to identify the location of anatomic structures is helpful in describing findings on examination. The pubic bone is referenced as 12 o'clock and the anus is at 6 o'clock 14 (Fig. 2).…”

Post-operative guidelines following hip arthroscopy

“…Concomitant pelvic floor pathologies must also be considered. In such cases, active external rotation is often restricted for 4-6 weeks to avoid tone and spasm of the obturator internus muscle, which has been demonstrated to exacerbate pelvic floor pain [19]. Phase I is the protective phase.…”