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Chronic Pelvic Pain

Chronic Pelvic Pain (Montenegro 2008)is described by the International Continence Society as pain that is less well defined than bladder, urethral, or perineal pain, is less clearly related to the menstrual cycle or to bowel function, and is not well localized to any single pelvic organ.  Estimated prevalence is 3.8% in women aged 15-73 years; 14-24% among women of reproductive age.  Costs exceed 2 billion dollars annually in the US alone.  60% of women with CPP never receive a specific diagnosis; 20% never undergo any investigation to elucidate the cause of the pain.  There is strong evidence that 85% of patients with CPP have musculoskeletal dysfunction including: poor posture, deficits in strength or flexibility, pelvic floor muscle dysfunction: overactive, non-relaxing, underactive, associated muscle dysfunction of the abdominals, or hip rotators or extensors.

I recently evaluated a 21 year old young lady who is an avid horsewoman.  She injured her back in February of this year and reports putting herself on bed rest.  After one month with no improvement, she went to see her local Nurse Practitioner who referred her to Physical Therapy for exercise, ultrasound, and electric stimulation.  She had 15 PT treatments without decreased low back pain and the start of her Chronic Pelvic Pain.  She reports that the week prior to menstruation she would have extreme pain and throbbing within the pelvic cavity and was not able to tolerate her recent pap smear due to extreme pain.  Her women’s health physician then referred her to me.

Upon exam I noted that is young lady had poor pelvic mobility which is essential for riding a horse.  She had no ability to move into lumbar extension which is required to stand comfortably or bend backwards.  Palpation revealed very local soft tissue changes in her lumbar spine.  In the front part of her body, the (iliopsoas) muscle that lies deep within the pelvic cavity and runs from the side of the lumbar spine towards the hip bone and into the leg, was very tight and painful.  She also had a pelvic nerve just inside the hip bone that was very irritated.

Visceral Manipulation is a technique I use to release fascial restrictions around the organs and muscles.  I used this technique to release the iliopsoas muscle as well as the lateral cutaneous nerve just inside the hip bone.  I also used soft tissue mobilization to the tight muscles in her lumbar spine.

My patient returned on her 3rd visit remarkably improved.  She reported no low back or pelvic pain.  In fact she had started her period with no prior cramping or throbbing.  The muscle tightness in her lumbar spine was gone and she was now able to move into lumbar extension without pain.  Her new home program: go ride your horse, proceed with caution.

Mary Boyd, MS, PT at 290-5575 or on the web at  or

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