Where Is Your Pain Really Coming From? Uncovering the Pelvic Floor Tension Myalgia Trigger Point Complex
By: Julie Sarton, PT, DPT, WCS and Christina Vivit, PT, DPT
The mind is a powerful organ.
So powerful, in fact, that the source of your chronic pain you perceive could actually be deceiving you! In this post, we want to break down the topic of referred pain, which can often occur with “trigger point” presence. However, we want to note that chronic pain is complex and there are many contributing factors. The following post highlights one of the most common sources of referred pain that we encounter in our clinic(s) on a daily basis.
Pelvic Floor Tension Myalgia Defined
Myofascial pain syndrome is defined as the overactivity of the pelvic floor muscles, most specifically the levator ani complex (pubococcygeus, iliococcygeus and puborectalis).
Common terms associated with this type of pain include:
Levator any syndrome/piriformis syndrome
Hypertonic pelvic floor disorder
Pelvic floor spasm
There are two components to pelvic floor tension myalgia: local manifestations, and referred manifestations. Read on to learn more.
What are myofascial trigger points?
Myofascial trigger points are localized lumps or nodules in the muscles or fascia, which is the connective tissue that overlays muscle. When under compression or stretch, pain is reproduced in predictable patterns (called “referral patterns”), based on the area of the trigger point. Myofascial trigger points can develop in any of the pelvic floor muscles, and these trigger points usually refer sensation or pain to adjacent sites. So, for example, the perineum, vagina, urethra, and rectum are often considered to be “referral sites” where pain seemingly manifests, but the issue actually stems from the pelvic floor muscles. Referral patterns have also been reported in the abdomen, back, thorax, hip/buttocks, and lower leg.
What causes trigger points?
Mechanical factors such as chronic faulty ergonomics or posture, faulty movement patterns, breathing patterns, and pelvic asymmetries can contribute to the formation of myofascial trigger points. Additionally, trigger points can stem from a combination of neurologic, mechanical, visceral, inflammatory, and psychologic factors as well.
Potential Physical Therapy Green Flags:
Repeated treatment of culture negative “urinary tract infections”
Repeated treatment for “yeast infections”
Exacerbation of symptoms by certain activities such as intercourse or being seated for a long period of time
Urinary incontinence worsens (especially after operation)
Urinary hesitancy or retention (especially immediately post-op)
Negative diagnostic laparoscopy
No response to intervention focused on other systems
Patient brings in article or internet search about their condition being treated with a pelvic floor physical therapist
Presenting Symptoms of Pelvic Floor Tension Myalgia:
Achy pelvic discomfort, pressure (differentiate from prolapse)
Dyspareunia (during or after intercourse)
Vaginal pain: sharp, burning, throbbing, radiating
Abdominal, low back, coccyx, suprapubic or hip pain
Urinary hesitancy or retention, painful urination
Urinary urgency/frequency
Anismus - functional bowel disease
Pain with prolonged sitting (in coccyx or ischial tuberosities)
Inability to wear tampons
Pain with annual exam
What does this have to do with my pelvic floor?
Myofascial trigger points can be found in various layers of the pelvic floor muscles, and can refer sensation or pain to surrounding regions. Did you know that multiple structures, such as the muscles in your lower back and legs, share the same nerve root supply as some urogenital structures, such as your bladder? In other words, your urinary urgency symptoms may be stemming from myofascial trigger points in the abdominal and inner thigh muscles.
What can pelvic floor Physical Therapy do to help?
We love being the detective! A pelvic floor physical therapist can provide a thorough examination of the musculoskeletal factors that may be contributing to your pain. Our examination allows us to dive deeper into where your symptoms may be coming from as we utilize physical measures—externally and internally—to identify the source of your pain. Through this, we provide you with a personalized healing plan. Furthermore, we value the importance of a team-based approach and work with our pelvic health colleagues to provide the most comprehensive care possible as we acknowledge the multi-factorial, holistic nature of the healing process.
References:
Sarton, J., Nesin M., & Nesin J. (2018). Pelvic Floor Tension Myalgia. Pelvic Floor and More - Pelvic Pain / 1.0 Musculoskeletal Role in Pelvic Pain. Pelvic Education Alliance.
Sarton, J. (2007) Physical Therapy for Pelvic Pain: Understanding the Musculoskeletal Connection. The Female Patient, 32(5).
Pastore, E. A., & Katzman, W. B. (2012). Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 41(5), 680–691. doi:10.1111/j.1552-6909.2012.01404.x
We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.
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