Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cb9f654ff-k7rjm Total loading time: 0 Render date: 2025-08-11T21:45:13.625Z Has data issue: false hasContentIssue false

Chapter 5 - Musculoskeletal Assessment for Patients with Pelvic Pain

Published online by Cambridge University Press:  08 March 2021

By
Lauren Hill  and
Karen Brandon
Edited by
Michael Hibner
Michael Hibner
Affiliation:
St Joseph’s Hospital & Medical Center, Phoenix, AZ
Get access

Summary

Pelvic floor assessment is probably the most important part of the physical examination in patients with chronic pelvic pain and this exam is best performed by a skilled pelvic floor physical therapist. Physicians who see a large number of patients with pelvic pain should probably partner with a physical therapist and refer those patients for assessment. Some of the red flags on the history part of the assessment for pelvic floor dysfunction are urinary hesitancy (delayed onset of urine flow when trying to urinate) and pain after intercourse, or pain with physical activity (post exertion muscle soreness). Patients with pelvic floor muscle spasms also often have discomfort and pain with use of tampons, vaginal probe ultrasound, and pelvic exam. On pelvic exam when palpating with one finger muscles may feel tight and tender, often to the point where the examiner is not able to insert one finger. The obturator internus muscle is best palpated during the pelvic exam in the lithotomy position with the patient pushing with her knee against the examiner’s external hand.

Information

Type
Chapter
Information
Management of Chronic Pelvic Pain
A Practical Manual
 , pp. 33 - 49
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

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(3):272e271-7.CrossRefGoogle ScholarPubMed
Huard, J, Li, Y, Fu, FH. Muscle injuries and repair: current trends in research. JBJS. 2002;84(5):822–32.CrossRefGoogle ScholarPubMed
Järvinen, TA, Järvinen, M, Kalimo, H. Regeneration of injured skeletal muscle after the injury. Muscles Ligaments Tendons j. 2013;3(4):337.CrossRefGoogle ScholarPubMed
Miller, J, MacDermid, JC, Richardson, J, Walton, DM, Gross, A. Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies. Arch Physiother. 2017;7:4.CrossRefGoogle ScholarPubMed
Wall, LL, DeLancey, JO. The politics of prolapse: a revisionist approach to disorders of the pelvic floor in women. Perspect Biol Med. 1991;34(4):486–96.CrossRefGoogle ScholarPubMed
FitzGerald, MP, Anderson, RU, Potts, J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182(2):570–80.CrossRefGoogle ScholarPubMed
FitzGerald, MP, Payne, CK, Lukacz, ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–18.CrossRefGoogle ScholarPubMed
Goldfinger, C, Pukall, CF, Gentilcore-Saulnier, E, McLean, L, Chamberlain, S. PAIN: a prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6(7):1955–68.Google Scholar
Mosqueda, LA. Assessment of rehabilitation potential. Clin Geriatr Med. 1993;9(4):689–703.CrossRefGoogle ScholarPubMed
Alappattu, MJ, Bishop, MD. Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain. Phys Ther. 2011;91(10):1542–50.CrossRefGoogle ScholarPubMed
Ballantyne, JC, Sullivan, MD. Intensity of chronic pain: the wrong metric? N Engl J Med. 2015;373(22):2098–9.CrossRefGoogle ScholarPubMed
Blickenstaff, C, Pearson, N. Reconciling movement and exercise with pain neuroscience education: a case for consistent education. Physiother Theor Pract. 2016;32(5):396–407.CrossRefGoogle ScholarPubMed
Dansie, EJ, Turk, DC. Assessment of patients with chronic pain. BJA: Br J Anaesth. 2013;111(1):19–25.CrossRefGoogle Scholar
Turk, DC, Dworkin, RH, Revicki, D, et al. Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain. PAIN. 2008;137(2):276–85.CrossRefGoogle ScholarPubMed
Dufour, S, Vandyken, B, Forget, MJ, Vandyken, C. Association between lumbopelvic pain and pelvic floor dysfunction in women: a cross sectional study. Musculoskelet Sci Pract. 2018;34:47–53.CrossRefGoogle ScholarPubMed
Coady, D, Futterman, S, Harris, D, Coleman, SH. Vulvodynia and concomitant femoro-acetabular impingement: long-term follow-up after hip arthroscopy. J Lower Genit Tract Dis. 2015;19(3):253–6.CrossRefGoogle ScholarPubMed
Sullivan, MJ, Bishop, SR, Pivik, J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524.CrossRefGoogle Scholar
Neblett, R, Hartzell, MM, Mayer, TG, Cohen, H, Gatchel, RJ. Establishing clinically relevant severity levels for the central sensitization inventory. Pain Pract. 2017;17(2):166–75.CrossRefGoogle ScholarPubMed
Lundberg, MKE, Styf, J, Carlsson, SG. A psychometric evaluation of the Tampa Scale for Kinesiophobia: from a physiotherapeutic perspective. Physiother Theor Pract. 2004;20(2):121–33.Google Scholar
Smith, RC, Marshall-Dorsey, AA, Osborn, GG, et al. Evidence-based guidelines for teaching patient-centered interviewing. Patient Educ Counsel. 2000;39(1):27–36.CrossRefGoogle ScholarPubMed
Pollard, CA. Preliminary validity study of the pain disability index. Percept Motor Skills. 1984;59(3):974.Google Scholar
Hummel-Berry, KWK, Herman, H. Reliability and validity of the Vulvar Functional Status Questionnaire (VQ). J Womens Health Phys Ther. 2007;31(3):28–33.CrossRefGoogle Scholar
Brewer, ME, White, WM, Klein, FA, Klein, LM, Waters, WB. Validity of Pelvic Pain, Urgency, and Frequency questionnaire in patients with interstitial cystitis/painful bladder syndrome. Urology. 2007;70(4):646–9.CrossRefGoogle ScholarPubMed
Wiklund, I, Fullerton, S, Hawkey, C, et al. An irritable bowel syndrome-specific symptom questionnaire: development and validation. Scand J Gastroenterol. 2003;38(9):947–54.Google Scholar
Wei, JT, De Lancey, JO. Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol. 2004;47(1):3–17.CrossRefGoogle ScholarPubMed
Hodges, PW, Sapsford, R, Pengel, LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26(3):362–71.CrossRefGoogle ScholarPubMed
Rosenbaum, TY. Musculoskeletal pain and sexual function in women. J Sex Med. 2010;7(2 Pt 1):645–53.CrossRefGoogle ScholarPubMed
Lee, D, Lee, L-J. The Pelvic Girdle. Edinburgh: Elsevier; 2011.Google Scholar
Itza Santos, F, Zarza, D, Serra Llosa, L, Gómez Sancha, F, Salinas, J, Allona-Almagro, A. [Myofascial pain syndrome in the pelvic floor: a common urological condition] (in Spanish). Actas Urol Esp. 2010;34(4):318–26.Google Scholar
Tu, FF, As-Sanie, S, Steege, JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med. 2006;51(3):185–9.Google Scholar
FitzGerald, MP KR. Rehabilitation of the short pelvic floor I: background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:261–8.Google Scholar
Mehin, R, Meek, R, O’Brien, P, Blachut, P. Surgery for osteitis pubis. Can J Surg. 2006;49(3):170–6.Google Scholar
Ekci, B, Tamam, C., Altinli, E. A rare clinical condition after pelvic surgery: osteitis pubis. Anatol J Clin Invest. 2009;3(4):259–61.Google Scholar
Sapsford, RR, Richardson, CA, Maher, CF, Hodges, PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil. 2008;89(9):1741–7.CrossRefGoogle ScholarPubMed
Hodges, PW, Moseley, GL, Gabrielsson, A, Gandevia, SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res. 2003;151(2):262–271.CrossRefGoogle ScholarPubMed
Padoa, A, Rosenbaum, TY. The Overactive Pelvic Floor. Cham, Switzerland: Springer; 2016.CrossRefGoogle Scholar
Hodges, PW, Richardson, CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997;77(2):132–42.Google Scholar
Hodges, PW, Moseley, GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361–70.CrossRefGoogle ScholarPubMed
Boyajian-O’Neill, LA, McClain, RL, Coleman, MK, Thomas, PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108(11):657–64.Google ScholarPubMed
Bedi, A, Dolan, M, Leunig, M, Kelly, BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;27(2):235–51.Google Scholar
Fonstad, P, Hooper, R.A. Hip labral tears as a co-morbidity of low back and pelvic girdle pain following motor vehicle collisions: a case series. J Back Musculoskel Rehabil. 2008;21:245–51.Google Scholar
Yavagal, S, de Farias, TF, Medina, CA, Takacs, P. Normal vulvovaginal, perineal, and pelvic anatomy with reconstructive considerations. Semin Plast Surg. 2011;25(2):121–9.CrossRefGoogle ScholarPubMed
Horton, R. The anatomy, biological plausibility and efficacy of visceral mobilization in the treatment of pelvic floor dysfunction. J Pelvic Obstet Gynaecol Physiother. 2015;117:5–18.Google Scholar
Pastore, EA, Katzman, WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680–91.Google Scholar
Bogduk, N, Pearcy, M, Hadfield, G. Anatomy and biomechanics of psoas major. Clin Biomech. 1992;7(2):109–19.CrossRefGoogle Scholar
Montenegro, ML, Gomide, LB, Mateus-Vasconcelos, EL, et al. Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):21–4.Google Scholar
FitzGerald, MP, Anderson, RU, Potts, J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182:570–80.Google Scholar
Suleiman, S, Johnston, D. The abdominal wall: an overlooked source of pain. Am Fam Physician. 2001;64(3):431–8.Google ScholarPubMed
Rosenbaum, TY, Owens, A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). J Sex Med. 2008;5(3):513–23.CrossRefGoogle ScholarPubMed
Hartmann, D, Sarton, J. Chronic pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):977–90.Google Scholar
Haylen, BT, Freeman, RM, Swift, SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22(1):3–15.Google Scholar
Laan EvL, RHW. Overactive pelvic floor: sexual functioning. In Padoa, A, Rosenbaum, TY (eds), The Overactive Pelvic Floor. New York: Springer Science+Business Media; 2016.Google Scholar
Faubion, SS, Shuster, LT, Bharucha, AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Paper presented at Mayo Clinic Proceedings; 2012.Google Scholar
Laycock, J, Jerwood, D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42.CrossRefGoogle Scholar
Loving, S, Thomsen, T, Jaszczak, P, Nordling, J. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: a cross-sectional population-based study. Eur J Pain. 2014;18(9):1259–70.Google Scholar
Kavvadias, T, Pelikan, S, Roth, P, Baessler, K, Schuessler, B. Pelvic floor muscle tenderness in asymptomatic, nulliparous women: topographical distribution and reliability of a visual analogue scale. Int Urogynecol J. 2013;24(2):281–6.Google Scholar
Reissing, ED, Brown, C, Lord, MJ, Binik, YM, Khalife, S. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol. 2005;26(2):107–13.CrossRefGoogle ScholarPubMed
Glazer, HI, Marinoff, SC, Sleight, IJ. Web-enabled Glazer surface electromyographic protocol for the remote, real-time assessment and rehabilitation of pelvic floor dysfunction in vulvar vestibulitis syndrome: a case report. J Reprod Med. 2002;47(9):728–30.Google Scholar
van der Velde, J, Everaerd, W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001;39(4):395–408.Google Scholar
Montenegro, ML, Vasconcelos, EC, Candido Dos Reis, FJ, et al. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract. 2008;62:263–9.Google Scholar
Rosenbaum, TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med. 2007;4(1):4–13.Google Scholar
Prendergast, SA WJ. Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol. 2003;46:773–82.Google Scholar
Hibner, M, Desai, N, Robertson, LJ, Nour, M. Pudendal neuralgia. J Minim Invas Gynecol. 2010;17(2):148–53.CrossRefGoogle ScholarPubMed
Engeler, D, Baranowski, A, Borovicka, J, et al. EAU guidelines on chronic pelvic pain. Paper presented at: EAU Guidelines, edition presented at the 27th EAU Annual Congress, Paris; 2012.Google Scholar
Stuge, B, Sætre, K, Brækken, IH. The association between pelvic floor muscle function and pelvic girdle pain: a matched case control 3D ultrasound study. Manual Ther. 2012;17(2):150–6.Google Scholar

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×