Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 4/2023

14-12-2022 | Myalgie | General Gynecology

Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia

Authors: Gregory K. Lewis, Anita H. Chen, Emily C. Craver, Julia E. Crook, Aakriti R. Carrubba

Published in: Archives of Gynecology and Obstetrics | Issue 4/2023

Login to get access

Abstract

Purpose

Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone.

Methods

This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release.

Results

Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008).

Conclusion

PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.
Literature
1.
Frederice CP et al (2021) Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. Int Urogynecol J 32(5):1087–1096CrossRefPubMed
2.
Frawley H et al (2021) An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 40(5):1217–1260CrossRefPubMed
3.
Moldwin RM, Fariello JY (2013) Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep 14(5):409–417CrossRefPubMed
4.
Bedaiwy MA, Patterson B, Mahajan S (2013) Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med 58(11–12):504–510PubMed
5.
Fouad LS et al (2017) Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy. J Endometr Pelvic Pain Disord 9(2):125–130CrossRef
6.
Halder GE et al (2017) Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investig Clin Urol 58(2):134–139CrossRefPubMedPubMedCentral
7.
Meister MR et al (2021) Effectiveness of botulinum toxin for treatment of symptomatic pelvic floor myofascial pain in women: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg 27(1):e152–e160CrossRefPubMedPubMedCentral
8.
Wallace SL, Miller LD, Mishra K (2019) Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol 31(6):485–493CrossRefPubMed
9.
Bonder JH, Chi M, Rispoli L (2017) Myofascial pelvic pain and related disorders. Phys Med Rehabil Clin N Am 28(3):501–515CrossRefPubMed
10.
van Reijn-Baggen DA et al (2022) Pelvic floor physical therapy for pelvic floor hypertonicity: a systematic review of treatment efficacy. Sex Med Rev 10(2):209–230CrossRefPubMed
11.
Doggweiler-Wiygul R, Wiygul JP (2002) Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients. World J Urol 20(5):310–314CrossRefPubMed
12.
VenâncioRde A, Alencar FG, Zamperini C (2008) Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio 26(2):96–103CrossRef
13.
Zoorob D et al (2015) A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain. Int Urogynecol J 26(6):845–852CrossRefPubMed
14.
15.
Bartley J et al (2019) Transvaginal trigger point injections improve pain scores in women with pelvic floor hypertonicity and pelvic pain conditions. Female Pelvic Med Reconstr Surg 25(5):392–396CrossRefPubMed
16.
Tarazona-Motes M et al (2021) Treatment of dyspareunia with botulinum neurotoxin type A: clinical improvement and influence of patients’ characteristics. Int J Environ Res Public Health 18(16):8783CrossRefPubMedPubMedCentral
17.
Ostelo RW, de Vet HC (2005) Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19(4):593–607CrossRefPubMed
18.
Beurskens AJHM, de Vet HCW, Köke AJA (1996) Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 65(1):71–76CrossRefPubMed
19.
Arnouk A et al (2017) Physical, complementary, and alternative medicine in the treatment of pelvic floor disorders. Curr Urol Rep 18(6):47CrossRefPubMed
20.
Engeler DS et al (2013) The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 64(3):431–439CrossRefPubMed
21.
Knudsen K et al (1997) Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 78(5):507–514CrossRefPubMed
22.
Rosenbaum T (2011) Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach. J Sex Marital Ther 37:89–93CrossRefPubMed
Metadata
Title
Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia
Authors
Gregory K. Lewis
Anita H. Chen
Emily C. Craver
Julia E. Crook
Aakriti R. Carrubba
Publication date
14-12-2022
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2023
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-022-06880-y

Other articles of this Issue 4/2023

Archives of Gynecology and Obstetrics 4/2023 Go to the issue

Correspondence

Think outside the box

Maternal-Fetal Medicine

Is it worth to insert uterine pack instead of Bakri balloon to control postpartum hemorrhage after vaginal delivery in hypertensive patients?

Maternal-Fetal Medicine

Incidence of postpartum hemorrhage and risk factors for recurrence in the subsequent pregnancy

Maternal-Fetal Medicine

Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP)

General Gynecology

Caesarean scar pregnancy: is there a light in the end of the tunnel?

Correspondence

Does cavity margin shaving reduce residual tumor and re‐excision rates? A systematic review