PT Eval:Myofascial Trigger Points - PFSM
PT Eval:Myofascial Trigger Points - PFSM
PT Eval:Myofascial Trigger Points - PFSM
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2/20/13 <br />
<strong>PT</strong> <strong>Eval</strong>:<strong>Myofascial</strong> <strong>Trigger</strong> <strong>Points</strong><br />
Sarah: positive B Psoas,<br />
iliacus and QL tr pts.<br />
<strong>Myofascial</strong> Pain & Dysfunction: The<br />
<strong>Trigger</strong> Point Manual. Vol I & II.<br />
Travell & Simons,1999<br />
Multiple Sites of Potential Nerve<br />
Entrapments<br />
1
2/20/13 <br />
Innervation of the vulva<br />
• To understand vulvodynia, it is important to remember<br />
the anatomy …the vulva receives input from 3 major<br />
nerves: the pudendal, ilioinguinal and genitofemoral.<br />
• posterior vulva = pudendal nerve (S2-S4)<br />
• anterior vulva = ilioinguinal and the genital branch of<br />
the genitofemoral nerve.<br />
Q- Tip test: Positive entire<br />
vestibule<br />
<br />
2
2/20/13 <br />
<strong>Eval</strong> of Pelvic<br />
Floor<br />
Muscles:<br />
Superficial,<br />
UGD<br />
deep layers<br />
Primary areas of restriction at<br />
PC & perineal muscles<br />
Reproduction of sexual<br />
intercourse pain and burning<br />
pain at vestibule and with<br />
muscle eval<br />
<strong>Trigger</strong> <strong>Points</strong>: Levator Ani<br />
Pain in lower abdomen<br />
Discomfort in the bladder<br />
ü Vulvar or Urethral pain<br />
ü Symptoms of Frequency<br />
and Urgency<br />
ü Entrance dyspareunia<br />
Feeling of Golf-Ball-Inthe-Rectum<br />
Discomfort<br />
3
2/20/13 <br />
<strong>Trigger</strong> <strong>Points</strong><br />
Obturator Internus<br />
Hip related pain<br />
ü Vulvar pain<br />
ü Urethral pain<br />
ü Pudendal Nerve Pain<br />
Dull Ache and Burning<br />
in the pelvic floor<br />
ipsilateral or bilateral<br />
<strong>Trigger</strong> <strong>Points</strong><br />
Coccygeus<br />
ü Pain in Tailbone<br />
ü Pain in Gluteus Maximus<br />
Pain after a Bowel<br />
Movement<br />
4
2/20/13 <br />
Education<br />
Posture<br />
Physical Therapy<br />
Intervention<br />
<br />
Training with husband<br />
Dilators<br />
For use at home for home program<br />
Relaxation<br />
Yoga<br />
Therapeutic Exercises<br />
Stretches to address muscle length<br />
Hip flexors, adductors, pf<br />
Physical Therapy<br />
Intervention<br />
<br />
External Manual therapy<br />
Muscle energy techniques to correct pelvic obliquity<br />
Soft tissue mobilization, myofascial release techniques,<br />
trigger point release, skin rolling/ connective tissue<br />
mobilization<br />
External work on pelvic girdle musculature 1 st every session<br />
Especially adductors, abdominals , IRF and gluteals<br />
5
2/20/13 <br />
<strong>PT</strong> Treatment: internal manual<br />
therapy<br />
v MFR<br />
v <strong>Trigger</strong> point release<br />
v Contract/relax<br />
v Strain Counter Strain<br />
v Visceral mobilization<br />
v Request of neuropathic<br />
agent from MD early on due<br />
to flares in sciatica after <strong>PT</strong>.<br />
Tried Elavil & then Lyrica<br />
v Use of m. relaxant<br />
suppositories<br />
v Referral to Dr Goldstein for<br />
hormone analysis to further<br />
address pain & lack or<br />
arousal<br />
<br />
Sarah’s Home Program<br />
<br />
Seating system<br />
Foam roller<br />
LE & LB Stretches<br />
Emu oil w/estrogen<br />
Self mob/skin rolling/<br />
tr. TP releasing<br />
Dilators<br />
Yoga<br />
6
2/20/13 <br />
Physical Therapy<br />
Intervention Outcomes<br />
<br />
Decrease in pelvic floor muscle spasm from severe to<br />
mild to normal tone<br />
Pain-free intercourse for 1 st time ever! ( not consistently yet<br />
without appropriate arousal)<br />
Decreased LBP<br />
Coccyx pain eliminated (still uses cushion to sit.)<br />
Urethral pain gone and bladder sxs normalized.<br />
Clinician and patient<br />
resources<br />
<br />
International Society for the Study of Vulvovaginal<br />
Disease<br />
www.issvd.org<br />
The National Vulvodynia Association<br />
www.nva.org<br />
International Pelvic Pain Society<br />
www.pelvicpain.org<br />
American Physical Therapy Association<br />
www.apta.org<br />
7
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