Dr. Janet Travell and Dr. David Simons were the pioneers of myofascial trigger points. They defined a trigger point as a hyperirritable spot in skeletal muscle that is associated with a palpable nodule in taut (tight) muscle fibers which can refer along typical pain patterns. They dedicated their lives to researching the cause and treatment of myofascial trigger points.
They wrote two definitive texts called Myofascial Pain and Dysfunction: The Trigger Point Manual, Volumes I and II in which they discuss the fact that abdominal trigger points can cause lower urinary tract complaints, groin pain, and dysmenorrhea, and other diagnoses that can be associated with chronic pelvic pain. In the second volume they discuss the association between pelvic pain and trigger points located within the adductor muscle group, as well as the internal and external pelvic floor muscles. These textbooks remain the most comprehensive sources of information regarding trigger points, which can be a significant cause of chronic pelvic pain.
Muscular origins of pelvic pain have really come to the forefront of assessment and treatment in the last ten years. Dr. Robert Moldwin, one of the leading Urologists in the United States for Painful Bladder Syndrome (formerly known as Interstitial Cystitis), estimates that pain from the muscles may be responsible for as much as 75-80% of painful bladder syndrome. Even though muscles are fairly easy and relatively non-invasive to treat (in comparison to some medical treatments including surgery), this origin of chronic pelvic pain was largely ignored for many years. One reason may be that there is not a dedicated medical discipline which oversees muscles in general, let alone the muscles of the pelvis specifically. Very little time is spent in medical school addressing the muscles as a source of pain. Some of the earliest research connecting muscular pain with chronic pelvic pain was found by King et al (1991). He found that 70% of pelvic pain patients reported complete or significant relief of their symptoms when the musculoskeletal dysfunction found during the physical therapy evaluation was treated.
Physiotherapists’ domain is musculoskeletal problems. This includes the assessment and treatment of the muscular system and the skeletal system, or bones. Therefore, physiotherapists are ideally suited through their training to assess and treat muscle dysfunction, both hypertonicity, or muscle trigger points, and hypotonicity, or muscle weakness.
A Randomized Clinical Trial (strongest type of study) was presented at the International Pelvic Pain Society conference (Chicago 2010), and has been published in the Journal of Urology (2012) that demonstrated internal pelvic floor myofascial treatment in urological pain patients was effective in 59% of patients compared to generalized massage therapy. This study was a multi-centre trial led by Dr. Fitzgerald et al.
The NIDDK (A National Research based organization in the States) were very excited to report these results since it is the first trial that they have sponsored in ten years which has shown a positive result for painful bladder syndrome, including medication, surgery and other therapeutic techniques.
We now have Level I evidence to support the use of Internal Pelvic Floor Myofascial Physiotherapy for painful bladder conditions specifically.
There are several excellent self-help textbooks for assessing and treating your trigger points for chronic pelvic pain. Since this is such a comprehensive subject, we will not cover them in detail on this website, but refer you to one of the self-help textbooks or a Pelvic Health Physiotherapist in your area.
The following are excellent resources:
A Headache in Pelvis by Dr. David Wise and Dr. David Anderson has very detailed pictures with regards to internal trigger points, as well as external trigger points. They also extensively review the concept of paradoxical relaxation, an important component of healing the mind-body connection that occurs in all chronic pain conditions. Men will want to access this book, although the authors have made it more female friendly in the later editions.
Heal Pelvic Pain by Amy Stein is the first comprehensive book written by a physiotherapist on the physiotherapy approach to treating chronic pelvic pain. She addresses both the external and internal approaches as well as some of the all-body techniques that can be used to calm down the sensitized nervous system.
Ending Female Pain by Isa Herrera is the latest edition to self-help books for chronic female pelvic pain. By far the most comprehensive self-help book so far. It is like having your own physiotherapist at your finger tips.