What Are My Myofascial Tender Points?

Dr. Janet Travell and Dr. David Simons were the pioneers of myofascial tender (“trigger”) points. They defined a tender point as a hyper-irritable spot in a 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 tender points.

This duo 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 muscle tension can cause lower urinary tract complaints, groin pain, dysmenorrhea, and other diagnoses that can be associated with chronic pelvic pain. In the second volume, they discuss the association between pelvic pain and tender 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 muscle tender 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. Dr. Robert Moldwin, one of the leading Urologists in the United States for Bladder Pain Syndrome, estimates that pain from the pelvic floor muscles may be responsible for as much as 75-80% of painful bladder symptoms.

Even though muscles are fairly easy and relatively non-invasive to treat, 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.

Musculoskeletal problems are in the domain of physiotherapists. 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 overactivity, or muscle tender points, and under-activity, or muscle weakness.

A randomized clinical trial was presented at the International Pelvic Pain Society Conference demonstrating that internal pelvic floor myofascial treatment in urological pain patients helped reduce bladder pain symptoms in 59% of patients compared to those that received generalized massage therapy. (Fitzgerald et al., 2012, Journal of Urology)

The NIDDK (A national research-based organization in the United States), were very excited to report these results since it is the first trial that they have sponsored in 10 years which has shown a positive result for urological pain, including medication, surgery, and other therapeutic techniques.

We now have Level I evidence (the highest supporting evidence) to support the use of Internal Pelvic Floor Myofascial Physiotherapy for painful bladder (urological) conditions.

There are several excellent self-help textbooks for assessing and treating your tender 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:

Why Pelvic Pain Hurts by Adrian Louw, Sandy Hilton, and Carolyn Vandyken. This is an excellent book written to reveal how pain really works and clear up any confusion. This book explores the first step toward calming an extra-sensitive nervous system.

A Headache in Pelvis by Dr. David Wise and Dr. David Anderson has very detailed pictures with regards to internal tender points, as well as external tender points. They also extensively review the concept of paradoxical relaxation, which is 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 how to treat chronic pelvic pain from a physiotherapy approach. She addresses both the internal and external approaches, as well as some of the all-body techniques that can be used to calm down the sensitized nervous system.

Ending Female Pain and Ending Male Pelvic Pain by Isa Herrera are self-help books for chronic female and male pelvic pain. This is by far the most comprehensive self-help book on pelvic pain. It is like having your own physiotherapist at your fingertips!