Admittedly, pelvic floor issues can be scary to treat for the un-trained physical therapist. For so long, pelvic floor issues have been relegated to the realm of pelvic-floor or women’s health trained physical therapists who do internal work. Due to the small numbers of pelvic pain physical therapists, these patients can wait months to be evaluated and just as long to begin their treatment often leaving them with serious dysfunction, pain, and inability to participate wholly in their daily life. In addition to specific urogynecological pathology, pelvic floor muscle pathology can contribute to a myriad of lower quarter dysfunction and when not investigated can prevent a patient from recovering from even what on the surface appears to be the simplest complaint of an acute low back pain episode.
So, you are not a pelvic floor therapist and have no intention of becoming one. How can dry needling assist you in treating these patients? One of the most remarkable and distinct characteristics of trigger points is referred pain. Elimination of trigger points being one of the intents of dry needling. When looking at the referred pain patterns of easily accessible muscles you will find that many of them can refer and mimic many pelvic floor pain complaints. In 2004, John Jarrell, MD, MSc, published an article entitled Myofascial Pain in the Pelvis.
This study is important in that it linked the presence of abdominal trigger points with chronic pelvic pain. Fortunately for the physical therapist who is not trained in internal pelvic floor work, the abdominal muscles are easily investigated and treated with dry needling when applicable.
Jarrell went on to further speculate that visceral disease and/or dysfunction may lead to the development of a “myofascial dysfunctional state.” All of this to say that it would be prudent to investigate the abdominal muscles in a patient who may be coming to you with pelvic floor pain complaints and who also has a history of visceral disease. Discriminating visceral pain from somatic pain is an important distinction.
In addition to the abdominal muscles, there are many other muscles that a non-pelvic floor dry needling therapist can impact. Some of the muscles with trigger point referral patterns that can refer to the region of the pelvic floor are obturator internus, adductor magnus, quadratus lumborum, and piriformis.
When these muscles are investigated and found to have active trigger points, their treatment with dry needling can have a serious impact on the pain the patient may be experiencing in their respective areas of referred pain, in particular, the pelvic floor.
Dry needling can be an incredibly powerful tool to be able to relieve someone of a pain that has usually persisted for an extended period of time and typically has been unresponsive to numerous interventions. Oftentimes, these patients are passed around from one practitioner to the next with very little resolution. Now, with just a thorough examination of muscles that are accessible to every physical therapist irrespective of training those patients have an opportunity to experience significant improvement in their pain as well as the ability to participate comfortably in their daily life.
Images from Dommerholt, J & Fernández De Las Peñas, C. 2018. Trigger point dry needling; an evidenced and clinical-based approach.Edinburgh, Churchill Livingstone, 2nd Edition