Additional Information
Book Details
Abstract
Edited by Leon Chaitow and Ruth Lovegrove, this clearly written and fully illustrated multi-contributor volume offers practical, comprehensive coverage of the subject area accompanied by a range of video clips. Covering all aspects of current diagnosis and management, this new book is suitable for physiotherapists, osteopathic physicians and osteopaths, medical pain specialists, urologists, urogynaecologists, chiropractors, manual therapists, acupuncturists, massage therapists and naturopaths worldwide.
- Offers practical, validated, and clinically relevant information to all practitioners and therapists working in the field
- Edited by two acknowledged experts in the field of pelvic pain to complement each other’s approach and understanding of the disorders involved
- Carefully prepared by a global team of clinically active and research oriented contributors to provide helpful and clinically relevant information
- Abundant use of pull-out boxes, line artwork, photographs and tables facilitates ease of understanding
- Contains an abundance of clinical cases to ensure full understanding of the topics explored
- Focuses on the need for an integrated approach to patient care
- Includes an appendix based on recent European Guidelines regarding the nature of the condition(s) and of the multiple aetiological and therapeutic models associated with them
- Includes a bonus website presenting film clips of the manual therapy, biofeedback and rehabilitation techniques involved http://booksite.elsevier.com/9780702035326/
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Chronic Pelvic Pain and Dysfunction: Practical Physical Medicine | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Foreword | ix | ||
| Acknowledgements | xi | ||
| Chapter 1: An introduction to chronic pelvic pain and associated symptoms | 1 | ||
| Introduction | 1 | ||
| Definitions of chronic pelvic pain syndromes | 1 | ||
| Chronic pain | 4 | ||
| Pelvic girdle pain and CPP: To separate or combine? | 4 | ||
| Connecting PGP with CPP | 5 | ||
| Aetiological features of CPP | 5 | ||
| Beyond single causes | 6 | ||
| Treatment aimed at pathology is only part of the answer | 7 | ||
| References | 9 | ||
| Chapter 2.1: An introduction to the anatomy of pelvic pain | 11 | ||
| References | 12 | ||
| Chapter 2.2: Anatomy and biomechanics of the pelvis | 13 | ||
| The anatomy of the sacroiliac joint | 14 | ||
| Why did nature create a seemingly flat SIJ? | 14 | ||
| What specific adaptations are available to prevent shear in the SIJs? | 15 | ||
| Why is the SIJ not perpendicularly orientated to the forces of gravitation? | 15 | ||
| Ligaments and their role in self-bracing the pelvis | 15 | ||
| Sacrotuberous ligaments | 17 | ||
| Long dorsal sacroiliac ligaments | 17 | ||
| Anatomical aspects | 18 | ||
| Biomechanical aspects | 18 | ||
| The role of the thoracolumbar fascia in stabilizing the lumbopelvic area | 20 | ||
| Anatomical aspects | 20 | ||
| Superficial lamina | 20 | ||
| Biomechanical aspects | 21 | ||
| Traction to the superficial lamina | 21 | ||
| Traction to the deep lamina | 22 | ||
| Muscles and self-bracing | 23 | ||
| Self-bracing during forward bending | 24 | ||
| Self-bracing in unconstrained positions | 24 | ||
| Failed self-bracing | 25 | ||
| Optimal and non-optimal pelvic girdle stability | 26 | ||
| Acknowledgement | 29 | ||
| References | 29 | ||
| Chapter 2.3: Anatomy of the pelvic floor | 33 | ||
| Pelvic floor muscles | 34 | ||
| The deep PFM: Levator ani muscle | 34 | ||
| The superficial PFM and perineal body | 35 | ||
| Endopelvic fascia | 36 | ||
| Pelvic viscera | 36 | ||
| Bladder and urethra | 36 | ||
| Prostate | 37 | ||
| Vagina and uterus | 38 | ||
| Penis, scrotum and testes | 38 | ||
| Rectum and anal canal | 38 | ||
| Innervation of the pelvic organs and PFM | 40 | ||
| References | 41 | ||
| Chapter 3: Chronic pain mechanisms | 43 | ||
| Defining chronic pelvic pain | 43 | ||
| Chronic pelvic pain syndrome: The cause | 44 | ||
| Chronic pelvic pain syndrome: The mechanisms | 44 | ||
| Mechanisms for chronic pelvic pain | 45 | ||
| Ongoing peripheral visceral pain mechanisms as a cause of chronic pelvic pain | 46 | ||
| Spinal mechanisms of visceral pain and sensitization: Central sensitization (Roza et al. 1998, Giamberardino 2005) | 48 | ||
| Visceral hyperalgesia | 48 | ||
| Supraspinal modulation of pain perception | 48 | ||
| Higher-centre modulation of spinal nociceptive pathways | 49 | ||
| Neuromodulation and psychology | 49 | ||
| Autonomic nervous system | 50 | ||
| Endocrine system | 50 | ||
| Genetics and chronic pain | 50 | ||
| Clinical paradigms and chronic pelvic pain | 50 | ||
| References | 52 | ||
| Chapter 4: Psychophysiology and pelvic pain | 53 | ||
| Introduction | 53 | ||
| Psychophysiology in historical perspective | 53 | ||
| Modern psychophysiological research | 54 | ||
| Prostate and pelvic pain | 55 | ||
| Alexithymia and pelvic pain | 57 | ||
| Pain catastrophizing and fear-avoidance | 58 | ||
| Hypervigilance and fear of movement | 60 | ||
| Avoidance of sexual activity | 60 | ||
| Defensiveness, emotional denial and repression | 62 | ||
| Placebo-nocebo chemistry as psychophysiology | 62 | ||
| Effects of physical and sexual abuse | 64 | ||
| Somatization | 64 | ||
| Acknowledgement | 65 | ||
| References | 65 | ||
| Chapter 5: Gender and chronic pelvic pain | 69 | ||
| Introduction | 69 | ||
| Gender and pain: The role of sex hormones | 69 | ||
| Sex hormones and pain | 70 | ||
| Visceral pelvic pain | 71 | ||
| Visceral pain | 72 | ||
| Pelvic pain from sex-specific internal organs | 73 | ||
| Pain from the female reproductive organs | 73 | ||
| Primary dysmenorrhoea | 73 | ||
| Endometriosis | 74 | ||
| Pelvic inflammatory disease | 75 | ||
| Pain from the male reproductive organs (See also Chapters 12 & 15) | 75 | ||
| Prostatitis/prostatodynia | 75 | ||
| Chronic orchialgia | 75 | ||
| Pelvic pain from non-sex-specific visceral organs | 76 | ||
| Irritable bowel syndrome | 76 | ||
| Interstitial cystitis/painful bladder syndrome | 77 | ||
| Mixed pelvic pain | 77 | ||
| Chronic pelvic pain of mixed origin | 77 | ||
| Chronic pelvic pain from viscerovisceral hyperalgesia | 78 | ||
| Are women more susceptible than men to chronic pain? | 78 | ||
| Conclusion | 79 | ||
| References | 79 | ||
| Chapter 6: Musculoskeletal causes and the contribution of sport to the evolution of chronic lumbopelvic pain | 83 | ||
| Introduction | 83 | ||
| Assessment of the movement system | 84 | ||
| Common postural types (see Kendall et al. 2005, Sahrmann 2002) | 89 | ||
| Lumbopelvic cylinder and chronic pelvic pain | 95 | ||
| Assessment and rehabilitation of muscles of the lumbopelvic cylinder | 95 | ||
| Voluntary activation of TrA independently from other trunk muscles (Richardson et al. 1999) | 95 | ||
| Assessment and rehabilitation of muscles of the lumbopelvic cylinder | 96 | ||
| Voluntary activation of pelvic floor muscles (Laycock | 96 | ||
| Voluntary activation of deep segmental lumbar multifidus (Richardson et al. 1999) | 97 | ||
| Voluntary activation of the posterior fasciculii of psoas (Gibbons et al. 2002) | 98 | ||
| Integration of voluntary activation of the lumbopelvic cylinder into function | 99 | ||
| The neural system and chronic pelvic pain | 99 | ||
| Sporting activities and chronic pelvic pain | 100 | ||
| The effect of aerobic exercise on chronic pelvic pain | 100 | ||
| Specific groin injuries | 101 | ||
| Ligament and muscle strain | 102 | ||
| Acetabular tears and impingements of the hip | 103 | ||
| Osteitis pubis | 105 | ||
| Athletic pubalgia or sports hernias | 105 | ||
| Stress fractures | 106 | ||
| Nerve compression | 106 | ||
| Cycling and genitourinary symptoms in men and women | 107 | ||
| Symptoms | 114 | ||
| Potential mechanisms | 114 | ||
| Therapeutic options regarding adjustable bicycle factors | 116 | ||
| Saddle design | 116 | ||
| Posture and type of bike | 117 | ||
| Saddle width | 117 | ||
| Saddle padding | 119 | ||
| Conclusions | 119 | ||
| Running | 119 | ||
| Football | 119 | ||
| Ice hockey | 120 | ||
| Sports involving repetitive flexion of the hip | 120 | ||
| Case study 6.1 | 120 | ||
| Case study 6.2 | 121 | ||
| References | 122 | ||
| Chapter 7: The role of clinical reasoning in the differential diagnosis and management of chronic pelvic pain | 129 | ||
| Introduction | 129 | ||
| Evidence-based practice: Where did it come from? Where is it going? | 130 | ||
| Understanding pain: What do we need to know? | 131 | ||
| What causes pain? Searching for the pain driver | 131 | ||
| Classifying pain | 132 | ||
| Timelines and mechanism of injury | 132 | ||
| Classification by pain mechanisms | 133 | ||
| Classification and clinical prediction rules: Are we searching for the holy grail? | 135 | ||
| It's about more than pain - Integrated systems for optimal health | 139 | ||
| The Integrated Systems Model for disability and pain: A framework for understanding the whole person and their problem | 141 | ||
| Underlying constructs of the model | 141 | ||
| Components of the model: The Clinical Puzzle - A tool for clinical reasoning and developing clinical expertise | 142 | ||
| The person in the middle of the puzzle | 143 | ||
| Strategies for function and performance | 144 | ||
| Articular, myofascial, neural, visceral systems | 144 | ||
| Case study 7.1 | 146 | ||
| Kristi's story | 146 | ||
| Strategies for function and performance | 146 | ||
| Standing posture | 146 | ||
| One leg standing | 146 | ||
| Active straight leg raise | 146 | ||
| Curl-up task | 146 | ||
| Clinical reasoning at this point | 146 | ||
| Articular system analysis | 147 | ||
| Neural system analysis | 147 | ||
| Myofascial system analysis | 148 | ||
| Clinical impression derived from hypothesis development, reflection and interpretive reasoning | 148 | ||
| Two days postpartum | 149 | ||
| Strategies for function and performance, myofascial and neural system analysis | 152 | ||
| Standing posture | 152 | ||
| One leg standing, active straight leg raise and curl-up tasks | 152 | ||
| Clinical reasoning and early postpartum management | 153 | ||
| Six weeks postpartum | 153 | ||
| Strategies for function and performance | 155 | ||
| Standing posture | 155 | ||
| One leg standing and active straight leg raise tasks | 155 | ||
| Articular and neural system analysis | 155 | ||
| Curl-up task and myofascial system analysis | 156 | ||
| Clinical reasoning and management | 158 | ||
| Twelve weeks postpartum | 158 | ||
| Fourteen weeks postpartum | 160 | ||
| Strategies for function and performance | 160 | ||
| One leg standing and active straight leg raise | 160 | ||
| Curl-up task and myofascial system analysis | 160 | ||
| Neural system analysis | 160 | ||
| Clinical reasoning and management | 160 | ||
| Case conclusion | 161 | ||
| Summary | 161 | ||
| References | 161 | ||
| Chapter 8.1: Multispeciality and multidisciplinary practice... | 165 | ||
| Multispeciality and multidisciplinary practice (Baranowski et al. 2008) | 165 | ||
| The medical teams | 166 | ||
| The multispeciality clinic | 166 | ||
| The multidisciplinary team and clinic | 166 | ||
| The role of the pain medicine consultant | 166 | ||
| The role of the psychologist | 168 | ||
| The role of the clinical nurse specialist or nurse consultant (Cambitzi & Baranowski 2009) | 169 | ||
| The role of the physiotherapist | 169 | ||
| The pain management programme | 169 | ||
| Summary | 169 | ||
| References | 169 | ||
| Chapter 8.2: Interdisciplinary management of chronic pelvic pain... | 171 | ||
| Introduction | 171 | ||
| Team management | 172 | ||
| Organic pathology intervention | 172 | ||
| Cognitive behavioural therapy | 172 | ||
| Manual physical therapy intervention | 173 | ||
| Altered neurodynamics | 173 | ||
| Lifestyle modifications and home exercise programmes | 174 | ||
| Pharmacological therapy | 174 | ||
| Simple analgesics | 174 | ||
| Neuropathic analgesics | 174 | ||
| Anticonvulsants | 174 | ||
| N-methyl-D-aspartate antagonists | 174 | ||
| Opioids | 175 | ||
| Trigger point injection therapy | 175 | ||
| Nerve blocks | 175 | ||
| Botulinum toxin therapy | 176 | ||
| Pulsed radiofrequency | 176 | ||
| Neuromodulation | 177 | ||
| Sacral neuromodulation | 177 | ||
| Posterior tibial nerve stimulation | 177 | ||
| Chronic/continuous pudendal nerve stimulation | 178 | ||
| Multimodal treatment algorithm | 178 | ||
| Reasons for poor treatment tolerance | 180 | ||
| Modifying manual treatment | 180 | ||
| Non-responding symptoms | 180 | ||
| References | 181 | ||
| Chapter 8.3: Chronic pelvic pain and nutrition | 185 | ||
| Introduction | 185 | ||
| Inflammation | 185 | ||
| Dietary anti-inflammatory strategies | 185 | ||
| Antioxidants and anti-inflammatory nutrients | 186 | ||
| Anti-inflammatory effects of omega-3 and -6 oils | 187 | ||
| Vitamin D and pelvic floor disorders in women | 187 | ||
| CPP/endometriosis and diet | 188 | ||
| Dysmenorrhoea: Studies and meta-analyses | 188 | ||
| Painful bladder syndrome | 188 | ||
| Vulvar vestibulitis syndrome and interstitial cystitis | 188 | ||
| Irritable bowel syndrome and diet | 189 | ||
| Peppermint oil | 189 | ||
| Turmeric (curcumin) | 189 | ||
| Probiotics | 189 | ||
| Acknowledgement | 190 | ||
| References | 190 | ||
| Chapter 9: Breathing and chronic pelvic pain... | 193 | ||
| Introduction | 193 | ||
| The lumbopelvic cylinder: Functional and structural connections | 194 | ||
| The retroperitoneal space | 196 | ||
| Interaction of CPP, pelvic girdle pain and breathing pattern disorders aetiological features | 197 | ||
| Postural and breathing patterns as aetiological features | 197 | ||
| Pelvic girdle pain: Respiratory connections | 198 | ||
| Gut connections to CPP and to respiration | 199 | ||
| An integrated system | 199 | ||
| Varieties of breathing pattern disorder | 200 | ||
| Breathing pattern disorders - The postural connection | 200 | ||
| Examples | 202 | ||
| Repercussions of breathing pattern disorders | 203 | ||
| BPD and hyperventilation: Physical features - Implications for rehabilitation | 203 | ||
| Viscerosomatic effects | 204 | ||
| 'Biologically unsustainable patterns' (Garland 1994) | 205 | ||
| Myofascial trigger points | 205 | ||
| Breathing rehabilitation assessment and interventions (Chaitow et al. 2002) | 205 | ||
| Functional examination: Identifying the locus of motion | 206 | ||
| HiLo test | 207 | ||
| Manual assessment of respiratory motion | 207 | ||
| Current thoracic excursion | 207 | ||
| Breath-holding tests | 208 | ||
| Teaching control of breathing | 208 | ||
| CO2 regulation study | 210 | ||
| The Mensendieck approach | 211 | ||
| Research on breathing as a pain intervention | 213 | ||
| Stress and breathing | 214 | ||
| Conditioned breathing responses | 214 | ||
| Manual treatment of selected key structures associated with respiration | 215 | ||
| Connective tissue manipulation | 216 | ||
| Trigger point deactivation and slow stretching (Travell & Simons 1999, Cox 2005) | 216 | ||
| Diaphragm | 216 | ||
| NMT for diaphragm (Chaitow 2007, Chaitow & DeLany 2008) | 216 | ||
| PRT for diaphragm | 217 | ||
| Intercostals | 217 | ||
| NMT for the intercostal muscles | 217 | ||
| Psoas | 218 | ||
| MET for psoas (Grieve 1994, Chaitow 2006) | 218 | ||
| Quadratus lumborum | 218 | ||
| PRT for quadratus lumborum | 218 | ||
| Scalenes (and other upper fixators of the shoulder/accessory breathing muscles) | 219 | ||
| PRT for scalenes | 219 | ||
| Thoracic and costal mobilization | 219 | ||
| MET for thoracic spine | 219 | ||
| Scar tissue release | 220 | ||
| Myofascial release (myofascial induction) | 220 | ||
| Study | 220 | ||
| Conclusions | 220 | ||
| References | 221 | ||
| Chapter 10: Biofeedback in the diagnosis and treatment of chronic essential pelvic pain disorders | 227 | ||
| Pain, relaxation and biofeedback | 227 | ||
| SEMG biofeedback | 228 | ||
| Skin temperature | 229 | ||
| Galvanic skin response | 229 | ||
| Breathing | 229 | ||
| Research applications to pelvic pain problems | 230 | ||
| Hand temperature and pelvic pain | 230 | ||
| Muscle biofeedback and pelvic pain | 230 | ||
| Intrapelvic SEMG in the treatment of functional chronic urogenital, gastrointestinal and sexual pain and dysfunction | 232 | ||
| Biofeedback meets evidence-based medicine: The Glazer Protocol | 232 | ||
| Applications | 233 | ||
| Patient selection | 233 | ||
| Assessment with the Glazer Protocol | 234 | ||
| Levels of interpretation and applications of SEMG evaluation data include both empirical and pathophysiological perspectives | 235 | ||
| Empirical | 235 | ||
| Physiological | 236 | ||
| Developing evidence-based biofeedback applications for pelvic pain | 236 | ||
| Selected ongoing international collaborative research | 237 | ||
| Research summary | 237 | ||
| Summary of Medline 'biofeedback' 'pelvic pain' literature search | 239 | ||
| Case study 10.1 | 239 | ||
| Health concerns | 240 | ||
| Hospital/surgery/major illness | 240 | ||
| Medications currently taking | 240 | ||
| Supplements | 240 | ||
| Allergies | 240 | ||
| Family history | 240 | ||
| Systems review | 240 | ||
| Psychometrics: MMPI-2 | 240 | ||
| Medical examination | 240 | ||
| Patient narrative | 241 | ||
| Sexual evaluation | 241 | ||
| Intrapelvic SEMG evaluation | 241 | ||
| History and data review and integration with treatment(s) prescribed | 241 | ||
| Summary of findings | 241 | ||
| Interpretation of findings | 242 | ||
| Treatment | 242 | ||
| Outcomes | 243 | ||
| Medical | 243 | ||
| Psychological, psychosexual | 243 | ||
| Social, marital, occupational | 243 | ||
| Substance use | 243 | ||
| Treatment compliance | 243 | ||
| References | 244 | ||
| Websites | 245 | ||
| Chapter 11.1: Soft tissue manipulation approaches to chronic pelvic pain (external) | 247 | ||
| Introduction | 247 | ||
| Local muscle dysfunction: Muscle trigger points | 248 | ||
| Trigger points and chronic pelvic pain | 248 | ||
| Why is inactivation of trigger points in chronic pelvic pain important? | 249 | ||
| Best evidence of soft tissue interventions for muscle trigger points | 249 | ||
| Application of soft tissue interventions for trigger points | 250 | ||
| Compression interventions | 250 | ||
| Static compression of piriformis/external obturator muscle trigger points | 250 | ||
| Static compression of pectineus muscle trigger points | 251 | ||
| Intermittent compression of pelvic floor muscle trigger points | 252 | ||
| Compression and contraction of gluteus maximus muscle trigger points | 252 | ||
| Stretching compression of iliopsoas muscle trigger points | 253 | ||
| Massage | 254 | ||
| Transverse massage of quadratus lumborum muscle trigger points | 255 | ||
| Stretching longitudinal massage of adductor muscle trigger points | 256 | ||
| Muscle energy interventions | 256 | ||
| Muscle energy technique of quadratus lumborum muscle trigger points | 257 | ||
| Neuromuscular technique connective tissue approaches for chronic pelvic pain | 257 | ||
| Longitudinal stroke of abdominal wall muscle trigger points | 258 | ||
| Stretching stroke of gluteus medius muscle trigger points | 259 | ||
| Dynamic longitudinal stroke of thoracolumbar extensor muscle trigger points | 260 | ||
| Myofascial induction interventions | 260 | ||
| Introduction to fascial tissue | 260 | ||
| Fascial continuity model | 262 | ||
| Which functional model may link all these requirements? | 262 | ||
| Theoretical aspects for the treatment of myofascial dysfunction syndrome | 263 | ||
| Mechanics of the myofascial dysfunction syndrome | 263 | ||
| Neurophysiological mechanisms for releasing the restrictions of the fascial tissue | 265 | ||
| Therapeutic strategies applied to the myofascial induction process | 266 | ||
| General observations related to the therapeutic process | 266 | ||
| Definition of myofascial induction process | 266 | ||
| Bases for clinical applications | 266 | ||
| General observations (Pilat 2003, 2010) | 266 | ||
| Clinical procedure principles (Pilat 2003, 2007a, 2009, 2010) | 266 | ||
| Examples of clinical applications | 267 | ||
| Transverse plane induction of the pelvic region (Figure 11.1.36) | 267 | ||
| Lumbosacral induction | 267 | ||
| Induction of the pubic region | 267 | ||
| Cross-hand induction of the lumbar spine (Figure 11.1.40) | 268 | ||
| Cross-hand induction of the abdominal fascia (Figure 11.1.41) | 268 | ||
| Lower induction of the thoracolumbar fascia (Figure 11.1.42) | 268 | ||
| Cross-hand induction of the thoracolumbar and gluteal fascia (Figure 11.1.43) | 268 | ||
| Quadratus lumborum fascia induction (Figure 11.1.44) | 269 | ||
| Paravertebral muscles fascia induction (Figure 11.1.45) | 269 | ||
| References | 270 | ||
| Chapter 11.2: Connective tissue and the pudendal nerve in chronic pelvic pain | 275 | ||
| Connective tissue dysfunction in chronic pelvic pain | 275 | ||
| Mechanisms of development of subcutaneous panniculosis | 276 | ||
| Viscerosomatic reflex | 276 | ||
| Superficial to muscles with myofascial trigger points | 277 | ||
| Dermatomes of inflamed neural structures | 277 | ||
| Superficial to areas of joint dysfunction | 277 | ||
| Connective tissue restrictions and altered neural dynamics | 278 | ||
| Efficacy of connective tissue mobilization | 279 | ||
| Connective tissue manipulation | 279 | ||
| Evaluation | 280 | ||
| Treatment | 280 | ||
| Patient response | 280 | ||
| Tissue response | 281 | ||
| Special considerations | 281 | ||
| Goals | 281 | ||
| Contraindications (Goats & Keir 1991) | 281 | ||
| The pudendal nerve in chronic pelvic pain | 281 | ||
| Pudendal neuralgia | 282 | ||
| Pudendal nerve entrapment | 284 | ||
| Possible consequences of pudendal neuralgia | 284 | ||
| Symptoms | 285 | ||
| Evaluation | 285 | ||
| Treatment | 286 | ||
| Neural mobilization | 286 | ||
| Bridging | 286 | ||
| Prone with hip internal rotation | 286 | ||
| Clinical response | 287 | ||
| Patient response | 287 | ||
| Home exercise programme | 287 | ||
| Special considerations | 287 | ||
| Case study 11.2.1 | 287 | ||
| References | 288 | ||
| Chapter 12: Evaluation and pelvic floor management of urologic chronic pelvic pain syndromes | 291 | ||
| Introduction | 291 | ||
| Urologic diagnostic evaluation | 292 | ||
| Prostate pain syndrome | 292 | ||
| Medical history | 292 | ||
| Physical examination | 293 | ||
| Imaging of the prostate in chronic prostatitis | 294 | ||
| Cystoscopy | 295 | ||
| Urodynamics | 295 | ||
| Isolated male orchalgia (pain in the testicles) | 295 | ||
| Pudendal nerve entrapment (pudendal neuralgia) | 296 | ||
| Bladder pain syndrome | 296 | ||
| Medical assessment | 297 | ||
| Neuromuscular treatment | 297 | ||
| Neuromuscular basis for therapy | 297 | ||
| Progress of discovery and understanding of chronic pain syndromes and myofascial trigger points | 298 | ||
| Wise-Anderson Stanford Protocol | 300 | ||
| Painful TrPs, areas of restriction and associated pain location | 303 | ||
| The personal therapeutic wand for chronic pelvic pain | 305 | ||
| Paradoxical relaxation | 305 | ||
| References | 309 | ||
| Chapter 13: Practical anatomy, examination, palpation and manual therapy release techniques for the pelvic floor | 311 | ||
| Chapter 14: Patients with pelvic girdle pain... | 339 | ||
| Introduction | 339 | ||
| Biomechanical model | 343 | ||
| Osteopathic manipulative treatment options | 345 | ||
| Respiratory-circulatory model | 347 | ||
| Neurological model | 348 | ||
| Metabolic energy model | 349 | ||
| Behavioural model | 349 | ||
| Case study 14.1: Male | 350 | ||
| Case study 14.2: Female | 353 | ||
| Home exercise programme | 354 | ||
| Exercise regimens and therapeutic options | 355 | ||
| Conclusion | 357 | ||
| References | 357 | ||
| Chapter 15: Intramuscular manual therapy... | 363 | ||
| Introduction | 363 | ||
| Acupuncture | 364 | ||
| Trigger points | 364 | ||
| Sham needling | 365 | ||
| Evidence of intramuscular manual therapy | 365 | ||
| General guidelines | 367 | ||
| Low back and hip muscles | 367 | ||
| Quadratus lumborum muscle | 367 | ||
| Chapter 16: Electrotherapy and hydrotherapy in chronic pelvic pain | 377 | ||
| Introduction | 378 | ||
| Goals of hydrotherapy and electrotherapy treatment in chronic pelvic pain | 378 | ||
| Modalities | 378 | ||
| Electrotherapy | 378 | ||
| Electrogalvanic and iontophoresis | 378 | ||
| Mechanism of action and physiological effects | 378 | ||
| Safety and contraindications | 379 | ||
| Galvanic current and levator ani syndrome | 379 | ||
| Galvanic iontophoresis | 379 | ||
| Additional naturopathic indications | 379 | ||
| Low-voltage electrical stimulation | 379 | ||
| Mechanism of action and physiological effects | 380 | ||
| Safety and contraindications | 380 | ||
| Indications | 380 | ||
| Intravaginal electrical stimulation in chronic pelvic pain | 380 | ||
| Transcutaneous electrical nerve stimulation | 380 | ||
| TENS in the symptomatic management of chronic pelvic pain | 381 | ||
| Electroacupuncture | 381 | ||
| Electroacupuncture relieves pain in chronic prostatitis/chronic pelvic pain | 381 | ||
| Percutaneous tibial nerve stimulation | 381 | ||
| Posterior tibial nerve stimulation in chronic prostatitis/chronic pelvic pain | 382 | ||
| Magnetic and pulsed electromagnetic therapy | 382 | ||
| Indications | 382 | ||
| Magnetic therapy for stress incontinence | 382 | ||
| Diathermy and inductothermy | 383 | ||
| Mechanism of action of shortwave diathermy | 383 | ||
| Thermal effects | 383 | ||
| Athermal effects | 383 | ||
| Safety and contraindications | 384 | ||
| Diathermy indications | 384 | ||
| Pulsed short-wave indications | 384 | ||
| Ultrasound | 384 | ||
| Appendix: Clinical outcomemeasurement tools | 395 | ||
| The Stanford Pelvic Pain Symptom Score (PPSS) for men (Stanford) | 408 | ||
| NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) | 409 | ||
| Female questionnaire | 411 | ||
| Female Sexual Function Index (FSFI) | 413 | ||
| FSFI scoring appendix | 416 | ||
| FSFI domain scores and full scale score | 419 | ||
| Female Sexual Distress Scale | 420 | ||
| Vulvar pain functional questionnaire (V-Q) | 423 | ||
| Nijmegen questionnaire | 425 | ||
| The self-evaluation of breathing questionnaire | 426 | ||
| Description of pelvic girdle pain tests (Vleeming et al. 2008) | 427 | ||
| Active straight leg raise test | 427 | ||
| Gaenslen's test | 427 | ||
| Long dorsal sacroiliac ligament (LDL) test | 427 | ||
| The LDL test in postpartum women | 427 | ||
| The LDL test in pregnant women | 427 | ||
| Pain provocation of the symphysis by modified Trendelenburg's test | 427 | ||
| Patrick's Faber test | 427 | ||
| Posterior pelvic pain provocation test | 427 | ||
| Symphysis pain palpation test | 427 | ||
| References | 428 | ||
| Index | 429 |