Trigger Point Injections Followed by Immediate Myofascial Release in the Treatment of Pelvic Floor Tension Myalgia

Abstract

<h3>Study Objective</h3> To determine whether adding pelvic floor physical therapy (PFPT) with myofascial release immediately following pelvic floor trigger point injection (PFTPI) provides better pain relief than pelvic floor trigger point injection alone. <h3>Design</h3> A retrospective chart review of patients with pelvic floor tension myalgia refractive to conservative treatment (physical therapy and muscle relaxants) who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analogue scale (VAS) pain scores were recorded pre-treatment and 2 weeks post treatment. <h3>Setting</h3> Academic tertiary care center. <h3>Patients or Participants</h3> Female patients being treated for pelvic floor tension myalgia. <h3>Interventions</h3> Trigger point injections using 20 mL Ropivacaine 5 mg/mL (0.5 %) with or without addition of pelvic floor physical therapy with myofascial release for myofascial pelvic pain within 1-2 hours after injection. <h3>Measurements and Main Results</h3> Sixty-five patients with pelvic floor tension myalgia refractive to primary therapy and proceeding to PFTPI were included in the final study analysis. Twenty-two patients underwent trigger point injections alone and Forty-three patients underwent PFTPI immediately followed by PFPT. Demographic and clinical characteristics were comparable between groups. PFTPI improved VAS pain scores for both groups of patients. The median pre-treatment score was 8 for both groups of patients. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, giving a median change in VAS score of 2 and 4 respectively (p=0.057). 74.5% of patients in the PFTPI followed by PFPT group had a change in VAS score greater than 2; whilst 45.4% of patients in the PFTPI only group had a change in VAS score greater than 2 (p=0.029). <h3>Conclusion</h3> Pelvic floor trigger point injection immediately followed by pelvic floor physical therapy with myofascial release seems to offer more improvement in pain for patients with pelvic floor tension myalgia. This may be due to tolerance of deeper physical therapy immediately following injections.