Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain

Abstract

Background: Pelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain.

Objective: The purpose of this study was to develop a simple, reproducible pelvic floor examination to screen for pelvic floor myofascial pain.

Study design: A screening examination was developed by Female Pelvic Medicine & Reconstructive Surgery subspecialists and women's health physical therapists at our institution and tested in a simulated patient. We recruited 35 new patients who underwent examinations by blinded, paired, independent examiners. Agreement was calculated with the use of percent agreement and Spearman's rank correlation coefficient.

Results: The final examination protocol begins with examination of the following external sites: bilateral sacroiliac joints, medial edge of the anterior superior iliac spine, and cephalad edge of the pubic symphysis (self-reported pain: yes/no). The internal examination follows with palpation of each muscle group in the center of the muscle belly, then along the length of the muscle proceeding counter-clockwise: right obturator internus, right levator ani, left levator ani, left obturator internus (pain on a scale of 0-10). Thirty-five patients were enrolled. Correlation was high at each external (0.80-0.89) and internal point (0.63-0.87; P<.0001).

Conclusion: Our newly developed, standardized, reproducible examination incorporates assessment of internal and external points to screen for pelvic floor myofascial pain. The examination is straightforward and reproducible and allows for easy use in clinical practice.

Keywords: myofascial pain; pelvic pain; trigger point.

Conflict of interest statement

FINANCIAL DISCLAIMER/CONFLICT OF INTEREST: NONE

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure 1.

Method of internal palpation. Internal palpation is performed with the index finger of the dominant hand, once in the center of the muscle belly, then in a sweeping motion along the length of the muscle in the direction of the orientation of that muscle and proceeds counter-clockwise: right obturator internus (OI; 1a), right levator ani (LA; 1b), left LA, and then left OI. Illustration used with permission of Ms. Marie Sena.

Figure 1.

Method of internal palpation. Internal palpation is performed with the index finger of the dominant hand, once in the center of the muscle belly, then in a sweeping motion along the length of the muscle in the direction of the orientation of that muscle and proceeds counter-clockwise: right obturator internus (OI; 1a), right levator ani (LA; 1b), left LA, and then left OI. Illustration used with permission of Ms. Marie Sena.