PTNarrative ReviewPM & R : the journal of injury, function, and rehabilitation2019

A Narrative Review of Musculoskeletal Impairments Associated With Nonspecific Chronic Pelvic Pain.

Marcie Harris-Hayes, Theresa Spitznagle, Daniel Probst and 2 others

PMID 31233286

WHAT IT FOUND

Musculoskeletal impairments like high pelvic floor tone and poor movement are present in women with chronic pelvic pain, but evidence linking them to the pain is weak.

Studies used subjective tests with poor reliability, so these findings do not yet justify specific treatments.

Key findings

01Elevated resting pelvic floor muscle activity was reported in most studies, but the criteria for defining 'elevated' varied widely and included controls with similar scores, making the finding unreliable.

02Postural and movement impairments were frequently observed in patients with chronic pelvic pain, but differences from asymptomatic controls were inconsistent and assessed using subjective methods without blinding.

03The review authors conclude they cannot make strong recommendations regarding the relationship between musculoskeletal impairments and chronic pelvic pain due to low-quality evidence and methodological flaws.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

All included studies exclusively recruited women, so findings do not apply to men with CPP. Sample sizes were small (12-108 participants). Measurement tools were often subjective (e.g., digital palpation) with poor or unreported reliability. Study designs were low level (cross-sectional, case-control), limiting causal inference. Inclusion/exclusion criteria for CPP varied significantly across studies, creating heterogeneity.

Declared interests

The research was supported by the National Institutes of Health (Extramural). No other conflicts of interest are reported in the provided text.

The easy way to misread this

Do not assume that elevated pelvic floor tone or postural deviations are the cause of chronic pelvic pain. The review found that asymptomatic controls also frequently met criteria for these impairments, and the tests used were subjective and unreliable.

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