Myofascial pelvic pain syndrome (MPPS) or myofascial pelvic pain (MPP) is a disorder of the muscles and fascia (connective tissue) found within the pelvic floor. These muscles are typically short, tight, tender, inflexible, or poorly coordinated.

This condition creates chronic pelvic pain and referred pain to other areas of the body. Just like with general myofascial pain, a major indicator of myofascial pelvic pain syndrome is the presence of trigger points—which are areas of hypersensitivity within the muscle tissue.

Trigger points are areas of tight muscle tissue that, when touched, can create intense pain that may be referred to other areas of the body. They are often described as “knots” or “lumps.”

In addition to trigger points and chronic pain, myofascial pelvic pain syndrome can create a number of other symptoms that can vary from person to person, such as the following:

• Incontinence
• Interstitial cystitis
• Constipation
• IBS
• Muscle spasms
• Pain with sex
• Coccydynia
• Worsened pain in other conditions such as endometriosis
• And more

The pelvic floor holds many important jobs, such as supporting the hips and spine, controlling urination, allowing for bowel movements, and providing sexual function and appreciation.

The pelvic floor muscles are very interconnected with the entire body, so problems with the pelvic floor can lead to problems with the abdominals, hips, pelvis, tailbone, and lower back.

Additionally, other conditions can be present simultaneously with myofascial pelvic pain syndrome, so identifying this condition and the cause of your pain can prove to be a challenge.

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Pain and other symptoms of myofascial pelvic pain syndrome occur when the muscles and fascia of the pelvic floor become tight, short, and tender.

These tightened muscles are inflexible and less mobile, which in turn affects other connected parts of the body mentioned previously. This is why chronic pain may be felt in many areas of the pelvis, in addition to the effects of referred pain caused by trigger points.

What causes these muscles and fascia to become tight? The answer is actually many different things. Poor posture, past injuries or trauma, repetitive movements, pregnancy and childbirth, and other conditions of the pelvic floor.

All of these possibilities are things that cause excess or repeated strain on the muscles, causing them to become strained, tight, and inflexible.

Finding a root cause of myofascial pelvic pain can be difficult. There are many problems that can occur with the pelvic floor and these symptoms often overlap with myofascial pelvic pain syndrome; therefore, it unfortunately goes undiagnosed or misdiagnosed in many cases.

While other conditions are able to be present alongside myofascial pelvic pain, treating those other conditions does not necessarily treat MPPS or ease the trigger points.

Unfortunately, there are no tests, ultrasounds or anything of the sort that can easily identify myofascial pelvic pain syndrome. It is a diagnosis based on physical examination, a discussion of your symptoms, and ruling out other testable conditions.

Although myofascial pelvic pain syndrome can be difficult to diagnose or understand, the good news is that it is treatable!

Pelvic floor physical therapy is one of the best ways to address myofascial pelvic pain syndrome. Pelvic floor therapists are experts of the pelvic floor, and are able to identify areas of tightness or tenderness.

Your pelvic floor physical therapist will examine your pelvic floor, hips, abdominals, and lower back to gain a better idea of any muscle imbalances in these areas. Based on their examinations and your symptoms, they will create a comprehensive plan of care catered to your unique needs!

Addressing these tight muscles involves treatment that promotes relaxation, restores function, and increases coordination of the pelvic floor. Your physical therapist will also work to eliminate behaviors that may cause further strain on your pelvis.

Let’s take a look at some methods that your pelvic floor physical therapist at Hive may use to address myofascial pelvic pain!

Oftentimes, tight pelvic floor muscles have tension, sensitivity, and tenderness from overuse and strain. To reduce your tension and pain, your pelvic floor physical therapist will help you relearn how to utilize your pelvic floor muscles efficiently, as well as teach you relaxation techniques to reduce strain and relieve pain in the pelvis.

Typically, the pelvic floor muscles are able to contract and relax as needed to allow for functions such as urination and defecation. With myofascial pelvic pain syndrome, these muscles are likely overactive and unable to relax properly (which can contribute to pain, constipation, painful sex, and more).

Additionally, these muscles can be weak and unable to coordinate together to allow for relaxation and contraction when needed, which can create many other symptoms (incontinence, pain, and more).

Therefore, your pelvic floor therapist will use neuromuscular re-education and biofeedback treatments to help you feel and gain an understanding of your pelvic floor muscles—and how to control contraction and relaxation effectively once again.

To address the pain, tightness, and trigger points found throughout the muscles, your pelvic floor therapist will utilize manual therapies to encourage relaxation and mobility of those muscles.

Manipulation and massage of the tight tissues, fascia, trigger points, and nerves will encourage better flexibility, reduce tension, and relieve pain.

Treatment at Hive Therapy and Wellness doesn’t just stop there. Not only do we want you to feel amazing when you finish treatment, but we want you to stay healthy long-term!

This means your treatment will incorporate preventative strategies and education that aims to prevent your myofascial pelvic pain from resurfacing in the future.

This preventative treatment involves a variety of behavioral modifications and exercises for you to practice at home:

• Your pelvic floor therapist will correct your posture to reduce strain and pressure on your pelvis. This can include all postures—standing, sitting, and restroom/toilet posture.
• To address muscle imbalances that can put strain on the pelvis and related areas (hips, lower back, etc.), your physical therapist will curate an exercise routine for your individual needs.
• If you play sports or perform repetitive movements in your career, your physical therapist can optimize your posture and movement mechanics to prevent injury or muscle strain, which can lead to myofascial pain.

There are many treatments that can be utilized to relieve your pain and reduce symptoms of myofascial pelvic pain syndrome.

The physical therapists at Hive are dedicated to creating individualized care experiences for each of their patients—meaning your care plan is customized and holistic, made up of treatments that best suit your needs and health goals.

To best provide you with a comprehensive and effective care experience, the physical therapists at Hive Therapy and Wellness may utilize any of the following treatments in your care plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback