Unexplained Pelvic Pain Treatment

With the abdomen and the pelvic floor hosting the digestive, reproductive and urinary system, experiencing pelvic pain can be quite scary.

There are numerous conditions that can cause pelvic pain including soft tissue related presentations.

In this blog post we’ll be talking about unexplained pelvic pain, or persistent pelvic pain that seems to have no medical explanation after a thorough doctor’s check up. We’ll also look at the treatment approach that we use at our INSIDE Brighton & Hove based clinic.

Unexplained pelvic pain is usually caused by musculoskeletal or soft tissue presentations or imbalances. There is A LOT! going on in that part of the body as we will discover in this article.

Let’s first of all take a look at the musculoskeletal system and how it works, this will help us understand pelvic pain and will provide reassurance and clarity on how to take action.

Understanding the musculoskeletal system

The musculoskeletal system in our body operates as a tensegrity structure, where the integrity of the structure comes from a balance between tensional and compressional forces.

The key components of this system are:

Tensional forces: Created by muscles, tendons, and fascia that pull and create tension throughout the body
Compressional forces: Primarily handled by bones that push and resist compression

At the core of this system is the myofascial tissue – a continuous spider web-like connective tissue that forms an interconnected network throughout the body.

This single piece of fabric wraps around muscles, bones, organs, blood vessels and nerves, it goes down to the cellular level.

The myofascial system is highly enervated, possessing more nerve endings than the skin itself, which makes it extremely reactive to both pressure changes and chemical changes in our body.

The myofascial system is deeply interrelated with the brain, both responding to it and constantly updating it.

When the myofascial system is in balance, the tensional-compressional forces work harmoniously to maintain optimal posture and functional movement. However, imbalances can lead to:

Areas of excessive tension in some tissues
Areas of insufficient support in others
Compressed joint spaces
Dysfunctional movement patterns
Compensatory patterns

Understanding the body as a tensegrity structure and the crucial role of the myofascial system is important when we’re trying to either find a solution for musculoskeletal pain or improve its performance.

The Myofascial Lines by Tom Myers

According to Tom Myers’ research, there are 12 distinct myofascial lines in the body:

Superficial Front Line
Superficial Back Line
Lateral Line (two sides)
Spiral Line
Arm Lines (four)
Functional Lines (two – front and back)
Deep Front Line

These lines act as tensile straps and slings within the musculoskeletal system.

The structures (muscles and fascia) that are part of each line are deeply connected. These lines serve as maps for soft tissue therapists and movement therapists to understand imbalances and symptoms.

One of the most crucial lines is the Deep Front Line, which runs from the inner arch of the foot, through the inner thigh, pelvic floor, deep abdominal muscles, and diaphragm, continuing upward through the deep muscles of the neck and head, finally ending inside the mouth.

The deep front line is one of the most relevant ones in understanding pelvic pain.

The Pelvis within the myofascial system

The pelvis plays a crucial role in the body’s tensegrity structure as a major crossover point between the upper and lower body.

Within the myofascial system, it serves as an important meeting point where numerous muscles attach from both upper and lower body, creating multiple pulling vectors in different angles and directions. It’s a busy intersection with high chance of imbalance.

The Deep Front Line mentioned above, as described by Tom Myers, runs through the pelvis as a continuous line of internal muscles and fascia and it plays a vital role in functions such as breathing, swallowing, and stabilising the spine and pelvis.

Within the Deep Front Line, the pelvic region contains several key structures:

The Iliopsoas muscle group – the only muscle that crosses from upper to lower body
The pelvic floor muscles
Deep abdominal muscles

The Deep front line is prone to restrictions and imbalances, especially due to modern lifestyle factors like prolonged sitting. These Myofascial imbalances can cause the activation of Trigger Points.

Trigger Points (TPs) in the Iliopsoas muscle group are often involved in the majority of pelvic pain presentations that we encounter in clinic.

TPs are usually triggered by overload stress, prolonged sitting (worst when hips are acutely flexed) or as a result of compensatory patterns.

Since TPs seem to be linked with pelvic pain in a great number of cases, let’s have a look at what Trigger Points are…

What are Trigger Points

A Trigger Point (TP) is a hyper-irritable spot within a taut band of skeletal muscle that is painful when compressed. Often referred to as “knots”, Trigger Points can be classified into two types:

Active Trigger Points: These actively cause pain and related symptoms.
Latent Trigger Points: These don’t actively cause pain but still affect muscle function and range of motion. They only become painful when compressed and can become active at any time.

Trigger Points can cause two types of pain:

Local Pain: Pain directly at the location of the trigger point
Referred Pain: Pain that is felt in other areas of the body, following predictable patterns (documented by Dr. Janet Travell). These patterns are consistent across different people, allowing therapists to trace symptoms back to their source and provide effective treatment.

As we’ve seen above, TPs in the Iliopsoas muscle group is one of the most common causes of unexplained pelvic pain.

Since it seems to play a major role in pelvic pain, let’s look at the Iliopsoas more in depth…

The Iliopsoas muscle group and its role in pelvic pain

The Iliopsoas is also known in the world of manual therapy as the “hidden prankster” in the sense that it’s involved in many important functions, it often causes trouble and pain and is virtually inaccessible*.

The Iliopsoas muscle group is one of the deepest muscles in the body and consists of two parts:

The psoas: Originates from the lumbar spine (lower back) and runs down through the pelvis onto the leg
The iliacus: Originates from the inner surface of the ilium (hip bone) and joins the psoas in its way to the leg

This muscle group is unique as it’s the only muscle in the body that crosses from upper body to lower body.

The major function of the iliopsoas is the flexion of the thigh at the hip, and plays a significant role in maintaining upright posture. It’s myofascially connected with the diaphragm playing an important role in breathing patterns.

It is also connected to our fight-or-flight response, as it flexes the body into a protective fetal position when stressed.

As we mentioned above, Trigger Points in the Iliopsoas muscle group can cause pain around the lower abdomen and pelvic area as well as refer pain into the lower back, groin and front of the thigh.

*A new concept pilot study that takes MRI imaging while manually accessing the Psoas major shows that we can actually contact this muscle. In this study the peritoneal cavity gives way and slides to the side leaving just 9mm distance between the hand of the therapist and the muscle belly. The study run by an American company specialised on manual therapy and exercise education called “Integrated Movement Health” hasn’t yet been fully disclosed.

What’s the best Treatment Approach for unexplained pelvic pain

Following the Psycho-Socioeconomic model, in our experience effective treatment for pelvic pain requires an approach that includes:

Myofascial release therapy to address tissue restrictions. In our Brighton based clinic we use a combination of Myofascial release with Trigger Point work and advanced stretching together with some other techniques for better results. In our experience results are more effective following a whole body approach to treatment were mind and body are considered with a focus on the nervous system.

Movement re-education and Functional strength training to restore proper movement patterns and address muscle imbalances

Therapy (when needed). Your therapy of choice to address the mind.

As mentioned above, in our experience, the treatment has shown to be more effective when focusing on the entire body as an interconnected system, rather than treating the pelvic area in isolation.

References:

Travell, J.G. and Simons, D.G. (1999). Myofascial pain and dysfunction. Baltimore: Williams & Wilkins.
Myers, T.W. (2009). Anatomy trains : myofascial meridians for manual and movement therapists. Edinburgh ; New York: Elsevier.
Fairweather, R. and Mari, M.S. (2015). Massage fusion : the Jing method for the treatment of chronic pain. Edinburgh: Handspring Publishing.
Ingber, D.E. (2008). Tensegrity-based mechanosensing from macro to micro. Progress in Biophysics and Molecular Biology, 97(2-3), pp.163–179. doi:https://doi.org/10.1016/j.pbiomolbio.2008.02.005.

About the author

Rocio Santiago

MA in Nursing, Dip. Soft Tissue Therapy

Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.

The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.

Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.

Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.