Characterizing Chronic Pelvic Pain: The Relationship between Extra pelvic Muscle Stiffness, Pain Level, Health History and Pelvic Floor Symptoms in Women with Chronic Pelvic Pain

Proulx L, Brilara B, Thompson K, Price SW, Rodriguez P and Koppenhaver S

Published on: 2023-05-02

Abstract

Background: Chronic pelvic pain (CPP) presents with numerous body system impairments including increased extra pelvic muscle stiffness. Effective treatment is delayed due to a lack of impairment prioritization or sub classification. Although muscle stiffness is routinely treated, its association with clinical impairments is unknown in women with CPP.

Objective: To assess the association of extra pelvic muscular stiffness measures with pelvic floor symptoms and other clinical impairments in a cohort of women with CPP. In addition to bivariate correlations, exploratory factor analysis (EFA) was used to identify multivariate clinical presentation patterns of CPP.

Study Design: Cross-sectional

Methods: Muscle stiffness measurements of 11 extra pelvic muscles were taken in 149 women with CPP. Associations between muscle stiffness measurements and clinical measures such as pelvic floor function, pain, psychosocial status, and uro-gynecology history were calculated. Additionally, variables were assessed using EFA to identify patterns of CPP.

Results: There were small but significant correlations between muscle stiffness measurements and clinical measures. Three categorizations of CPP symptoms and impairments emerged from the 25 continuous variables chosen for EFA. These could be classified as: 1) pelvic floor dysfunction and psychosocial involvement, 2) muscle stiffness of the hips and thighs, and 3) muscle stiffness of the low back and abdomen; collectively, making up 49.1% of the variance.

Conclusion: Stiffness of commonly treated extra pelvic muscles was not strongly correlated to overall self-report pain level or health history of women with CPP. The first EFA component is consistent with patients routinely seen by pelvic health physical therapists and the latter components are consistent with those who may benefit from orthopedic physical therapy