Anyone who has experienced pelvic pain and migraine headaches can attest to the fact that pelvic pain can rival even the most intense migraine headache. A well-known book about pelvic pain entitled “A Headache in the Pelvis” (Wise, Anderson) draws other similarities between headaches and pelvic pain, such as the phenomenon of referred pain. In simple terms, referred pain is the result of a confused and oversensitive nervous system. Many times referred pain is a product of myofascial trigger points (taut muscle “knots”). When muscles refer to the head or pelvis, it can be hard to achieve lasting results when treating only the perceived area of pain. In these cases, it is important to treat the bigger muscles around the pelvis that possess a greater capability to refer pain. In respect to pelvic pain, this can include examining and treating the following muscles:
- The inner thigh muscles, including the adductor magnus, longus, and brevis muscles contains a fascial connection into the pelvic floor and are often involved in pelvic pain symptoms including vaginismus, endometriosis, painful intercourse, and pudendal neuralgia.
- The quadratus lumborum muscles are located on the side of the lower back. The muscle is often tender in patients with pelvic pain and can in fact refer pain and other sensations to the pelvis
- The abdominal oblique muscles have a fascial connection that can be traced into the spermatic cord and one of the leg muscles (sartorius muscle), which mimics the established referred pain pattern of the muscle
- The rectus abdominis muscle, aka the “six-pack” muscle, needs to be examined with patients in pelvic pain, particularly the lower fibers for patients with bladder symptoms and testicular pain.
- The hamstrings muscles, particularly the most proximal portion right up near the sitz bone, often features tight and ropey contractures that can mimic pelvic pain symptoms.
Addressing the referred pain can be a key component of pelvic health physical therapy. Many times this will eliminate the need to treat the smaller muscles in the pelvic floor. At the very least it will drastically reduce the sensitivity, allowing more tolerable internal treatment of the pelvic girdle.