The first step in treating pain caused by pelvic trigger points is physical therapy. Beth Malak, MPT, BCIA-PMDB, a physical therapist at Froedtert Hospital, specializes in therapy that targets sensitive sites of the pelvis to relieve muscle pain.

Physical therapy includes:

  • Patient education — patients learn about the pelvic muscles, how they work and where they are attached.
  • A physical assessment of a patient’s pelvic muscles.
  • Muscle stretching and relaxation exercises
  • Biofeedback — technique to test the pelvic floor muscles. Biofeedback helps a person gain awareness and control of the pelvic muscles to help relax the muscles when there is pain in that region. Electrodes (small pads placed on the skin) or patient-inserted internal sensors are used to “feed back” information about the activity in the pelvic muscles at rest and during exercise. The sensor or electrodes are attached to a device that shows information about pelvic muscle activity on a screen, so the patient and physical therapist can see how the muscles are actually working. This information can then be used to promote easier relaxation of the muscles.

If biofeedback and stretching don’t succeed in resolving pain after three to five sessions, the physical therapist will look more specifically at where the pain is. There are many muscles in the pelvic floor that interact with the hips and lower back. The therapist will assess the patient’s hips and back as they move to determine the exact site of the pain.

The next step in treatment is called soft tissue mobilization, a type of internal massage of the affected muscle. If this proves helpful, Malak will continue to provide this therapy. If the pain doesn’t improve after about five visits, however, the next step is trigger point injections.