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Jerry L. Lowder - One of the best experts on this subject based on the ideXlab platform.
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Pelvic floor Myofascial Pain severity and pelvic floor disorder symptom bother: is there a correlation?
American Journal of Obstetrics and Gynecology, 2019Co-Authors: Melanie R. Meister, Siobhan Sutcliffe, Asante Badu, Chiara Ghetti, Jerry L. LowderAbstract:Background Pelvic floor Myofascial Pain, which is predominantly identified in the muscles of the levator ani and obturator internus, has been observed in women with chronic pelvic Pain and other pelvic floor disorder symptoms, and is hypothesized to contribute to their symptoms. Objectives To describe the prevalence of pelvic floor Myofascial Pain in patients presenting with pelvic floor disorder symptoms and to investigate whether severity of pelvic floor Myofascial Pain on examination correlates with degree of pelvic floor disorder symptom bother. Study Design All new patients seen at 1 tertiary referral center between 2014 and 2016 were included in this retrospectively assembled cross-sectional study. Pelvic floor Myofascial Pain was determined by transvaginal palpation of the bilateral obturator internus and levator ani muscles and scored as a discrete number on an 11-point verbal Pain rating scale (range, 0–10) at each site. Scores were categorized as none (0), mild (1–3), moderate (4–6), and severe (7–10) for each site. Pelvic floor disorder symptom bother was assessed by the Pelvic Floor Distress Inventory short form scores. The correlation between these 2 measures was calculated using Spearman rank and partial rank correlation coefficients. Results A total of 912 new patients were evaluated. After exclusion of 79 with an acute urinary tract infection, 833 patients were included in the final analysis. Pelvic floor Myofascial Pain (Pain rated >0 in any muscle group) was identified in 85.0% of patients: 50.4% rated as severe, 25.0% moderate, and 9.6% mild. In unadjusted analyses and those adjusted for postmenopausal status, severity of pelvic floor Myofascial Pain was significantly correlated with subjective prolapse symptoms such as pelvic pressure and heaviness but not with objective prolapse symptoms (seeing or feeling a vaginal bulge or having to push up on a bulge to start or complete urination) or leading edge. Severity of Myofascial Pain at several individual pelvic floor sites was also independently correlated with lower urinary tract symptoms, including Pain in the lower abdomen (Myofascial Pain at all sites) and difficulty emptying the bladder (right obturator internus and left levator ani); and with defecatory dysfunction, including sensation of incomplete rectal emptying (Pain at all sites combined and the right obturator internus), anal incontinence to flatus (Pain at all sites combined), and Pain with defecation (Pain at all sites combined, and the right obturator internus and left levator ani). Conclusion Pelvic floor Myofascial Pain was common in patients seeking evaluation for pelvic floor disorder symptoms. Location and severity of pelvic floor Myofascial Pain was significantly correlated with degree of symptom bother, even after controlling for postmenopausal status. Given the high prevalence of pelvic floor Myofascial Pain in these patients and correlation between Pain severity and degree of symptom bother, a routine assessment for pelvic floor Myofascial Pain should be considered for all patients presenting for evaluation of pelvic floor symptoms.
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Physical examination techniques for the assessment of pelvic floor Myofascial Pain: a systematic review
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Melanie R. Meister, Nishkala Shivakumar, Siobhan Sutcliffe, Theresa Spitznagle, Jerry L. LowderAbstract:Background Myofascial Pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred Pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor Myofascial Pain in the absence of local or referred Pain has also been observed in patients with lower urinary tract symptoms, and we have found that many patients report an improvement in these symptoms after receiving Myofascial-targeted pelvic floor physical therapy. Objective We sought to systematically review the literature for examination techniques used to assess pelvic floor Myofascial Pain in women. Study Design We performed a systematic literature search using strategies for the concepts of pelvic floor disorders, Myofascial Pain, and diagnosis in Ovid MEDLINE 1946-, Embase 1947-, Scopus 1960-, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Database of Systematic Reviews. Articles were screened by 3 authors and included if they contained a description of a pelvic Myofascial physical examination. Results In all, 55 studies met our inclusion criteria. Overall, examination components varied significantly among the included studies and were frequently undefined. A consensus examination guideline was developed based on the available data and includes use of a single digit (62%, 34/55) to perform transvaginal palpation (75%, 41/55) of the levator ani (87%, 48/55) and obturator internus (45%, 25/55) muscles with a patient-reported scale to assess the level of Pain to palpation (51%, 28/55). Conclusion Physical examination methods to evaluate pelvic musculature for presence of Myofascial Pain varied significantly and were often undefined. Given the known role of pelvic floor Myofascial Pain in chronic pelvic Pain and link between pelvic floor Myofascial Pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor Myofascial Pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.
Melanie R. Meister - One of the best experts on this subject based on the ideXlab platform.
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Pelvic floor Myofascial Pain severity and pelvic floor disorder symptom bother: is there a correlation?
American Journal of Obstetrics and Gynecology, 2019Co-Authors: Melanie R. Meister, Siobhan Sutcliffe, Asante Badu, Chiara Ghetti, Jerry L. LowderAbstract:Background Pelvic floor Myofascial Pain, which is predominantly identified in the muscles of the levator ani and obturator internus, has been observed in women with chronic pelvic Pain and other pelvic floor disorder symptoms, and is hypothesized to contribute to their symptoms. Objectives To describe the prevalence of pelvic floor Myofascial Pain in patients presenting with pelvic floor disorder symptoms and to investigate whether severity of pelvic floor Myofascial Pain on examination correlates with degree of pelvic floor disorder symptom bother. Study Design All new patients seen at 1 tertiary referral center between 2014 and 2016 were included in this retrospectively assembled cross-sectional study. Pelvic floor Myofascial Pain was determined by transvaginal palpation of the bilateral obturator internus and levator ani muscles and scored as a discrete number on an 11-point verbal Pain rating scale (range, 0–10) at each site. Scores were categorized as none (0), mild (1–3), moderate (4–6), and severe (7–10) for each site. Pelvic floor disorder symptom bother was assessed by the Pelvic Floor Distress Inventory short form scores. The correlation between these 2 measures was calculated using Spearman rank and partial rank correlation coefficients. Results A total of 912 new patients were evaluated. After exclusion of 79 with an acute urinary tract infection, 833 patients were included in the final analysis. Pelvic floor Myofascial Pain (Pain rated >0 in any muscle group) was identified in 85.0% of patients: 50.4% rated as severe, 25.0% moderate, and 9.6% mild. In unadjusted analyses and those adjusted for postmenopausal status, severity of pelvic floor Myofascial Pain was significantly correlated with subjective prolapse symptoms such as pelvic pressure and heaviness but not with objective prolapse symptoms (seeing or feeling a vaginal bulge or having to push up on a bulge to start or complete urination) or leading edge. Severity of Myofascial Pain at several individual pelvic floor sites was also independently correlated with lower urinary tract symptoms, including Pain in the lower abdomen (Myofascial Pain at all sites) and difficulty emptying the bladder (right obturator internus and left levator ani); and with defecatory dysfunction, including sensation of incomplete rectal emptying (Pain at all sites combined and the right obturator internus), anal incontinence to flatus (Pain at all sites combined), and Pain with defecation (Pain at all sites combined, and the right obturator internus and left levator ani). Conclusion Pelvic floor Myofascial Pain was common in patients seeking evaluation for pelvic floor disorder symptoms. Location and severity of pelvic floor Myofascial Pain was significantly correlated with degree of symptom bother, even after controlling for postmenopausal status. Given the high prevalence of pelvic floor Myofascial Pain in these patients and correlation between Pain severity and degree of symptom bother, a routine assessment for pelvic floor Myofascial Pain should be considered for all patients presenting for evaluation of pelvic floor symptoms.
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Physical examination techniques for the assessment of pelvic floor Myofascial Pain: a systematic review
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Melanie R. Meister, Nishkala Shivakumar, Siobhan Sutcliffe, Theresa Spitznagle, Jerry L. LowderAbstract:Background Myofascial Pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred Pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor Myofascial Pain in the absence of local or referred Pain has also been observed in patients with lower urinary tract symptoms, and we have found that many patients report an improvement in these symptoms after receiving Myofascial-targeted pelvic floor physical therapy. Objective We sought to systematically review the literature for examination techniques used to assess pelvic floor Myofascial Pain in women. Study Design We performed a systematic literature search using strategies for the concepts of pelvic floor disorders, Myofascial Pain, and diagnosis in Ovid MEDLINE 1946-, Embase 1947-, Scopus 1960-, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Database of Systematic Reviews. Articles were screened by 3 authors and included if they contained a description of a pelvic Myofascial physical examination. Results In all, 55 studies met our inclusion criteria. Overall, examination components varied significantly among the included studies and were frequently undefined. A consensus examination guideline was developed based on the available data and includes use of a single digit (62%, 34/55) to perform transvaginal palpation (75%, 41/55) of the levator ani (87%, 48/55) and obturator internus (45%, 25/55) muscles with a patient-reported scale to assess the level of Pain to palpation (51%, 28/55). Conclusion Physical examination methods to evaluate pelvic musculature for presence of Myofascial Pain varied significantly and were often undefined. Given the known role of pelvic floor Myofascial Pain in chronic pelvic Pain and link between pelvic floor Myofascial Pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor Myofascial Pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.
Stuart Hart - One of the best experts on this subject based on the ideXlab platform.
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Myofascial Pain and pelvic floor dysfunction in patients with interstitial cystitis
International Urogynecology Journal, 2011Co-Authors: Renee Bassaly, Natalie Tidwell, Siobhan Bertolino, Lennox Hoyte, Katheryne Downes, Stuart HartAbstract:Introduction and hypothesis The objectives of this study are to investigate Myofascial Pain in patients with interstitial cystitis (IC) and to correlate Myofascial exam findings with validated questionnaires.
Anthony H Wheeler - One of the best experts on this subject based on the ideXlab platform.
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Myofascial Pain disorders theory to therapy
Drugs, 2004Co-Authors: Anthony H WheelerAbstract:Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and actuates movement against inertia. Muscular injury can occur when soft tissues are exposed to single or recurrent episodes of biomechanical overloading. Muscular Pain is often attributed to a Myofascial Pain disorder, a condition originally described by Drs Janet Travell and David Simons. Among patients seeking treatment from a variety of medical specialists, Myofascial Pain has been reported to vary from 30% to 93% depending on the subspecialty practice and setting. Forty-four million Americans are estimated to have Myofascial Pain; however, controversy exists between medical specialists regarding the diagnostic criteria for Myofascial Pain disorders and their existence as a pathological entity.
Nan-ying Yu - One of the best experts on this subject based on the ideXlab platform.
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Multi-Scale Surface Electromyography Modeling to Identify Changes in Neuromuscular Activation With Myofascial Pain
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2013Co-Authors: Ching-fen Jiang, Nan-ying YuAbstract:To solve the limitations in using the conventional parametric measures to define Myofascial Pain, a 3-D multi-scale wavelet energy variation graph is proposed as a way to inspect the pattern of surface electromyography (SEMG) variation between the dominant and nondominant sides at different frequency scales during a muscle contraction cycle and the associated changes with the upper-back Myofascial Pain. The model was developed based on the property of the wavelet energy of the SEMG signal revealing the degree of correspondence between the shape of the motor unit action potential and the wavelet waveform at a certain scale in terms of the frequency band. The characteristic pattern of the graph for each group (30 normal and 26 patient subjects) was first derived and revealed the dominant-hand effect and the changes with Myofascial Pain. Through comparison of individual graphs across subjects, we found that the graph pattern reveals a sensitivity of 53.85% at a specificity of 83.33% in the identification of Myofascial Pain. The changes in these patterns provide insight into the transformation between different fiber recruitment, which cannot be explored using conventional SEMG features. Therefore, this multi-scale analysis model could provide a reliable SEMG features to identify Myofascial Pain.
