Trigger Point Injections
Pelvic pain caused by trigger points can be treated with physical therapy approaches or, when necessary, injections to relieve pain.
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.
Trigger Point Injections
If physical therapy doesn’t effectively reduce pain, trigger point injections may offer effective pain relief. A mixture of a numbing medication (anesthetic) and an anti-inflammatory (steroid) medication is injected in the tender muscles in the pelvic floor. A total of four injections are given over four weeks.
These injections are given by Medical College of Wisconsin physician Sumana Koduri, MD, a urogynecologist, of the Women’s Incontinence and Sexual Health (WISH) Program at Froedtert & the Medical College of Wisconsin.
During the procedure, the physical therapist helps guide the physician to the site of the trigger point. Patients may receive mild sedation before receiving the injection.
After each injection, when the muscle is numb, the physical therapist is able provide more intense manipulation of the tender muscle. The anesthetic makes it possible to stretch the sore muscle or group of muscles more without hurting the patient.
In most cases, trigger point injections reduce the pain. The amount of relief obtained from the injections varies from person to person and may last from a few weeks to a few months.