Piriformis Syndrome

PIRIFORMIS SYNDROME

Frequently women with piriformis syndrome will not completely rehabilitate without pelvic floor therapy.

Piriformis syndrome, often called sciatica, is a musculoskeletal problem that involves the piriformis muscle and sciatic nerve when exacerbated. Frequently women with piriformis syndrome will not completely rehabilitate without pelvic floor therapy.

Piriformis syndrome presents as numbness or weakness in the structures neurologically supplied by the sciatic nerve including the gluteal region, posterior thigh, leg, or foot. It can cause pain when walking upstairs, a dull soreness or ache in the buttocks area, increased pain after sitting 15–20 minutes, inability to move the hip, and/or drop foot. 

Women are diagnosed with piriformis syndrome six times more often than men. This ratio can be explained by the wider quadriceps femoris muscle angle in the coxae of women.

Due to the anatomical location of the piriformis, lying deep to the gluteus maximus, pelvic floor therapy is more effective to loosen the piriformis compared to the moist heat or ultrasound modalities used in traditional physical therapy.

Treatment options may include:

• Manual Myofascial Techniques
• Nerve Gliding Manipulations and Exercises
• Neuromuscular Reeducation
• Biofeedback
• Ultrasound
• Therapeutic Exercise

The goal in therapy is to loosen the tension on the piriformis and sciatic nerve to function pain free.

Buttock Pain

BUTTOCK PAIN

Pelvic floor dysfunction is often an overlooked cause of buttock pain in the athlete.

Buttock pain is common amongst female athletes. Buttock pain can result from a variety of issues including muscle-ligament injury, piriformis syndrome, radiculopathy, sacralilliac instability, spondylosis, facet pain, myofascial trigger points, hamstring tendonitis, greater trochanteric pain syndrome, ischial bursitis, ischial femoral impingement, coccydynia, non-relaxing pelvic floor, and more.

Muscles of the pelvic floor are responsible to intiate and control motion at the hip, sacroiliac joint, and lumbar spine. They are foundational to athletic performance.

Pelvic floor dysfunction is often an overlooked cause of buttock pain in the athlete. When left untreated, it causes chronic low back and pelvic pain.

Pelvic floor therapy is a more effective therapy to rehabilitate buttocks than traditional physical therapy because it addreses ALL of the hip and pelvic muscles.

Treatment options can include:

• Manual Techniques
• Joint Mobilization
• Pelvic Floor Muscle Training
• Biofeedback
• Transcutaneous Electrical Nerve Stimulation
• Cryotherapy/Thermotherapy

The goal for each patient is to maximize performance pain free.

Pelvic floor therapy for the female athlete can not only resolve buttock pain, but also enhance athletic performance. 

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Coccyx Dysfunction (Coccydynia)

COCCYDYNIA: TAILBONE (COCCYX) PAIN

A key symptom of coccyx dysfunction is pain and intolerance of sitting. There are many structures that attach onto the small surface area on the coccyx.

The position of the coccyx will affect everything that attaches to it, which is why women’s health therapists are uniquely qualified to treat coccydynia. In fact, medical research cites therapy to be 90% effective in treating coccydynia [source].

Therapeutic treatment modalities can include:

• Manual Techniques
• Joint Mobilization
• Pelvic Floor Muscle Training
• Biofeedback
• Transcutaneous Electrical Nerve Stimulation
• Cryotherapy/Thermotherapy

When coccyx pain is left untreated, it causes chronic low back and pelvic pain that is difficult to resolve with traditional physical therapy because the muscles are best accessed via the pelvic floor. 

The goal for each patient with coccydynia is to be pain free.

Citation:

Lirette, L. S., Chaiban, G., Tolba, R., & Eissa, H. (2014). “Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain.” The Ochsner Journal, 14(1), 84–87.

Athletic Bladder Issues

BLADDER ISSUES

The more elite the athlete, the higher risk for bladder issues.

Due to the unique demands of sport participation on the body, female athletes are at increased risk for pelvic floor issues, most typically bladder issues.

Activities such as jumping, running, lifting, or landing that occur with athletic participation create high levels of abdominal pressure placing increased stress onto the pelvic floor. When the muscles, fascia, and ligaments are negatively impacted, the female athlete can experience pain, weakness, and dysfunction.

Increased neurological activity from sport also increases the nerve impulse to the bladder creating forceful and frequent urge sensations.

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Female athletes, with and without children, experience accidental bladder leakage. Studies have found that 30% of young female athletes leak urine and that number over doubles after athletes deliver children [source]. Regulating these neuro impulses, stabilizing, and conditioning the pelvic floor are important elements in the ability of the female athlete to Take CONTROL! and stay dry (and out of the bathroom).

In therapy, we determine which structures are unable to manage the increased force of intrabdominal pressure and provide an individualized treatment plan which can include:

• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is always to be 100% dry whether jumping, lifting, landing, skiing, laughing, dancing, running, or managing impact in any other sport.

Citation:

Opara, J., Socha, T., Bidzan, M., Mehlich, K., & Poswiata, A. (2011). Stress urine incontinence especially in elite women athletes extremely practicing sports. Archives of Budo, 7.

Triathlete Issues

ISSUES SPECIFIC TO TRIATHLETES

Pelvic floor disorders are common and bothersome in female triathletes.

A 2016 survey found 37.4% of female triathletes have stress related urinary incontinence and 28% have anal incontinence. Urgency-type urinary incontinence (16%) and pelvic organ prolapse (5%) are less common, but still significant. Pelvic girdle pain is reported by 18% of female triathletes [source].

Women who have had children are more succetible to pelvic floor dysfunctions. The prolonged stress of triathlete training creates high levels of abdominal pressure on the pelvic floor musculature. When the muscles, fascia, and ligaments are neurologically fatigued, the female triathlete can experience pain, weakness, and dysfunction.

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The high neurological input to the pelvic floor muscles of the triathlete often creates a condition called non-relaxing pelvic floor. 

Conditioning the female triathlete to sustain prolonged stablization of the pelvic floor is essential for the female triathlete to avoid pelvic floor dysfunction.

At You’re In CONTROL!, we guide the athlete to develop pelvic floor coordination and endurance to resolve pelvic floor dysfunctions and prevent prolapse. Therapeutic interventions may include:

• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is always to be 100% dry and pain free whether swimming, biking, or running, or managing impact in any other sport.

Citation:

Yi, Johnny MD; Tenfelde, Sandi PhD; Tell, Dina PhD; Brincat, Cynthia MD; Fitzgerald, Colleen MD. “Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain, and Female Athlete Triad.” Female Pelvic Medicine & Reconstructive Surgery 22(5):p 373-376, 9/10 2016.  DOI: 10.1097/SPV.0000000000000296

Gymnastics, Dance, and Cheerleading Issues

GYMNASTICS, DANCE, and CHEERLEADING ISSUES

The high impact demands of gymnastics, dancing, and cheerleading can create pelvic floor dysfunction.

Repetative pressures from jumping and landing often lead to stretching and eventual weakening of the tissues of the pelvic floor. As the pelvic floor muscles try to function, they often develop a condition called non-relaxing pelvic floor, because the muscles are too tight to function and support abdominopelvic loads.

A 2021 survey of elite gymnastic and cheer athletes, who trained more than 4 days a week, found that 67% reported urinary incontinence and 84% have anal incontinence [source]. 

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Athletes will often avoid certain exercises or limit their training to prevent urinary or fecal accidents. Therapy restores coordination and function to the pelvic floor and trains the athlete to manage the high repetative loads in order to fully participate in their sport.

In therapy, we train the pelvic floor muscles and help them coordinate with intrabdominal pressure to function correctly. Once the athlete developes normal muscle tone of the pelvic floor, they may be prescribed vaginal weights. Using vaginal weights with a non-relaxing pelvic floor can create injury, so we strongly recommend working with a pelvic therapist before beginning the use of vaginal weights.

An individualized treatment plan for gymnasts, dance, and cheer athletes can include:

• Pelvic Floor Muscle Training
• Biofeedback
• Pelvic Floor Weight Training
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is always to be 100% dry whether jumping, lifting, landing, skiing, laughing, dancing, running, or managing impact in any other sport.

Citation:

Skaug, K. L., Engh, M. E., Frawley, H., & Bø, K. (2021). “Urinary and anal incontinence among female gymnasts and cheerleaders-bother and associated factors. A cross-sectional study.” International Urogynecology Journal,  Advance online publication. DOI: 10.1007/s00192-021-04696-z

Crossfit Issues

CROSSFIT ISSUES

The unique demands of crossfit create high pressure loads to the pelvic floor muscles. 

CrossFit is the functional workout that does some serious work on an athlete’s muscles, including the pelvic floor muscles. A recent study reported 26.1% of female crossfit athletes have urinary incontinence, 6% experience fecal incontinence, and 3.2% suffer from pelvic organ prolapse [source].

Additionally, the increased neurological activity from CrossFit also increases the nerve impulse to the bladder creating forceful and frequent urinary urge sensations.

The pelvic floor muscles are primary movers of the lumbar spine, abdominals, and hips. They are also the foundation of the core. When the pelvic floor muscles are not conditioned to manage the high loads of CrossFit, they will become too tight and develop a condition called non-relaxing pelvic floor. Non-relaxing pelvic floor can cause lower back, pelvic, or buttocks pain, urinary or fecal incontinence, or other gynecological issues including pelvic organ prolapse or dyspareunia (pain with sex).

Pelvic floor therapy assists the CrossFit athlete to coordinate the pelvic floor muscles with the functional movments to mangage the loads and resolve or prevent symptoms.

 Treatment can include:

• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is to be 100% dry and pain free when training or competing.

Citation:

High, Rachel DO; Thai, Kim MD; Virani, Hina MD; Kuehl, Thomas PhD; Danford, Jill MD. “Prevalence of Pelvic Floor Disorders in Female CrossFit Athletes.” Female Pelvic Medicine & Reconstructive Surgery: August 2020 – Volume 26 – Issue 8 – p 498-502. DOI: 10.1097/SPV.0000000000000776

Runner's Issues

RUNNER’S ISSUES

Regular running is one of the risk factors that leads to pelvic floor damage.

When running, our entire body takes the impact for a prolonged period of time. Every single stride puts pressure on the pelvic area, and the muscles of the pelvic floor are in charge of cushioning and protecting it.

The pelvic floor muscles are also primary movers of the lumbar spine and hips. They are the foundation of the core. 

When the pelvic floor muscles are not conditioned to manage the prolonged pressure of running, they will become too tight and develop a condition called non-relaxing pelvic floor. Non-relaxing pelvic floor can cause lower back, pelvic, or buttocks pain, urinary or fecal incontinence, and other gynecological issues including pelvic organ prolapse or dyspareunia (pain with sex).

Additionally, the increased neurological activity from running also increases the nerve impulse to the bladder creating forceful and frequent urinary urge sensations.

Pelvic floor therapy assists the runner to coordinate the pelvic floor muscles with the functional movments to mangage the loads and resolve or prevent symptoms.

Treatment can include:

• Pelvic floor muscle training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is to keep you 100% dry and pain free when training or competing.