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A Matter of Urgency
By
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
Anita, a 44 year old teacher, was referred to MyoRehab by her
chiropractor for Myofascial Trigger Point Therapy of the buttocks
and hip muscles. Two years ago, while setting a box on an upper
shelf, Anita stepped backwards, tripped and landed hard on her right
buttocks.
Although successfully treated by her chiropractor for low back
pain resulting from her fall, she continued to suffer from the buttocks
and hip pain. She also experienced urgency to urinate, as well
as, a pressure pain in the pelvic area. These symptoms began
just weeks after her fall.
Anita was unaware that the symptoms of a Urinary Tract Infection
(UTI) were related to her fall. After several lab tests proved
negative for a UTI, Anita was at her wits end. A biological
cause for her symptoms could not be found. Also, antibiotics
did not help.
It wasn’t until the third treatment of her Myofascial Pain that
Anita commented on her UTI dilemma. When questioned further,
it was learned that Anita experienced temporary relief of her UTI
symptoms following pelvic mobilization by her chiropractor.
Trigger Points shorten muscles which in turn can maintain joint
misalignment. A Trigger Point is a hypersensitive spot in a
muscle that when stimulated, produces pain that is referred in a
predictable pattern usually away from the Trigger Point. In
Anita’s case, the referred pain was to the buttocks and hips.
Unfortunately, her UTI symptoms would return coincidentally
with her buttocks and hip pain. The relief of her pain with
chiropractic adjustments lasted no more than two or three days.
It was obvious to us and to her chiropractor that muscles were responsible
for causing the continued pelvic and hip misalignment and the return
of the symptoms.
As you might suspect, Myofascial Trigger Points in the
gluteus maximus were contributing to the buttocks and hip pain.
However, the primary culprit was the piriformis which lies deep underneath
the gluteus maximus. (Illustration A) Since it is attached
to both the sacrum and the top of the thigh bone, Trigger Points
in the piriformis can cause misalignment of the sacrum.
When the sacrum is misaligned, other parts of the pelvis
can also be out of alignment. This can cause the two halves
of the pubic bone to be out of level. When this occurs, patients
often report UTI symptoms. These include pressure pain, urgency
to urinate and urinary leakage (incontinence) with sneezing or laughter.
If this misalignment persists, an actual UTI can occur.
his happens when the two halves of the pubic bone are not level and
complete emptying of the bladder is not always possible. In
this case, antibiotics will successfully treat the infection.
When UTI symptoms frequently reoccur, with or without infection,
muscle and joint dysfunction should be addressed.
Myofascial Trigger Points can mimic many common pain syndromes.
Likewise, many serious pain syndromes can mimic Myofascial pain.
Having an evaluation for both Myofascial Trigger Points and the possibility
of a serious pain producing pathology should be considered.
Treating the muscles of the pelvis and chiropractic adjustments
of the hips relieved the buttocks and hip pain and most of the UTI
symptoms. Anita, however, continued to suffer with pelvic floor
pain. When asked, Anita told us that walking up stairs or hiking
uphill increased the pain.
Our suspicions were correct. Although several muscles
can cause pelvic floor pain, the adductor magnus is active when walking
uphill and inactive when walking downhill. (Illustration B)
After successful treatment of the adductor magnus, a specific exercise
for this muscle was added to Anita’s Home Exercise Program.
As part of a complete treatment protocol, patients are
given a Home Exercise Program specifically designed for their individual
needs. This program retrains the muscles to stay at their normal
resting length in a pain-free state.
Do you have “A Matter of Urgency” in your life?
Give us a call at MyoRehab.
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