Skip to main content

The Pelvic Floor

  • Chapter
  • First Online:
Posterior Hip Disorders

Abstract

The pelvic floor is often forgotten when evaluating and treating hip dysfunction. This chapter sets out to describe the pelvic floor’s anatomy, function, treatment, and role in posterior hip dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cox JM, Bakkum BW. Possible generators of retrotrochanteric gluteal and thigh pain: the gemelli–obturator internus complex. J Manip Physiol Ther. 2005;28(7):534–8.

    Article  Google Scholar 

  2. George SE, Clinton SC, Borello-France DF. Physical therapy management of female chronic pelvic pain: anatomic considerations. Clin Anat. 2013;26(1):77–88.

    Article  PubMed  Google Scholar 

  3. Doggweiler R, Stewart AF. Pelvic floor therapies in chronic pelvic pain syndrome. Curr Urol Rep. 2011;12(4):304–11.

    Article  PubMed  Google Scholar 

  4. Wei JT, De Lancey JO. Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol. 2004;47(1):3–17.

    Article  PubMed  Google Scholar 

  5. Hartmann D, Sarton J. Chronic pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):977–90.

    Article  PubMed  Google Scholar 

  6. Prather H, Dugan S, Fitzgerald C, Hunt D. Review of anatomy, evaluation, and treatment of musculoskeletal pelvic floor pain in women. PM&R. 2009;1(4):346–58.

    Article  Google Scholar 

  7. Irion J, Irion G. Women’s health in physical therapy: principles and practices for rehabiliation professionals. Philadelphia, PA: Lippincott-Williams & Wilkins; 2009.

    Google Scholar 

  8. Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010;40(2):82–94.

    Article  PubMed  Google Scholar 

  9. Retchford T, Crossley K, Grimaldi A, Kemp J, Cowan S. Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact. 2013;13(1):1–12.

    PubMed  CAS  Google Scholar 

  10. Aung HH, Sakamoto H, Akita K, Sato T. Anatomical study of the obturator internus, gemelli and quadratus femoris muscles with special reference to their innervation. Anat Rec. 2001;263(1):41–52.

    Article  PubMed  CAS  Google Scholar 

  11. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus. 2009;26(2):E9.

    Article  PubMed  Google Scholar 

  12. Devor M. Pathophysiology of damaged nerves in relation to chronic pain. In:Textbook of pain. Philadelphia, PA: Elsevier; 1999. p. 129–64.

    Google Scholar 

  13. Possover M, Forman A. Neuropelveological assessment of neuropathic pelvic pain. Gynecol Surg. 2014;11(2):139–44.

    Article  Google Scholar 

  14. Possover M, Schneider T, Henle K. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril. 2011;95(2):756–8.

    Article  PubMed  Google Scholar 

  15. Lemos N, Possover M. Laparoscopic approach to intrapelvic nerve entrapments. J Hip Preserv Surg. 2015;2(2):92–8. hnv030.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barton PM. Piriformis syndrome: a rational approach to management. Pain. 1991;47(3):345–52.

    Article  PubMed  CAS  Google Scholar 

  17. Wyant GM. Chronic pain syndromes and their treatment II. Trigger points. Can Anaesth Soc J. 1979;26(3):216–9.

    Article  PubMed  CAS  Google Scholar 

  18. Martin HD, Reddy M, Gómez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg. 2015;2(2):99–107.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. Am J Roentgenol. 2009;193(1):186–90.

    Article  Google Scholar 

  20. Ailianou A, Fitsiori A, Syrogiannopoulou A, Toso S, Viallon M, Merlini L, et al. Review of the principal extra spinal pathologies causing sciatica and new MRI approaches. Br J Radiol. 2014;85(1014):672–81.

    Article  Google Scholar 

  21. Gajraj NM. Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain. J Pain. 2005;6(5):333–7.

    Article  CAS  PubMed  Google Scholar 

  22. Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg. 2004;74(1–2):23–6.

    Article  PubMed  Google Scholar 

  23. Martin HD. Subgluteal space and associated disorders. In:Operative hip arthroscopy. Berlin: Springer; 2013. p. 309–29.

    Chapter  Google Scholar 

  24. Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: diagnosis and treatment. Neurourol Urodyn. 2007;26(6):820–7.

    Article  PubMed  Google Scholar 

  25. Possover M, Forman A. Voiding dysfunction associated with pudendal nerve entrapment. Curr Bladder Dysfunct Rep. 2012;7(4):281–5.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Berman JR, Goldstein I. Female sexual dysfunction. Urol Clin North Am. 2001;28(2):405–16.

    Article  PubMed  CAS  Google Scholar 

  27. Pink L, Rancourt V, Gordon A. Persistent genital arousal in women with pelvic and genital pain. J Obstet Gynaecol Can. 2014;36(4):324–30.

    Article  PubMed  Google Scholar 

  28. Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;27(2):172–81.

    Article  PubMed  Google Scholar 

  29. Lee SC, Rha DW, Kim HJ, Yang HM, Lee SH, Koh D. Ultrasound-guided injection of the intrapelvic portion of the obturator internus in a cadaver model. Reg Anesth Pain Med. 2014;39(4):347–50.

    Article  PubMed  Google Scholar 

  30. Murata Y, Ogata S, Ikeda Y, Yamagata M. An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle. Spine J. 2009;9(6):e16–8.

    Article  PubMed  Google Scholar 

  31. Shinohara H. Gemelli and obturator internus muscles: different heads of one muscle? Anat Rec. 1995;243(1):145–50.

    Article  CAS  PubMed  Google Scholar 

  32. Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic pain. Pain. 2003;104(1–2):375–80.

    Article  PubMed  Google Scholar 

  33. Valovska A, Zaccagnino MP, Weaver MJ, Valovski I, Kaye AD, Urman RD. Intrapelvic obturator internus muscle injections: a novel fluoroscopic technique. Pain Physician. 2015;18:E237–43.

    PubMed  Google Scholar 

  34. Smith J, Wisniewski SJ, Wempe MK, Landry BW, Sellon JL. Sonographically guided obturator internus injections: techniques and validation. J Ultrasound Med. 2012;31(10):1597–608.

    Article  PubMed  Google Scholar 

  35. Swezey RL. Obturator internus bursitis: a common factor in low back pain. Orthopedics. 1993;16(7):783–5. Discussion 785-6.

    CAS  PubMed  Google Scholar 

  36. Dalmau-Carola J. Myofascial pain syndrome affecting the piriformis and the obturator internus muscle. Pain Pract. 2005;5(4):361–3.

    Article  PubMed  Google Scholar 

  37. Rohde RS, Ziran BH. Obturator internus tendinitis as a source of chronic hip pain. Orthopedics. 2003;26(4):425–6.

    PubMed  Google Scholar 

  38. Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239–46.

    Article  PubMed  Google Scholar 

  39. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 2007;18(3):477–96.

    Article  PubMed  Google Scholar 

  40. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42.

    Article  Google Scholar 

  41. Spitznagle TM, Robinson CM. Myofascial pelvic pain. Obstet Gynecol Clin N Am. 2014;41(3):409–32.

    Article  Google Scholar 

  42. Lee D. The pevlic girdle an integration of clinical experience and research. Amsterdam: Elsevier; 2011.

    Google Scholar 

  43. Washington University Program in Physical Therapy. Diagnosis dialog: pelvic floor conditions. 2015. https://dxdialog.wusm.wustl.edu/Presentations%20and%20Publications/Forms/AllItems.aspx?RootFolder=%2fPresentations%20and%20Publications%2fSection%20on%20Women%27s%20Health%20%2d%20Table%20of%20Pelvic%20Floor%20Conditions&FolderCTID=&View=%7bA55622A3%2dED08%2d4684%2d8C32%2d116BFC4546E4%7d. Accessed 28 Feb 2016.

  44. Swisher E, Rich J, Weiss PM. Pelvic floor spasm the missing link in chronic pelvic pain. Contemp OB GYN. 2012;57(10):38–46. 9p.

    Google Scholar 

  45. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794–819.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine (Phila Pa 1976). 2001;26(10):1167–71.

    Article  CAS  Google Scholar 

  47. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10(3):207–18.

    Article  PubMed  Google Scholar 

  48. Dutton M. Orthopaedic examination, evaluation and intervention. 2nd ed. New York: McGraw Hill; 2008.

    Google Scholar 

  49. Flynn T, Cleland J, Whitman J. Users’ guide to the musculoskeletal examination: fundamentals for hte evidence-based clinician. Louisville, KY: Evidence in Motion; 2008.

    Google Scholar 

  50. Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012;87(2):187–93.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–82.

    PubMed  Google Scholar 

  52. Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80.

    Article  PubMed  Google Scholar 

  53. Shelley B, Neville C, Strauhal M, Jenkyns P. Pelvic physical therapy level I. American Physical Therapy Association Section on Women’s Health 2010.

    Google Scholar 

  54. Doughty D. Urinary & fecal incontinence: current management concepts. 3rd ed. St Louis: Elsevier; 2006.

    Google Scholar 

  55. Laycock J, Haslem J. Therapeutic management of incontinence and pelvic pain. 2nd ed. London: Springer; 2008.

    Google Scholar 

  56. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):261–8.

    Article  PubMed  CAS  Google Scholar 

  57. Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. J Minim Invasive Gynecol. 2010;17(2):148–53.

    Article  PubMed  Google Scholar 

  58. Rummer E, Prendergast S. The role of physical therapy in treating myofascial pelvic pain syndrome. In: IASP SIG on pain of urogenital origin-Newsletter, vol. 1(2); 2009.

    Google Scholar 

  59. Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing-an experimental study. Pain Med. 2012;13(2):215–28. 14p.

    Article  PubMed  Google Scholar 

  60. Wiebe J. The pelvic floor piston:foundation for fitness; 2014. DVD.

    Google Scholar 

  61. Prendergast S, Rummer E. The role of physical therapy in the treatment of pudendal neuralgia. IPPS Vision. 2007;15(1):1–4.

    Google Scholar 

  62. Padoa A, Rosenbaum TY, editors. The overactive pelvic floor. Berlin: Springer; 2016.

    Google Scholar 

  63. Butler D. The sensitive nervous system. Adelaide: NOI Group; 2000.

    Google Scholar 

  64. Vandyken C, Hilton S. The puzzle of pelvic pain: a rehabilitation framework for balancing tissue dysfunction and central sensitization II: a review of treatment considerations. J Womens Health Phys Ther. 2012;36(1):44–54. 11p.

    Article  Google Scholar 

  65. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Valerie L. Bobb PT, DPT, WCS, ATC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bobb, V.L., Hathaway, L., Hill, C. (2019). The Pelvic Floor. In: Martin, H., Gómez-Hoyos, J. (eds) Posterior Hip Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-78040-5_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-78040-5_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-78038-2

  • Online ISBN: 978-3-319-78040-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics