Advance Sports and Spine Therapy , Portland, Oregon, USA.
Department of Allied Health Professions, Sheffield Hallam University , Sheffield, UK.
J Man Manip Ther. 2020 Jul;28(3):170-180. doi: 10.1080/10669817.2019.1668994. Epub 2019 Nov 8.
Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms.
Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated.
Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management.
These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into 'Mechanical Pelvic Syndrome' is proposed. Level of Evidence: 4.
伴有骨骼肌肉和膀胱症状的慢性盆腔疼痛（CPP）是一个复杂且具有挑战性的问题。然而，临床上并未常规质疑这些症状的共存，也未彻底调查其骨骼肌肉来源。本病例系列的目的是介绍在 7 例同时患有慢性盆腔疼痛、膀胱功能障碍和骨骼肌肉症状的患者中使用机械诊断和治疗（MDT）原则。
回顾性分析了 7 例同时存在盆腔健康和骨骼肌肉体征和症状的患者。最常见的症状是尿频、尿失禁、盆腔疼痛、夜尿、性交困难、膀胱协同失调以及腰部、骨盆或臀部疼痛。所有患者均未能认识到两组症状之间可能存在的相互关联。每位患者均表现出定向偏侧（DP），随后确定了 MDT 暂定的紊乱分类；DP 力的使用消除或显著改善了两组症状和运动障碍。在所有情况下，DP 最初是持续矢状面力，但最终需要侧向力和松动。
盆腔影响问卷、Care Connections 骨盆底和腰椎的变化均具有临床意义，并且多次超过最小临床重要差异。每位患者平均接受 5.8 次治疗。平均 3.3 年的随访显示，患者对独立自我管理的持续满意度和信心。
这些病例研究强调了在骨盆和骨骼肌肉患者中确保扩大摄入问题以确定可能存在的症状共存的重要性，这可能表明需要进行机械干预。建议将暂定的亚分类为“机械性骨盆综合征”。证据水平：4 级。
