Hypertonicity of the pelvic floor is a disabling condition with urological, gynecological and gastrointestinal symptoms, sexual problems and chronic pelvic pain, impacting quality of life. Pelvic floor physical therapy is a first-line intervention.
Pelvic floor physical therapy is first-line therapy for treatment of pelvic floor tension myalgia. Pelvic floor trigger point injections are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following pelvic floor trigger point injections provides improved pain relief compared to trigger point injection alone.

This was a retrospective cohort analysis of 63 female patients with pelvic floor tension myalgia who underwent pelvic floor trigger point injections  alone or pelvic floor trigger point injections  immediately followed by pelvic floor physical therapy . Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received pelvic floor trigger point injections  alone and those who received pelvic floor trigger point injections  followed by myofascial release.

Of the 63 patients in this study, 18 received pelvic floor trigger point injections alone and 45 patients received pelvic floor trigger point injections followed by myofascial release . The median pre-treatment VAS score was 9 for both groups. The median post-treatment score was 6 for the pelvic floor trigger point injections  only group and 4 for the Pelvic floor trigger point injections  followed by myofascial release  group, showing a median change in VAS score of 2 and 4, respectively (p = 0.041). Seventy-seven percent of patients in the pelvic floor trigger point injections followed by myofascial release  group had a VAS score improvement of 3 or more, while 45% of patients in the pelvic floor trigger point injections only group had a VAS score improvement greater than 3 (p = 0.007).

Pelvic floor physical therapy for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. 
Pelvic floor trigger point injections immediately followed by myofascial release offered more improvement in pain for patients with  pelvic floor tension myalgia. This may be due to greater tolerance of myofascial release immediately following injections.

It is advisable to continue to study the method of trigger point injections followed by myofascial release in the treatment of pelvic floor tension myalgia.
Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to Pelvic floor physical therapy. Use of a biopsychosocial model is important for the overall well-being of each patient.