The study design included 30 patients suffering from extensive pelvic pain and different patterns of location, as well as low back pain and LUTS. Inclusion criteria were pelvic pain of different patterns, inguinal, pubic, vulvodynia, rectal pain, and LUTS, and any relevant urological or gynecological disease was excluded. Healthy 30 individuals were included as controls. All patients underwent general examination, MRI, precise physical tests, and extensive functional multilevel multiparameter neuromuscular US using 4-8 MHz/5-12 MHz probes in the shoulder, sacroiliac junction (SIJ), intervertebral spaces, foot, ankle, gluteus region and pelvis, abdominal wall, diaphragm, and pelvic floor motility. The researchers also did M-mode, transient elastography, and shear wave elastography (SWE) of nerves and muscles, evaluated structure, CSA, detected compressions, contact to scars, muscle TrPs, spasticity, and evaluated nerve motion and SWE during overstraining neurodynamic tests. All patients underwent transabdominal pelvic ultrasound for the evaluation of bladder neck motility. Transabdominal US measurements of bladder neck rotation in a postero-inferior direction at rest and on maximal Valsalva were performed, and measurements were taken before and after intervention. The researchers evaluated bladder motion, deformation, and determined the side of deviating bladder (according to the position/tone of the psoas muscle) before and after intervention. Then patients received DN of detected MTrP under US guidance [1-3]. The researchers applied the treatment approach that included ultrasound identification of MTrPs with following dry needling under US guidance using steel acupuncture needles (28 gauge) to elicit the LTR effect. The retention of needles depended on muscle twitch response and `needle grasp` duration. Visual analogue scale data (0 to 10) was used.
Additionally, our focus was on the intrinsic and extrinsic factors associated with pelvic floor hypermobility and pelvic pain. In terms of intrinsic factors, we examined the levator ani and obturator internus muscles using functional ultrasound as they play a crucial role in postural balance in the pelvis and beyond. We found that muscle activation physiotherapy and exercise can be limited in effectiveness, but deactivation of trigger points in the deep pelvic muscles after the inactivation of paravertebral muscles' trigger points can increase efficacy.
We also looked at extrinsic factors, which included shoulder impingement, multiple trigger points in the lumbar and thoracic multifidus muscles, dysfunction of the sacroiliac joint, fascia and muscles at upper and lower portions, obturator muscles, gluteus medius, anterior approach (pectineus and iliacus muscles), thoracolumbar fascia, local applications, psoas muscle, abdominal wall, diaphragm, and lower extremities' health (walking and amputees).