Document Type : Case Report


Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran


Background:There are various factors that may cause pain and dysfunction in the pelvic region. Myofascial trigger points can likewise contribute in pelvic pain. Common treatments for myofascial trigger points include electrotherapy, laser therapy, massage, ischemic compression, dry-needling, stretch, icing, heating, and biofeedback.Case report:A 26 year old man with an exertion-related pain that lasted 5 months was referred for physiotherapy consultation. He had no pain at rest but reported a referral pain from perineal region to the anus and muscular stiffness following a bout of physical activity. On palpation there was a trigger point in the perineal region with referral pain to anus.  At the beginning of the treatment, the patient was asked to stop his physical activities. The patient received a treatment package which was useful in the management of trigger points. After 7 sessions of treatment the pain was diminished and there was no exercise induced stiffness. The patient was followed for 10 months later and no pain and stiffness was reported.Conclusion:The application of heat, friction massage, stretching, combined with endurance exercise could be an effective treatment for reliving the pain and muscular stiffness caused by trigger points.


  1. Chaitow L. Chronic pelvic pain: Pelvic floor problems, sacro-iliac dysfunction and the trigger point connection. Journal of Bodywork and Movement Therapies 2007;11(4):327-39.
  2. Starlanyl DJ. Pelvic Pain and Dysfunction, Fibromyalgia, and Trigger Points; 2012.
  3. Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. Journal of Obstetric, Gynecologic & Neonatal Nursing 2012;41(5):680-91.
  4. Aguilera F, Martin DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. Journal of manipulative and physiological therapeutics 2009;32(7):515-20.
  5. Ibañez-Garcia J, Alburquerque-Sendin F, Rodriguez-Blanco C, Girao D, Atienza-Meseguer A, Planella-Abella S, et al. Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique. Journal of bodywork and movement therapies 2009;13(1):2-10.
  6. Mohamadi M, Ghanbari A. Tension–Type–Headache treated by Positional Release Therapy: A case report. Manual therapy 2012;17(5):456-8.
  7. Ghanbari A, Rahimijaberi A, Mohamadi M, Abbasi L, Sarvestani FK. The effect of trigger point management by positional release therapy on tension type headache. NeuroRehabilitation 2012;30(4):333-9.
  8. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. International journal of osteopathic medicine 2006;9(4):120-36.
  9. Downie W, Leatham P, Rhind V, Wright V, Branco J, Anderson J. Studies with pain rating scales. Annals of the rheumatic diseases 1978;37(4):378-81.
  10. Bassaly R, Tidwell N, Bertolino S, Hoyte L, Downes K, Hart S. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. International urogynecology journal 2011;22(4):413-8.
  11. Bendaña EE, Belarmino JM, Dinh JH, Cook CL, Murray BP, Feustel PJ, et al. Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm. Urologic nursing 2008;29(3):171-6.
  12. Jarrell J. Myofascial dysfunction in the pelvis. Current pain and headache reports 2004;8(6):452-6.
  13. Blanco CR, de las Peñas CF, Xumet JEH, Algaba CP, Rabadan MF, de la Quintana MCL. Changes in active mouth opening following a single treatment of latent myofascial trigger points in the masseter muscle involving post-isometric relaxation or strain/counterstrain. Journal of Bodywork and Movement Therapies 2006;10(3):197-205.
  14. Chaitow L, DeLany J. Clinical application of neuromuscular techniques: the upper body: Elsevier Health Sciences; 2008.
  15. Wolgin F. The Nursing Assistant'2005 Ed: Rex Bookstore, Inc; 2005.
  16. Sullivan PE, Markos PD. Clinical decision making in therapeutic exercise: Appleton & Lange Norwalk, CT; 1995.