Pelvic pain in athletes involves a wide spectrum of differential diagnoses:
1. Is it orthopedic?
2. A labral tear?
3. A pelvic girdle issue?) Or perhaps myofascial?
4. Pelvic floor? Adductors?)
5. Neurological? (Pudendal? Obturator?)
The possibilities are endless.
Today’s therapist working with dysfunctions in and around the pelvis needs a solid grounding in the many different body systems that pass through the crossroads of the body – paying respect to not only the mechanical effects and issues associated with the biomedical systems that traverse the pelvis (neuro, musculo-skeletal, digestive, or vascular, to name a few), but also the biopsychosocial layers that can influence pelvic pain.
BIOPSYCHOSOCIAL CAUSES :
To use an example,1 think of how a dog behaves when he is happy – a lot of tail wagging and freedom of movement, right? But when a dog is scared or in pain, that tail gets firmly tucked between its legs.
Now, imagine you are a collegiate athlete, dependent on a scholarship for your continuing education and you hear the dreaded diagnosis of ‘groin strain’ or ‘labral tear’ or ‘pudendal neuralgia.’ That stress has the potential to be stored in the emotionally responsive muscles of the pelvic floor and other lumbopelvic allies, such as the psoas and diaphragm. This adds another layer of mystery and intrigue on the path to finding the correct/causative issue that started the cascade of pain and dysfunction.
Many sports medicine therapists are intimidated by a possible pelvic pain diagnosis. We have all acknowledged that the pelvic floor is part of the lumbopelvic canister system. Further research has possibly negated the role of specific ‘core stability’ training vs. generalized exercise training when it comes to lumbo-pelvic pain. The current clinical practice leans more towards functional integration of the ‘canister muscles,’ particularly the diaphragm and pelvic floor. This approach depends on establishing fully functional ranges of motion and coordination more than previous models of ‘bracing’ in relatively static positions – which is not an efficient or effective rehab strategy.