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Management of Levator Ani Syndrome With Osteopathic Manipulative Treatment: A Case Study

Journal: The AAO Journal Date: 2014/06, 24(2):Pages: 20, type of study: case report

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

levator ani syndrome [2]
pelvic pain [58]
pelvic floor muscles [3]
chronic pain [204]
osteopathic manipulative treatment [2973]
OMT [2951]
case report [514]
conference abstract [108]

Abstract:

Background: Levator ani syndrome describes a disorder in which pelvic pain is attributed to short, tight, and tender pelvic floor muscles, commonly occurring in conjunction with hypersensitive tender points. It can cause chronic pelvic pain, which can be sufficiently debilitating to a patient by interfering with daily activities and the patient’s sense of wellbeing. Osteopathic manipulative treatment (OMT) can be beneficial in treating this disorder. This case describes how treating patients who have levator ani syndrome with OMT produces positive results shown objectively via improvement on imaging and subjectively through reassessment by the patient. Material and Methods: The patient in this study complained of pain with sitting, identified to be caused by spasm of her levator ani muscles. She was treated with OMT for five months. The unrestricted OMT protocol included intrarectal treatment of levator ani and coccygeal muscles. Two months into her treatment, the patient received pelvic floor physical therapy (PT) in adjunct to OMT. This facilitated improvement of symptoms. Magnetic resonance images (MRIs) of the pelvis were obtained pre- and post-treatment, five months apart. Results: Subjectively, the patient reported a 60% reduction in symptoms since starting OMT after five months of treatment. Objectively, a post-treatment MRI of the pelvis, taken five months after pre-treatment MRI, showed significant changes to the pubococcygeus and other levator ani muscles. Improved palpable changes were found on exam. Conclusions: Both objective improvement and subjective improvement were found using OMT to treat patients for levator ani syndrome. In this case, OMT in combination with pelvic floor PT has been shown to be beneficial in treating levator ani syndrome. Thus, OMT should be considered as the standard of care for patients with this disorder.


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