Musculoesqueletic evaluation of the lumbar-pelvic complex end the pelvic floor muscle of women with deep endometriosis
IUGA Academy. BEZERRA L. Jun 30, 2018; 213012; 296 Topic: Pelvic Pain

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Musculoesqueletic evaluation of the lumbar-pelvic complex end the pelvic floor muscle of women with deep endometriosis

Bezerra, L1; Moreira, R2; Barros, A2; Magalhaes, G2; Monteiro Bilhar, AP1; Lira, S3; Lima, P4

1: FEDERAL UNIVERSITY OF CEARÁ - Maternidade Escola Assis Chateaubriand; 2: FEDERAL UNIVERSITY OF CEARÁ- Surgery post-graduation; 3: FEDERAL UNIVERSITY OF CEARÁ-FAMED- Department of Physical Therapy; 4: FEDERAL UNIVERSITY OF CEARÁ -FAMED- Department of Physical Therapy

Objective: To assess the concomitant presence of lumbo-pelvic complex and pelvic floor muscle alteration and impairments in women with deep endometriosis and chronic pelvic pain.

Methods: This is a preliminary, cross-sectional study of women with clinical and imaging diagnosis of deep endometriosis and / or chronic pelvic pain. All of them underwent the musculoskeletal physiotherapeutic evaluation of the lombopelvic complex and the pelvic floor musculature. The parameters evaluated in the lumbar-pelvic complex were: Visual scale of the pain, muscle triggers points (TP) using average pressure by algometer (piriformis, lumbar square, Psoas iliacus, rectus abdominis and adductor magnum) and evaluation of the range of motion (piriformis, ischiatibialis, psoas iliac and lumbar spine. We evalueted the PFM by palpation with PERFECT schema and electromyography.

Results: 25 women were consecutively evaluated, with deep endometriosis Mean age of 30.4 years (± 5.2), mean waist of 81.2 cm (± 11.9), mean BMI 25.7 kg / m² ( ± 4.0), the majority were overweight (48%). Physical examination of the pelvic floor revealed absence of perineal awareness (59%) and (86%) absence of pelvic organ prolapse. The pelvic floor muscle (PFM) evaluation show that most did not report palpation of PFM (73%), hypertonic vaginal tone (55%), spasm in the PFM (64%), spasm in the right internal obturator muscle %) and in the left internal obturator muscle (45%). PERFECT PFM evaluation showed mean power of (1.82 ± 0.96), mean duration of contraction (Endurance) of (2.59 ± 2.97 seconds), mean number of sustained contractions (2 , 09 ± 1.90 repetitions) and the mean number of fast contractions (3.23 ± 3.07 times). Functional evaluation of the PFM by electromyography showed mean electrical activity of the muscle at rest (7.02 ± 1.49 μv), maximal voluntary isometric contraction (66 ± 45.6 μv) and endurance (16.23 ± 13, 42 μv).The visual pain scale evaluated was on average 7.55 (± 2.63). For the Lumbar-pelvic complex we found interestings results.The mean pressure of the TP of the right piriformis was 4.86 kgf (± 1.87) and the left pressure was 4.85 kgf (± 1.93), the TP mean pressure of the right lumbar square was 4.49 kgf (± 1.54) and the left 4.51 (± 1.58), the TP mean pressure of the right iliac Psoas was 4.19 kgf (± 1.64) and left on average 3.87 kgf (± 1.56), the TP mean pressure applied at the rectum abdomen was 3.51 kgf (± 1.41) and the left pressure was 3.63 (± 1.55), the TP average pressure of the right adductor trigger point was 3.44 (± 1.19) and the left one was 3.34 (± 1.29), The right piriform range of motion was on average 26.32 ° (± 5.88) and the left range was 25.61 ° (± 7.50), right ischiatibial range of motion was on average 123.68 ° (± 15.97), and the left one was 126.58 ° (± 14.44), range of motion psoas iliac right was on average 36.71 ° (± 12.43) and the left one was 64.26 ° (± 11, 88), range of motion right lumbar square was on average 9.44 cm (± 4.21) and the left 9.27 (± 3.21).

Conclusion: This is a short preliminar study were we observed important alterations in the physical therapy evaluation of the Lumbar-pelvic complex in close association with the alterations of the PFM in women with deep endometriosis. Painful changes and restriction of movements of the piriformis, lumbar, Psoas iliacus, rectus abdominis, ischiostibial adrenocortical muscles should be evaluated in this populational group.


Work supported by industry: no.

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