Muscle Relaxation and Re-education, Biofeedback, and Electrical Stimulation
Muscle tension in the pelvis, hips, and lower back may be caused by, or lead to CPP. Helping a woman to identify and relax tension, become aware of and adjust her body mechanics and standing and sitting posture, and wear appropriate shoes to minimize postural problems can help to reduce pain caused by structural imbalances. Pelvic relaxation training techniques should be taught and practiced regularly. Much of this can be done at home, but physical therapy can be helpful if there is limited joint movement or muscular problems. Prolonged sitting or standing can aggravate CPP, so patients may need suggestions and supportive counseling for modifying jobs or activities that require positions that exacerbate the problem. Exercises such as running or high-impact aerobics also may be aggravating, and should be replaced with gentler, relaxing forms of exercise, for example, walking, tai chi, yoga, or dance. Physical therapy for the treatment of musculoskeletal problems or postural problems can be beneficial for women with CPP.
Biofeedback machines can be effective in helping women to identify and improve the effectiveness of pelvic muscle relaxation techniques for acquired muscle tension. The woman is instructed to visualize and practice muscle relaxation techniques while using a biofeedback device for feedback on the relaxation efforts.
Electrical stimulation using vaginal, rectal, or surface electrodes is used to produce rhythmic contraction and relaxation of the pelvic floor muscles. Electrical stimulation may give immediate reduction in the level of pain early in treatment, restore more normal muscle activity patterns over time, and also may help to disperse inflammatory mediators caused by chronic muscle spasm.
Uterine Displacement-Mayan Uterine Massage
It has been suggested that uterine retrodisplacement can lead to symptoms of CPP. Although the role of pelvic tension and improper posture in the etiology of chronic pelvic pain is accepted, conventional medicine does not address the potential for uterine displacement, other than prolapse associated with pelvic relaxation as an etiologic factor. Mayan uterine massage is a practice introduced into the United States by Rosita Arviga, after dedicated study with a Belizean shaman who specialized in this technique. Ms. Arviga trains and certifies people in this technique and it has grown in popularity because of many anecdotal reports of success for the treatment of vague but sometimes debilitating complaints such as CPP, as well as for many other gynecologic problems. The treatment is predicated on the belief that uterine displacement, which may occur as a result of childbearing, poor posture, sedentary lifestyle, improper carrying and work habits, etc., can lead to significant pelvic congestion, gynecologic, nervous, circulatory, and digestive problems. No studies have been done to objectively demonstrate efficacy. The practice appears generally noninvasive (it is an intervention); however, it should not be used for pregnant women.