Somatic Dysfunctions of Hip and Pelvis Overlooked in a Case of Vulvodynia

Participants

• Number: 1

• Description: a 40-year-old woman with chronic perineal pain that had began a year earlier following a vigorous walk that had induced acute pain in her left hip, hamstring, and buttock. The pain would get worse when she lay on her left side or after sitting for a long time. Sexual intercourses had also become painful.
  Cystoscopy and vaginal ultrasonography were normal. For 6 months she followed physical therapy treatments (which also included ultrasounds, dry needling, SI support belt and left heel lift). Then, for 3 months she followed physiotherapy treatments specifically targeting the pelvic floor. However, due to poor results, she received 3 injections in the trigger points and 4 vulvar injections of Botox, but with temporary effects.

For the past 6 months she had been taking amitriptyline daily, but with no improvement, while for the past 3 months she had been taking gabapentin: although this medication had induced improvement, it made her feel tired and down, so much so that she described herself as depressed.
The patient was an accountant, married to a man described as sweet and supportive. She had no children, no history of any particular illness or surgery. She was taking contraceptives and multivitamins, while she did not use tobacco, alcohol, or drugs.
Physical evaluation showed prevalent somatic dysfunctions in the left hand side of her body at the level of the sphenobasilar symphysis, thoracolumbar junction, sacroiliac joint with decreased primary respiratory mechanism, suprapubic fascia, pelvic floor, hip, left leg, buttock, harmstrings, ribs and diaphragm muscles.

Interventions and evaluations

• Evaluation of the symptoms.
• Hip MRI after first visits.
• 8 OMT sessions: 5 weekly and 3 monthly.
• OMT: balanced ligamentous tension techniques, myofascial release, cranial osteopathy, with focus on the pelvic diaphragm in relation to the thoracic diaphragm and breath.

Results

After the first visit, the functional impairment of the left leg had been corrected and, therefore, the patient was advised not to wear an insole any more.
At the first follow-up visit the vulvodynia had also decreased and sitting was less painfull, whereas her left hip and hamstrings’ pain was more noticeable. Pelvic floor restrictions had decreased, synchrony of movement between the pelvic and thoracic diaphragms had increased, but several somatic dysfunctions were still present.
An MRI of the left hip revealed a tendinopathy at the level of the tendon of insertions of the harmstrings, but without injury or effusion.
During the following 3 weekly visits, the vulvodynia continued to decrease, and so did the pain and the symptoms of depression.
After 3 monthly visits, the patient reported feeling better and was able to discontinue the gabapentin.

Discussion