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The Effect of Manual Physical Therapy In Patients Diagnosed With Interstitial Cystitis, High-Tone Pelvic Floor Dysfunction and Sacroiliac Dysfunction

OBJECTIVE: The purpose of this study was to determine the effect of manual physical therapy on symptomatology in patients diagnosed with interstitial cystitis, high-tone pelvic floor dysfunction, and sacroiliac dysfunction as measured by the O'Leary-Sant Interstitial Cystitis Symptom Index and the Modified Oswestry Disability Scale.

METHODS: The pilot study consisted of sixteen female subjects (mean age 42.5 (range 27-63)) who were diagnosed with interstitial cystitis and high-tone pelvic floor dysfunction. Pelvic floor dysfunction was detected by trigger point palpation upon digital examination by a urologist. Patients were then referred to physical therapy for suspected sacroiliac dysfunction. Each subject was issued an O'Leary-Sant Insterstitial Cystitis Symptom Questionnaire and Modified Oswestry Disability Scale prior to evaluation. These questionnaires collectively evaulate urinary frequency, nocturia, urgency, suprapubic pain, and dyspareunia. Evaluation performed by a certified manual physical therapist included a structural assessment of pelvic alignment in the sitting, standing, supinc, and prone positions. Heights of the iliac crests, PSIS, ASIS, pubic tubercles, ischial tuberosities, and inferior lateral angles of the sacrum were evaluated. Active and passive range of motion of the lumbar spine and hips, as well as strength and flexibility of all pelvic and spinal stabilizers were assessed. Palpation for tenderness and increased tone of the surrounding pelvic musculature was identified. Manual therapy included direct myofascial release, joint mobilization, muscle energy techniques, strengthening, stretching, neuromuscular re-education, and instruction in an extensive home exercise program for a mean of 8.72 visits (range 2 - 15). All patients were then re-issued O'Leary-Sant and Modified Oswestry Questionnaires for comparison.

RESULTS: In all sixteen cases, sacroiliac dysfunction was identified. A comparison of pre- and post-treatment Modified Oswestry scores revealed a 94% improvement in dyspareunia. Pre-treatment Modified Oswestry scores ranged from 1 to 5 with a mean of 2.75. Post-therapy scores ranged from 0 to 4 with a mean of .875. Nine of 16 patients were able to return to pain-free intercourse. A comparison of pre- and post-treatment O'Leary Sant scores revealed a 94% improvement symptomatology, with the greatest improvement seen in the indices of frequency and suprapubic pain, and less improvement in urgency and nocturia. Pre-treatment scores ranged from 1 to 20 with a mean of 8.5.

CONCLUSION: Manual physical therapy may be useful therapudic modality for patients diagnosed with interstitial cystitis, high-tone pelvic floor dysfunction and sacroiliac dysfunction. Intervention seems to be most useful in patients with primary complaints of urinary frequency, suprapubic pain and dyspareunia.

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