Pelvic Floor Dysfunction
The specific aim of this chapter is to introduce the role of the pelvic floor and pelvic floor dysfunction for arthroscopic and open hip joint preservation surgery patients presenting with pain and functional impairments. Painful pelvic floor muscles may occur as a result of inherent musculoskeletal causes or may be the result of somatic dysfunction occurring in the hip. An overview of the muscles, bones, and nerves of the pelvis and pelvic floor will be presented. Visceral and somatic referral patterns and biomechanical links between the hip, pelvis, pelvic floor, and lumbar spine will be pointed out, in particular in the context of the patient with chronic symptoms and/or increased tone and muscle dysfunction. The reader will be exposed to the epidemiology, pathophysiology, and presentation of pelvic floor dysfunction in order to raise awareness of the pelvic floor as a symptom generator in “hip” pain patients. Patient evaluation, including the pelvic floor examination, will be presented to increase understanding of how to utilize the physical examination to identify dysfunctions and guide in comprehensive treatment planning. Although some clinicians may prefer to refer pelvic floor patients to expert providers, this chapter will provide knowledge regarding the evaluation such providers will perform; collaborative care with physicians and physical therapists treating pelvic floor patients is invaluable in this patient population. Ultimately, knowledge of pelvic floor function and dysfunction will broaden the differential diagnosis for patients presenting with hip- and pelvic-related pain increasing the accuracy of diagnosis and help dictate the most appropriate treatment for these patients.
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