Treatment of the musculoskeletal component of chronic pelvic and perineal pain

To describe muscle examination in patients with chronic pelvic and perineal pain and to determine the results that can be expected from specific treatments (physiotherapy and botulinum toxin). Review of the literature, especially the Medline indexed literature. Description of the physical rehabilitation techniques that can be used in this context. The management of patients with chronic pelvic and perineal pain requires preliminary clinical analysis designed to identify trigger points responsible for myofascial pain, pelvic floor muscle tension, and lumbar-pelvic-hip instability. Physiotherapy must be initiated early in the course of the disease by therapists trained in these recent techniques. Botulinum toxin injections have been shown to be effective in piriformis syndrome, but a review of the literature indicates more controversial results in the other chronic pelvic and perineal pain syndromes.