Specific Conditions
Thursday, July 17, 2008 at 3:37PM
Eliza Andrews

Breast Issues

Women may experience breast pain and swelling due to injury or trauma, infections, breastfeeding complications, cancer, or surgery.  Overuse or injury of the pectoralis muscle can result in a strain and cause breast pain and swelling.  Many times there is pain along the sternum (breastbone) and anterior chest wall.  Another source of breast pain may be costochondritis which is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the sternum.  Trauma can include vigorous coughing or vomiting. The resulting strong, sustained contractions of the intercostal (rib) muscles can lead to chest wall tenderness that may be perceived as breast pain.  Some women experience mastitis, infection of the breast glands/ducts, which can lead to obstruction, pain, and result in inability to breastfeed your newborn. Blocked ducts, stress, fatigue, cracked nipples, and previous mastitis are risk factors. Women faced with breast cancer may develop musculoskeletal impairments following mastectomy and breast reconstruction.  Lymphedema and weakness are complications that can affect the entire arm. Women who have undergone breast augmentation may experience swelling, scar tissue tightness and myofascial pain.

Coccygodynia or Coccydynia

Coccygodynia is a term that refers to the pain in or around the coccyx, also known as the tailbone.  In most cases, patients feel the pain while in the sitting position yet it can also be apparent in various positions, even while walking.  The pain can also be described as rectal and/or vulvar burning.  Numbness of the buttock or posterior thighs can also be experienced.  The coccyx pain can be aggravated by prolonged sitting, bowel movements, sexual intercourse, or during menstruation. Almost one third of all cases of coccygodynia are idiopathic in nature, which means that the real cause is unknown.  Known causes include trauma from a fall backwards, fracture or injury from childbirth, repeated poor posture, straining upon bowel movements, spasms or trigger points of the surrounding pelvic floor muscles, referred pain from the sacrum or spine, inflammation or irritation of the surrounding nerves, and misalignment of the sacrum or sacrococcygeal joint.


There are different types of urinary incontinence. Stress incontinence is when you leak urine during activities that increase pressure on the bladder such as sneezing, coughing, laughing, jumping, jogging, or lifting.  There may be insufficient strength in the muscles supporting the bladder, urethra, and pelvis.  Urge incontinence is when you feel a terrible urge or pressure to urinate and leak on your way to the bathroom.  Some also may experience urge and leak when they put their keys in the front door, when hearing water running, or when outside in the cold weather.  Mixed incontinence is when someone has both stress and urge incontinence.  Fecal incontinence is when you are unable to hold or control stool in the rectum and leak feces.


Myofascial restrictions or adhesions (abnormal connective tissue cross linking) can bind pelvic organs or structures together.  Adhesions involving the female reproductive organs (ovaries, uterus, Fallopian tubes) can and do cause infertility. Pelvic, sacrum, coccyx, and/or spinal joint malalignment may compromise normal physiological processes necessary to facilitate pregnancy.

Interstitial Cystitis (IC) or Painful Bladder Syndrome

IC is a chronic pain problem involving the pelvis, bladder, and urethra that occurs in men and women. Chronic inflammation of the bladder can occur.  Symptoms may include urination frequency, urgency, pain, pressure, and burning.  These symptoms can occur in the suprapubic region of the pelvis and /or surrounding areas.  Patients may experience thigh, groin, low back, and hip pain.  Some experience pain or pressure before, during and/or after urination.  Upon urinating, symptoms are often alleviated. 

Pelvic Pain

Pelvic pain may be acute, chronic, or recurring.  Chronic pelvic pain is pain that has been present for more than 3 months.  Both men and women can experience chronic pelvic pain.  Pelvic pain is pain in the groin, lower abdomen, sacrum, coccyx (tailbone), vaginal, testicles, or rectal regions that can spread to the thighs, lower back or buttocks.  Issues and diseases that contribute to or cause chronic pelvic pain include gynecological, urologic, gastrointestinal, musculoskeletal, neurological, trauma, sexual dysfunction, and depression. These issues can be related to myofascial trigger points in the abdomen, low back, and pelvic floor muscles.



 At Inspirit Physical Therapy Associates, our therapists understand the birthing process, common medical interventions, and aftercare.  After labor and delivery, women often have incontinence complaints, low back and pelvic pain, scar pain from c-section or episiotomy site, pain with intercourse, weak abdominals including diastasis recti, and pelvic floor dysfunction.  At times, the cause of the problem is from the birthing experience including positioning, length of time pushing, trauma, pre-existing conditions, and other medical interventions. Some women may sustain a pubic symphysis separation or coccyx injury during childbirth.  Obtaining clearance from your physician or midwife to begin exercise is advised.  Postpartum women often are dealing with changes in their bodies, fatigue, and post partum depression.


At Inspirit Physical Therapy Associates our therapists are experts in working with pregnant patients.  We understand the demands placed on the body during the different phases of pregnancy.  There are tremendous increases in blood volume and hormonal changes that can impact soft tissue structures. Many pregnant women experience low back pain and "sciatica", which are usually caused by postural changes and sacroiliac dysfunction. Edema or swelling of the arms and legs, carpal tunnel symptoms, neck pain, headaches, incontinence, pelvic pain, and lower extremity pain are other common ailments.  Stretching of the round ligaments that support the uterus may cause groin discomfort.  Increased laxity in the ligaments may be a contributing factor to low back and pelvic pain during pregnancy.

Pudendal Nerve Entrapment

The pudendal nerve of the pelvis can become compressed as it passes through the inside portion of the ischium or "sits bones" portion of the pelvis.  The nerve path exits from the greater sciatic foramen, travels around the ischial spine, and passes through the lesser sciatic foramen.  Compression can occur at any of these sites.  Chronic pain can be felt in the perineum, abdomen, buttock, vulva, penis/testicles, and anus.  Many patients have increased pain upon sitting.  The pain is usually one-sided but there have also been cases where both sides are involved.  Symptoms can be pain, burning, numbness, and/or tingling in the pelvis and can radiate elsewhere.

Sports and Orthopedic Injuries

At Inspirit Physical Therapy Associates our therapists are experts in dealing with all orthopedic and sports injuries. Exercising improves health and is strongly promoted by health care professionals but sometimes injuries occur unexpectedly or overtime.  Accidents, insufficient training, or using improper equipment can cause these injuries.  Not warming up, poor hydration, fatigue, or lack of stretching can also lead to injuries.  Some of the most common sports injuries are sprains and strains, knee injuries, Achilles tendon injuries, plantar fasciitis, shin splints, fractures, dislocations, tennis/golfer’s elbow, iliotibial friction syndrome, patellofemoral syndrome, low back pain, and rotator cuff tears. One of the best treatments for an injury that has just occurred is to rest, ice, apply compression, and elevate the injured area.  This method helps to reduce swelling and pain and expedite healing.  Seeing a physician is highly recommended to make sure the injury is not more severe than initially expected.


Vaginismus is described as an involuntary contraction or tightening of the pelvic floor or vaginal muscles in response to attempted penetration.  There are many possible causes such as anxiety, prior physical experiences that may have been traumatic, childbirth, hormonal changes, surgery, or a medical problem.  If penetration is painful or there is a history of pain with intercourse, a cycle of pelvic muscle spasm can occur.


Vulvodynia is defined as pain in the vulva lasting more than 3 months.  The pain can be described as burning, rawness, itching, achy, stinging, throbbing, irritation, or discomfort.  Vulvar pain can be generalized meaning that the general area of the vulva hurts or localized meaning that a specific area of the vulva hurts.  Vulvar pain can occur at rest and/or be provoked by touch/pressure. Localized vulvar pain can be local to the vestibule (vaginal opening) called vulvar vestibulitis or local to the clitoris called clitoridynia. Many patients complain of pain with intercourse, sitting, tight clothing, and/or sensitivity to topical agents such as creams and soaps.  Others report that their pain fluctuates with their menstrual cycle.  Vulvar pain can be related to an infection, inflammation, skin conditions, diseases, neurologic or musculoskeletal disorders.  

Article originally appeared on Inspirit Therapy Associates Physical Therapy for Green Bay, WI (http://inspiritpt.com/).
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