By: Courtney Edgecomb
It’s needless to say that getting into a car accident is scary. Adding in any form of injury on top of an accident can be life-changing. I have become more cognisant of such life-changing accidents since I started my physical therapy career in Los Angeles a few years ago. A large amount of the patients I have seen have suffered pelvic fractures or similar injuries from being in motor vehicle accidents (MVAs). Injuries to the pelvis due to MVAs are highly associated with being a driver or front passenger, getting hit from the side, getting hit as a pedestrian, or driving a motorcycle. Recent studies have shown that accidents involving a motor vehicle have lead to 57.5% -74% of all pelvic ring injuries(3).
Furthermore, pelvic ring injuries typically occur along side multiple injuries. Gansslen et al found that less than 31% of all types of pelvic ring injuries were sustained without any other concomitant injury(3). Some of these other injuries can include the lumbar or sacral spine, genitourinary complex (think kidneys, bladder, urethra), liver, spleen, and lower extremities(1,2). Serious pelvic injuries from MVAs also have a higher rate of emergency intervention, which most commonly consists of an external fixator or clamp to hold the pelvis in a stable position.
But what happens after all of the hardware is removed and you are no longer in the hospital? What if your pelvis wasn’t even treated due to other injuries that took priority after your accident? Chances are you are still in pain and aren’t back to the daily activities you could normally do prior to your accident. You probably have a hard time standing, sitting, or walking even short distances. You might be waiting to get back in the gym, but the pain and mobility restrictions are not making it easy. It’s even possible that you may have noticed a change in urinary, sexual, or bowel functions such as painful urination or difficulty urinating, increased urinary urge and frequency, painful intercourse, or constipation. What is going on and why isn’t it going away? It’s possible that your doctor may not ask about these symptoms and it can be a difficult subject to bring up on your own. Maybe you have these symptoms but thought it was “just from the accident” and not something going on in your body (AKA the pelvic floor, which we will talk about later). Hopefully your doctor sent you to outpatient physical therapy to address pain and mobility, but treatment of pelvic pain and pelvic floor related symptoms can be specific and is not well-known in the spectrum of orthopedic outpatient physical therapy. A few examples of injuries and possible symptoms include:
- Pelvic reconstruction surgery → walking with a limp, pain when sitting, pain with transitional movements (sitting to standing, rolling in bed, getting into/out of a car), vaginal/penile/testicular pain, numbness in your pelvis or legs, discomfort wearing tight clothing, painful intercourse – penetration or thrusting
- Lumbopelvic muscle spasm → pain when sitting or standing, vaginal/penile/testicular pain, painful urination, urinary hesitancy, urinary urge/frequency, painful intercourse, constipation
- Traumatic compression injury → pain when walking or sitting, pain with transitional movements, difficulty or pain engaging core stabilizing muscles, numbness, limited range of motion in hips or pelvis, painful intercourse, urinary hesitancy, urinary urge
Following surgery or traumatic injuries, our bodies begin to develop myofascial restrictions, scar tissue, muscle weakness, nerve injuries, decreased blood flow, and more. Pain that follows an accident or surgery tends to make our muscles tense up and develop trigger points. Our bodies naturally form scar tissue to heal any injured tissues or surgical incisions, which gets very stiff throughout the various layers of muscle, connective tissue, and skin. These restrictions in muscles, connective tissue, and scar tissue can limit the space around our blood vessels and nerves, then causing more pain or burning, reduced sensation, tingling, or shooting pains. All of the above can contribute to your difficulty walking or sitting, reduced endurance or strength, and PAIN. When these things happen in your pelvis, more specifically in or around your pelvic floor, it can lead to pelvic pain, vaginal or penile pain, and the changes in your urinary, sexual, or bowel functions I mentioned above. Check out Shannon’s post here on the pelvic floor for a fun anatomy lesson and better understanding of how these symptoms occur.
So the good news is you can address all of these issues with the help of a pelvic floor physical therapist! Your PT will ask about your symptoms and functional limitations, help determine the underlying causes, discuss other interventions that will assist your recovery, and help you get back on your feet with a plan of care. Your PT will also begin a home program for you that may include diaphragmatic breathing, foam rolling or self-massage, gentle mobility exercises, posture training, or other symptom management strategies fit for you.
If you have been in a car accident recently and suffered a pelvic injury, don’t hesitate to reach out for help. You can get moving again, pain-free!
1. Inaba K et al. The Increasing incidence of severe pelvic injuries in motor vehicle collisions.Injury. 2004 Aug;35(8):759-65.
2. Kobziff, L. Traumatic Pelvic Fractures. Orthopaedic Nursing. 2006 Jul-Aug;25(4):235-241.
3. Pieriera et al. Epidemiology of Pelvic Ring Fractures and Injuries. Rev Bras Orthop. 2017 May-Jun; 52(3): 260–269.