{VIDEO} Stephanie Talks Trigger Points, Connective Tissue Restriction

In Pelvic Floor Physical Therapy by Stephanie Prendergast14 Comments


[Note to readers: Listening with earphones will provide clearer audio.]

When asked to deliver a lecture at the First World Congress on Abdominal and Pelvic Pain in Amsterdam this month, I immediately knew what topic I wished to focus on: myofascial trigger points and connective tissue restrictions.

Both play a major role in many abdomino-pelvic pain syndromes, yet are often overlooked by providers, both physicians and physical therapists.

In this post, I’d like to share a video of my talk with you. The lecture is titled “The External Expression of Abdomino-Pelvic Pain: Referred Soft Tissue Phenomena.” (For those of you who have read our posts on physical therapy for pelvic pain, this talk will go a long way toward explain the “external” work that we administer to patients.)

In addition, if you’d like to check out the slides I presented during the lecture, please click on the link below. (Unfortunately, the videos I included in the slide presentation are not accessible via this link.)

To view the slide presentation shown during my lecture, please click here.

All my best,



  1. Thank you for sharing -it is very informative. I have chronic fissures along with PFD, IC SIJD, vvs – what areas of the body do you find have connective tissue restrictions in your patients that have chronic fissures? thank you

    1. Author

      Dear Rachel,

      I would evaluate all of the connective tissue from your ribs to your knees, back and front, but particularly the connective tissue in your buttocks, the peri-anal tissue, the perineum, your low back and the backs of your thighs.

      All my best,

  2. The study demonstrated that focused myofascial TrP therapy is superior to global massage therapy to treat pelvic pain? I would think this is obvious. But I have found that once the areas with Trps and restrictions are located, a good myotherapist is as good or better than most PTs at releasing the offending muscles and fascia. The problem is that myotherapists are not trained to evaluate myofascial pelvic pain, and they generally cannot work internally. Most PTs are not well-trained to work externally to perform TrP release. There is a need to marry pelvic floor PT expertise to myotherapist bodywork expertise. My 2 cents

    1. Good comment Joe. I’ve been seeing a myofascial therapist and PT for exactly the same reasons. And insurance many times will not pay for a myofascial therapist.

      1. Thank-you for your comments on a true problem in the field. Not all PTs have appropriate training in myofascial trigger point therapy. We suggest working with a therapist that has had specific training through groups such as the MyoPain Seminars and Kineticore. I also agree with your comment that providers other than physical therapists can help people deal with aspects of their pelvic pain, as is demonstrated in this study where the group of patients receiving massage did show some benefit. Finally, one would absolutely expect skilled physical therapy to improve symptoms over massage. This research design required a control arm and the investigators determined that the closest therapy to manual physical therapy is global therapeutic massage.

  3. Thank you for all you do for both patients and providers. You are helping to change this great unknown of pelvic disorders and providing true hope for healing. Thanks again-

    Amy- patient and provider

  4. Would connective tissue dysfunction cause the grainy sandlike feeling inbetwen tissue when u hold it between fingers?

    1. Author

      Dear Amanda,

      Yes, that is a great description!


  5. Thank you for moving the research forward. I am not a medical professional but your talk seemed extremely clear and concise. It is wonderful that you are spreading knowledge about the illness and about treatment.

  6. Do you have any resources that compare and contrast trigger points and connective tissue restrictions? I am familiar with trigger points, but I am unsure how to distinguish connective tissue restrictions from TPs. Thanks!

    1. Author

      Dear Joshua,

      No I’m sorry, but we do not know of any resources that compare/contrast trigger points and connective tissue restrictions. Can you ask your PT to show you how to treat any connective tissue restrictions you can reach/and/or how to treat any trigger points you might also be able to access. We find this is the best way to approach learning to self-treat.

      All my best,

  7. What is your opinion of the effectiveness of trigger point injections? I have heard of people finding these effective in treating pelvic pain.

    1. Author

      Dear Beverley,

      Trigger Point Injections are an effective way to eliminate a trigger point. The issue is making sure the trigger point in question is in fact a pain contributor and that the person doing the injections is skilled and can recognize when the trigger point is eradicated. Several rounds of injections may be needed into the same trigger point to eliminate it.

      All my best,

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