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Physical Therapy Management of Sacroiliac Pain and Dyspareunia: A Case Report

Background:Literature varies in regard to the prevalence, etiology, and management of dyspareunia. Although associations between pelvic floor and sacroiliac dysfunctions have been suggested, a lack of consensus prevails in regard to the management of these conditions, especially when they present concurrently. Study Design:This is a single-subject case report describing examination, evaluation, intervention, and outcomes. Case Description:This case report describes the physical therapy management of a client presenting with both dyspareunia and sacroiliac pain. Intervention primarily addressed the sacroiliac dysfunction; this treatment algorithm was selected on the basis of available literature suggesting relationships between sacroiliac pain and pelvic floor dysfunction and also due to the client's preferences for treatment. The client attended 5 physical therapy sessions over a 4-week period, with intervention including manual therapy techniques to correct pelvic ring malalignment, therapeutic exercise, and home program instruction to address and correct soft-tissue extensibility and strength deficits contributing to improper alignment. Outcomes:Postintervention outcomes included improved Female National Institutes of Health-Chronic Prostatitis Index scores, improved tolerance for internal pelvic floor examination, and reported resolution of dyspareunia symptoms. Discussion:This case report describes how available literature, client preferences, and clinician expertise can guide the decision-making process for the physical therapy management of a client presenting with dyspareunia and sacroiliac pain. Although the therapist also presented evidence-based options for intervention, the client's preferences were considered and regarded.