An introduction to the anatomy of pelvic pain

2.1 An introduction to the anatomy of pelvic pain

The anatomy of pelvic pain can conveniently be divided into the clinical anatomy and biomechanics of the pelvis (see Chapter 2.2) and the anatomy of the pelvic floor (Chapter 2.3). However, the human body operates as a system (Ahn et al. 2006, Reeves et al. 2007) and cannot be divided quite so simplistically. Each component of the movement system is likely to influence distal and proximal regions, it is modulated by many factors from across somatic, psychological and social domains (Moseley 2007, Fall et al. 2010) and ultimately it is controlled by the central nervous system (CNS). It is therefore important always to remind ourselves not to focus solely on the end organ that we may perceive to be ‘at fault’, particularly as the relationship between pain and the state of the tissues becomes weaker as pain persists (Moseley 2007).

The lumbopelvic spine is encompassed by a dense ligamentous connective tissue stocking (Willard 2007) containing five lumbar vertebrae, sacrum, coccyx and two innominates, which are joined by strong ligamentous attachments posteriorly at the sacroiliac joints and anteriorly at the symphysis pubis. Furthermore, the thoracolumbar junction (T10–L2) can, when stimulated, result in pain perceived in the pelvis, and will also need to be evaluated in patients with chronic pelvic pain (CPP). The stiffness of the spine will be the result of reaction forces acting across it, and is modified by gravity, the shape of the articular surfaces, the actual joint position, proprioceptive muscle reflexes, the level of muscle (co)contractions and increased ligament tension.

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