Scoliosis is a spinal curvature that can be a cause of an symmetrical pelvis. One side of the pelvis sheers upwards as a compensation of the curvature. Besides causing a functional leg length discrepancy (side of sheered pelvis upwards “shortens” the leg), there are many changes in the soft tissue structures such as pelvic ligaments, pelvic muscles, and nerves. Structures on the sheered or upslip side are tractioned or pulled upwards. In this patient, she is experiencing left sided chronic pelvic pain. Her left pelvic floor muscles are being tractioned or pulled upwards. This can result in pelvic floor muscle dysfunction such as pain, tension, and myofascial trigger points on the same side. The sacrospinous and sacrotuberous ligaments are being pulled or tractioned also. Because the pudendal nerve travels between these two ligaments that cross one another deep in the pelvis tension of the ligaments can cause a compression or squeezing of the nerve. This can result in pudendal nerve irritation. Pelvic nerve entrapment or PNE can occur due to trauma. In this case, she had also sustained a trauma from a subsequent fall onto her pelvis. Patients may feel pelvic pain or burning in sitting, buttock pain, vulva or scrotal pain, pain with intercourse, and may report urinary hesitancy, bladder pain or painful bowel movements. Rehabilitation goals for this patient would be to soften and maximally correct the scoliosis and pelvic alignment, resolve the pelvic floor muscle dysfunction, calm the nerve pain with modalities, and strengthen her core muscles. She has been referred to a physiatrist to be assessed for injections to help with reducing her pain level.
