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Graded exposure and manual therapy in chronic pelvic pain

Is the addition of graded exposure therapy to manual therapy beneficial in chronic pelvic pain?

Chronic pelvic pain (CPP) is often a debilitating condition experienced by women of all ages. Like many chronic conditions, this can lead to significant fear avoidance behaviours which ultimately result in varying degrees of disability.

The women in this study were treated with graded exposure therapy in addition to manual therapy which resulted in significant improvements in their fear avoidance beliefs, pain and disability.  

Based on this study, manual therapy can lead to significant improvements for women with chronic pelvic pain however the addition of graded exposure therapy is likely to result in superior benefits.

> From: Ariza-Mateos et al., Arch Phys Med Rehabil 100 (2019) 9-16 . All rights reserved to American Congress of Rehabilitation Medicine. Click here for the online summary.

Expert opinion by Willem-Paul Wiertz

This study highlights the importance of being patient-centered when managing any patient, especially those with a chronic condition.

All patients in the graded exposure group were managed differently (as their fearful movements varied) which may be a critique of this study in terms of standardization of treatment, but it is more realistic of a real life clinical scenario and was still able to demonstrate significant benefits to the patients in the group. 

A clearer description of the location and type of manual therapy techniques used in this study would have been beneficial for the reader.

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