Chronic pelvic pain (CPP) is a common clinical condition among women of reproductive age, lasting for more than 6 months and frequently carries significant physical, functional, and psychological burdens that negatively affect quality of life. The prevalence of CPP in women ranged between 5.7% and 26.6% worldwide and 12% in Turkey. 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points (TP). Moreover, their pathophysiology is not known clearly, variable methods have been practiced clinically. In addition to surgical and medical treatment, conservative physiotherapy methods are among the prominent options. The efficacy of ischemic compression (IC) in musculoskeletal pain has been demonstrated and a few studies have been conducted in the pelvic region(1,2). Although several studies have used laser therapy in myofasyal pain syndrome (3), there are no studies comparing the IC and laser in CPP.
The purpose of this study was to evaluate the efficacy of ischemic compression (IC) versus low level laser therapy (LLLT) combined with exercise for TP in women with CPP and to compare the effects of the methods with each other. We think that both methods will be effective in the treatment of TP in CPP.

The sample size of our study was calculated by G power sample size calculator program. The number of patients was calculated as 12 for each group using the minimal clinical important difference of VAS from the primary outcome measeres was 30mm and the standard deviation was 23.6mm , 95% confidence interval and 90% power.
We conducted a parallel group randomized trial including 21 women with CPP. Subjects were randomly assigned to one of two intervention groups. One group received IC and the other group received LLLT was administered at the TPs during two weekly sessions  for six weeks. IC and LLLT were administered 90 sec for each TP found in predetermined pelvic region muscles. Both groups also received the same exercise programe including streching and core stabilization. Our primary outcomes were pressure pain threshold (PPT) measured using a pressure algometer and the visual analog scale (VAS). Our secondary outcomes were McGill Melzack Pain Questionnaire (MMPQ), range of motion (ROM) measured using a digital goniometer, functional state measured by Urogenital Distress Inventory (UDI) and Global Pelvic Floor Bother Questionnaire(GPFBQ), quality of life measured by the Short Form-36 (SF-36), psychological state measured by Hospital Anxiety and Depression Scale (HADS) and patient satisfaction measured by Patient Global Impression of Improvement (PGII). All subjects were evaluated at baseline and after the interventions. The  PPT was measured at before and after sessions as repeated measure.
Statistical analysis of the data was performed using the Statistical Package for Social Sciences “(SPSS) Version 21.0 program. Data were compared between groups and within groups.

As a result of our study; pain (VAS and MMPQ), PPT, functional status(UDI and GPFBQ), quality of life (physical-mental health, pain and vitality subgroups of SF-36), anxiety and depression evaluations were improved in both groups (p<0,05). In comparison between group; IC was found superior to LLLT for VAS at rest and night, pain severity of MMPQ, PPT, UDI, pain and energy subgroups of SF-36 and depression values (p<0,05). In the evaluation of range of motion; hip flexion was significant in both groups (p<0,05). There were no difference between the groups in terms of patient satisfaction (p>0,05).

The results of our study are consistent with similar studies in the literature.  In literature, wavelength, density and duration of LLLT are controversial. Studies have not found superiority of different doses to each other (3). Our study was the first study using LLLT in CPP patients. We used 3 J/cm2 density and 780 nm wavelength for 90 sec. Our results showed that the laser method is suitable for use in the pelvic region.
According to a study performed in the pelvic region using IC, our IC outcomes were more significant on PPT (2). We believe that this improvement in our study is related to the combined use of IC with exercise. The improvement in quality of life can also be attributed to the same reason. It is already reported that TP therapies should be performed in combination with exercise.
The TP in the pelvic floor muscles and bladder may affect each other  (1). Therefore, we used scales including bladder problems and questioned bladder complaints. While both groups showed significant improvement in both scales, IC group was superior in UDI scores.In addition to UDI in GPFBQ, there are also questions of intestinal function, constipation and sexual function. GPFBQ may have measured more sensitive with a 5-point Likert type.
Compared to another study, although our patients pain scores were higher, the HADS scores were lower (2). This may be due to the fact that patients' hope for recovery is reduced and they accept to live with pain.
Our study is an exemplary study in terms of use TP treatment in CPP and being a physiotherapist-gynecologist joint work.

Both treatment modalities are successful and can be used safely in patients with CPP. Since IC method is superior in terms of pain and quality of life, it can be recommended to physiotherapists primerly.

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