Healing from the Inside Out: Chronic Pain and Pelvic Floor Therapy
Chronic pain can feel like a relentless companion–one that shadows every movement, every breath, and every attempt to reclaim comfort. For many, especially those dealing with persistent pelvic, lower back, or abdominal pain, the root cause may lie deeper than expected: in the muscles of the pelvic floor.
Understanding Chronic Pain
Chronic pain is defined as pain that lasts longer than three months and which resists conventional treatment, resulting in negative cognitive, behavioral, social, and functional changes. It can stem from injury, inflammation, nerve dysfunction, or even emotional stress. Over time, the body adapts to pain in ways that create new problems such as tight muscles, altered posture, and disrupted movement patterns.
But what if the pain isn’t just a symptom, but part of a larger cycle?
The Pelvic Floor: More Than Just Muscles
The pelvic floor is a group of muscles that support the pelvis, spine, bladder, bowel, and reproductive organs. They play a crucial role in core stability, sexual dysfunction, toileting, and even breathing. When they become tight, weak, or uncoordinated, the result can be a wide range of chronic conditions, including:
Pelvic pain
Lower back pain
Hip and groin pain
Painful intercourse
Urinary urgency
Urinary leakage
Bowel disorders
How Pelvic Floor Therapy Helps
Pelvic floor therapy is a specialized approach that addresses the intimate connection between muscle function, nervous system regulation, and emotional wellbeing via manual therapy, targeted exercises, breathwork, and by helping to facilitate healthy lifestyle changes (Starzec-Proserpio et al., 2024).
Breaking the Pain Cycle
Chronic pain often creates a feedback loop: pain leads to an increased perception of potential threats, muscle guarding, anxiety, and shallow breathing, which often leads to more pain. “This diversity of potential threats can lead you into a cycle of pain and disability from which it can be really difficult to break free” (Butler & Moseley, 2013). Pelvic floor therapy helps to interrupt this cycle by restoring balance and function. Patients frequently report improvements not just in pain levels, but in mood, sexual function, and overall quality of life (Bittelbrunn et al., 2022).
A Holistic Path Forward
Healing chronic pain requires a multifaceted approach, with therapy being a powerful piece of the puzzle, especially for those whose pain has defied explanation or traditional treatment. By reconnecting with the pelvic floor, patients can begin to heal from the inside out.
References:
Bittelbrunn, C. C., de Fraga, R., Martins, C., Romano, R., Massaneiro, T., Mello, G. V. P., & Canciglieri, M. (2023). Pelvic floor physical therapy and mindfulness: Approaches for chronic pelvic pain in women—a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 307(3), 663–672. https://doi.org/10.1007/s00404-022-06514-3
PubMed
Butler, D. S., & Moseley, G. L. (2013). Explain Pain (2nd ed.). Adelaide, Australia: Noigroup Publications.
Publisher link
Starzec-Proserpio, M., Frawley, H., Bø, K., & Morin, M. (2025). Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 232(1), 42–71. https://doi.org/10.1016/j.ajog.2024.08.006
PubMed
Written by: Candice Garrett, OTR/L