Pelvic Floor Pain — A Chiropractic Perspective

Written By Brandon Steele

Reading time: 5 minutes

The pelvic floor is one of the most complex anatomical and functional areas of the human body and to this day has remained an enigma. Fortunately, there are several treatments delivered by evidence-based chiropractors to help this underserved population of patients. Today’s blog will highlight strategies (7 in-office treatments and 3 at-home research-backed exercises) to help patients return to a pain-free life. 

Evidence-Based Chiropractic Treatment for Pelvic Floor Dysfunction

  1. Myofascial release is beneficial for pelvic myofascial pain syndrome, particularly in hypertonic patients. (1) 

  2. Dry needling, where allowed, may be a helpful technique for reducing myofascial involvement. (2) 

  3. Extracorporeal Shockwave Therapy (ESWT) is another potentially helpful modality for pelvic floor dysfunction. (3) 

  4. HVLA manipulation of the pelvis and lumbosacral region has been shown to affect the strength and tone of pelvic floor muscles (4) The female pelvic floor is innervated by T12-S5, most notably the Pudendal Nerve arising from L4-S4.

  5. Acupuncture is helpful. (5) 

  6. Concurrent general aerobic training may enhance outcomes for pelvic floor rehab. (6, 7) Regular aerobic exercise may also help maintain improvements achieved through pelvic muscle training. (5) 

  7. Incorporating Pilates and yoga may be useful adjuncts although yoga proved more beneficial than pilates. (8) 

Focused Evidence-Based Rehabilitation

There is nothing wrong with prescribing Kegel exercises. However, management of pelvic floor dysfunction is multifaceted, as evidenced by the fact that more than 40% of patients suffer from symptoms for more than five years. (9) If left untreated, the problem can be a significant deterrent to intimacy, work, and social functions. (10) The associated symptoms can lead to depression, isolation, and anxiety. (9) 

The knee jerk reaction of most healthcare providers is to only prescribe Kegel exercises for those with pelvic floor pain. There is varying success in using only Kegel exercises due to three roadblocks:

  • Prescribing Kegel exercises is dependent on a hands-on pelvic exam, however, very few practitioners are qualified and willing to provide that service. 

  • Many patients will often incorrectly bear down, performing a Valsalva maneuver instead of a Kegel.  Women with pelvic floor dysfunction often have an inaccurate self-perception of pelvic floor muscle contraction. (11)

  • Finally, there is no consensus on the specific type of pelvic floor muscle contractions (long vs shorthold), exercise frequency, and patient position.  (12, 13)

For Better Results… Use the Bear Position and Breathing Retraining For Rehab

Bear Position

This dynamic stabilization exercise allows patients to manage intra-abdominal pressure with the pelvic floor in an elevated position while limiting the tendency to bear down. This allows for eccentric control of the pelvic floor and simultaneous pressurization of the core canister. (14)

Diaphragm Breathing

Patients with pelvic floor dysfunction often present with paradoxical breathing patterns, so instruction on proper diaphragmatic breathing is crucial. Proper diaphragmatic breathing helps to improve pelvic floor relaxation and allows better-coordinated function for overall canister stability. (14)

4 Little Known Facts About Pelvic Floor Pain 

Pelvic floor muscle training performed for three months can lead to significant quality of life improvements. (15) 

Women who perform pelvic floor muscle training are five times more likely to report resolution of urinary incontinence. (16) 

Kegel exercises, when appropriate, have been shown to improve sexual function in both genders (12), including symptoms of erectile dysfunction in men. (17) 

Urinary incontinence is a symptom of pelvic floor dysfunction. Diaphragmatic breathing exercises are beneficial in the treatment of urinary incontinence. (18)

Download the Condition Report for Pelvic Floor Dysfunction

 
 

For More information, read the newly updated Condition Reference for Pelvic Floor Dysfunction within the Clinical Skills section in ChiroUp.

 
 

Conservative management of pelvic floor dysfunction consists of myofascial techniques, rehabilitation exercise, and lifestyle advice. Proper management often requires a coordinated multi-disciplinary team to resolve all components, including any underlying comorbidities. (19)

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    1. Dong XX, Guo M, Huang LX, Chen C, Hu JH. The efficacy of manipulation as a treatment for myofascial pelvic pain. International Urology and Nephrology. 2021 Apr 2:1-5. Link

    2. Connor K.Geletka B. Dry Needling for Pelvic Dysfunction? University Hospitals. February 25, 2020 Accessed 03/16/21 from: https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2020/02/dry-needling-for-pelvic-dysfunction

    3. Long CY, Lin KL, Lee YC, Chuang SM, Lu JH, Wu BN, Chueh KS, Ker CR, Shen MC, Juan YS. Therapeutic effects of low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence. Scientific reports. 2020 Apr 2;10(1):1-0. Link

    4. de Almeida BS, Sabatino JH, Giraldo PC. Effects of high-velocity, low-amplitude spinal manipulation on strength and the basal tonus of female pelvic floor muscles. Journal of manipulative and physiological therapeutics. 2010 Feb 1;33(2):109-16. Link

    5. Howard C. RE: “Pelvic Floor Dysfunction Protocol.” Message to Tim Bertelsman regarding advice on chiropractic management of pelvic floor dysfunction patients via direct email on 03/04/2021.

    6. Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women. Canadian Urological Association Journal. 2010 Dec;4(6):419. Link

    7. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of physical medicine and rehabilitation. 2001 Aug 1;82(8):1081-8. Link

    8. Kannan P, Hin HW, Tung SW, Man CL, Assor A, Ming HC. Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: A randomised controlled pilot trial. Complementary Therapies in Clinical Practice. 2021 Oct 26:101502. Link

    9. Bedretdinova D, Fritel X, Zins M, Ringa V. The effect of urinary incontinence on health-related quality of life: is it similar in men and women?. Urology. 2016 May 1;91:83-9. Link

    10. Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. Journal of Obstetrics and Gynaecology Canada. 2003 Jun 1;25(6):487-98. Link

    11. Uechi N, Fernandes AC, Bø K, de Freitas LM, de la Ossa AM, Bueno SM, Ferreira CH. Do women have an accurate perception of their pelvic floor muscle contraction? A cross?sectional study. Neurourology and urodynamics. 2020 Jan;39(1):361-6. Link

    12. Mohktar MS, Ibrahim F, Rozi NF, Yusof JM, Ahmad SA, Yen KS, Omar SZ. A quantitative approach to measure women’s sexual function using electromyography: A preliminary study of the Kegel exercise. Medical science monitor: international medical journal of experimental and clinical research. 2013;19:1159. Link

    13. Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women. Canadian Urological Association Journal. 2010 Dec;4(6):419. Link

    14. Mumma, L. RE: “Pelvic Floor Dysfunction Protocol.” Message to Tim Bertelsman regarding advice on chiropractic management of pelvic floor dysfunction patients via direct email on 03/09/2021.

    15. Fitz FF, Costa TF, Yamamoto DM, Resende AP, Stüpp L, Sartori MG, Girão MJ, Castro RA. Impact of pelvic floor muscle training on the quality of life in women with urinary incontinence. Revista da Associação Médica Brasileira (English Edition). 2012 Mar 1;58(2):155-9. Link

    16. Uechi N, Fernandes AC, Bø K, de Freitas LM, de la Ossa AM, Bueno SM, Ferreira CH. Do women have an accurate perception of their pelvic floor muscle contraction? A cross?sectional study. Neurourology and urodynamics. 2020 Jan;39(1):361-6. Link

    17. Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual medicine reviews. 2016 Jan 1;4(1):53-62. Link

    18. Toprak N, Sen S, Yigit B. The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. Journal of Bodywork and Movement Therapies. 2022 Jan 1;29:146-53. Link

    19. Shannon MB, Mueller ER. Pelvic Pain Associated with a Gynecologic Etiology. InPelvic Floor Disorders 2021 (pp. 879-889). Springer, Cham.

Brandon Steele

Dr. Steele is currently in private practice at Premier Rehab in the greater St. Louis area. He began his career with a post-graduate residency at The Central Institute for Human Performance. During this unique opportunity, he was able to create and implement rehabilitation programs for members of the St. Louis Cardinals, Rams, and Blues. Dr. Steele currently lectures extensively on evidence-based treatment of musculoskeletal disorders for the University of Bridgeport’s diplomate in orthopedics program. He serves on the executive board of the Illinois Chiropractic Society. He is also a Diplomate and Fellow of the Academy of Chiropractic Orthopedists (FACO).

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