Can pelvic floor physical therapy help the SI joint?

Hi everyone!

Here’s a question that’s been coming up pretty frequently, so I wanted to take some time to answer it for all of you.

People want to know if pelvic floor physical therapy can help them, and my answer is, of course, yes!

Let me go on to explain some key points.

First… what is the pelvic floor?

The term pelvic floor refers to the sling of muscles that make up the bottom of the pelvis and support the various organs and structures we have there. Obviously, these structures are slightly different in men and women, but we all have a pelvic floor.

Female pelvic floor and pelvic organs, courtesy of Bruce Blaus
Muscles of the female pelvic floor, courtesy of OpenStax Anatomy and Physiology

And what is pelvic floor PT?

It’s a special branch of physical therapy that requires additional courses beyond the standard 3 years of PT school.

A pelvic floor PT is trained to assess the strength and function of the muscles of the pelvic floor. When these muscles have a dysfunction– they can be too tight, too weak, or not coordinated enough– it can have an impact on a lot of our body’s other functions and it can also cause pain. And pull unevenly on the SI joints.

Pelvic floor PT is really fascinating and can actually help with a lot of different issues.

Obviously, for the purposes of this post, I’m going to focus on the SI joint and pelvic pain, but just you know… pelvic floor PT’s can help with tons of different issues… if you’re having an issue in the pelvis, whether it’s related to going to the bathroom, pain during sex, you name it.. a pelvic PT can probably help.

How can a pelvic PT help with the SI joint?

A pelvic PT can help in ways that are similar to an orthopedic PT, in that they can assess which muscles are tight, which ones are weak, which ones are in spasm, etc.

The main difference here is that while an orthopedic PT is likely going to be assessing the strength of your legs (quads, hamstrings, etc.) the pelvic PT is going to look more directly at the muscles within the pelvic floor.

While an orthopedic PT might have you doing exercises to strengthen your quads, for example, a pelvic PT might start by releasing trigger points within your pelvic floor. If these muscles were tight and pulling unevenly on the bones of your pelvis, this can contribute to SI joint dysfunction.

However, I don’t think of pelvic floor PT as a replacement for traditional orthopedic PT.

I think that identifying and correcting muscle imbalances in the pelvic floor can be hugely important, and can certainly be a missing piece of the puzzle for many people. But I think it is unlikely to be the only piece of the puzzle,and it will always be important to eventually go through a whole-body strengthening program as part of your recovery.

With that being said, I do think it can be an amazing tool that everyone should check out!

And again, I especially think this if you have any other ongoing health issues that occur within the pelvis.

After all, everything in the body is connected. If you have chronic discomfort in your abdomen whether it’s due to digestive issues, interstitial cystitis, or vaginal pain, a pelvic PT can definitely help.

And, in terms of the SI joint, this chronic discomfort can actually cause your pelvic floor muscles to go into spasm as part of the body’s protective response. Which can, in turn, exacerbate your SI joint issues.

So, if you are interested in pelvic floor, here are a few ways to get started:

Pelvic Floor Dysfunction for Women Facebook Group — I know one of the admins personally and she is great!

This directory of pelvic floor PT’s from the well-respected pelvic floor educational institute Herman & Wallace.

This article from the Pelvic Health and Rehabilitation Center offers some great tips — it also makes the point that some pelvic PT’s out there really only focus on urinary incontinence. This has to do with the fact that that was really the original focus of pelvic floor PT, back when it was first started several decades ago, and there are foundational courses that really only focus on strengthening the pelvic floor muscles for this reason only. I have encountered pelvic floor PT’s like this myself in real life and it can be quite frustrating. So this article offers some great tips on how to “interview” a pelvic PT and make sure they have the training that fits your needs.

Pelvic Sanity also has a great article on tips to locate the right pelvic PT for you.

But for some personal stories, I also recommend checking out:

The Happy Pelvis Blog and author Michelle’s Instagram account

Blogger Sara Norquist— very honest about her chronic health struggles, including pelvic floor issues

This personal story from a woman who sought out pelvic floor PT for her debilitating pelvic pain

There is so much great information out there– hopefully this gives you a place to start! Happy researching!

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