Pelvic Pain
CSPC Leeds offers specialist Pelvic Pain Physiotherapy for both men and women to assess, treat and manage acute or chronic pelvic pain, providing expert assessment, targeted treatment and long-term support to reduce pain, improve function and restore confidence.
What is pelvic pain?
Pelvic pain is a very broad term covering pain in and around the pelvis. It includes the whole of the pelvis, the lower back, the sacrum and the hips, as well as the muscles and nerves in this area. Pelvic pain can affect anyone – male, female, old or young, athlete and non-athlete, as well as the more well-known pelvic pain related to pregnancy. Despite the very simple description, there are many reasons why we may get pelvic pain and it is actually a very complicated area to treat.
CSPC is well placed to assess and treat your pelvic pain because we have a team of very experienced physios who have the ability to assess and treat all of the areas that may result in pelvic pain, which means that we can usually help, even in complicated or chronic cases. You may have pelvic pain for a number of reasons; for example, it may be biomechanical from a pelvic torsion or a leg length difference; it may be secondary to issues elsewhere in the body (i.e. feet, thorax, shoulders, a previous trauma or head injury), or due to a visceral component that you weren’t aware you had. It may also simply be due to how you move. Our highly skilled team can help to identify the root cause of your pelvic pain and help you get on your road to recovery.
Types of pelvic pain
Although it is unlikely that pelvic pain only comes from one type of structure, pelvic pain can be broken down into several different categories. If it is long term issue, then several areas may also be affected due to compensatory movement patterns, and your therapist may need to address several areas, depending on what they find during the assessment.
Pelvic girdle pain
This is likely to refer to the bony areas you can touch around your pelvic girdle. Your pelvis is made up of right and left ilium bones joined at the front by the pubic symphysis, which is a joint, and the two sacro-iliac joints at the back. The sacro-iliac joints join the two sides of the pelvis (or ilia) to the sacrum, which is the flat bone at the bottom of your spine. Your pelvic bones can develop subtle twists which can change the alignment of the pelvis and result in pain in the pubic symphysis or the sacro-iliac joints. This pain can be from the ligaments or the joints themselves, and in some cases it can be bony. If the pelvis alignment changes, it will have an effect on the alignment of the spine above it, or the lower limbs below. There are various techniques that can be done to help improve positioning and therefore reduce pain.
Sacro-iliac joint pain
Any alignment issues in and around the pelvis can result in pain in the sacro-iliac joints at the back of the pelvis. These joints can become too stiff or too loose, and get chronically sore for this reason. They may be worse with sitting or standing, and may be related to a leg length difference (one leg longer than the other which is more common than you may think and may not have been identified previously). This pain can be coming from the ligaments around the joint, or the joint itself.
Hip-related pelvic pain
Issues in the hip joints may result in pain around the pelvis due to the effect on how you move. The femur, or thigh bone attaches to the pelvis at the acetabulum, which is the cup that makes up the hip joint. Too much or too little mobility at the joint, lack of strength and stability or using the hips badly during walking, running and sitting can all result in pelvic pain and it would be necessary to treat these factors to address pelvic pain.
Lower back-related pelvic pain
Lack of mobility in the lower back due to stiff joints and tight muscles, as well as poor posture, will put stress on the pelvis and can result in pain. Again, it would be necessary to work out why your lower back is creating issues in the pelvis, to then be able to alleviate your pelvic pain.
Pelvic floor-related pain
Pain in the pelvic floor can affect both men and women. It can be the result of slips and falls, coccyx injuries, surgery, pregnancy and giving birth, and for men can be the unwelcome side effect of prostate examinations. Your pelvic floor which is the group of muscles that make up the hammock at the base of the pelvis and basically stops your organs falling out through gravity. To walk and move normally during any activity, your pelvic floor should be able to contract and relax depending on the activity. Your pelvic floor can become too tight or too loose and may be different on each side, which can alter movement patterns, alter pelvic alignment and cause pain.
Pudendal nerve pain
This is notoriously hard to treat and often not mentioned as it can be really uncomfortable and in a very personal area. It simply refers to the irritation of the pudendal nerve that runs from the sacrum to the rim around the pelvis, where you would sit on a saddle. It can be damaged with surgery, trauma, labour and child birth, prostate examination, and sitting on a bike or a horse for too long. It is possible to assess and treat this with the right skillset, and several of the physiotherapists at CSPC are able to do this. Pudendal nerve pain can result in tightness or dysfunction in the pelvic floor, and can also affect the way the sacro-iliac joint works.
Postural and biomechanical pelvic pain
This can be the result of all of the factors above. It can be the result of issues elsewhere in the spine and ribs, poor postural habits during activity or at rest, poor muscle flexibility, poor joint mobility, leg length differences, and even poor foot and lower limb biomechanical alignment. Again, a thorough assessment of your alignment and the way you move can really get to the root cause of your issues and help to get you on the road to getting rid of your pain.
Persistent chronic pelvic pain
Don’t give up hope of finding a fix for your long-term pelvic pain symptoms. There are so many causes of chronic pelvic pain. A physiotherapist who is able to assess the many areas that may be contributing to your individual issues, in most instances, will be able to help you or guide you to someone who can if something more specialist is required. The physiotherapists and other therapists at CSPC have a broad tool box of assessment and hands-on treatment skills and are keen to help you get back to your best.
Common symptoms
There are a number of symptoms that are indicative of pelvic issues and are worth mentioning when you see the physiotherapist. If you find that stretching and strengthening exercises make little or no difference, then it is definitely worth finding out what you should be doing instead!
Symptoms you may experience can include:
- Pain around the pubic bone, sacro-iliac joints, coccyx (tail bone), lower back, and hips
- Pain or tightness in the groin, adductors, buttocks and hip muscles
- Tight or painful hamstrings
- Tight muscles in the glutes (buttocks)
- Deep ache in the pelvis or a feeling of heaviness
- Pain or aching up into the upper back or rib cage
- Pain when walking, standing, turning, lifting
- Pelvic floor dysfunction – incontinence or not being able to relax enough to go to the toilet
- Pain aggravated by sitting
What causes pelvic pain?
You can have pelvic pain for a number of reasons. It is important for your therapist to work out why you have pelvic pain and to get to the root cause of that. For example, your balance or stability may be poor, but if that is secondary to another issue like pelvic alignment, where the hip is sitting in the joint, or how your feet function, then it is important to sort that out first.
Pelvic misalignment
If the pelvis is out of line or slightly twisted, then it is important to work out what is causing this. The bony of configuration of the pelvis can be misaligned and there are various techniques to correct this. The alignment of the pelvis can also be affected by muscle imbalance- front to back or left to right. Often muscles that are short and tight need soft tissue work and stretching, and is an important adjunct to the alignment work. If, for example, your pelvis has a torsion, due to one quadriceps muscle (down the front of your thigh) being tighter than the other, no amount of aligning will help until the muscle length of that quadriceps is improved.
Pelvic misalignment for any reason can result in joint dysfunction and cause pain in the pubic symphysis, sacro-iliac joints, your lower back, as well your hips. This can cause irritation in the various nerves that pass through the pelvis – for example the sciatic and femoral nerves, sacral nerves, pudendal and obturator nerves to name a few of them.
Pelvis misalignment may also be a direct result of trauma (car crashes, falling off a bike), operations, scars that are having a tightening effect on muscle length, and poor core activation. You may also be overloading certain parts of your pelvis depending on which muscles you use/ overuse, and this can result in bony injury. Again, a thorough assessment will help to identify why you have pelvic pain, and how to address it.
In summary, pelvic pain has many causes:
- Pelvic misalignment
- Muscular imbalance
- Scars - appendix, hernia, laparoscopy, Caesarean sections
- Stress fractures, stress reactions and bone marrow oedema
- Joint dysfunction (sacro-iliac joint, pubic symphysis and hip)
- Postural or biomechanical factors
- Nerve irritation (pudendal, obturator, femoral, sciatic, sacral nerves)
- Movement patterns
- Visceral dysfunction
- Pelvic floor dysfunction
- Sports / repetitive strain
- Core stability deficits
- Previous injuries (hips, low back) contributing to pelvic load
CSPC’s approach to pelvic pain
CSPC is well placed to assess and treat your pelvic pain because we have a team of very experienced physiotherapists who have the ability to assess and treat all of the areas that may result in pelvic pain, which means that we can usually help, even in complicated or chronic cases. The physiotherapists, soft tissue therapists and the podiatrist at CSPC have a broad tool box of assessment and hands-on treatment skills and are keen to help you get back to your best. The complexity of pelvic pain necessitates a thorough examination by those who have the knowledge base to get to the root cause of your issues. In most cases, they will be able to help you or if not, they can guide you to someone who can. The team at CSPC are complex case specialists due to our unique skill set and collaborative team work.
CSPC’s unique approach to successfully treating pelvic pain includes the following:
- Full biomechanical assessment
- Pelvic alignment evaluation
- Hip, lumbar, and sacro-iliac joint screening
- Thoracic and rib cage assessment
- Movement pattern analysis (walking, sports-specific tasks)
- Muscle length testing
- Soft-tissue and joint techniques
- Assessment of nerve mobility
- Assessment of scars if present (appendix, hernia, laparoscopy, Caesarean)
- Pelvic floor assessment where appropriate
- Visceral mobility testing
- Pelvic stability, hip and thorax strength and stability
- Breathing and core coordination
- Dry needling / acupuncture (if appropriate)
- Individualised exercise rehab
- Education and load management
When pelvic pain overlaps with other issues
Due to the complex nature of pelvic pain, there are some categories where we have given further details.
- If your pain is pregnancy-related please go to our pages on pregnancy-related pelvic girdle pain
- If your pain is at the pubic joint at the front of the pelvis, you have groin pain or have been diagnosed with osteitis pubis, please visit our pages on osteitis pubis and groin pain
- If your pain is sport-related, please go to our pages on osteitis pubis and groin pain for further information
Treatment options at CSPC
Following an assessment with physiotherapist, your therapist will explain why they feel you have pelvic pain and discuss what treatment they feel you will best respond to. Treatment may include a mixture of
- Manual therapy
- Pelvis and SIJ alignment work
- Soft tissue treatment
- Myofascial release of scars
- Visceral mobilisation
- Neural gliding techniques
- Biomechanical retraining
- Core strengthening
- Hip mobility and stability work
- Pelvic floor exercises
- Acupuncture / dry needling
- Training and cross training advice
- Gait retraining
- Strength & conditioning
- Home exercises
- Pain management strategies
Who can pelvic pain physiotherapy help?
Physiotherapy is suitable for anyone who is experiencing pain and dysfunction in the pelvis. Pelvic pain can have a limiting effect on our day-to-day and leisure activities. We can help
- Men, women, children and adolescents
- Pregnant and postnatal women
- Athletes
- People with persistent pain
- People who have been involved in trauma- car or bike crashes, or general falls.
What can I expect?
- An explanation of a likely cause of my pelvic pain
- A treatment and exercise plan
- Reduced pain
- Improved confidence in movement and function
- Return to daily activity and sport
- Better stability
- Reduced injury risk
- Improved physical performance
- Improved physical resilience
Frequently Asked Questions
Most pelvic pain comes from a combination of poor pelvic alignment, muscular imbalance, and altered movement patterns. Dysfunction in any part of the body can overload the pelvis when you move and cause pain, so it is important that your therapist works out the root cause of your pain.
Yes, it is definitely worth coming for an assessment. At CSPC, we have a very varied skill set, and it could be that we can treat something that is the root cause of your pain, that has been missed previously.
In most cases, no. Pelvic pain is usually biomechanical rather than structural, and physiotherapists can diagnose the cause through movement assessment and hands-on testing. They can discuss onward referral to a doctor or for a scan if they feel it is indicated.
No. Pelvic pain affects men, women, and athletes of all ages. Pregnancy-related pelvic girdle pain is one type, but there are many others. Pelvic pain can occur after surgery, falls, and also be sport related.
Yes. Overactive or weak pelvic floor muscles can create tension and torsion in the pelvis, nerve irritation, or joint overload, leading to pain around the pelvis, hips, back, or groin.
Your physiotherapist will look at pelvic alignment, hip mobility, core function, muscle balance, movement patterns, and any contributing factors from the spine or lower limbs.
Treatment may include manual therapy, pelvic alignment work, pelvic-floor exercises, strengthening, acupuncture/dry needling, movement retraining, and personalised rehabilitation.
This varies, but many people notice improvement within two and four sessions as pain reduces and movement becomes easier. The number of sessions will depend on how chronic your issues are. You may have a few sessions together early on and then space them out as you work on your own rehabilitation.
Yes. Issues in the hips and lumbar spine can alter how you move and therefore have an effect on the pelvis, which is why comprehensive assessment is essential.
Sometimes, but persistent pelvic pain usually needs targeted treatment to address the underlying cause and prevent flare-ups.
If pain has lasted more than a few weeks, affects daily activities, worsens with movement, or keeps returning, an assessment is recommended.
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