Central Consideration of this Article: How is the work of a Pelvic Floor Physical Therapist (PT) integral to treating chronic pelvic pain?
Bio: Ariel Wynne is a pelvic floor physical therapist in
Chicago. She is a passionate sex educator and
advocate for her patients. Her interest in pelvic floor PT
started with hearing about her friend’s struggles with
vaginismus, a condition that makes vaginal penetration
difficult due to pain and muscular restriction. Pelvic floor
physical therapy helped her friend use tampons, go to
doctors appointments, and have pain free sex. Ariel
wanted to become a pelvic floor PT so that she could
improve her patients quality of life the same way!
Background on Pelvic Floor Physical Therapy:
A physical therapist is a muscle and bone specialist who helps patients get back to
their previous daily activities and move about the world. A pelvic floor PT does the same
thing but with a focus on the area in and around the pelvis. We work with a wide variety
of patients from children, pregnant adults, cancer survivors, and people who are post-menopausal. The pelvic floor is tied in to our identity and independence from potty training onwards!
Treatment can include a pelvic examination to assess the pelvic floor muscles, scar
tissue mobilization, strengthening, and trigger point release to name a few. Your PT will
do an evaluation and come up with a personalized plan for your condition and goals.
JR: What did your training involve to become a pelvic floor PT?
AW: I graduated with my Doctorate of Physical Therapy (DPT) in 2018. I learned a lot
about becoming a PT during graduate school but very little about the pelvic floor! We
had a few specialist lectures and learned the basics but I was determined to learn more
so I could treat these patients. I immediately started continuing education courses to
learn more about pelvic floor rehabilitation. This included courses, readings, and tests
outside of my regular full time schedule as a PT.
JR: What are some classic causes of pelvic pain?
AW: We work with the referring Doctor to rule out more serious causes of pain like
infections or hormonal disorders. After that, most often I see patients with pelvic pain
due to tight muscles. Those symptoms might be felt in the pelvis or they can refer to the
hips, inner thighs, low abdominals, and back. These patients are often not aware of how
tight these muscles are or how to relax them even if they tried. I always use the neck
and upper shoulders as my example. We all know someone who gets a tight neck and
high shoulders when they are stressed, sometimes they may even get headaches or
jaw aches because of all that tightness. The same thing happens in the pelvis! Those
muscles can be tight and restricted which causes problems elsewhere in the body.
JR: What does PT treatment for pelvic pain look like for you with your patients?
AW: I spend a lot of time educating my patients on the pelvic floor anatomy and
functions. Once you understand what is going on, you are better able to manage it. We
usually start with deep breathing and stretching to reduce tension. Many patients also
benefit from hands on therapy like massage or trigger point release to help lengthen
JR: What are some of the most frequent myths and misconceptions of your work as a
Pelvic Floor PT that you hear from patients or the general public?
AW: I think the biggest misconception about pelvic floor PT is that it is something
shameful or embarrassing. There are countless numbers of people who could benefit
but don’t seek out care for that reason. I always tell my patients there are muscles and
bones there just like other parts of the body and they can get better just the same way.
I think another big misconception is that pelvic floor problems are “normal” as we age.
People will talk to their friends or family about these issues first and often hear that pain
with sex or severe menstrual cramps happen to everyone. This is where I always say
“just because something is common, does not make it normal!” If you are having any
issues of pain in and around the pelvis, talk to your Doctor and get the help you
JR: How do you approach discussing goals with your patients?
AW: Goals are wildly different for everyone! Some patients want to be able to sit long
enough to focus on work, some want to get back to running marathons. Some want to
get back to pain free sex with their partner, some want to use a tampon for the first time.
It takes time to really see the effects of pelvic floor PT so it is so important to get a clear
idea of what success means to your patient and use that as the motivating factor on
days when progress feels slow. I ask my patients to really dream big and not let the
present limit their vision of the future.
JR: What is the most meaningful part of your work to you? Why?
AW: I love surprising my skeptical patients! My patients often have seen multiple
specialists and some have had issues for years before seeing me. They may not think
things can change much, but once we start working they dream a little bigger. I got an
email from a former patient just the other day to tell me she had sex for the first time in
her life and she had mostly given up on that as a possibility because of her struggles
with pain before. She thanked me for validating her experience and giving her hope
things could change. It made my day!