Pelvic Pain and the Overactive Pelvic Floor

Presented by Heather Rader

Video Runtime: 70 Minutes; Learning Assessment Time: 25 Minutes

This course provides healthcare practitioners with the clinical knowledge to identify and manage pelvic floor muscle overactivity, a frequently misunderstood driver of chronic pelvic pain. While many clinical programs focus on pelvic floor strengthening, there is a significant practice gap regarding the identification of muscles that are too tense or unable to relax, which can exacerbate symptoms of pain and dysfunction. To address this, the curriculum explores specific clinical indications to assist patients with calming, rather than strengthening, interventions. Participants will learn to implement evidence-based strategies, including diaphragmatic breathing, progressive muscle relaxation, and stretching progressions for the lumbopelvic–hip complex. This training is designed for a multidisciplinary audience—including physical therapists, occupational therapists, and nurses—across settings such as outpatient clinics, hospitals, and home health.

Learning Outcomes
  • Identify intrapelvic pain conditions related to pelvic organ dysfunction of the bladder, bowels, and genitalia
  • Recall extrapelvic pain conditions related to pelvic joint dysfunction, including the pubic symphysis, sacroiliac, and coccyx joints
  • Differentiate overactive pelvic floor muscle dysfunction and its link to bladder, bowel, and pelvic health from normal muscle relaxation during toileting activities
  • List physiologic calming strategies, pelvic floor muscle lengthening exercises, lumbopelvic flexibility exercises, and sitting adaptations to reduce pelvic pain symptoms

Meet your instructor

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Heather Rader

Dr. Heather Rader is the owner of Rader Pelvic Physical Therapy, a practice devoted to the treatment of pregnancy-related pain and dysfunction, incontinence, pelvic organ prolapse, and complex pelvic pain in all genders. A physical therapist since 1994, she graduated from the University of Miami with a master’s degree in…

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Chapters & learning objectives

Intrapelvic Pain

1. Intrapelvic Pain

This chapter explores organ-based pelvic pain conditions involving bladder, bowel, and genital dysfunction. It reviews key clinical presentations of conditions such as bladder pain syndrome / interstitial cystitis, irritable bowel syndrome, and pudendal neuralgia to support effective screening, and it highlights the role of pelvic floor muscle overactivity in persistent pelvic pain.

Extrapelvic Pain

2. Extrapelvic Pain

In this chapter, learners will examine the pelvic joints as a regional component of the lumbopelvic–hip complex. Clinical conditions including coccydynia, pubic symphysis dysfunction, and sacroiliac joint dysfunction will be presented, along with differential diagnosis strategies to distinguish these conditions from spinal, sciatic, or hip joint–related pain. Emphasis will be placed on recognizing regional postural dysfunctions characterized by muscular overactivity, or “gripping” patterns, which can simplify the identification of muscle imbalances and their impact on pelvic floor conditions.

Overactive Pelvic Floor Muscles

3. Overactive Pelvic Floor Muscles

This chapter examines overactivity of the pelvic floor muscles. Learners will explore the roles of the superficial and deep pelvic floor musculature in sphincteric control of bladder and bowel function, as well as in providing internal postural support for the pelvic organs. The chapter also addresses key clinical features associated with pelvic floor muscle overactivity, including heightened threat detection, myofascial tightness, and muscular tenderness.

How to Calm Overactive Pelvic Floor Muscles

4. How to Calm Overactive Pelvic Floor Muscles

This chapter presents movement-based strategies for calming overactive pelvic floor muscles. It includes physiological relaxation and breathing techniques, as well as pelvic floor lengthening, or reverse Kegel, techniques. Extrapelvic flexibility exercises are demonstrated, and adaptive sitting strategies for individuals experiencing pelvic pain with sitting are discussed.

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