You are wondering if pelvic floor therapy works because you are about to start pelvic floor therapy or have already tried and are wondering if it actually works because it is either not working for you or its effectiveness has plateaued. Unfortunately, this is not as uncommon as you may think and when it comes to the world of pelvic floor, there are multiple issues that contribute to its lack of complete effectiveness.

What Are The Challenges of Pelvic Floor Therapy?

Let’s face it, most people don’t look into their aches and pains, or health issues here and there unless it is too bad for them to ignore. Then you go to your family doctor and once it is bad enough, you may (or may not) remember to mention something. Now you are at the mercy of your primary care physician’s judgment of getting a referral or handing you a prescription medication. If you get a referral, then you are seeing a gynecologist or a urologist and that is assuming the pelvic floor issue we are talking about has to do with ‘leaking’ and incontinence. Maybe testicular pain or pain during sex.

Other than that, ALL THE MANY faces of pelvic floor dysfunction get mistaken for things like lower back pain, hip pain, and bad posture as an example.

Bottom line, your pelvic floor dysfunction gets missed as something else!

The challenges pelvic floor dysfunction faces are:

  • Patients wait too long
  • Physicians don’t recognize all the other signs of pelvic floor dysfunction as pelvic floor dysfunction.
  • Not all pelvic floor therapists are created the same!
  • Pelvic floor therapy training hardly focuses on the pelvis alignment and posture.
  • How can you ‘set’ the ‘floor’ when the ‘house’ is unstable?

What is Missing From the Treatment of Pelvic Floor Dysfunction?

I strongly suggest you pause and read my blog ‘What is missing in pelvic floor dysfunction treatment’, to get into this issue in detail while below is an outline of the missing parts in the treatment of pelvic floor dysfunction. The major factors missing in the treatment of pelvic floor dysfunction are:

1. The most important factor missed in pelvic floor dysfunction treatment is the most basic fact about us, human beings!

  • Your posture is a reflection of how your brain is managing what you ‘throw at it’. If movement was a concert, your brain would be the conductor, the blueprint of movement and sensation, which you are born with and that gets detailed the first 2 years of your life, is the musical note. The body parts are the musicians that not only need to know their part but know exactly what to do when ‘playing’ with the rest of the body.
  • Postural Neurology is all about that.

2. When it comes to rehabilitation of our movement and posture, the ‘part’ with a problem is isolated and worked on but the problem is NEVER in isolation. Movement involves the whole body even if it is minute.

  • If we find out how functional (or dysfunctional) you are in your movement, we know what the movement needs to be by design; that is we have the ‘key scantron’ and find what your ‘scantron’ is and whatever does not match points to the area we need to look into.
  • Functional movement is all about that. That means no isolation of the body part, no single focus on strengthening or stretching. That means full-body movement treatment no matter what.

3. Functional Rehabilitation of the joints connected to the pelvis (lower back spine, sacroiliac joint, and hips) is a must.

Pelvis bones

Pelvic Bone (https://orthoinfo.aaos.org/)


  • Unfortunately, this gets missed more often than not; how can you set the ‘floor’ if the ‘house is unstable?
  • The ‘house’ that you are having ‘floor’ issues with is the pelvis and the lower back, and the hips are connected to the ‘house’. Any issues with those areas mean issues with the ‘house’.
  • My favorite form of functional rehabilitation is ART or Active Release Technique.

4. Kegel exercise is not for every kind of dysfunction and yet, many think it is for every kind of pelvic floor issue.

  • My go-to treatment to jump-start Kegel exercises WHEN indicated is Emsella Chair treatment.
  • Self-application of Kegel exercise should include not compression but the compression-pull combination which is hardly ever done by patients!

5. We hardly ever talk about the importance of breathing in all movements!!!

  • This is only talked about as the ‘therapist’ is doing internal manual work or is teaching the patient how to do the Kegels.
  • We innately should move in sync. with movements but in treatment, I see many who either hold their breath or have a reverse relationship between their movement and breathing.
  • Watch my video on the concept of breathing which we know from babies all over the world.

6. Ergonomics is hardly EVER looked at with pelvic floor dysfunction issues!

  • And yet, your movement and posture are directly influenced by your lifestyle and habits.
  • Today, most people have some degree of pelvic floor dysfunction because of their sedentary lifestyle.
  • Contact me for a checklist to see how much of your ergonomics contributes to your pelvic floor dysfunction.

Why would we get a full resolution if our treatments are partial treatments at best? When we put close-circuit glasses on, we don’t see the whole picture so the treatments we choose are partial and partial treatment means a return of the problem sooner than later. So does pelvic floor therapy treatment work? The answer is it depends!!

It depends on:

  • How soon you realize your issue is pelvic floor dysfunction.
  • How good of a physician you have in recognizing the subtle signs of pelvic floor dysfunction before it is a full blow problem.
  • Who you see for treatment.
  • How thorough is the therapist (who can be a trained physical therapist, chiropractor, occupational therapist, nurse, or even a physician)

If you suffer from pelvic floor dysfunction, have not been successful with your pelvic floor dysfunction treatment, or wish to find out if you have pelvic floor dysfunction, contact me.

Dr. Shakib