The OB PT Clinic

Wellness Begins in the pelvis
Heal
&
Hope again

Pelvic Girdle

Pelvic Floor

Spine & Hip

Pelvic Nerves

Abdominal and pelvic pain woman in bed in fetal position

Abdominal & Pelvic Pain

Pelvic Girlde Dysfunction

Pelvic Girdle Dysfunction

Tailbone, Pubic, and Sacroiliac Joints

Pelvic Girdle Dysfunction refers to pelvic joint issues.

The pelvic girdle consists of three joints:

Sacroiliac joints (right and left)
Pubic symphysis (pubic bone)
Sacrococcygeal joint (tailbone)

While these joints are quite small and have very little movement compared to your shoulder or knee, they are crucial to the body's ability to stabilize itself.

Common movement issues include pain and difficulty with sitting, prolonged standing, standing on one leg, extreme flexion of the trunk and hips, and wide squat type movements.

Conditions include

Coccydynia - Tailbone pain and fracture
Sacroiliac joint dysfunctions and alignment issues
Pelvic fracture recovery
Pubic Symphysis pain

Female pelvis in blue yoga pants holding water bottle

Pelvic Girdle Pain can impact your ability to stay fit. Pain with walking, running, and cycling is common.

Pelvic Floor Dysfunction

Bladder, Bowel, and Sexual Dysfunction

Pelvic prolapse woman sitting on blue exercise ball

Pelvic Floor Muscle Dysfunction

The pelvic floor muscles are part of the "core" you hear so much about. It teams up with the deep back muscles (multifidus), deep abdominal muscles (transverse abdominis), and the breathing diaphragm. Just like any other team, it's only as strong as its weakest link. This means dysfunction in one area can contribute to dysfunction in another. The pelvic floor muscles are at the base of the pelvis. They form a sling or hammock shape from the tailbone to the pubic bone and are situated between your sit bones in the underwear area.

The pelvic floor muscles support the bladder, bowels and genitals inside the pelvis. They give you bladder and bowel control. A normal pelvic floor can contract and relax. Your pelvic floor may be weak, tight, or even uncoordinated, just like any other muscle. While strength is important for control and preventing incontinence, the pelvic floor muscles have to relax, too. If they can’t, you might have trouble emptying your bladder (Urinary Retention) or feel like your bowel movements are obstructed (Obstipation).

Dr. Rader will evaluate the function of your pelvic floor muscles by determining their strength and power, endurance, and coordination, as well as the ability to relax. She has decades of experience helping men and women with these difficult and sensitive problems.

Pelvic floor muscle therapy under the guidance of a pelvic health specialist, such as Dr. Rader, has been a recognized and highly recommended treatment approach by the American Urological Association since 2014.

Underactive Pelvic Floor Muscles

Symptoms of a weak and unsupportive pelvic floor muscle group include urinary and/or fecal leakage, urgent and frequently need to visit the toilet, and getting up often at night. Orgasm strength can also be compromised.

Conditions include

Urinary and fecal incontinence
Urinary and fecal urgency and frequency
Chronic UTIS's
Voiding dysfunction (strain to empty, weak stream)
Pelvic Organ Prolapse (bladder, rectal, uterine)
Post-surgical leakage (prostate cancer, prolapse or incontinence surgeries, hysterectomy, cesarean birth)

Overactive Pelvic Floor Muscles

The urethra, vagina, and anus pass through the pelvic floor muscles. If they are tight, tense, or in a spasm, pelvic floor muscles can impede the flow of urine, obstruct bowel movements, and make sex painful. Sitting pain is also a common issue with a tight pelvic floor. Pelvic floor muscles are very "protective" and will guard against nearby pain. That's why overactive pelvic floor muscles are so common with pelvic and abdominal organ pain conditions.

Bladder and Urinary Conditions:

Interstitial Cystitis
Bladder Pain Syndromes
Chronic bladder infections
Urinary and urethral pain
Urinary Retention issues

Bowel and Anorectal Conditions:

Constipation
Anal pain and fissures
Painful Bowel Movements
Incomplete stool evacuation
Tailbone pain

Genital and Sexual Dysfunctions:

Painful sex
Vaginismus
Dyspareunia
Penile and scrotal pain
Clitoral pain
Vulvodynia and vulvar pain
Prostate pain and prostatitis
Gender confirmation management

Ted Talk quote from Dr. Heather Rader pelvic physical therapist

Check out Dr. Rader's blog on overactive pelvic floor dysfunction,

"When Pelvic Floor Muscles Attack!"

Spinal and Hip Pain

How it's Related to your Pelvis

Pelvic Dysfunctions and the Spine and Hip

Do you have stubborn low back, buttocks, or hip pain? Do you have trouble sitting? Researchers estimate up to 30% of “low back pain” is really pelvic pain.
The pelvis is the base from which your spine and hips move. So it makes sense that pelvic dysfunction could impact how your back and leg function.
Very often, Dr. Rader can help you rule out the pelvis as a contributing factor to your hip or back problem.

The Hip and the Pelvic Floor

Many traditional gynecological conditions, like vulvodynia, have a higher association with hip conditions.
Many "groin" strains are really pelvic floor muscle and genital pain issues.
Focusing solely on the hip joint and the rest of the leg, and excluding how the hip and the pelvis function together, can lead to the real problem being missed.

Conditions

Hip arthritis pain
Hip labrum tear
Hip impingement syndromes
Snapping hip syndromes

The Low Back and the Pelvic Floor

Low back pain has a very high association with incontinence and breathing disorders.
Dr. Rader will screen your entire core function (deep back muscles, deep abdominal muscles, the breathing diaphragm, and pelvic floor) to determine how well they all work together.

Conditions

Low Back Pain
Spondylolisthesis
Stenosis
Sciatica
Herniated discs
Degenerative disc disease

Pelvic Nerve Conditions

Sciatica, Pudendal Neuralgia,and Cauda Equine Syndrome

When someone experiences nerve pain in the pelvis, there are 3 areas to consider before an accurate diagnosis can be made. All three can cause pelvic and genital pain.

Nerves from the T12-L2 Region (Thoracolumbar plexus) are often called the "border nerves" because they innervate the area between your abdomen, thigh, and upper pubic region.

They can become compressed in the belly or leg crease due to poor posture, repetitive motions, or because of surgical scarring.
Because these nerves come from the mid back and the pain is in the underwear area, misdiagnosis is common.
Dr. Rader can help you find relief due to:
- Meralgia paresthetica
- Iliohypogastric neuralgia
- Genitofemoral neuralgia
- Ilioinguinal neuralgia

Nerves from the S2-S4 Region (Sacral Plexus) provide sensory and muscle functions to the pelvic floor and pelvic organs.

The primary nerve, the pudendal nerve, is responsible for bowel and bladder control, as well as sexual arousal and orgasm.
The 3 branches span from the anus, to the perineum, and to the penis or clitoris. They are very superficial, which means when you sit, you are sitting on them.
People who sit a lot (desk job, cycling, horseback or motorcycle riding) are at risk. So are weight lifters. Any pelvic surgery can lead to pudendal nerve irritation.
Pudendal neuralgia is also known as Cyclist's Syndrome. Symptoms include tingling pain in the genital region, extreme difficulty with sitting, and disruption of normal bladder, bowel, and sexual functions.
Other lesser known nerves also contribute to these functions, and also give control over the gluteal muscles and hip rotators.
You can get expert treatment at the OB PT Clinic for these sacral plexus nerve issues:
- Pudendal Neuralgia
- Pudendal Nerve Entrapment (PNE)
- Post-surgical or post-injection rehab
- Posterior Femoral Cutaneous Neuralgia (can mimic sciatica)
- Superior and Inferior Gluteal Neuralgia
- Obturator Internus and Piriformis nerve dysfunctions

Nerves from L3-S4 (Lumbosacral Plexus) are primarily responsible for lower extremity function.

Pelvic PT evaluation for level pelvis of woman in blue shirt and black yoga pants

The Sciatic Nerve

Every nerve that innervates your thigh, knee, leg, ankle, and foot passes through the pelvis, and the vast majority of leg nerves branch from the sciatic nerve.
If you are experiencing nerve symptoms like tingling in the leg and shooting, electric pain down the back of the thigh and into the foot, you may have sciatica.
Dr. Rader does not consider sciatica to be a true low back issue - she evaluates the nerve's function from a pelvic perspective, not as a spinal condition.

The Cauda Equina

Did you know your spinal cord ends high in the back at the L1-L2 vertebral level?
Remaining spinal nerves that reach your leg branch off and travel down to the pelvis. This is called the Cauda Equina because it looks just like a horse's tail.
Cauda Equina Syndrome (CES) is a collection of neurological symptoms due to damage to the cauda equina due to compression (usually a herniated disk), infection, trauma, epidurals, childbirth, cancer, autoimmune or connective tissue disorders.
If you are reading this and you have any of the CES Red Flag Symptoms after sustaining a recent trauma to the butt or back, go to the the emergency room now and DEMAND an MRI.
Cauda Equina Syndrome is a medical emergency that typically needs immediate surgical correction to spare your bladder and bowel control. Click here to learn more.
If you have been diagnosed with CES and have residual bladder, bowel, sexual, and pelvic pain issues, know that pelvic rehabilitation can still improve your symptoms.