Pelvic Floor Physiotherapy: The Hidden Roadblock to Chronic Injury Recovery
When recovering from injury, we often focus on the obvious—painful joints, tight muscles, or movement restrictions. But what if the root of persistent pain or stalled progress lies deeper—right in your pelvic floor?
Most people associate the pelvic floor with bladder control or postnatal rehab, but its role reaches far beyond continence. As part of the body’s deep stabilising system, the pelvic floor can be a major blockage in chronic injury recovery—especially when it’s not functioning in harmony with the rest of the body.
How the Pelvic Floor Affects the Whole Body.
The pelvic floor isn’t just passive tissue; it’s a hub of efferent nerve signalling (motor output), core stability, breath mechanics, and posture. Dysfunction here can create a feedback loop that interferes with muscle firing patterns throughout the entire kinetic chain. This means tightness, weakness, or incoordination in the pelvic floor may inhibit neuromuscular activation, particularly in surrounding structures like the hips, glutes, and deep abdominal muscles
This misfiring can contribute to:
• Ongoing low back pain
• Hip or groin injuries that won’t resolve
• Core instability or poor load transfer
• Recurring hamstring or adductor strains
The Postural Connection to the Pelvic Floor
To understand the pelvic floor’s broader role, we can look to Thomas Myers’ Anatomy Trains. The pelvic floor is a central component of the Deep Front Line (DFL)—a fascial and muscular chain that connects the arches of the feet to the tongue. This line weaves through the diaphragm, pelvic floor, hip flexors, and deep spinal
When the pelvic floor is overactive or underactive, it affects pressure distribution, breathing, and alignment along this chain. Postural compensation patterns, such as rib flaring, lumbar extension, or internal hip rotation, often arise. These shifts change the body’s loading patterns, perpetuating or even causing injuries in distant areas like the shoulders, knees, or feet.
The Pelvic Floor, Prolapse, incontinence, and bloating. The Pressure System.
The pelvic floor works in synergy with the diaphragm, transversus abdominis, and multifidus to manage intra-abdominal pressure (IAP). Disruption here can impair trunk stability and force transmission, crucial in athletic performance and injury resilience.
Think of it like a balloon: if one part of the balloon is weak or stiff, the pressure inside becomes uneven. Similarly, a dysfunctional pelvic floor can lead to poor pressure management during movement—especially under load—setting the stage for recurrent injury or performance plateaus.
Assessing the Pelvic Floor as Part of the Whole System
A proper assessment should never isolate the pelvic floor—it must consider:
• Breathing patterns
• Core engagement
• Postural alignment
• Hip mobility and stability
• Fascial tension across the body’s myofascial lines
At Perfectly Human Physiotherapy, we assess pelvic floor function through movement, breath, and postural evaluation, not just internal exams. We often find that what presents as a hip issue or stubborn hamstring tear has a silent partner in the pelvic floor and pressure system.
Treating the Whole Body, Not Just the Floor
Effective treatment integrates:
• Manual therapy and fascial release along the DFL and related lines
• Diaphragmatic breathing and pressure system retraining
• Targeted core and pelvic floor coordination drills
• Progressive movement-based rehab that restores fluidity through the kinetic chain
This approach helps reprogram the nervous system, optimise muscle sequencing, and restore true stability and resilience.
If your injury isn’t getting better—no matter how many exercises you’ve done or therapists you’ve seen—consider what lies beneath. Pelvic floor dysfunction could be the missing piece. When assessed and treated as part of the body’s global posture and pressure system, the pelvic floor becomes a powerful ally in recovery and performance.