Pelvic Pain/Floor

Pelvic Floor Muscle Dysfunction (PFMD) is the most common name used among healthcare providers to cover a wide range of diagnoses and syndromes involving the pelvic floor muscles.

Examples of these diagnoses and syndromes are vaginismus, vulvodynia, non-bacterial prostatitis, levator ani syndrome, urinary incontinence, post-partum pelvic pain and chronic constipation. 

The pelvic floor muscles comprise the base of the pelvic bowl and are critical for bowel and bladder continence.  They also contribute to sexual climax as well as lumbo-pelvic stability along with the other core muscles.  People with PFMD may have non-ideal bowel or bladder habits, constipation, leakage, pain with intercourse or ejaculation, low back or hip pain.  It is important that a medical work-up rule out any issues that may not be related to the joints and muscles.  If your physical therapist (PT) has any concerns s/he will ask that you consult your medical doctor, or if you need a referral, your PT can make a recommendation. 

PFMD can present in many different ways.  As specialists in motor control and movement, PT’s often categorize PFMD by whether the muscles are hypertonic (over-worked), hypotonic (under-used), or poorly coordinated in their timing or in relation to synergistic muscles.  Your PT will evaluate the muscles to determine what your primary type of PFMD is. 

 

Evaluation of the pelvic floor muscles (PFM) can be accomplished through manual palpation, Real Time Ultrasound imaging (sonogram picture of the muscle used as a biofeedback tool), and by surface electromyography (sEMG) which reads the electrical activity created by the muscle.  Physical therapists are interested in the pelvic floor muscle resting tone, timing, magnitude and quality of contraction. 

 

Treatment of PFMD by a qualified PT will address the joints of the spine, pelvis and hips as well as the PFM and their partner muscles.  KNOSIS therapist Rebecca Gordon specializes in treating PFMD.  

Endometriosis

Whole-body care for a complex condition

Endometriosis affects an estimated 1 in 10 individuals assigned female at birth—but its impact is often invisible, misunderstood, or misdiagnosed. Though it is widely recognized as a gynecological disorder, endometriosis is a whole-body condition. It can affect the pelvic organs, gastrointestinal system, musculoskeletal structures, and nervous system—resulting in a wide spectrum of symptoms that disrupt daily life.

At KNÓSIS, we approach endometriosis through a collaborative, integrative lens. Pelvic floor physical therapy is a key part of that care—offering a non-invasive, personalized path to reduce pain, restore function, and support long-term well-being.

What is Endometriosis?

Endometriosis occurs when endometrial-like tissue—similar to the lining of the uterus—grows outside the uterus. These lesions can be found on the ovaries, fallopian tubes, bladder, bowel, abdominal wall, and beyond. This tissue responds to hormonal cycles, triggering inflammation, adhesions, and scarring that can lead to chronic pelvic pain and organ dysfunction.

Common Symptoms

Each person’s experience with endometriosis is unique, but common symptoms may include:

  • Chronic or cyclical pelvic pain

  • Painful periods (dysmenorrhea)

  • Pain with intercourse (dyspareunia)

  • Pain during bowel movements or urination

  • Bloating, constipation, or diarrhea

  • Low back, hip, or abdominal discomfort

  • Fatigue and disrupted sleep

  • Infertility

Diagnosis

Currently, the only definitive way to diagnose endometriosis is through laparoscopic surgery. During this procedure, endometrial lesions can be visualized and removed by a trained specialist. Unfortunately, diagnosis is often delayed for years due to the variability of symptoms and lack of awareness in clinical settings.

How Pelvic Floor Physical Therapy Can Help

While pelvic floor therapy cannot treat endometriosis at the source, it plays a powerful role in managing its impact. At KNÓSIS, our approach addresses the muscular, fascial, biomechanical, and neurological effects of living with chronic pelvic pain.

Our clinical care includes:

Nervous System Regulation

Chronic pain sensitizes the nervous system over time. We help restore balance through:

  • Craniosacral therapy

  • Vagus nerve stimulation techniques

  • Breath work and somatic grounding strategies

Myofascial & Visceral Release

Pain often leads to protective tension in the pelvic floor and surrounding tissues. We use:

  • Myofascial release techniques targeting the hips, abdomen, diaphragm, and pelvic floor

  • Visceral manipulation to reduce restrictions in pelvic and abdominal organs

Breath Mechanics & Intra-Abdominal Pressure (IAP)

Effective pressure management is essential for restoring core and pelvic function. We help patients:

  • Re-establish healthy diaphragmatic breathing and rib expansion

  • Learn how to manage IAP during movement to reduce strain and prevent flare-ups

Movement Re-education & Pilates-Based Rehab

Pain alters how we move. We use gentle, functional strategies to reintroduce movement with ease:

  • Pilates-informed rehab focused on alignment, control, and adaptability

  • Progressive strength and mobility work tailored to individual tolerance and recovery

Whole-System Collaboration

Endometriosis is complex, and no one provider has all the answers. We coordinate with:

  • Excision surgeons

  • Pain management specialists

  • Functional and integrative dietitians

  • Mental health providers

This whole-body model ensures each patient receives comprehensive, integrative care.

Additional Considerations

  • Education & Empowerment: Understanding your body is a vital part of recovery. We prioritize teaching strategies for flare-up management, self-regulation, and long-term support.

  • Bowel & Bladder Retraining: Many with endometriosis experience GI or urinary challenges. We offer supportive retraining programs to improve function.

  • Sexual Health Support: Treatment may include strategies to reduce pain during intimacy, improve mobility, and restore pelvic tissue health.

You Are Not Alone

Endometriosis can feel overwhelming—but it’s not something you have to manage in isolation. Our therapists are here to be part of your support system, helping you rebuild strength, regain control, and reconnect with the things that matter most to you.

If you’re wondering whether pelvic floor therapy could be a helpful part of your care, we’d love to talk.