The Pelvic Floor is one of the most intricate and crucial components in the human body. It is composed of multiple muscles, ligaments, and fascia. So we are on the same page, the pelvic floor muscle group spans from the top of the pubic bone all the way to the tip of the tailbone. To have a hypertonic pelvic floor involves overly tense muscles, tight ligaments, and wound up  fascia. Fascia has a form similar to a spiders-web, covering and interacting with all the important muscles, bones, ligaments, etc in our body. This issue is becoming increasingly common and needs to be treated efficiently with a targeted physical therapy program.

What is a hypertonic pelvic floor?

A patient with a Hypertonic Pelvic Floor will have abnormally tense muscles in their pelvic region, in which they experience great difficulty relaxing. Simply put, it is a pelvic floor that is tight and tense. Unlike the more commonly diagnosed pelvic floor disorders associated with over-relaxation of the muscle groups, the hypertonic pelvic floor can present more varied symptoms which can be harder to recognize. It is important that this pelvic dysfunction is recognized early. This allows time to educate the patient on a major skeletal and muscle group in their body and prescribe appropriate treatment such as physical therapy. Interestingly, more women experience pelvic floor dysfunction (hypertonic or not), than men. Often it can be a sensitive area to discuss with the patient which makes it all the more important to educate them on the cause, area, symptoms, and physical therapy treatment strategy. Symptoms experienced as a result of a hypertonic pelvic floor often come on slowly, making it hard for the patient to comprehend how or why they are experiencing this dysfunction.

What does the hypertonic pelvic floor feel like?

Symptoms may include urinary incontinence, constipation, sexual dysfunction, bloating, muscle spasm and discomfort around the pelvis, and a potential lack of lower body control on a musculoskeletal level (this means the alignment of the body and how the muscles work within this skeletal framework). Patients will often present with insufficient lumbopelvic stability, which is the major cause of incontinence. As you can imagine, these symptoms can seriously affect the individual’s day-to-day life and need to be treated as promptly and efficiently as possible.

How does Pelvic floor physical therapy help these patients?

This peer-reviewed medical journal explains the highly important roles and functions of the pelvic floor in the human body, emphasizing the need to treat hypertonic pelvic floor dysfunction. The journal explains that “the pelvic floor consists of bone, muscles, and connective tissue; together, these elements provide support to the pelvic organs, spine, and pelvic girdle and assist with urinary, defecatory, and sexual function.” If a patient’s pelvic floor is tense and tight, it will not function properly and the support to these vital components mentioned above is compromised. It is essential that the patient learns to relax and regain control, mobility, and coordination of the pelvic floor muscles. This can be achieved with pelvic floor specific physical therapy.

For women, changes in the pelvic floor are extremely common with pregnancy and childbirth. Female patients should be educated by a specialist physical therapist on the importance of establishing a pelvic health routine around these important life events. It is surprising how many women are unaware of the multiple roles and functions of the pelvic floor, in supporting the entire structural framework of the body. Routine physical therapy assessments should be must for women who are in the childbirth phase of their life.

How is hypertonic pelvic floor treated?

A hypertonic pelvic floor should be treated in guidance with the symptoms experienced by the patient. However, most patients will experience a lack of lumbopelvic control and stability, and as a result, decreased or hindered spinal function. The term ‘lumbopelvic’ refers to the framework containing the lumbar spine, pelvis, and organs in these systems. It is important to remember that the pelvis assists in coordinating how we move our trunk, hips, and lower limbs. It has many crucial and key roles in the human body including day-to-day functioning and our movement biomechanics.

Considering these factors, the physical therapists will often prescribe exercises that target the lower back, lower deep abdominal muscle area (not the superficial ‘6-pack’ muscles we see visually), and glute stabilization and function. The reason why physical therapists target these areas is the pelvic floor muscle group, which includes everything from the pubic bone to the tailbone, optimizes the functioning and health of these regions. If the pelvic floor muscle group is not working optimally or likewise any of these target areas are not working properly, the whole area is compromised. The functioning of our lower back (lumbar spine), Sacroiliac Joints (S.I joint), deep abdominal region, and bladder are all relying on the pelvic floor muscles to work properly and efficiently!

A treatment plan should be multifaceted, meaning various methods of manual therapy are also integrated. This is often based around muscle release to reduce the tightness and tension that makes the pelvic floor ‘hypertonic’. Such methods include and are not limited to, trigger point massage, joint mobilization, myofascial therapy massage, cupping, and dry needling/acupuncture. Another form of treatment that is being researched and explored is neuromuscular cueing or ‘biofeedback’ carried out by the patient and guided by the physical therapist. This involves working with the patient to form mental cues to connect with muscles and joints in the body

The diagnosis and treatment of the hypertonic pelvic floor needs to be discussed more in modern physical therapy and sports medicine literature. This would allow for more research to be facilitated which would greatly benefit a majority of the population. Did you know that 1 in 3 women have a pelvic health disorder of some form?

How do you relax hypertonic pelvic floor muscles?

Breathe! The pelvic floor plays a key role in the musculoskeletal alignment of the whole human body, and therefore it has a vital impact on the patient’s postural control. Establishing and facilitating optimal breathing patterns, which in turn ‘fires’ the correct muscle groups is a must. In our fast-paced, increasingly stressful lifestyle, the potential for the pelvic floor region to become tight and tense is higher. This is due to the overactivity and increased engagement of the muscles. We want to encourage relaxation of the pelvic floor muscles!

Often, patients do not release they have a tendency to grip certain muscle groups, or that certain muscles are not working as they should in the body. Breathing patterns are extremely important in this case, think of it as the number one domino in a complex domino pattern of the postural muscles. The patient should be breathing through the diaphragm and abdomen. If this is not the case, it needs to be addressed to facilitate a well-functioning pelvic floor. As discussed above, manual therapy can also greatly assist in a specific treatment plan to help relieve tensions.