Pelvic Pain

We understand the unique needs of our pelvic pain patients. We offer you a safe, compassionate and expert level of treatment to resolve your pelvic pain. Individuals with pelvic pain have a particular soft spot in our heart and we have devoted ourselves to studying chronic pelvic pain and the rehabilitation from chronic pain. We offer you physical therapy that is effective, compassionate and provides you with results. Purple Mountain Physical Therapy is a place for you to feel heard, guided, supported and cared for. Pelvic pain can disrupt so much of your life: urinary function, bowel function, sexual health, ability to sit, exercise and think clearly. We have heard you and our other patients! We know this is tough and you don’t want to go to someone who doesn’t know what they are doing. Providing you effective treatment for your pelvic pain is what we do. More importantly, you should understand that you are the person who will unravel your pain. We don’t do it for you. We will guide you on your path to recovery, provide effective treatment that you can’t do for yourself and teach you what you must do for yourself. This piece, you doing what must be done, is very important. We will advise you on home exercise, behavioral changes, nutritional insights, mind/body self-care and other things. You must be committed to undertaking these things so your recovery is optimized. We will walk your journey with you and root for you the whole way. You are not alone in this recovery. Multidisciplinary care is the gold standard for treating all chronic pain and we are happy to work with your other providers.

Pelvic pain conditions we treat:

  • High tone pelvic floor. Pelvic floor dysfunction
  • Chronic pelvic pain
  • Myofascial pain syndrome
  • Interstitial Cystitis/Bladder pain syndrome
  • Endometriosis
  • Chronic Prostatitis and Chronic non-bacterial prostatitis
  • Pelvic Girdle Pain and Pregnancy related pelvic girdle pain, Sacroiliac joint dysfunction (SIJ)
  • Pubic Symphysis Pain:
  • Male chronic genital pain syndromes
  • Perineal pain, Pain in the perineal body
  • Pain during or after intimacy, genital pain, perineal pain, penile pain
  • Dyspareunia (painful sex)
  • Testicular pain (orchialgia)
  • Pudendal neuralgia (PN), pudendal nerve irritation and pudendal nerve entrapment (PNE)
  • Posterior Femoral Cutaneous Nerve Neuralgia
  • IBS: Irritable bowel syndrome, chronic constipation, chronic diarrhea and associated abdominal & pelvic pain
  • Genitourinary Syndrome of Menopause (GSM), vulvovaginal atrophy, Atrophic Vaginitis
  • Coccydynia (coccygodynia), tailbone pain
  • Pelvic Organ Prolapse (POP), Rectocele, Cystocele, Uterine prolapse, Rectal prolapse
  • Persistent Genital Arousal Disorder (PGAD)
  • Vulvodynia, vestibulodynia, clitorodynia
  • Vestibulodynia
  • Vaginismus
  • Urethral pain syndrome and dysuria (painful urinating)
  • Recurrent urinary tract infections
  • Groin pain
  • Sports hernia, athletic pubalgia, pubic symphysis pain
  • Inguinal or abdominal hernias
  • Scar tissue related pain. Hysterectomy and perineal incisional healing
  • Hip labral tears, Hip osteoarthritis, hip pain
  • Low back pain and Sciatica
  • Piriformis syndrome
  • SIJ dysfunction (sacroiliac joint dysfunction)
  • Central sensitization
  • Abdominal pain
  • Hamstring, adductor or gluteal strain or tear

High tone pelvic floor: you might not be familiar with this, but it is a common cause of pelvic pain. With high tone your pelvic floor does not lengthen and relax properly. Therefore, you may experience myriad pelvic symptoms ranging from pain to bowel/bladder disorders to sexual disorders. We will assess you and determine whether you have a high tone pelvic floor. If your pelvic floor has high tone, we will treat this and will teach you how to restore your pelvic tone and you will find your pain eases. High tone pelvic floor and pelvic floor dysfunction are within the core of our specialty. When you choose Purple Mountain Physical Therapy for your pelvic needs, you are selecting very experienced physical therapists who can confidently advise you on what’s going on with your pelvis.

Pelvic Pain, Chronic pelvic pain (CPP), Myofascial Pain Syndrome (MPS): There are many causes of male pelvic pain and in our 20+ years of experience in pelvic health we offer you the experience necessary to get you results. The most important thing to know is that physical therapy is an effective, research backed, first line treatment for treating your chronic pelvic pain. When the right evaluation and treatment are conducted, we can identify multiple things contributing to your pain and help you get relief. There is hope. We offer you expert care, utilizing numerous techniques and methods to help you improve. We have helped many men overcome their chronic pelvic pain and get their life back. Chronic pelvic pain is typically a multifactorial problem that may involve your pelvic floor, musculoskeletal, genital, urological, neurological (peripheral nerves, central nervous system and autonomic nervous system), gastrointestinal, neuroendocrine and immune systems. We will treat all areas that are contributing to your pelvic pain and we will teach you what exercises, strategies and behavioral modifications are helpful for you to overcome this pain. We often find patients have reduced blood flow to their myofascial tissues, underlying pelvic floor dysfunction, trigger points and myofascial restrictions in the abdomen, back, hips and thighs. We have many techniques to treat these problems. Through our heart rate variability coherence training program, we can teach you to improve your autonomic nervous system, to optimize your Vagus Nerve function, and to regulate and improve your body. The gold standard of care for chronic pain is multidisciplinary and we are happy to work with your other providers to help you. Most importantly, we offer you effective treatment that can resolve your pain.

Interstitial Cystitis/Bladder Pain Syndrome (BPS): You have finally found the right place to receive your physical therapy for your interstitial cystitis and bladder pain syndrome. Yes, we’ve treated men and women who have interstitial cystitis/bladder pain syndrome. Yes, you can feel better. Yes, there is hope. We are expert pelvic health physical therapists and we have spent our career helping people like you, studying pelvic pain and bladder conditions, attending professional conferences and even teaching other professionals advanced treatment techniques. Even if you’ve had a cystoscopy that shows you have glomerulation or Hunner lesions, we can work with you and help you. We will evaluate you and, together, we will discover what is going on, what skilled treatment you require and what you can do to help yourself. We will design a custom treatment program for your interstitial cystitis/bladder pain syndrome, based in research backed treatments and rooted in over 20 years of experience working with individuals like you. In the skilled hands of your physical therapist you will find a path forward that actually works. Our treatment addresses your pain and bladder function so you feel better. Our evaluation usually reveals numerous things contributing to your pain and bladder dysfunction such as tissues that are not optimally healthy and that lack optimal blood flow, restrictions in connective tissue, trigger points in muscles, pelvic floor dysfunction and altered breathing patterns. And, to be clear, our treatment will address all areas of your core and thighs and will include pain neuroscience education. We also offer heart rate variability coherence training using biofeedback to teach you a skill to help your condition. We also teach you what you can and should be doing for yourself so you can feel better. We expect that when you come to Purple Mountain Physical Therapy for your interstitial cystitis/Bladder pain syndrome you will start to see a light at the end of the tunnel, a pathway forward to a full and complete life where your bladder and pain do not govern your every thought. Treatment for IC & BPS is best done with multidisciplinary care and we are happy to work with your other providers to optimize your outcome.

Endometriosis: Women who experience endometriosis often come to us with chronic pelvic pain, bladder or bowel challenges and sexual health concerns that they have experienced for years. Their pain might be abdominal pain that comes and goes, vaginal pain, SIJ (sacroiliac joint) pain, low back pain, hip pain, dyspareunia (painful sex) or located somewhere else. With endometriosis we recognize you may additionally experience other things, as well, such as migraines, anxiety, IBS, vulvodynia, interstitial cystitis, fibromyalgia and polycystic ovarian syndrome (PCOS). During your evaluation we will examine your abdomen, hips, low back and pelvic floor to determine whether you have any musculoskeletal issues in these areas that are contributing to your pain. Because endometriosis has usually been going on for quite a while, we find that it has caused your musculoskeletal system to react, sustaining painful trigger points, myofascial restrictions, postural changes and hip and low back problems. Endo can also set off your bladder or bowel, causing urinary or bowel symptoms, as well. This is where physical therapy can help you! We are musculoskeletal pain, bladder, bowel and pelvic health physical therapy specialists and we provide you with a proper evaluation to determine where you have myofascial restrictions, connective tissue dysfunction, trigger points, scar tissue adherence and pelvic floor dysfunction. We then treat these areas to get you relief from your pain and other symptoms. We use manual therapy, trigger point release, dry needling, biofeedback heartrate variability coherence training, movement therapy, flexibility/stretching exercises, neuromuscular reeducation techniques and other interventions to help you feel better. We will teach you effective exercises and strategies to implement at home. These are most important and you must be committed to doing what is recommended. Because endometriosis affects so many of your systems, we recognize the importance of stress management, sleep and support to optimize your digestive, endocrine, immune and nervous systems; we offer strategies and techniques for promoting wellbeing in these areas. We value your other healthcare providers and are happy to collaborate with them and keep communication open with them so your treatment program can be comprehensive and most effective. We’ve treated many women with endometriosis related chronic pain, bowel and bladder issues and have helped them restore their quality of life. We understand you might have days you want to spend in bed each month. We know you are suffering. We have heard you; we believe you and we are confident we can help you. Other women have proven this to us.

Chronic Prostatitis and Chronic non-bacterial prostatitis: Chronic prostatitis is a common diagnosis we treat for men for their complaints of pelvic pain and bladder symptoms. What we tend to find is myofascial restrictions in multiple areas including the abdomen, thoracic and lumbar spine, hip girdles, thighs and pelvic floor. Additionally, there is typically underlying pelvic floor dysfunction and discoordination of the core muscle complex leading to the chronic pain and genitourinary symptoms. We will use our experience helping other men with this condition to help you get relief. We understand you are tired of taking antibiotics that don’t work, we know that you feel an ache and discomfort in your pelvis and you might have odd things happening with your ability to urinate and defecate. We have experience working with this condition and helping men get real results so they can get rid of their pain.

Pelvic Girdle Pain and Pregnancy related pelvic girdle pain, Sacroiliac joint dysfunction (SIJ): Pelvic girdle pain can be located anywhere within the ring of bones around your pelvis that begin at the base of the spine, progress down to the vaginal area and laterally to the hips. Therefore, pelvic girdle pain is found anywhere in the front or back of the pelvis, including the symphysis pubis and the sacroiliac joints, and can also affect the hips or thighs. Pelvic girdle pain can occur in both men and women and is common during pregnancy and in the postpartum period. If you have pelvic girdle pain you might feel a variety of uncomfortable symptoms including stiffness, sharp pain, a dull ache, throbbing, clicking, grinding, heaviness and difficulty moving or lifting your legs. If you are pregnant, pelvic girdle pain is not harmful to your baby, but can make it challenging for you to function. At Purple Mountain Physical Therapy, we will evaluate and treat your pelvic girdle pain, following research backed guidelines and will help you recover and get back to your active life.

Pubic Symphysis Pain: The two sides of your pelvis come together in the front to form a connection at the symphysis pubis. We have worked with many women and men who experience symphysis pubic pain. It is quite painful and compromises your ability to move easily, as you experience pain in the pubic bones when you try to walk, climb stairs and squat down. We will evaluate you and treat your pain so you can get back to feeling like yourself and moving without caution at every step.

Male chronic genital pain syndromes: A man can experience genital pain that is often associated with sexual dysfunction and lower urinary tract symptoms and can therefore be categorized as chronic genital pain syndrome. Typically, the men we treat with genital pain (penile, testicular or perineal pain) also report some or all of the following symptoms: discomfort or pain when urinating (dysuria), feeling of incomplete bladder emptying, urinary frequency, slow urinary stream, urinary urgency and painful sex (dyspareunia) either during or after sex. What we often find when we evaluate the low back, hip girdles, pelvis, thighs and pelvic floor muscles is a series of myofascial restrictions, trigger points and connective tissue restrictions that contribute to their pain and their bladder symptoms. We also may find scar tissue (from prior abdominal surgery) that might be painful and, if you have it, we will treat this. We evaluate your breathing mechanics to optimize your core muscle coordination. For your trigger points we offer functional trigger point dry needling, as an augmentation to other manual therapy techniques to resolve your trigger points. We check your abdominal wall to see if you have a diastasis rectus abdominus (DRA: separation of your abdominal muscles). While DRA is a condition more widely known by women, men can have it, and we have treatment to help it to resolve. We review your daily habits and interests to uncover hidden sources of pain and the things you would like to be able to return to. You will be provided exercises and self-care recommendations to help you recover from your symptoms, whether they are bladder, pain, bowel or sexual. We base our treatment on your specific findings and your goals, so that you can experience meaningful results and get your life back.

Perineal pain, Pain in the perineal body: The perineal area is comprised of fibro-muscular structures. Men and women can develop pain in the perineum or perineal body. For men the perineum can be found under your testicles and in front of your anus. For women it is the area between the vagina and anus. Sometimes the perineal area can be injured with childbirth. Both men and women can experience perineal pain that can vary from achy, sore, tense, burning or shooting pain. Pain here is a symptom of pelvic floor dysfunction and typically there are also other contributing factors we identify and treat. We will evaluate your hips, thighs, abdomen, pelvis and low back to identify any myofascial issues contributing to your perineal pain. We often find issues related to high tone pelvic floor, reduced blood flow, connective tissue restrictions and impairments in the regions where your nerves traverse. Our treatment program will help restore these areas and will also educate you in how to care for these problems so that you can resolve your pain.

Pain during or after intimacy, genital pain, perineal pain, penile pain: Often this is related to nerve or muscular tension accompanied by myofascial restrictions and pelvic floor dysfunction. We will evaluate your pelvic floor and all associated myofascial tissues to identify why you are experiencing pain. Your treatment will be directed to restoring the connective tissues, muscle and nerve function of your pelvic floor muscles, hips, abdomen, midback and low back. We will use neuromuscular re-education techniques to help you to retrain the coordination of all of your pelvic muscles, so you don’t end up with spasm or pain. We have helped many men recover from this and will offer you effective treatment.

Dyspareunia (painful sex): If you are struggling with painful sex, we are here to help you. Often there is underlying pelvic floor dysfunction and myofascial restrictions that can be addressed to help restore your ability to engage in intimacy without clenching in pain. We have treated many women with dyspareunia, some of them are postpartum and others have never been pregnant. This is a condition that can be very emotionally taxing and we provide you a safe, gentle place to receive effective care to help you recover intimacy without pain. We will provide you with a gentle examination, education and feedback regarding our findings. Going forward, we will treat these findings and guide you in what you can do at home to help improve your condition and to take steps towards intimacy. Improving your dyspareunia will include a comprehensive treatment program to address all myofascial and visceral findings discovered in your evaluation. We understand there is fear and anxiety related to intimacy when it is painful. We also provide specialized biofeedback training in heart rate variability coherence so you can learn how to calm your fear and return to intimacy. We recognize the importance of all of your healthcare providers if you have dyspareunia and we can communicate with them to provide you with the best plan of care.

Testicular pain (orchialgia): Physical therapy can help your testicular pain! When men have been referred to us for their testicular pain, typically they have been to specialists who have told them that there doesn’t seem to be anything wrong with their testicle and they suggest physical therapy treatment. What we often find is an underlying pattern of trigger points and myofascial restrictions in the abdomen, hip and pelvic floor, leading to compromise of muscles, blood flow, and nerve firing and contributing to referred pain into the testicle. We will assess and treat your hips, abdomen, low back, pelvic floor and inner thighs to identify the areas of restriction in your joints, muscles, fascia and nerves. Guided by these evaluation findings we can customize your treatment plan of care and teach you what to do to help yourself.

Pudendal neuralgia (PN), pudendal nerve irritation and pudendal nerve entrapment (PNE): Pain arising from the pudendal nerve is its own beast and, yes, we have worked with men and women who have had Pudendal neuralgia, pudendal nerve entrapment and irritation of their pudendal nerve. The pudendal nerve contributes to anal, perineal and genital innervation, so a person with pudendal neuralgia can experience symptoms in any of these regions. Yes, we have been able to help them get back to their active lives, free from constant pain. Yes, there is hope for you. Physical therapy has proven to be effective at helping to resolve your pudendal pain.

The pudendal nerve carries fibers that are sensory (give you feeling), motor (give you strength) and autonomic (specifically the sympathetic nervous system, which control fight or flight, among other things). Therefore, when your pudendal nerve is irritated you may experience changes in your sympathetic nervous system, as well. These could include increased heart rate, changes in blood flow, anxiety, changes in bowel motility (constipation, diarrhea) and sweating. You can imagine these symptoms alone might make you miserable. Unfortunately, because the nerve is 80% sensory, pudendal nerve problems also include pain. Painful signs and symptoms of pudendal neuralgia, nerve irritation or entrapment can include: pain with sitting, burning pain, sharp pain, sensation of a golf ball or fullness in the anus, itching, shooting pain, bladder or bowel symptoms including difficulty starting your urinary stream, urinary urgency, urinary retention, constipation, painful sex, genitalia pain and discomfort wearing constrictive clothing.

The literature notes both non-mechanical injury and mechanical injury can be culprits in causing your pain. We have predominantly seen mechanical causes in our patients, such as an excessive stretch of the nerve during a fall/injury, excessive compression such as sitting long hours during tax preparation season and chronic constipation, causing strain. We have also treated women who have pudendal neuralgia related to childbirth, surgery and pelvic trauma/injury. Examples of non-mechanical causes of pudendal neuralgia in the literature include infections (such as herpes), multiple sclerosis and diabetes. Our thorough evaluation and treatment program is designed to help you feel better, to restore your myofascial restrictions and to help your pudendal nerve calm down. We have helped men accomplish this and we can help you, too.

Anatomical overview of the pudendal nerve: When coming out of the sacrum the nerve passes between two muscles, the piriformis and coccygeus. We will evaluate these muscles to determine if they have tension, tightness, shortness or dysfunction that might be impairing your pudendal nerve and, if so, you will receive treatment to them. The nerve then leaves the pelvic cavity through a space that is near a thick, stabilizing ligament, the sacrotuberous ligament. We will evaluate this ligament, as well, to determine if it might have issues contributing to your pudendal neuralgia. We will also look at your hamstring insertion into the same region as the sacrotuberous ligament, as your hamstring might be contributing to tension in this region. There is another nerve in this area that we will evaluate, as well: the posterior femoral cutaneous nerve. Though not mentioned as often as pudendal neuralgia, we have found posterior femoral cutaneous nerve (PFCN) problems to be a large contributor to pelvic pain and sometimes it is only the PFCN and not the pudendal nerve that is the issue. Next, the pudendal nerve must pass near a prominent small portion of the bone of your pelvis, your ischial spine, and continues underneath another ligament, the sacrospinous ligament, to re-enter the pelvic cavity through another hole that allows the nerve to pass. From here the pudendal nerve continues to travel through an area called Alcock’s canal or the pudendal canal. In this region is also an important pelvic muscle, your obturator internus, that we will assess and treat. We evaluate these areas to identify any myofascial restrictions that would benefit from treatment to give you relief. The ischiorectal fossa (also known as ischioanal fossa) is an important area to evaluate and treat to optimize blood flow and reduce tension and myofascial restrictions in and around your pudendal nerve and associated structures. The pudendal nerve branches into 3 segments, the inferior rectal, the perineal branch and the dorsal sensory nerve that goes either to the penis or the clitoris. Keep in mind that the nerve is traveling all this distance within your other myofascial tissues, so connective tissue restrictions, blood flow restrictions and high tone pelvic floor will be addressed to optimize the health of your nerve. Because of the complexity of this condition, it takes years of experience to develop proficiency with treating it. We have been treating individuals with pudendal neuralgia for years. As with all pelvic pain conditions we treat, multidisciplinary care is the gold standard and we are happy to partner with your other medical providers to optimize your treatment plan.

Posterior Femoral Cutaneous Nerve Neuralgia: This is another nerve that can contribute to pelvic pain and pain in the thigh and perineum. The posterior femoral cutaneous nerve is located around the ischial tuberosity (the “sit bone”) and can be compressed with prolonged sitting. While pudendal neuralgia gets all the attention when a person cannot tolerate sitting, we have found and research has also identified that the posterior femoral cutaneous nerve may, in fact, be the problem related to pain with sitting. The nerve has perineal and inferior cluneal branches, so you can experience perineal pain that is from this nerve. We will evaluate this nerve as part of your exam to determine if you have problems related to this nerve. If you do have issues here, we will treat them and advise you how to proceed to recover from your pain. Nerves require a large amount of blood supply to keep them healthy. Our treatment works to restore your blood flow, reduce your connective tissue and muscular tautness/restrictions/impairments and to address underlying musculoskeletal factors that can be bothering your nerve.

IBS: Irritable bowel syndrome, chronic constipation, chronic diarrhea and associated abdominal & pelvic pain: Irritable bowel syndrome is a condition that often overlaps with other pelvic pain conditions. When a person has IBS, they experience recurrent episodes of abdominal pain and changes in the frequency, consistency and formation of their stool. With irritable bowel syndrome you may strain to have a bowel movement, or you might have loose stools and fecal urgency. Some people with IBS live in fear of fecal incontinence. Other people might feel cramping, abdominal pain, nausea, fatigue or fullness. The irritable bowel syndrome can “turn on” musculoskeletal pain, such that you are left with abdominal discomfort quite often, even not related to a bowel episode. We will evaluate you and determine if you have myofascial issues contributing to your symptoms. Often there is also pelvic floor dysfunction. We will discuss gut health and make recommendations for optimizing your wellbeing. As with all conditions that we treat, we are happy to partner with your other medical providers to develop a plan of care that delivers you results.

Genitourinary Syndrome of Menopause (GSM), vulvovaginal atrophy, Atrophic Vaginitis: Genitourinary syndrome of menopause (GSM) is a newer diagnostic term that has been adopted to reflect that a woman in menopause may experience changes in her genital region, urinary system and sexual comfort. GSM is meant to replace the older, more commonly used terms, vulvovaginal atrophy and atrophic vaginitis, now known to be limited terminology that does not reflect the full spectrum of issues that a woman can experience during menopause. These GSM symptoms can include urinary urgency, painful urination (dysuria), recurrent urinary tract infections, vulvovaginal dryness, burning and irritation and sexual pain/discomfort, reduced function and lack of lubrication. At Purple Mountain Physical therapy, we provide you meaningful, comprehensive treatment to address the underlying myofascial issues, such as pelvic floor dysfunction, connective tissue restrictions, trigger points, joint stiffness and weakness, that may contribute to you experiencing these constellations of symptoms. We have treated many menopausal women with these symptoms and have helped them recover and feel more like themselves. We will help you rehabilitate your pelvic region so that you, too, can feel better in all of these commonly effected areas.

Coccydynia (coccygodynia), tailbone pain: We have treated many men and women with this coccydynia. Often this pain develops after falling on your tailbone or following labor and delivery. A classic symptom of coccydynia is pain when sitting. Women often report severe pain in the tailbone when they are in the middle of trying to stand up or sit down. Because the pelvic floor muscles are around and attach to this bone, if you have pelvic floor dysfunction it can contribute to your pain. We offer you expert care for your pain that can help address what’s going on and clear up your pain. You need relief, we understand this and will provide you with path forward.

Pelvic Organ Prolapse (POP), Rectocele, Cystocele, Uterine prolapse, Rectal prolapse: Do you experience vaginal pressure, a feeling of heaviness, a sense that something is falling out of your vagina? With this pressure do you also experience back pain or sacroiliac joint (SIJ) pain, difficulty urinating or evacuating your stools? These are some of the symptoms of a pelvic organ prolapse. A prolapse is a condition when there is descent of the vaginal wall, uterus or top of the vagina such that there is no longer optimal support of the pelvic organs. When we treat women with pelvic organ prolapse, we are looking at ways to improve the support system of her pelvic organs and to decrease strain on the organs. The pelvic floor muscles are like a hammock or trampoline beneath the vagina, supporting the organs. Recovering optimal function, strength and responsiveness of the pelvic floor is one important component of treating the symptoms of a pelvic organ prolapse. Additionally, the hip girdles, diaphragm, abdominal muscles and low back muscles also contribute to stability and intra-abdominal pressure control. At Purple Mountain Physical Therapy, we have been specialists in pelvic health for over 20 years. We have worked with many women who have POP and who are able to recover their pelvic floor and core muscle function so that they optimally support the organs and improve their ability to empty their bladder and bowels.

Persistent Genital Arousal Disorder (PGAD): We have treated women with persistent genital arousal disorder and we understand the unwanted, bothersome and distressing nature of this condition. We have advanced education in treating this condition and are members of ISSWSH, the International Society for the Study of Women’s Sexual Health and the International Pelvic Pain Society, two professional organizations that offers continuing education and advanced practice recommendations for PGAD. We have found that women with this condition have a variety of musculoskeletal impairments that benefit from pelvic health physical therapy. We utilize numerous treatments to help your persistent genital arousal disorder to calm down. Multidisciplinary care is known to be the best method of treating all pelvic pain conditions and we are happy to work with your other providers. You can expect compassionate care that is laser focused on delivering you the highest quality treatments that can deliver you results. You don’t need do suffer silently and feel alone, we are here to help you.

Vulvodynia, Vestibulodynia, Clitorodynia: Women who experience vulvar pain often do so silently and alone. This condition is very bothersome and there are treatments for you! Whereas vulvodynia involves pain that can be within the entire vulva (vestibule, clitoris, labia majora, labia minora) there are also what are called “localized vulvodynia” sub-categories, including vestibulodynia and clitorodynia, that are defined by one specific area that hurts you. Your pain may be provoked (meaning it hurts when it is touched) or it can be spontaneous (it hurts without any known reason) or you might have a mixture of provoked and spontaneous. Women with vulvodynia have been identified to have hypertonic pelvic floor (overactive pelvic floor) in several controlled studies. We provide experienced, expert, gentle care to evaluate you and develop a comprehensive plan of care. We find underlying factors in the myofascial tissues of the women’s abdomen, legs, hips, back and pelvic floor that perpetuate your pain. We have helped many women with this condition and we can help you, too. We value communication with your other medical providers so you can have the best outcome. There may also be underlying infectious, inflammatory or hormonal issues that are present and your physician partners are important providers for these issues.

Vestibulodynia: A type of vulvodynia that exclusively involves pain in the vestibule area of the vulva, rather than the entire vulva. During your evaluation we will determine if vestibulodynia is present in your case. Your vestibulodynia might be provoked, where it hurts you if you contact it, such as inserting a tampon or attempting intercourse. Or it might be spontaneous, meaning it hurts without any known trigger. Some women have a combination of provoked and spontaneous. We will conduct a comprehensive evaluation of your pelvic floor and vulvar tissues and also your abdomen, hips, thighs and back. There is hope for your pain and we have helped many women recover from this condition.

Vaginismus: Vaginismus is a condition that causes a woman to be unable to experience vaginal penetration. Some women cannot insert a tampon due to vaginismus. Others have success with tampons, but find sexual penetration impossible or very painful and difficult. We have years of experience treating women who have vaginismus. You don’t need to suffer with this condition, there is help. Having worked with many women we understand the grief this condition generates, the loss of intimacy and the difficulty it might cause within your relationship. Women who are in their fertile years and hope to start a family are under significant stress related to this condition. We understand and we are here to help you. We will provide a gentle examination, educating you in what we find. We will evaluate your abdomen, hips, low back and thighs, as well as your pelvic area. Typically, there are myofascial and visceral restrictions in these areas contributing to your vaginismus that might include impairments in the pelvic floor, vagina and vulva, trigger points in the hips, thighs and abdomen and connective tissue restrictions in these areas. We will treat these and teach you what you can do to help yourself. We also offer specialized biofeedback for heart rate variability coherence training so you can learn to balance your autonomic nervous system and reduce your stress and anxiety related to vaginismus, so that when you are ready to attempt sexual intimacy you feel more confident in your ability to do so.

Urethral pain syndrome and dysuria (painful urinating): Urethral pain syndrome is quite bothersome to women, as they feel pain in the urethra and often are prescribed many courses of antibiotics that do not resolve the pain. It can be perplexing, as well, because the pain may come and go for unknown reasons. We have found that underlying pelvic floor dysfunction and pelvic myofascial restrictions, in particular high tone in the pelvic floor muscles, are typically present. This increased resting tone of the pelvic floor may also accompany increased tone of the urethral striated sphincter. When you attempt to urinate you may experience pain, even though you do not have an infection. We will evaluate you and create a treatment program to address your pelvic floor as well as myofascial tissues of your abdomen, low back, thighs and hip girdles because these areas play into your pelvic floor dysfunction. We expect your urethral pain to diminish so that you can be fit and active without fear of turning on your pain and you can urinate without wondering whether it will activate your pain.

Recurrent urinary tract infection: To be clear, if you have an infection or think you have an infection, you must see your physician and get that treated. What we treat is actually two things: First, a condition where women feel like they have an infection, but there is no infection present! Second, women who do get recurrent urinary tract infections that leave them in pain, even after the infection has resolved with medications, and they want to resolve their pain and determine if they have pelvic floor dysfunction or other bladder issues causing these infections. If this is you, we can help you. A woman can experience pelvic pain that mimics a urinary tract infection, even in the absence of an infection. We’ve treated many women over the years who have told us that they thought they had an infection, they did everything right by seeing their physician and getting a urine culture, but the culture came back negative. In this case typically the woman has pelvic floor dysfunction, myofascial restrictions related to the pelvis and possibly a combination of impairments in how she urinates. We can identify and treat these myofascial related issues and help you get to the bottom of your recurrent urinary tract infections. Yes, you need your physician to treat an actual infection. Yes, there can be hormone contributions to developing these infections, for which your physician and you can determine a plan. And, yes, there are often underlying musculoskeletal issues going on in your pelvis contributing to your pain and the feeling you have an infection, even when you do not. We can help you.

Groin pain: Groin pain is a vague term that can have numerous causes. We will evaluate you to determine the musculoskeletal contributions to your groin pain and to develop a plan of care to get you relief. Sometimes the culprit is related to your psoas muscle an important muscle of your hip, your abdominal wall muscles, adductor (inner thigh) muscles or other muscles, nerves and connective tissues. Because the psoas attaches to your hip and low back spine, we will evaluate both your back and your hip to determine what is going on, in addition to your abdomen and thighs. We will also review constipation, breathing patterns and other aspects of your daily activities that may be contributing to your groin pain. We will work with you to achieve your goals, including returning to exercise and sports.

Sports hernia, athletic pubalgia, pubic symphysis pain: A sports hernia typically causes severe pain at the time of injury. When a person comes to physical therapy for athletic pubalgia, often the pain has become lingering and chronic, either a dull ache, intermittent sharp pain or pain that limits return to sport or work. We’ve treated men with this condition whose goal was to get active again by playing their sport and working. We will help you overcome the musculoskeletal contributions to your pain and to implement a fitness program that allows you to progress back to your sport. Because we are experts in pelvic health, we offer a high level of insight into musculoskeletal contributions to your pain. We go beyond strength and conditioning and also include hands-on manual therapy to address myofascial restrictions, trigger points and other problem areas that are discovered in your evaluation.

Inguinal or abdominal hernias: If you have a hernia and you do not need surgery, but you experience pain from it, we can help address underlying factors related to your hernia pain. We will evaluate and treat your pelvis, hips and spine, your core muscular coordination, breathing methods, posture and activities, mechanics when defecating and urinating and muscle or fascial imbalances. We work with your physician providers, as well, because you do need to have their input to have a comprehensive plan of care.

Scar tissue related pain. Hysterectomy and perineal incisional healing: Scar tissue from prior abdominal and pelvic surgeries may result in abdominal or pelvic pain and sometimes it may alter the function of your bladder. We assess and treat your scar tissue and all abdominal pelvic fascia to help resolve your pain. For women, following childbirth, whether vaginal or via a hysterectomy, we can monitor the healing of your tissues and advise you in ways to promote optimal healing and scar development. We have worked with men and women for whom their scar is uncomfortable, perhaps burns at times or hurts to have clothing touch it. If this is the case for you, we can assess and treat your scar to help alleviate these problems. If you have any abdominal scars, whether from a hysterectomy or other surgery, we will also evaluate those tissues to determine if they are contributing to any pelvic pain you may have. Following vaginal delivery, your pelvic tissues also need to heal, whether you had an episiotomy or not. If you have any concerns about your healing, we can help advise you. If your tissue has healed, but you find it causes you pain, perhaps during intimacy or with clothing touching it, we can assess and treat this scar tissue to help you to feel better.

Hip labral tears, Hip osteoarthritis, hip pain: Underlying issues in the hips can result in considerable hip and pelvic pain, difficulty walking and exercising and weakness in hip muscles. We can evaluate and treat your hip to optimize your range of motion, mobility, strength, balance, load transfer ability and to decrease your pain. Because we are pelvic health specialists, also, we offer the added benefit of truly, comprehensively treating your entire pelvic girdle, spine and hip region to optimize your biomechanics and reduce wear and tear on your hip. We have found that individuals who have hip problems often also have pelvic floor dysfunction and may have pelvic pain as well as bowel or bladder symptoms. We can treat both your hip and your pelvic condition, if this is the case for you!

Low back pain and Sciatica: Physical therapy is a first line treatment for low back pain and sciatica. You might be experiencing pain, numbness, tingling or weakness in your low back, hips, thigh, calf or foot. It is common to have an underlying mechanical issue contributing to the flare up of your pain. You may also have muscle guarding, trigger points, tightness and poor coordination of your core muscles. We will evaluate and treat you and so you can move freely and get back to your life. We have helped many men and women, including pregnancy related back pain, get back to being able to sit, stand and move without severe pain. Dr. Maureen O’Keefe’s first subspecialty in orthopedic physical therapy was the spine. She completed advanced postgraduate training in spine care and has extensive experience working with individuals with all neck and back problems. Her expertise in the pelvic region is an added benefit to your treatment because there often are pelvic problems that are also present with the back pain.

Piriformis syndrome: The piriformis muscle is a hip muscle that can cause you to experience pain in your gluteal area. It is also a muscle that is part of your greater pelvis, so it can also play a role in your pelvic pain, urinary or bladder control issues. Because the sciatic nerve is near the piriformis muscle, if you develop Piriformis syndrome, you might also experience some sciatica symptoms, as well. Sometimes there is macrotrauma to this area contributing to overuse or strain to this muscle, such as when training for a long run or long walk or when having altered walking patterns following an injury in another area (such as ankle sprain or low back pain). We will evaluate your spine, hips and pelvic muscles to determine if you have muscle imbalances, non-optimal coordination of muscle firing during your activities, connective tissue restrictions, trigger points or tightness leading to compression. Your treatment will be customized to your findings to provide you with the results you want.

SIJ dysfunction (sacroiliac joint dysfunction): The sacroiliac joints, located between your sacrum bone and the ilium bones of your pelvis, are a key area for your body to transfer loads as you move throughout the day. This area has strong ligaments and helps us transfer load from one leg to the other. We will assess your low back, your SIJ, your hips and your pelvis. We will evaluate all of your core muscles, including your diaphragm, abdomen, back muscles, pelvic floor and hip muscles. We will have you demonstrate how you move so we can see how your body coordinates your movements and transfers load from one side to the other. Our evaluation findings, taken together, will guide your treatment program so that you can get back to moving freely, without fear of pain, nagging discomfort or ongoing SIJ dysfunction.

Central sensitization: Individuals who have central sensitization experience pain even though their tissues are healed, there is no injury and there is no obvious “reason” for them to be in pain. As a broad overview, the central nervous system (brain and spinal cord) is sending pain signals even in the absence of an injury, thus perpetuating your sensation of pain. We’ve seen this often and we will help unravel what is going on. We are members of the International Pelvic Pain Society, avid readers of pain science and have completed countless post graduate education courses on pain neuroscience and how to best treat it. As such, you will receive pain neuroscience education in your treatment program so you have a better understanding of what is going on and how you can mitigate the pain. Central sensitization has been a prevalent component of Dr. O’Keefe’s pelvic pain patients, which has driven her to seek out best practices and advanced techniques to offer you quality care that gives you results. If a person has central sensitization, multidisciplinary collaboration is best and we are happy to work with your other providers.

Abdominal pain: Some of our patients arrive to us with a primary complaint of abdominal pain. Sometimes the pain is in the left lower abdomen, other times above the pubic bone, could be right lower abdomen or near the belly button or elsewhere. Often these patients have seen their providers and gotten a good workup with no major findings, so the person is told they have abdominal pain. From our physical therapy perspective, we find the person has myofascial issues contributing to their pain. For example, there can be muscular trigger points and unhelpful postural overutilization of some abdominal muscles. If you have ongoing abdominal pain, we can evaluate you to determine if you have musculoskeletal contributions to your pain. Sometimes you also have a GI problem, such as IBS, or a stomach problem, such as gastroparesis or something else. Even if you have these conditions, your abdominal pain may improve with the right physical therapy. We also help women with abdominal pain during pregnancy and the postpartum period. When you are pregnant you should first bring this to the attention of your Ob/Gyne or midwife who can assess you and determine if you may benefit from a referral to physical therapy. We look forward to helping you overcome your abdominal pain. We offer many treatment methods to address whatever we find in you and we will work with you to achieve your goals.

Hamstring, adductor or gluteal strain or tear: These are important muscles in your thighs and hips that can experience injury and contribute to pain, stiffness, weakness and lack of speed & power during sports activities. If you have torn your hamstring, inner thigh or other muscle and experience lingering problems from this, we offer expert physical therapy to treat your problem and develop a plan to get you back to full activities.