If you’re interested in reading more on ideas presented in the article below, I suggest reading Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation. If you’d like movement instruction via video, start with Nutritious Movement for a Healthy Pelvis.

Hypertonus of the pelvic floor is extremely common and often treated incorrectly (as general pelvic floor weakness) because many do not understand the biomechanical functions of muscle well. The problem lies here:

1. There is some sort of pelvic floor or low back or hip issue.

2. The pelvic floor is evaluated for “strength” because it is well understood that in order to maintain correct skeletal orientation and pressures on nerves and ligaments and stuff, the pelvic floor is really important.

3. The pelvic floor evaluation comes back as NOT CONTRACTING WELL, as measured by EMG (electromyograph) or by good old fashioned pressure on a finger.

4. The low-force producing pelvic floor is deemed weak and one is typically given strengthening exercises.

This is all very logical, but unfortunately the very large oversight is that tight or hypertonic pelvic floor muscle will register as “weak” because it is unable to generate force due to the fact that this muscle is already in its tightest (and shortest) position.

Currently there is no agreed-upon clinical standard for measurement (i.e. value of EMG or the finger test) that indicates, when the pelvic floor is not performing correctly, if it’s because it is too tight (read: short) or too loose (read: long). The general misunderstanding seems to be that all a weak muscle needs is a little EXERCISE to fix it up. In actuality, research shows that MORE KEGELS, MORE CORE TENSION, AND MORE SUCKING IN THE GUT MAKE THIS PROBLEM WORSE AND NOT BETTER.

Most pelvic floor issues are created not by one-time events like pregnancy or a skiing accident (like falling on a hip), but by habits that accumulate over time — especially those habits we all share — sitting in chairs the bulk of every day, not using a squat throughout a lifetime, exposure to chronic stress, and then, of course, doing extreme correctives and overdeveloping tension in the abdomen and pelvic floor.

This is a letter from my inbox, which the author gave me permission to share with ya’ll:

Dear Katy,

I was hoping the Pelvic Floor Guru in you would have some pearls of wisdom for me. I am 35, a virgin (sad as that may be, it’s not my main problem!), and have a steel trap for a pelvic floor–not in a good way. There have been times when a pap smear/etc. were in order, but no doctor has been able to get a speculum in. Not even an “infant” size. The smallest of tampons is uncomfortable. You can imagine the implications this has on my life.

If you think of the vagina like a clock, 3 and 9 o’clock (hip to hip) seem fine, but there is NO give at 12 and 6 (front to back). Does that make sense?

I have several of your DVDs and do the “Down There” stretches every day. I’ve talked to a RN, who is also a physical therapist specializing in the female zone, and she says there are some things she could try to help get those muscles to unclench, but, frankly, it sounds the opposite of delightful.

Boy-howdy, do I hope you have some ideas for me! Thank you for any thoughts you may have!

First of all, thank you for writing, lovely reader. Your description of front-to-back tension is very clear — thank you for that. When you have tension in this direction, it is key to learn about the sacrum and how the pelvic floor can act upon it (read more here) as well as understand that the butt muscles are strong force generators that should be keeping the PF muscles supple in the front-to-back direction.

Understanding the roll of the bum to keep the pelvic floor healthy, full-of-blood (not in a vampire/Halloween way, but in a “hey, I’m healthy, used, and full-of-blood kind of way”), and to provide appropriate leverage for the pelvic floor is essential.

No butt, no pelvic floor. Know butt, know pelvic floor.

Someone should make that a bumper sticker. You’d put that on your car’s rear end, yeah?

Anyhow. When hypertonus is diagnosed correctly, there’s usually one option when it comes to what your insurance will cover and that is physical therapy, but most specifically, “internal work.” Internal as in

Checking your oil.

Going under the hood.

Gettin’ one’s hands dirty.

And, a bunch of other euphemisms that seem to relate to cars.

P.S. Isn’t this a great book cover? I just found it on Amazon (click) and think a Do-It-Herself Guide a great graduation gift for any women heading off to the next steps in life!

So, what’s the problem with internal work? Well, if your pelvic floor has developed some sort of chronic issue that is causing you grief, chances you, like the writer of the email, are not very enthralled with the idea of some stranger poking around in your goods.

Because I am the Queen of Down Under,

I will attempt to shed a bit of light on both the process of internal work, my personal experience with it, as well as things you can do that can also improve hypertonus if you’re not ready to get down with your bad self. To help me out, I’ve brought in Pelvic Floor Physical Therapist Susan McLaughlin.

Susan is not only a bad-ass therapist, she’s also a graduate and Master-Teacher-in-Training of our Restorative Exercise™ Whole-Body Alignment program. She does internal work a lot, so I’m going to have her explain what the process is “like” for those who want to know.

So, Susan. Is internal work as creepy as it sounds?

There is a lot of taboo in our culture about genitalia, incontinence and sex and so first of all, it can be an uncomfortable experience to share your pelvic floor issue with your friends or even health care provider. Don’t let that stop you, please! For me, as a practitioner, internal work is a key component to understanding the state and function of the muscles, fascia, potential scar tissue and nerves. So, no, not creepy.

I don’t know, Susan. The word “genitalia” is kind of creepy. But then again, so is the word “creepy,” so I might just be overreacting.

Can you explain a bit about the actual process of internal work?  Once when I was getting a facial, I was all relaxed and my face was  warm and wet and I had a small fluffy animal placed over my eyes to  really make it a spa-like, relaxing experience you know? Then, out  of the blue, I hear this sound like someone is being electrocuted,  and then I realize that the buzzing and zapping electricity thing is  now touching my face, which is wet and my eyes are covered… I had  a major freak out that ruined the facial. Even though the therapist  knew that the electrical-zappy thing wouldn’t hurt me, I didn’t.

Wow, that was a long story.

But important! Because I, like most people, don’t like to be  startled in a session, so I want to know everything that’s going to  happen. What is a session with internal work like?

Prior to the internal exam, a superficial assessment is performed.

Sorry to interrupt. Just wanted to clarify that a superficial  assessment does not in anyway imply that the practitioner is a shallow person, but that before going in, they take a look around at the surface. You many continue.

The practitioner visually inspects the skin (identifying redness due to inflammation, discoloration, swelling, etc) and observes the perineum for tissue integrity/responsiveness during a pelvic floor  contraction, cough and bearing down, as well as palpation of the  superficial muscle for tenderness, symmetry. The internal exam is a one finger vaginal (or rectal) assessment. The client is asked to perform a pelvic floor contraction. The quality and strength of the contraction is assessed as well as the ability to return to resting  position. If a person is not in a painful state, it is good to assess the endurance of the muscle by having the person hold a  pelvic contraction for 10 seconds and then repeat as many repetitions as they can until they fatigue. Quick contractions are assessed by having the client repeat as many as they can in 10  seconds. Again the quality of the muscle activity is important. Some people contract, but never go back to resting position…that is not good. Also the muscles are  palpated for tone, tenderness, trigger points. The process is then repeated on the other side.

You sound smart and all clinically and stuff. Do you wear a white coat while you do this?

A lab coat is not my style, though many PTs wear them.

Well, so far it sounds swell. Like a massage, only not 😉 But this  is what everyone really wants to know: Does it hurt?

Initially, the evaluation and some follow-up visits may be painful. As the muscles and fascia begin to release, the holding patterns let go and many people experience pain relief during the internal work.

As a biomechanist, I’d like to chime in here for a second about the pain thing. Knowing how sensory receptors work and having had internal work myself, would you agree that the amount of pain felt is equal to the amount of tension or resistance to the pressure being applied? Meaning, the therapist might not be pushing at all, it’s the muscles pushing BACK that cause pain. And if one could use the pain as a mental signal — “oh, here is a place that  needs to soften” — instead of just thinking — “Damn Woman, stop hurting me!”, wouldn’t the sensation of “pain” instantly lessen?

Yes, actually.  I have people practice breathing and mindfully letting the muscles go.  I can feel the change in the muscle instantaneously if they are able to do that… and most people can.

Ok. So you’re really just helping people become aware of tension patterns they didn’t even know they had, and open their eyes to a situation that they can actually fix themselves! With a little help, of course…

How does an internal work session compare to a Pap exam? This one time, I thought I’d schedule my annual Pap on my birthday. Which, I  just wanted to let everyone know, is not as good of an idea as it sounds.  But anyhow, please continue. I just thought you might be interested in knowing the highlights of my Pap history.

Thanks. The sessions are different than a Pap because there is no speculum used. And internal sessions are focused on the re-education of muscles, habits, movements, alignment. If a person is experiencing pain, it is important to teach them how to relax the pelvic muscles. Because these muscle have been held in tension it can be difficult to know how to relax. I have found it very helpful to use a finger inserted at the vaginal opening to assist with the cue to “drop” the pelvic muscle downward/backward. A slight pressure onto the muscle provides stimulus to tell the muscle to let go. This can be helpful for the first few visits until the person has confidence in  performing the relaxation on their own. Each therapist has their own manual therapy skills to assist in releasing the muscle/fascia/joint dysfunction.

It sounds very clinical and not that fun. Do you ever laugh at all?  I mean, not tell dumb jokes or anything (like me), but would you recommend we pick a therapist they feel comfortable with? To me, a therapist is like a pair of shoes in the store. If they don’t quite fit in the beginning, does the relationship improve? Or, better yet, do people  have the right to “interview” an internal therapist for maybe 5 minutes to see if they feel relaxed in general? What are your thoughts?

I am being very clinical right now, my bad. I do actually have a sense of humor and am able to help people feel at ease. I like to explain to people what I will be doing so people know what it going to happen and they can choose whether they feel comfortable or not. Comfort is a big deal. It’s a good idea to call a clinic before you make an appointment and have a quick chat with the therapist to see if it would be a good fit.

Ha ha. You said make sure your vagina therapist is a good fit. Get it? (P.S. If you didn’t laugh at that, then pause, take a breath or two, and see if you can relax your pelvic floor muscles Right Now and read it again!)

Anyways. Do you use equipment? Wires? Electrodes? Headlamps?

Currently I don’t use any equipment.  However, many therapists utilize biofeedback, electrical stimulation or TENS.

Oh, right. A TENS. Um, do you want to tell us what a TENS is?

A TENS unit (transcutaneous electrical nerve stimulation) is something that clients can use at home for pain. There are external electrodes that stick to your sacral/low back area or on your abdomen. The electric impulses travel through the nerves to the spinal cord and block the pain impulses that go to the brain (basically keeping the secretary busy so she can’t relay the message to the boss that something is going on). This doesn’t hurt and can actually allow some temporary pain relief. You can buy them off of Amazon for like 40 bucks.

Thanks for explaining the TENS. Although I think many people find a nightly glass or two of wine to be effective 🙂

Ok, back to internal therapy. How long does it take to work?

Generally, it may take anywhere from  6-8 visits.  Of course, this depends on many factors: is the client doing their home play, how  long they have experienced the issue, etc.

Ok. So how does internal work work. (Seems like a lot of work.) Are  you fixing my muscles for me? What am I supposed to do/feel/change?

Physical therapy can help facilitate joint mobility and release of fascia and muscle trigger points. The client should begin to become  more aware of the pelvic floor muscles as well as all muscles. Notice habits like holding breath, sucking in, excessive sitting and begin changing dysfunctional patterns. The key to lasting change is held by the client. In all of my sessions I emphasize whole-body alignment principles, stress reduction/management, exercise and movement, and nutrition when appropriate.

Is there homework?

Always homework! Restorative Exercise™ and every-day alignment principles.

I’d like to jump in and offer my favorite, get-the-heck-off-your-sacrum, you are damaging your pelvic floor tip  here — make sure you are sitting in neutral pelvis and not on a slightly tucked one. Watch this video, and try it sitting on a rolled towel the first few times, to get a feel for old tucking habits and your new, healthy-pelvis position.

What’s internal work like for a practitioner? What are you feeling for?

The practitioner is feeling for muscle tone/twitch, connective tissue mobility, dense thickened bands in the tissue, adhesion, and symmetry between sides.

Most people think of pelvic floor as just the vaj, but after my vaginal delivery, I developed a hematoma that burst and it seemed to send my deep hip rotator on that side into a spasm. No amount of  stretching or specific correctives could get to it and I could still feel that something was off in my hips, even though my vaj was fine. During my session, through help in “finding” the tension I was carrying, I was able to let go of the protective mode I’d been in for almost a year. It made me cry, and not because it hurt. It didn’t!  But I just had all this feelings — tense, sad, worried, joy, relief  — tied up with this one tiny spot and the event of my son’s birth and, who knows what else! Do other people cry or do seemingly unrelated things?

One of our deep hip rotator muscles called the obturator internus can be palpated and accessed easily through the vagina. This muscle can be a key site in pelvic pain syndromes due to the close connection with the pudendal nerve. The pudendal nerve is the nerve to the muscles of the pelvic floor. Its course of travel runs right over this hip rotator muscle. Tension in the hip rotators can cause irritation of the nerve, and then pain.

And the crying?

Candace Pert, MD was the first to scientifically prove the biochemical basis of emotions.  And these emotions, she found are neuropeptides residing not just in the limbic system, but flow throughout the whole body in the nervous, musculoskeletal, immune and cardiovascular systems.

You experienced an emotional release through the fascial and muscle memory!  It’s cool stuff and I witness this in my office on a regular basis. This is normal and very liberating. I applaud anyone who is able to feel safe enough to let the emotional release happen.


So Susan, tell me. How did you get into vaginas? I mean pelvic floor health?

I landed a job as a spine specialist and they asked me if I had any  interest in women’s health and I said “Hell Yes!” I started taking  courses toward my specialization. When I was an anatomy teacher’s  assistant I had a fascination with the sacrum. I felt that it was a  powerful bone and I felt that, because the pelvis is the area of our  center of mass, that there has to be a lot going on in there. Also,  my favorite color is orange, the color of the second chakra, the pelvic area…my fate was set!

Orange is your favorite color? Mine too! I never thought about it like that, although I’ve been fascinated by the pelvis ever since taking anatomy as an undergraduate. Do you think or natural interest in orange pelvises and vaginas is why we get along so well?

That and our high sense of fashion! <—— This is a very funny joke that is probably only funny if you spent a week going through our similar wardrobes of sweats, track pants, yoga pants, and fancy yoga pants for formal occasions.

What do you love the most about women’s health work? What do you wish more people understood about their pelves?

I love that the pelvis is our center. It is the house of our womb and bowels. I would like women and men to feel more comfortable expressing themselves to healthcare workers and friends, so pain and  dysfunction doesn’t go on for years.

Also, I wish people understood that their daily habits and movement  patterns contribute to pelvic pain and that there is a way out of  pain without meds and surgery, through awareness and movement.

I really love that. The solution to chronic pain — pelvic, in this case, but of course, it’s the same for all tissues — is through awareness and movement. Beautiful.

Ok, last question. To be crystal clear, internal work is not just for women, right? Men develop hypertonicity with the same frequency (if not more) than women and it’s a risk factor for not only pelvic pain but  prostatitis, ya?

The pelvic floor and the obturator internus are easily accessed through the rectum. I see men in my practice as well. Prostatitis is usually the diagnosis they get from the urologist, when in fact, the painful symptom and urinary dysfunction is caused by the hypertonicity of the pelvic floor and other alignment factors.

YES! Fellas, don’t let your PF tension get out of control. It’s a major contributing factor to issues of the colon and prostate. This post is just as much for you as it is the ladies. (Hi Dad!)

Thanks for your time in answering my questions! If you’re in the SLC area of Utah, you’re lucky to have Susan as a potential therapist. Find more info about her practice, her classes, and her pregnancy/pelvic health workshops here:

Now let’s say for a moment that someone with a pelvic floor issue  just can’t bring themselves to sign up for internal work yet. Susan and I have each come up with a few tips that can help with habits that create or perpetuate hypertonus. I’ll post those in the next day or so, because this post is too long already!

Are you still interested in learning more on this?

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66 thoughts on “ATooTightPelvicFloor

  1. SO much useful information, as ever. thanks, Katy.

    I am left with one burning question, though. The small fluffy animal that was placed on your face at the spa. Was it alive?

  2. Total lightbulb about tampon pain as a teen. Fortunately it resolved. FYI, I would totally put that bumpersticker on my car 😉 Thanks to both of you for a great article!

  3. Katy,

    Well worth the wait!! The bumper sticker should read know butt, know pelvic floor OR no butt, no pelvic floor! Thanks for sharing all your knowledge with us. I feel so blessed to have found you! Slow steady progress, and hoping I can inspire others.


  4. Katy, you are awesome. THANK YOU. Susan too. It’s sad that this kind of information is nearly impossible to discover via one’s health care providers. You could appropriately go put on unitard and cape right about now.

  5. Thanks for a great post.

    Reading this gets me all in a hissy fit about vaginal weights. I know, Katy & Susan, we have different ideas about the value of kegels. However, I’m sure we would all agree that

    a) if one is going to do kegels, relaxation needs just as much attention and practice as contraction


    b) Women need to throw away those @#$%$ vaginal weights! Vaginal cones, kegel “eggs,” ben wa balls, all those weight-based devices… women don’t understand that they are simply training those muscles to clench. I sputter with frustration every time I think about those rotten things! Sigh.

    Looking forward to your next post.

  6. I had some internal work done after my first child. I went in for PT because of back pain and I mentioned the pelvic floor pain (which was way worse but somehow not something my doctor knew to do anything about) and the back PT turned me over to her Women’s health PT friend. At first, I was all “you are going to do what??!” but after that first obdurator release, I was a convert. I lived for those things! Unfortunately, I wasn’t given any other info or homework or things to change to not need an obdurator release, so I just kept going in (because otherwise the pain would get so bad I couldn’t function) every week until the PT decided I’d had enough treatment and closed the case…

    I think what Susan says about homework is SOOOOOO important. If you’re having internal work done and not given anything to do or change outside the clinic, find another clinic. Knowing what I know now (which is still not all I need to know, still having issues here and there), there were a lot of resources wasted, on both sides, because the mentality of the PT was “here’s the treatment I’m going to do to you to fix you” instead of “here’s the treatment I’m going to begin and here are the tools you need to fix yourself.” At least, that’s my opinion.

    And it’s ridiculous how hard it is to find this kind of information. Or I’m a poor googler. But all my early attempts to try and research my issue made me feel like I was the only out there with this problem.

  7. I just had an emotional release reading this post……thanks ladies for demystifying internal work.


  8. In the spirit of bodily functions down there, how about some posts (or references to older posts) on sacral nutation/counter nutation and bowel movements/constipation issues? I realize the above post and this issue are related. Butt, for some reason, all those daily vitamix veggie drinks and warm prune juice, daily squatting when not standing @ my work station, and hamstring and calf stretching aren’t really working so well.

    Thanks again Katy. Hope the pregnancy is going swimmingly, and you are not on a strained steamed cauliflower diet again. YUK

  9. Awesome post! I wonder, as Susan had mentioned, that you can access the obturator muscle via the entrance through the vagina. Do you think it is something that someone (such as me) can possibly access? I know that when I roll on a foam roller or tennis balls, that is one sensitive spot for me and would be intrigued to know if I can release that muscle internally as well. Thanks!

    1. Tia, yes you can access it externally. You can get at it yourself if you lay on your side, let’s say left side. Take your right hand and feel for your left ischial tuberosity (SITS bones), and then take your thumb and come toward the midline (medial) so now you are on top of the left tuberosity. Sink your thumb into the tissue there, down toward the bone, you are on the obturator internus. It is usually tender for most people… Hope that makes sense.

  10. Katy, thank you for ALL of your wonderful postings. I love your blog. As a movement-based expressive arts practitioner/teacher, I wish to chime in about the ability of somatic work to release emotion. I see it over and over again in my workshops: tears, unexpected joy, and seemingly unexplainable feelings of freedom (or, conversely, of being stuck).

    Our creativity is, I believe, rooted in our pelvic area. It is totally understandable that people who feel stuck or “uncreative” or “untalented” in my workshops also hold a great deal of tension (and denial) in the PF and pelvis/hips/lower back.

    Thank you, again, Katy. Please never stop writing your blog!

  11. Having “down there” as a work in progress along with all the other 25 alignment points, I appreciated this great information. I will soak up any more you want to send our way.

    A second on Theresa Steven’s request for more posts on sacral nutation, counter nutation and bowel movements/constipation issues.

    Does anyone know of a Pelvic Floor Physical Therapist who does Internal work and is located in the Ventura vacinity?

    Thanks for “getting down” information that actually makes sense.

    Standing at my computer and loving it. Mary Ann

    1. to Mary Ann,

      there are a few therapists in Ventura County who do internal work. I don’t wish to post their names w/ out permission. However, you can call BEACH and Breena could give you guidance, or you can email me separately and I can provide a recommendation (

  12. Thanks for great article. I did have PT for 4 weeks Therapist is certified and only one in our area. she did internal and external trigger points on me then followed with external e-stim unit. First week was great I could hold my urine for four hours. Internal message the most painful I have ever had without IV sedation. I have had interstitial cystitis for 26yrs now severe!!. On internal massage I would be climbing up the table towards the head of the table. I kept going but she flared my IC to worst it had been in over 20 yrs say prediagnosis days. I went back to nocturia and after my last PT session she hit me hard at six o clock and would not let up……..I left in so much pain and now daytime frequency. She ruined and made my IC the worst ever I emailed my top IC specialist Dr Clemens U of MI told him of all this and he along with my PFD MD told me to stop the PT. I stopped and was in bed in pain for good three weeks awaiting hydrodistetion that settles my IC that the PT flared so bad

    Recently I am wanting to and I have an order to try internal e=stim administered by Uro NP no internal or external massage at all . I am excited concerned

    Is it possible that internal estimulation could flare my Interstitial cystitis again ? Please advice thank you. NO i will never go back to that PT she flared my IC so bad I thought i had a UTI and I could hardly walk the pelvic pain was so bad

  13. I want to thank you for an excellent dual post. The two of you dealt with a very touchy subject in a straightforward and humorous manner. Also, thanks for mentioning that this is not just a female issue. Including the how-much-do-you-sit quiz and the short video was very helpful. Awaiting the pelvic health tips.

  14. Is it possible for PF muscles to ever fix themselves in relation to us fixing poor habits? For a while after my son was born, whenever I would stand for long periods of time, it felt like all the blood was rushing down to my perineum, and I would have this painful burning sensation in my lower back. I hadn’t found this gem of a site at that point, and was probably doing 100+ kegels daily, trying to be diligent and stay tuned. *hah* After finding this site, squatting, walking 4+ miles daily, and giving up on kegels, (My apologies to the queen!) I no longer experience that pain. I always thought it was just time more fully healing my body, but could these changes have been my body self correcting as I learn better habits?

  15. I was wondering if Susan could recommend a way(s) to locate an appropriately trained practitioner. Is there a professional organization with a website that might have a searchable list? Thanks!

  16. You wrote:

    “Understanding the ROLL of the bum to keep the pelvic floor healthy…”


  17. I’ve had PDF along with vaginismus for over five years. For 2-3 of those years I was misdiagnosed with UTIs. Then, after seeing numerous doctors and reading a ton of stuff online, I came across PFD and starting going to an PT, who taught me stretches and did internal work. I still use a dilator myself and continue doing the stretches. I’ve recently found Katy and feel as though I’ve found the missing component to all my work–especially spinal alignment, pelvic tilt, and no sitting!

    However, Susan, you say it takes about 6-8 visits for internal work. Is it unusual that I still need to do dilations? Or is my body so used to tightening because of stress (I’ve been working on doctorate–that is VERY stressful, so I look forward to seeing what my pain is like when that is over–which is soon!) that it’s going to take longer for my body to get out of the habit of tightening?

    Also, is my vaginismus related to all this? Is there anything I can do about that?

  18. I have a question about the opposite problem. What about not being tight enough as in a rectocele? Can internal work help with that kind of issue?

    Thank you for posting about this? It is such a touchy subject and it really helps to know what will happen in a session.

  19. K,

    6–8 visits is an average, and for longer history of PFD and vaginismus, 12-20 visits and even more is common. Becoming aware of the tension patterns with mindfulness ,and relaxation can help. Learning how to tune into the pelvic floor muscles and let them go 5-7 times a day can be very effective at reducing tension. Check out my post that describes this:

    There is a website that may be of resource to you:

    They have a workbook and CD that can be helpful for managing stress


    1. Thank you so much Susan! I appreciate learning anything that I can! I have read all your blog posts and look forward to reading more. I’ll check out the website your recommend.

  20. Love *love* this post. I did internal work while pregnant and was so SORE – this has continued. I cancelled elective surgery in relation to pain ‘down there’ and have been doing the pelvic floor online course. I would so love to see an internal work practitioner – but I haven’t had much luck finding one in Victoria, Australia 🙁

    1. Is there no physiotherpist site that lists them? Boo…I’d contact the national board and see if there is, in fact, a list! Also, check for mysfascial therapy training. There might be someone who can do that with you!

    1. Too loose would be following a child birth delivery, where things are getting stretched out. Good to do a little muscle-motor test. But if not, check and see if your hamstrings and calves are tight. If your pelvis tucks under and you sit on your sacrum. Most people have a too-tight pelvis, unless just after birthing…

  21. I have a question, I have frequency and urgency of urination due to a hypertonic felvic floor. It was triggered by recurring utis, the last was Nov 11, and since then the frequency/urgency never stopped. So far i have had about 6 sessions of pt and she is also doing electrostimulation to relax my bladder. So far no improvement.

    I have been very stressed about the problem and apparently it was my anxiety and stress which caused the muscles to tighten in the first place. My question is, if my physiotherapist helps relax the muscles but i continue to be stressed and worry (which i cant seem to control), will it just undo the work she has done, by tensing up the muscles meaning the muscles just wont relax. Can the stress really cause the muscles to become so tense again and so quickly?


    1. Yes, that chronic tension is likely to be the root problem. See if you can find a book on stress management or a class — or see if the PT might have a recommendation for a therapist who can help you with the day-to-day experience with stress you are having. In the long run, stress is the largest variable in most disease, so a little work there can go quite a ways in increasing your quality of life!

  22. Hi Katy,
    Thanks for your incredible work. I am a pro dancer now teaching pilates and have been battling PF tension and hip pain for years. I have your dvds and do tbe exercises. The docs recommend bilateral hip
    Replacements. Any insight on doing one ata time vs both simultaneously? Other advice?

    Many thanks!

  23. I had surgery in July for endo. After experiencing slight relief I saw another surgeon and had surgery again in March. In preparation I spent two weeks in pt. This was a much more extensive surgery and after 4.5 hours of surgery and 2 nights in the hospital I was home. Within two week I started pelvic floor physical therapy. I’ve continued weekly until about a week ago. My therapist has seen little to no progress, she says my muscles are super tight and I’m not getting a full range of motion. It’s only getting worse. Muscle spasms, urgency, incomplete emptying and frequency with urination. The pain is horrible, I have nausea and vomiting with minor activity, digestion is becoming an issue with acid reflux and when i do vomit 6-8 hours after eating I’m still vomiting food. I’m getting incredibly discouraged. Any suggestions would be greatly appreciated.

  24. Hello! I’ve been going to physical therapy for an extremely tight pelvic floor (minimal penetration possible with extreme pain before treatment), and I found a great place and an amazing pt and have made significant improvements! I’m still struggling with being able to relax my pelvic floor quickly though. It takes me a long while to fully relax, and this makes intimacy with my partner more difficult for me. Do you have any advice for this?

    I also have issues with not constantly sucking in my stomach. I discovered with my physical therapist that my hip muscles, inner thigh muscles, and lower abdomen are way tight. I’ve been able to incorporate yoga and stretching to work out my leg and hip muscles, which has been very beneficial, but my stomach muscles have been more difficult because I have been unconsciously sucking in my whole life. Now I am afraid not to because (and this is embarrassing) I feel ugly and fat if I don’t suck in. I know in my head that this isn’t the case, but I feel extremely ashamed of my body if I don’t keep my stomach muscles tighter. Are there any exercises I can do that will keep my stomach smooth and relatively small, but not tight in a bad way? I’m sorry if that’s a silly question, but I am having extreme body anxiety and yet I still want to be able to enjoy intimacy fully with my partner and have a healthy pelvic floor and body in general.

  25. Hi Katy,

    Ok, first of all your work is amazing and I want to be you when I grow up. I’m 21 and was recently diagnosed with dyspareunia, which seems to correlate with the hypertonicity that you are talking about here. I have suspected for a long time that I was tight down there and that it was the cause of painful sex, but doctors have preciously discouraged such ideas. I am also a dancer (ballet and modern) and am a strange combination of flexible and tight (when I am warmed up my leg muscles stretch a tremendous amount and tighten up again when I am not). Would it make sense that someone like a dancer who is constantly using the muscles around the pelvis, is probably more likely to suffer from pelvic tightness? I have a natural anterior pelvic tilt (a common trait in Black girls with a booty), which I constantly am compensating for with a tuck in ballet class. I think the more I dance, the tighter I get down there. So, I’m having trouble deciding whether my pelvic muscles are “weak” as you describe in your video where the muscles are not able to lengthen properly or “strong” because I think they do grip. My gluts are strong but my psoas and abdominals tend to be tight. The conventional physical therapy treatment for dyspareunia seems to include the used of vaginal dilators to train the muscles to relax. What would you recommend other than squatting? Are there specific stretches? Also, why is it so hard to find info about these types of problems? Is there just not enough research? Thank you so so so so much for the info you have given!

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