Pelvic pain physiotherapy in Sydney CBD

Which structure is causing it, and why that comes before any exercise

Pelvic pain is not one condition, so it does not have one treatment. The pelvis has three joints and a deep layer of muscles that hold it together, and pain can come from any of them, or be referred into the pelvis from your lower back or hip. Our physiotherapists work out which one is causing yours, treat it, and give you the exercises that keep it settled.

People come to us for pain at the front of the pelvis or in the pubic bone, a deep ache in one buttock, pain that makes rolling over in bed or climbing stairs difficult, or pain that has been put down to the pelvic floor. Many arrive in pregnancy, many in the months after a birth, and plenty have had the pain for a long time and been told nothing is wrong.

The studio is on George Street opposite the QVB, three minutes from Town Hall Station. You do not need a referral, and the first appointment is an hour so the assessment is not rushed.

What the pelvis is, and why it hurts

Your pelvis is the platform between your trunk and your legs. It passes the weight of your upper body down to your hips and feet, and it takes load back the other way when you walk, climb stairs or lift something heavy. Three joints do that work: the pubic joint at the front, and the two sacro-iliac joints at the back, one either side of the base of your spine.

Those joints have very little movement of their own, which is exactly why they need the muscles around them to be strong and well timed. When a joint is irritated, or the muscles that should support it are not doing their share, the load lands somewhere it should not. That is the pain you feel, and it is why treatment works on the joints and the muscles together rather than on the sore spot alone.

The kinds of pelvic pain we treat

Pregnancy pelvic girdle pain

Pregnancy is the most common time for the pelvic joints to become painful. Your posture changes as your belly grows, and the hormone relaxin softens the ligaments around the joints in preparation for birth, so joints that were stable start to give. Pain turns up at the front of the pelvis, over the pubic bone, in the buttock, or at the base of the spine.

The everyday movements are the ones that hurt: rolling over in bed, standing on one leg to dress, going up stairs, getting out of a chair, and sitting for a long time. Treatment combines gentle hands-on work on the joints, exercises to restore the support around them, and a support belt or taping for the days you are on your feet more.

Most women find it settles over the weeks after the birth as relaxin leaves the body. If it has not, our pregnancy and postnatal physiotherapy page is the place to start.

Sacro-iliac joint pain

The sacro-iliac joints sit at the back of the pelvis, close to where your buttock meets your lower back. Pain here is felt deeply in one buttock, sometimes on both sides, and it can travel into the side of the upper leg. It rarely goes past the mid thigh. Standing on one leg, the first steps after sitting, turning in bed and walking up stairs are the movements people notice most.

These joints carry a lot of load and rely on the muscles of the abdomen, the pelvic floor, the buttocks and the hips to keep them steady as you move. Treatment is not just the joint: it is the timing and strength of all of those muscles together, which is slow, precise work and the reason a course of sessions beats a one-off.

Pelvic floor pain and dysfunction

The pelvic floor is a sling of muscle at the base of the pelvis. It can be too weak, too tight, or not coordinating with the other deep muscles, and each of those feels different. Weakness shows up as leaking, heaviness or a sense that something is not held up. An overactive floor gives pain, urgency, or discomfort with sex, sitting and emptying your bladder or bowel.

Scans and tests often come back normal, which is why this pain gets missed. It responds to assessment and retraining rather than to rest. Much of this work is with women, and when someone needs a men's health physiotherapist we refer them to one nearby.

Pain after a birth

Pain in the pelvis, tailbone or pelvic floor in the months after birth is common, and it is treatable rather than something to put up with while you look after a baby. It can follow a long labour, a tear, an episiotomy or a caesarean, and it often sits alongside a core that does not feel connected yet.

We treat the pain first and then rebuild the strength, which is what our postnatal Pilates classes are for once the acute part has settled.

Pain referred from the lower back or the hip

Not all pelvic pain starts in the pelvis. Joints and nerves in the lower back and the hip refer pain into the buttock, groin and pelvis, and it can feel identical to a pelvic joint problem until someone examines it properly. The assessment checks the spine and the hip as well as the pelvis, because treating the wrong joint is the most common reason a course of physiotherapy does not work.

If you are not sure where it is coming from, these pages cover the other two possibilities: lower back pain physiotherapy and hip pain physiotherapy.

What happens at your first appointment

The first appointment is an hour, one on one with a physiotherapist. You talk through when the pain started, what makes it worse, what you have already tried, and anything in your history that matters, including pregnancies, births and surgery. Then your physiotherapist watches you move and examines the joints, muscles and nerves of the pelvis, the lower back and the hips.

If a pelvic floor assessment is part of the picture, they will explain what it involves and ask your consent before doing it. Nothing is done without you agreeing to it first.

You leave the first appointment with an explanation of what is causing the pain, treatment started that day, a program for the days in between, and a clear idea of how many sessions it is likely to take.

How treatment works

Hands-on treatment comes first: gentle work on the stiff or irritated joints, massage and mobilisation of the muscles and soft tissue around them, and taping or a support belt when the pain needs help immediately. That is what makes the days between sessions bearable.

Then comes the part that makes it stay fixed. We rebuild the strength and timing of the deep abdominal muscles, the pelvic floor, the buttocks and the hips, starting at a level your body can actually control and progressing from there. The exercises are specific rather than general gym work, and they change as you improve.

For most people the last stage is a return to loading: carrying, lifting, running, the gym, or a normal Pilates class, with the pelvic floor checked against the load rather than assumed to be ready. Our clinical rehabilitation classes are the small-group version of that stage, taught by a physiotherapist in the studio.

Prices, rebates and how to book

Physiotherapy consultations are rebated by most private health funds under physiotherapy extras, and we claim through HICAPS at the desk so you only pay the gap that day. Bring your fund card.

Work injuries and motor vehicle injuries are treated here too, under the NSW workers compensation and compulsory third party schemes. If you have a GP care plan, DVA cover, or one of those claims, tell us before you book and we will tell you what it covers and what you will pay. Bring the claim details and we will handle the paperwork with you.

Book online or call (02) 9264 0077.

Book your pelvic pain assessment

The work you can do at home

Between sessions you can follow the same physio-led work through our letting go program for pelvic pain, and the rest of the pelvic pain library sits alongside it in The Fix Program Online. Both are the exercises your physiotherapist teaches in the treatment room, filmed so you can check your form at home.

What people say about the studio

Clients write about their treatment on our Google listing, unedited. Read a few of them before you book.

Related reads

• What is a cause of pelvic pain?
• Visualising the sacro-iliac joint
• The overactive pelvic floor
• Pelvic girdle pain
• Pelvic floor muscle injury in labour
• The pelvic bowl: keeping your pelvis level