A Tale of Two Pain States: The Integrative Physical Therapy Approach to the Overactive Pelvic Floor

Abstract

This chapter presents a framework for the evaluation and treatment of pelvic pain and the overactive pelvic floor (OPF) from a biopsychosocial perspective. Level 1 evidence supports central pain mechanisms as a key feature of many pelvic syndromes including pain associated with the OPF. The treatment strategies presented in this chapter are designed to address both the pelvic musculature and central pain mechanisms involved in persistent pain. Research supports the therapeutic need to target the nervous system as well as the muscles and joints when treating persistent pain. We present this information with a focus on patient education in current pain science, graded imagery exercises, and integrated mindfulness techniques that are optimal for restoring balance to an OPF.