Why Every Orthopedic Physical Therapist Should Consider Adding Pelvic Health to Their Practice

When most physical therapists think about pelvic health, they picture urinary incontinence, pregnancy, or postpartum rehabilitation. While those are certainly important areas of practice, pelvic health physical therapy is much broader—and more connected to orthopedic care than many clinicians realize.

Many of the patients who are being seen by orthopedic PTs may also have pelvic health issues that are not identified unless specifically screened.

Low back pain. Hip pain. Sacroiliac joint dysfunction. Persistent groin pain. Tailbone pain. Abdominal surgeries. Chronic pain. Athletic injuries. Postoperative rehabilitation. These patients may have underlying pelvic floor involvement that influences movement, function, and recovery. Emerging evidence suggests that addressing pelvic floor muscle function may improve outcomes in some individuals with low back pain. ^1,2,3

Adding pelvic health to your clinical toolkit doesn't mean abandoning orthopedic practice—it means becoming an even more effective musculoskeletal clinician.

The Pelvic Floor Is Part of the Kinetic Chain

As orthopedic clinicians, we understand that the body functions as an interconnected system. We routinely evaluate how mobility, strength, motor control, breathing, and movement patterns influence symptoms throughout the body.

The pelvic floor is an integral component of the lumbopelvic system. Pelvic floor muscles function in coordination with the abdominal and respiratory musculature and contribute to continence, pressure regulation, and pelvic control.^1,2

• Core stability

• Load transfer

• Pressure management

• Continence

• Sexual function

• Bowel function

• Movement efficiency

When one component of this system is impaired, the effects can extend well beyond the pelvis.

Your Patients Already Have Pelvic Health Conditions

Many orthopedic patients never mention pelvic symptoms unless they're asked.

A patient recovering from hip surgery may quietly be managing urinary leakage.

An athlete with recurrent groin pain may also experience pelvic pressure.

Someone receiving treatment for chronic low back pain may avoid discussing constipation, painful intercourse, or urinary urgency because they don't realize those symptoms are related—or they're embarrassed to bring them up.

Without screening, these concerns often remain hidden.

By incorporating simple pelvic health screening questions into your evaluation, you can identify contributing factors that may be affecting your patient's recovery and quality of life.

In the literature:

In a study of patients attending physical therapy in a rehabilitation center for other issues (71% of cases were orthopedic), 45% of those surveyed had at least one pelvic floor dysfunction.⁴

Urinary incontinence was associated with higher rates of complications of THA and TKA compared to controls, with recommendations that perioperative management of UI may help reduce these complications.⁵

Older women with hip fractures had a high prevalence of urinary incontinence and/or fecal incontinence, related to depressed mood, constipation, prolonged urinary catheter use, and poor nutrition.⁶ Understanding strategies to manage incontinence in orthogeriatric settings is important for quality of life and falls prevention in these patients. 

Low back pain and urinary incontinence are strongly linked in studies.⁷

Urinary incontinence is prevalent in patients with chronic respiratory disorders, such as asthma.⁸

Pelvic Health Extends Beyond Bladder Leakage

Pelvic health physical therapy serves people across the lifespan and across all genders.

Common patient populations include:

• Individuals with low back, hip, or pelvic girdle pain

• Athletes with lumbopelvic dysfunction

• People experiencing urinary urgency, frequency, or incontinence

• Patients with bowel dysfunction

• Individuals recovering from abdominal or pelvic surgery

• Men following prostate cancer treatment

• Patients with chronic pelvic pain

• Individuals experiencing sexual pain or dysfunction

• Older adults working to maintain continence and independence

Whether you work in outpatient orthopedics, sports medicine, hospital-based rehabilitation, or private practice, you're likely already seeing these patients.

Expand Your Clinical Reasoning

Pelvic health education doesn't simply teach new treatment techniques.

It strengthens clinical reasoning.

You'll gain a deeper understanding of:

• Regional interdependence

• Pressure management

• Breathing mechanics

• Functional movement

• Neuromuscular coordination

• Pain science

• Patient communication for sensitive topics

Even clinicians who ultimately choose not to perform internal pelvic floor examinations consistently report that pelvic health education changes how they evaluate and treat the entire body.

Meet an Increasing Patient Need

Pelvic floor disorders affect millions of people, yet access to qualified providers remains limited in many communities. Patients often spend months—or even years—searching for answers before being referred to pelvic health physical therapy.

Expanding your knowledge allows you to:

• Better identify pelvic health conditions

• Provide evidence-informed conservative care

• Collaborate with physicians and other healthcare professionals

• Improve access for patients in your community

• Grow your practice with an increasingly needed specialty

You Don't Have to Become an Expert Overnight

Many orthopedic clinicians hesitate because pelvic health feels intimidating. Like learning vestibular rehabilitation, hand therapy, or dry needling, becoming confident in pelvic health happens over time. The journey begins with foundational education. High-quality continuing education provides structured learning in anatomy, evaluation, clinical reasoning, treatment progression, patient communication, and appropriate clinical decision-making. Whether your goal is to integrate pelvic health screening into your orthopedic evaluations or develop a dedicated pelvic health practice, every clinician starts with the same first step.

Invest in Your Future—and Your Patients'

Healthcare continues to move toward whole-person, integrated care. Physical therapists who understand the relationship between the musculoskeletal system and pelvic health are uniquely positioned to improve patient outcomes and address conditions that are often overlooked. Adding pelvic health doesn't mean changing who you are as a clinician. It means expanding your expertise, increasing your confidence, and helping more patients find answers they may have been searching for for years.

Ready to Get Started?

If you're interested in expanding your orthopedic skill set, consider taking a foundational pelvic health continuing education course. Comprehensive training can help you build confidence, strengthen your clinical reasoning, and integrate pelvic health principles into everyday orthopedic practice—whether you're treating athletes, postoperative patients, individuals with chronic pain, or those with complex lumbopelvic conditions.

Your next patient may already need these skills—you just haven't learned them yet.

Browse Special Topic Courses to Support Your Patients

References

1. Lim Y, Do Y, Lee SH, Lee H. Efficacy of pelvic floor muscle training with physical therapy for low back pain: A systematic review and meta-analysis. Clin Rehabil. 2024;38(12):1590-1608. doi:10.1177/02692155241287766 

2. Bernard S, Gentilcore-Saulnier E, Massé-Alarie H, Moffet H. Is adding pelvic floor muscle training to an exercise intervention more effective at improving pain in patients with non-specific low back pain? A systematic review of randomized controlled trials. Physiotherapy. 2021;110:15-25. doi:10.1016/j.physio.2020.02.005 

3. Kazeminia M, Rajati F, Rajati M. The effect of pelvic floor muscle-strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials. Neurol Sci. 2023;44(3):859-872. doi:10.1007/s10072-022-06430-z 

4. De La Ossa AMP, Catai CC, Lopes S, et al. Do patients undergoing physical therapy in a rehabilitation center have a high prevalence of pelvic floor dysfunction and psychological disorders? A cross-sectional study. Braz J Phys Ther. 2023;27(4):100536. doi:10.1016/j.bjpt.2023.100536 

5. Budin JS, Waters TL, Collins LK, et al. Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty. Arthroplast Today. 2024;27:101355. Published 2024 Mar 14. doi:10.1016/j.artd.2024.101355 

6. Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Kujala MA, Nuotio MS. Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women. Aging Clin Exp Res. 2022;34(6):1407-1418. doi:10.1007/s40520-021-02046-z 

7. Yumusakhuylu Y, Caglar Yagci H, Bayindir SN. Lower Urinary Tract Symptoms in Patients With Chronic Low Back Pain: A Cross-Sectional Study. Cureus. 2023;15(9):e45939. Published 2023 Sep 25. doi:10.7759/cureus.45939 

8. Paes FGDS, Salgado Filho N, da Silva MACN, Lima HCM, Ferreira DAP, Nascimento MDSB, Costa MRSR. Effect of urinary incontinence on the quality of life of asthmatic women. J Asthma. 2016;53(5):553-558. doi:10.3109/02770903.2015.1108439