How Pilates Can Support Recovery from Pelvic Pain and Tension
- Brittany Schroeder
- Jan 24
- 6 min read
Insights From a Pelvic Floor PT & Pilates Instructor
By Dr. Britt, PT, DPT, NCPT, WCS
One of the most common questions we hear at Core Moves Physical Therapy & Pilates in Victorian Village, Columbus, Ohio is:
“Is Pilates good or bad for pelvic pain?”
The honest answer is: it depends.
Not on Pilates alone — but on how it’s taught, how it’s cued, and the intention behind the movement practice.
Any form of exercise — Pilates, yoga, strength training, running — can be helpful or harmful depending on the individual, their nervous system state, and the way movement is approached.
This is especially true for people with hypertonic (overactive) pelvic floor dysfunction.
What Is a "Hypertonic" Pelvic Floor?
A hypertonic pelvic floor refers to pelvic muscles that are:
Overactive or guarded
Difficulty relaxing
Often associated with pelvic pain, painful intercourse, urinary urgency, incomplete emptying, tailbone pain, and constipation (PMID: 16027257)
In these cases, the problem is rarely simple “weakness.”
It is more often related to:
Altered nervous system signaling
Poor coordination between breathing and pelvic floor movement
Impaired body awareness
Protective holding patterns
Cueing Changes How We Move (For Better or Worse)
Research consistently shows that verbal cueing can influence motor patterns, muscle recruitment, and movement efficiency.
Motor learning research demonstrates that where attention is directed during movement — known as attentional focus — changes coordination strategies and muscle activation (PMID: 17325987, 17006377).
In simple terms:
How an instructor cues matters just as much as what exercise is being performed.
This becomes critically important in pelvic health.
Why Heavy “Squeeze Your Pelvic Floor” Cueing Can Be Problematic
Many group fitness and Pilates environments rely heavily on contraction-based cues such as:
“Engage your pelvic floor”
“Lift your pelvic floor”
“Squeeze between your sit bones”
“Brace your core”
Here’s the issue:
You cannot visually assess what someone’s pelvic floor is doing.
Research shows that many individuals with pelvic floor dysfunction demonstrate poor awareness and impaired ability to correctly contract or relax their pelvic floor muscles, even with instruction (PMID: 16248463).
For someone with a hypertonic pelvic floor, contraction-heavy cueing may:
Increase muscle guarding
Reinforce holding patterns
Elevate nervous system threat
Trigger symptom flares
Worsen pain
This is why generalized pelvic floor cueing — especially in group settings without individualized assessment — can unintentionally do harm.
Awareness-Based Cueing Is Often Safer for Pelvic Pain
At Core Moves Columbus, we prioritize cueing strategies that:
Promote curiosity
Encourage observation
Improve sensory awareness
Reduce threat-driven tension
Support nervous system regulation
Examples include:
“Notice how your breath expands your ribs.”
“Observe where movement feels smooth versus guarded.”
“Allow your pelvis to feel heavy and supported.”
"Use as much effort as necessary, as little as possible."
"Give your body permission to..."
Motor learning research shows that external and sensation-based attentional focus improves coordination and reduces excessive muscle co-contraction (PMID: 17325987).
For pelvic pain populations, this matters.
Better awareness leads to better control — without forcing contraction.
Mindful Movement Improves Motor Control and Reduces Threat
Classical Pilates was never intended to be “burn-and-sweat fitness.”
Joseph Pilates emphasized control, precision, breath, rhythm, and awareness — what modern rehabilitation would describe as mindful movement practice.
Research supports that mindful attention during movement improves sensorimotor integration and motor performance (PMID: 17325987).
For individuals with pelvic pain and hypertonic pelvic floor dysfunction, mindful movement can:
Improve coordination
Reduce unnecessary muscle guarding
Increase movement confidence
Lower perceived threat associated with motion
When movement feels safe, the nervous system allows muscles to release.
This is why we emphasize intentional, controlled Pilates rather than high-intensity fitness-style formats at our Victorian Village studio.
Rhythmic Reformer Movement Can Calm the Nervous System
One of the most powerful — and underappreciated — aspects of reformer Pilates is rhythmic, repetitive movement.
Research on vestibular-autonomic interactions shows that rhythmic movement and vestibular input influence autonomic nervous system regulation and parasympathetic (vagal) activity (PMID: 14517426).
This is the same principle behind:
Rocking infants to sleep
Rhythmic walking to regulate stress
Gentle repetitive motion used in neurological rehab
For pelvic pain patients who often live in heightened “fight or flight” states, rhythmic reformer movement can:
Lower baseline muscle tone
Reduce threat signals
Improve movement tolerance
Support nervous system calming
Many patients describe reformer sessions as “grounding” or “soothing” — and neuroscience helps explain why.
Breath Reconnects Diaphragm and Pelvic Floor Mechanics
Breathing is not just relaxation — it is biomechanics.
Research shows that the pelvic floor functions as part of the respiratory system and moves in coordination with the diaphragm (PMID: 30447797, 26311935).
During inhalation:
The diaphragm descends
The pelvic floor naturally lengthens
During exhalation:
The diaphragm ascends
The pelvic floor recoils upward
This pressure-based coordination helps regulate muscle length, tension, and load management.
When people brace excessively, hold their breath, or over-contract during exercise, this natural rhythm becomes disrupted — often reinforcing hypertonic patterns (PMID: 17304528).
Pilates that emphasizes breath coordination helps restore this physiological relationship without forcing pelvic floor release.
Pilates Isn’t the Problem— Intention Is
Pilates itself is not “bad” for pelvic pain.
When taught with a pelvic health-informed approach, it can be extremely therapeutic by improving:
Movement efficiency
Pressure management
Postural awareness
Nervous system regulation
Body trust
But Pilates taught with rigid bracing, excessive contraction cueing, and performance-driven intensity can absolutely aggravate symptoms in the wrong context.
How We Teach Pilates For Pelvic pain Differently at Core Moves (Columbus, Ohio)
At Core Moves Physical Therapy & Pilates in Victorian Village, we specialize in working with pelvic pain and hypertonic pelvic floor populations.
Our instructors are trained to:
Modify cueing strategies
Avoid excessive contraction emphasis
Adapt movement intention
Support nervous system regulation
Individualize progressions
Integrate pelvic health principles into class design
Our goal is not to make you “work harder.”
It’s to help you move smarter, safer, and with less threat to your nervous system.
A note about cueinG
At Core Moves Physical Therapy & Pilates in Victorian Village, Columbus, Ohio, we intentionally avoid rigid, contraction-heavy language — especially for patients with pelvic pain and hypertonic pelvic floor patterns.
Instead, we use cueing that invites permission, awareness, and gentle expansion, rather than forcing control.
You’ll often hear phrases like:
“Give yourself permission to let go.”
“Allow space rather than forcing effort.”
“Inflate an imaginary balloon in your rib cage and pelvis as you inhale.”
“Notice how your body passively recoils back toward center as you exhale.”
“Let the breath create movement for you.”
"Meet your body with patience and curiosity rather than demands and judgment"
This style of cueing matters.
Rather than commanding muscles to contract, we guide the nervous system toward safe expansion, pressure distribution, and natural recoil — restoring the diaphragm and pelvic floor’s coordinated movement pattern (PMID: 30447797, 26311935).
By emphasizing imagery and sensation over force, we help patients:
Reduce guarding patterns
Improve breath-to-movement coordination
Normalize pelvic floor length-tension relationships
Decrease threat associated with motion
Build internal awareness without over-controlling
For hypertonic pelvic floor populations, this approach often feels safer, more intuitive, and more sustainable than traditional “engage harder” strategies.
The Takeaway
There is no universally “good” or “bad” exercise for pelvic pain.
What matters most is:
The intention behind the movement
The cueing used
The nervous system state
The individual’s awareness and history
The stage of healing
When these factors are respected, movement becomes medicine.
When they’re ignored, even well-intentioned exercise can create setbacks.
If You’re Dealing With Pelvic Pain or Hypertonic Pelvic Floor Symptoms
You deserve movement support that understands your body — not one-size-fits-all fitness advice.
If you’re in Columbus, Ohio, our team at Core Moves is here to help you rebuild movement confidence safely, intelligently, and sustainably.
References
Wulf G, Höß M, Prinz W. Instructions for motor learning: differential effects of internal versus external focus of attention. J Mot Behav. 1998;30(2):169–179.PMID: 17006377
Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ.2010;44(1):75–84.PMID: 17325987
FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):261–268.
Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26(3):362–371.
Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–282.PMID: 16248463
Yates BJ, Miller AD, Lucot JB. Physiological basis and pharmacology of motion sickness: vestibular-autonomic interactions. Brain Res Bull. 1998;47(5):395–406.PMID: 14517426
Gordon KE, Reed O. The role of the pelvic floor in respiration: a literature review. Physiotherapy.2019;105(2):155–162.PMID: 30447797
Park HJ, Kim SH, Lee SY, et al. Correlation between pelvic floor muscle contraction and diaphragm movement during breathing. J Phys Ther Sci. 2015;27(7):2113–2115.PMID: 26311935
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