Susan Liu Dedicated Women Health Physiotherapist for Personalised Pelvic Care
June 30thMany women describe the same pattern when they first come in.
They have been dealing with something for months, sometimes years, and assumed it was normal. Not normal in the sense that it felt fine, but normal in the sense that nobody had told them otherwise.
Bladder leakage during a workout. A feeling of heaviness low in the pelvis by mid-afternoon. Pain that made intimacy something to dread. These are not inevitable textures of a female body. They are signals from a system that is not working as well as it could, and in most cases they respond meaningfully to the right assessment and care.
What a dedicated women’s health physiotherapist offers is more than treatment for a single symptom. It is a structured, whole-body understanding of how pelvic function interacts with movement, hormones, exercise load, and the specific demands of a woman’s life at a given stage.
Pelvic Health Is More Than Kegels
Consider a woman who has spent two years faithfully doing Kegel exercises because she was told her pelvic floor was the problem. Her urgency incontinence has not improved. On some days it is worse. In this scenario, a thorough internal assessment may show a hypertonic pelvic floor rather than the classic “weak” pelvic floor.
A hypertonic pelvic floor is one that is often chronically tense, unable to fully relax between contractions, and responds to increased demand by gripping harder rather than coordinating better. This is why in some cases, just strengthening your pelvic floor may worsen symptoms and is not actually helping the underlying cause.
Treatment for a hypertonic pelvic floor is often the opposite of strengthening. It begins with down regulation and release work before any strengthening is introduced. It reflects the mechanism of the problem, and getting it in the wrong order can unnecessarily extend signs and symptoms.
This is the kind of clinical reasoning a dedicated women’s health physiotherapist applies from the first appointment.
What the Assessment Actually Looks For
A thorough initial appointment moves through several layers. The history covers more ground than most people expect. It may include birth history, bladder and bowel habits, exercise type and frequency, any history of pelvic pain or painful periods, intimacy issues and how current symptoms behave across different activities.
The external assessment is broader than one might imagine. Not only do we look at mechanics of the local area e.g. lower back, hips and pelvis, but we also look at overall posture, breathing mechanics, and neck and shoulder position. There is an important connection between the upper body and the pelvic floor, often through the diaphragm, that can provide heaps of valuable information even before an internal assessment is completed.
The internal pelvic assessment looks much more locally at the structures of the pelvis and pelvic floor. It gives direct information about tone, strength, coordination, and tissue sensitivity that no external examination can reliably substitute for.
Together, they can paint a much bigger picture of the person and their symptoms.
At Kinematics, pelvic findings are always read through the lens of the clinic’s broader biomechanical assessment framework, meaning they inform and are informed by how the whole body loads and moves as a whole.
The Pressure System Nobody Explains
The pelvic floor sits at the base of a closed pressure system. When it functions well, load is shared across the diaphragm above, the deep abdominals in front, and the deep spinal muscles behind. A rise in abdominal pressure during a cough, a heavy lift, or a landing from a jump is met by a coordinated response across all four walls of that pressure system.
When one part of the system stops contributing, the others compensate. A person with restricted thoracic mobility who cannot breathe fully into their lower rib cage will often show an over-worked pelvic floor under loading.
This is why it’s important to consider other areas of the body when working with pelvic floor conditions as it often works within a bigger system. To effectively treat pelvic floor symptoms, pelvic floor-trained clinicians should be looking beyond the confines of the pelvis. This is what makes our treatments much more tailored to the individual sitting in front of us.
The Full Span of Pregnancy Physiotherapy
Often people believe that physiotherapy for pregnancy comes in after you give birth to your baby, however, we can start helping you through your pregnancy journey a lot earlier than that.
We recommend having an assessment early in your second trimester to get a baseline of your current pelvic floor function. During this initial consultation, we can discuss any pregnancy-related changes that are of concern, discuss your pelvic floor health prior to pregnancy, and provide a rehab program for you to begin. As you move through your pregnancy journey, modifications and adjustments will be made to your program depending on how your body is responding.
At 34 weeks of gestation, a birth preparation appointment is recommended. The main goal during this consultation is to demonstrate how to perform perineal massage, which can commence from 34 weeks up until full term. It has good evidence for reducing the rate of severe tearing, and it can be taught alongside breathing techniques and positioning for the pushing stage of labour. In addition, we can discuss post-natal recovery and what to expect for the first 6 weeks post-partum.
At Kinematics, we also provide a home visit at 3 weeks post-partum to close the gap for support. During this session, we can check on your tummy separation, discuss feeding positions to help offload your upper body, and begin your pelvic floor and deep core exercises. Evidence now suggests that earlier care and movement can help promote a faster post-partum recovery. This sets people up well for their in-clinic 6-week post-natal check and allows them to return to daily activities and exercises sooner.
Endometriosis, PMOS and Adenomyosis
Persistent pelvic pain changes the way tissues behave. Over time, the nervous system learns to recruit the surrounding muscles into a protective holding pattern. The pelvic floor tightens. The hip flexors shorten. The abdominals stay engaged. In conditions like endometriosis and adenomyosis, where the underlying pain source is chronic, this secondary muscular response can become a significant contributor to daily symptoms.
A woman with endometriosis may experience pain that intensifies during certain movements because the surrounding musculature is so consistently overloaded that any additional demand tips it over the edge.
Physiotherapy itself does not treat the endometriosis. What it addresses is the behaviours your body has adapted to in order to protect itself. It helps release persistently overactive tissue, identify movement strategies that reduce rather than provoke the protective response, and provide practical tools for managing flares. This work is coordinated with the gynaecologist and GP to provide a holistic approach to the patient. The women’s health physio team at Kinematics operates within that collaborative framework as a matter of practice.
Returning to Running After Pelvic Floor Dysfunction
Returning to running after pelvic floor dysfunction needs to be guided and gradual. Jogging can increase loading on the pelvic floor of approximately 1.5-2.5 times your body weight with each foot strike. This has a large impact on the pelvic floor muscles, especially if they’re not ready for this load.
Before being cleared to run, we need to ensure that you do not experience any pelvic floor symptoms (e.g. pain, heaviness, leaking) and that your musculoskeletal system is also strong enough to withstand the demands of running.
These are tested through assessments and examinations which are to be completed in the clinic. Once a baseline of your pelvic floor and musculoskeletal function is established, we can then create a tailored return-to-running program that ensures you’re building up your body progressively and safely.
Menopause and the Pelvic Floor
Oestrogen has a direct structural effect on the connective tissue of the pelvic floor and the pelvic organs (bladder, bowels, reproductive organs). As levels decline during perimenopause and menopause, those tissues become less elastic and more responsive to pressure and friction. The result is a cluster of changes that can include increased urinary urgency, reduced bladder volume tolerance, vaginal tissue fragility, and in some cases new or worsening prolapse symptoms.
Additionally, the drop in oestrogen also affects tendon stiffness, bone density, and joint proprioception throughout the body. This means that there may be an increase in tendon and bone injuries during this life stage. We most commonly see this in the hips, shoulders and knees.
However, there is a lot of research to suggest a guided rehab program including pelvic floor muscle training and musculoskeletal strengthening can help improve these symptoms. The women’s health physio team at Kinematics approaches perimenopause and menopause with a wide, holistic lens to help you address your specific needs.
Taking the First Step
If something about your pelvic health has been unclear, persistent, or quietly limiting you, an assessment can give you a precise picture of what is happening and why.
At Kinematics in Richmond, the women’s health physiotherapy team works within a clinic that integrates treatment, movement, and rehabilitation under one roof. Your care develops with you, adjusted as your body responds, and supported by a team that communicates across disciplines.
Book a Women’s Health Physiotherapy appointment online, or reach out through the Kinematics contact page if you would like to understand what an initial appointment involves before you come in.