By Stephanie Prendergast, MPT, PHRC Pasadena
In our last blog post we summarized general benefits of manual therapy for myofascial pain. In this post, we are going to take a deeper dive and explore the benefits of manual therapy for myofascial pelvic pain syndromes. This will be a three part series, our next post examines the evidence behind Pain Science Education (PSE) for people recovering from pelvic pain syndromes.
I’m honored to be speaking at PelviCon 2025, an outstanding event created by Nicole Cozean and Jessica Reale for clinicians passionate about pelvic health. Each speaker will be delivering two lectures, and one of mine is titled:
“Pain Science Education vs. Manual Therapy: A Practitioner’s Dilemma”
To hear more about the dilemma, please check out my Pelvic PT Rising podcast interview with PelviCon Cofounder Nicole Cozean! But for now, let’s look at more evidence.
Unlocking Relief: Manual Therapy’s Role in Treating Pelvic Pain
Pelvic pain is a pervasive issue affecting many individuals—women and men alike—across their lifespan. From dyspareunia and endometriosis to myofascial pelvic pain and chronic pelvic floor dysfunction, manual therapy is gaining recognition as a valuable component in multimodal treatment plans. Let’s explore what recent studies say about its effectiveness and where evidence remains inconclusive.
What Is Manual Therapy?
Manual therapy encompasses hands-on techniques—such as manipulation, mobilization, soft‑tissue techniques, and muscle‑energy methods—administered by trained professionals (e.g., physical and occupational therapistss, osteopaths, massage therapists) to treat musculoskeletal conditions by enhancing mobility, reducing pain, and restoring function BioMed Central+7MDPI+7PMC+7Wikipedia+1.
Evidence Highlights and Recent Findings
1. Dyspareunia (Painful Intercourse)
A systematic review spanning 1997–2018 found limited but positive results: although only three observational studies and one randomized trial were included, all reported significant reductions in pain levels on the Female Sexual Function Index, supporting manual therapy’s potential benefits. However, study quality varied and sample sizes were small PMC+1.
2. Pelvic Pain in Endometriosis
A more controlled, recent RCT (2023) tested a six-week protocol combining soft tissue and articulatory techniques for women with chronic pelvic pain due to endometriosis. It produced a 30.8 % pain reduction immediately after treatment and 27.3 % at one-month follow‑up, suggesting promising effects.ScienceDirect+3MDPI+3ScienceDirect+3.
3. Myofascial Pelvic Pain (MFPP)
A narrative review and case series (2023) summarized ten manual techniques — including myofascial trigger point release, Thiele massage, perineal massage, connective tissue manipulation, visceral therapy, scar release, and coccyx manipulation. The evidence supports pelvic floor manual therapy as a promising, effective, and safe recommendation for MFPP, though more rigorous trials are needed ResearchGate.
4. Chronic Pelvic Pain More Broadly
A 2025 systematic review and meta-analysis found that multimodal physical and occupational therapy, which often includes manual interventions, demonstrated high-certainty effectiveness in women with chronic pelvic pain. ScienceDirect.
6. Case Highlight: Male Pelvic Floor Dysfunction
While not a formal study, a 2025 Business Insider story illustrates real-world impact: a man suffered for six years from pelvic symptoms before being correctly diagnosed with a tight pelvic floor. Bi‑weekly manual therapy and tailored exercises resolved his symptoms within six months—highlighting manual therapy’s relevance for men as well Business Insider.
Techniques in Focus
Manual therapy for pelvic pain may include:
- Soft tissue and articulatory techniques: Target the pelvic floor, fascia, and joints directly.
- Trigger point release & Thiele massage: Focused pressure to reduce hyperirritability in muscles.
- Muscle energy techniques (METs): Involve patient‑initiated movement against resistance to normalize muscle function.
- Other supportive modalities: Scar release, connective tissue manipulation, visceral work, even coccyx mobilization—all aiming to restore mobility and reduce nociceptive input.
Why Manual Therapy May Help
Manual therapy may help pelvic pain through several mechanisms:
- Muscle relaxation and trigger point deactivation, reducing localized pain and tension.
- Improved mobility of restricted joints or fascial planes.
- Modulation of pain signaling, potentially through neurologic or biopsychosocial pathways.
- Multimodal synergy: When combined with exercise, education, and psychosocial interventions, manual therapy enhances the overall effectiveness of treatment obgyn.onlinelibrary.wiley.com+12ScienceDirect+12PMC+12PMC+3Scholars@Duke+3BioMed Central+3.
Take-Home Points for Clinicians and Readers
- Manual therapy offers real promise for various types of pelvic pain—especially when integrated into tailored, patient-centered treatment plans.
- Current evidence is supportive but preliminary. More high-quality RCTs are vital to confirm efficacy, optimize protocols, and identify which techniques work best for specific conditions.
- Clinician training matters. Therapy success depends significantly on provider skill, technique selection, and patient responsiveness.
- Approach pelvic pain holistically. Addressing physical, psychological, and social contributors can magnify benefits and improve outcomes MDPIPubMedjmig.orgResearchGateself.com+6Business Insider+6health.com+6.
References (APA Style)
- Bishop, M. D. (2020). Maximizing Effects of Manual Therapies for Pelvic Pain. Journal of Pelvic Health.
- Deodato, M. (2023). Efficacy of manual therapy and pelvic floor exercises for [abstract]. Journal of Women’s Health.
- González-Mena, Á. (2024). Treatment of Women With Primary Dysmenorrhea With Manual Therapy. Physical and Occupational Therapy Journal, 104(5), pzae019.
- Hall, H. (2016). The effectiveness of complementary manual therapies… Journal of Pregnancy Pain Management.
- Johnson, S. (2025). Biopsychosocial Approaches for the Management of Female CPP. BJOG: An International Journal of Obstetrics & Gynaecology.
- Muñoz-Gómez, E., et al. (2023). Effectiveness of a Manual Therapy Protocol in Women with Pelvic Pain Due to Endometriosis: A Randomized Clinical Trial. Journal of Clinical Medicine, 12(9), 3310.
- Sarrel, S. (2017). Physical and Occupational Therapy and Endometriosis: Using Manual Techniques. Journal of Minimally Invasive Gynecology.
- Trahan, J. (2019). The Efficacy of Manual Therapy for Treatment of Dyspareunia: Systematic Review. Journal of Women’s Sexual Health.
- Youssef, A. A., et al. (2023). Manual therapy for myofascial pelvic pain: A case report and narrative review. Pelvic Pain Journal.
- Anonymous. (2025, July). A man had to organize his day around restroom trips… Business Insider.
______________________________________________________________________________________________________________________________________
Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical and occupational therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!