Pelvic Hip Pain, A Patient Success Story

In Female Pelvic Pain by Emily TranLeave a Comment

By Jillian Giannini, DPT, PHRC Pasadena, Jennifer Keesee, DPT, PHRC Westlake Village and Emily Schwerdtfeger, BA, PHRC Westlake Village

“I’m the exception, right?” “It could never happen to me.”

Emily is a 25 year old female that has had left hip pain for five years now. She describes her hip pain as:


  • Achy or sharp 
  • In front of L hip and feels deep 


Aggravating Factors include:


  • Sitting 
  • Exercise (although sometimes exercise can seem to lower some of the pain level and frequency)
  • Driving tolerance 


Emily is our admin at the PHRC Westlake Village office and when she started discussing her symptoms we had to get her in with our physical therapist, Jillian Giannini. Emily’s symptoms first began around the same time following her bunionectomy on her left foot in 2015. When she explained this, Jillian, was already suspecting that the hip pain could have been a result of a change in walking mechanics following her bunionectomy. During the evaluation Jillian found decreased hip range of motion, bilaterally, although more on the left versus right side. The range of motion was limited due to soft tissue restrictions as well as pain in front of the hip. Due to the pain, Jillian dove deeper and did some hip special tests and did find a + Hip Scour test which can be indicative of femoral acetabular joint pathology. Emily was educated on seeing an Orthopedic MD to rule out other hip pathologies (i.e. labral tear, capsulitis). Then Emily’s connective tissue and soft tissue were evaluated. She presented with moderate CTR and STR along the pelvic girdle muscles that can also be contributing to her pain and lack of hip range of motion. Along with these restrictions she also presented with suspected left posterior innominate rotation, bilateral hip flexor and glute weakness. 


For treatment we started with CTM along her bony pelvis, medial and anterior thighs, and posterior hips, myofascial trigger point releases along hip rotators, glutes, iliopsoas and starting her on some hip flexor and glute strengthening. Emily could barely hold a table top position without fatiguing quickly and aggravating symptoms. It was also important to address her ergonomic set up at work and car seat since her symptoms were primarily with sitting. Check out our blog on tips for an at home work station.


In the next session Jillian also decided to assess Emily’s pelvic floor. Although Emily does not complain of any bladder, bowel, and sexual dysfunction, Jillian thought due to Emily’s unresolved long history of hip pain it may be a good idea to also assess the pelvic floor muscles, especially a deep hip rotator that shares fascia with the pelvic floor, the obturator internus. Low and behold, Emily had moderate hypertension and myalgia along her left LAM and OI muscles. 


After incorporating myofascial release of the pelvic floor into the treatment plan Emily already started to feel a shift in her symptoms. She no longer was having deep left hip pain, she could sit for a longer period of time, and not have as much pain with driving. She was also able to hike without any hip pain and now she’s already progressing her therapeutic exercises without aggravation of symptoms. 


After the first month of PT, the patient was not experiencing much relief, or enough relief to return to normal activities. Following an evaluation with the cofounder, Emily was instructed to take a month off exercising completely and be seen once weekly for treatment. After a month of this, foam rolling was implemented into her home exercise program (glutes, thighs). 


Two weeks of consistent foam rolling lead her to progress enough into actual exercises geared towards strengthening her hip muscles.


Patient portion:

“I’m the exception, right?” “It could never happen to me.” “Chances are so low, so why worry about it?” That’s what I thought, until I paid a bit more attention to my body. Those aches and pains that I always dismissed, those terrible cramps and the accompanying hip pain. My mom had hip pain and periods are supposed to come with cramps, so why worry?


Better question- why NOT worry? Up until recently, I was one of the many who thought the pain I was experiencing was normal, expected and nothing to write home about. I was wrong. Unfortunately, my viewpoint was a bit misconstrued. If you’re experiencing pain regularly, it’s not normal.


Like many others, my knowledge of bodily health came from my school education back in middle and high school. Surely the educational system wouldn’t be sending out millions of kids every year without a full rounded education, right? Wrong again. Health class, specifically sex ed, lacks in various areas and usually does not cover the full spectrum that encompasses pelvic health. According to the CDC, 18% of teenagers receive their sex education before the age of 18. (1) To break that down further, only 70% of female teenagers were given education about methods of birth control. There is so much I have learned after experiencing negative side affects from birth control, that absolutely should be taught in sex education. Birth control can drastically change your body and give adverse side effects. If we are taking medication, shouldn’t we be fully aware of what could happen being on it?


I am thankful today that I have the proper resources (THANK YOU PHRC) to fix my pain. When I spoke to my boss and cofounder of this company, Stephanie Prendergast, she told me that under any circumstances, should I be experiencing this amount of pain for this long, especially this young!


My history:


My mother had a history of endometriosis, ovarian cysts and has had hip pain since before I was born (which means 24 + years of pain). My hip pain started about five years ago, after I had a bunionectomy (surgical procedure to correct a deformed area of the foot near the big toe). This surgery left me bedridden for at least a month to heal with another month and a half of physical therapy to get me walking properly after that.


My pain felt deep rooted in my left hip, a constant low grade dull pain. When I sit for too long, don’t stretch properly or even sleep, I experience this pain. My hip pops when I throw my leg out of bed to get up in the morning. It aches when I finish a work out or go for ‘too long’ of a walk in the evenings. 


The solution:


Pelvic floor physical therapy. Your muscles in your body are connected; which means if one area is tight (or weak), it can affect the muscles around it. Pelvic floor physical therapy can help address the route cause of your pain while also acknowledge the other areas connected to the problem area.

I wanted to share my story for a few reasons: 1- Readers of this might be in a similar situation, 2- Young people shouldn’t be in pain, 3- ‘Accepting’ the pain is NO way to deal with it, 4- Mental health can suffer because of the constant pain. I am a mental health advocate and current grad student studying to become a licensed Marriage and Family Therapist. Chronic pain affects thousands of people all over the world. Accepting your pain should be the step you take into finding the right provider for you to fix it, instead of making it part of your ‘norm.’


If you are suffering from chronic pain, or your story sounds similar to mine, please reach out to us! If you aren’t located near our locations, we offer telehealth services. If you need help finding another provider, use the links below to locate one. If you are experiencing a mental health crisis or your physical health is taking a toll on your physical health, please use one of the links below to find help:



Pelvic Pain Explained: Endometriosis + Resource List

Endometriosis: A PT’s Journey to Diagnosis & Treatment

Period Drama: Endometriosis Diagnosis and Treatment

How Pelvic Floor PT helps Endometriosis




Martinez G, Abma J, Copen C. Educating teenagers about sex in the United States. NCHS data brief, no 44. Hyattsville, MD: National Center for Health Statistics. 2010.

Educating Teenagers About Sex in the United States

Current Contraceptive Use in the United States,  2006–2010, and Changes in Patterns  of Use Since 1995 (PDF)

Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019

Current Contraceptive Use and Variation by  Selected Characteristics Among Women Aged 15–44:  United States, 2011–2013 (PDF)

National Survey of Family Growth



Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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