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PELVIC PAIN2021-07-09T13:15:47+10:00


Pelvic Floor Physiotherapy is now ONLY available at Northbridge and Liverpool.

Pelvic Pain Physiotherapy

Women that live with pelvic pain on a daily basis deserve the best help and support available from a multi- disciplinary team of health professionals.  For many women this is a really difficult subject to talk to their GP about. They may not go to see their doctor for fear that he or she may need to do an internal examination, and this thought alone is terrifying for some women and puts them off…possibly for years! It is the GP’s job to help find the ‘cause’ of your pain and refer you for appropriate tests or consultation to other health professionals/specialists.

Currently Dyspareunia and Vaginismus still fall into the Diagnostic and Statistical Manual of Mental Health Disorders. S o the first referral is often to a sex therapist or psychologist. This may be necessary if there is significant emotional concerns for the patient. Many Pelvic conditions have ‘Musculoskeletal’ (muscle, ligament and joint) involvement. With careful, appropriate pelvic floor physiotherapy some women with pelvic pain can be helped tremendously. Pelvic floor physiotherapy is NOT just about strengthening the muscles!

‘Pelvic pain’ is a general term for pain in or around the pelvic area. It encompasses bone, muscle, fascia, organs, and vessels including blood vessels, nerves and nerve sheaths. CHRONIC PELVIC PAIN is generally described as pain in your pelvic region — the area below your belly button and between your hips — that lasts three months or longer. There are many, many sub-divisions of this topic and I have touched on some of them under the ‘pelvic floor’ page. My focus on this page will be the treatment for clients with chronic pelvic pain CPP.

There is also a substantial amount of information about understanding how Chronic Pain is constantly  driven by connections from our spinal cord to our brain and then an’up- sensitising’ of pain in the brain…..The brain decides whether you are going to have pain or not! 


Dyspareunia is pain at the entrance to; and/or inside the vagina, just before, during or after sexual intercourse. The vagina is a muscular tube providing a passage between your uterus and the outside of the body. It has three functions: admitting the penis during sexual intercourse, allowing menstrual blood to leave the body, and giving birth. The labia minora are folds of hairless skin containing sweat glands that make up part of your external genitalia. The clitoris is a pea-size sexual organ located in front of the urethra, close to where the labia minora meet. It is highly sensitive with over 8,000 nerve endings and functions for sexual pleasure.

The location and frequency of pain with dyspareunia may vary. Symptoms often include: Pain at the entrance of the vagina with initial penetration; even from penetration from a finger or tampon Deeper vaginal pain with movement of the penis Pain may be a sharp and burning, or deep and aching You may also experience an involuntary tightening of the pelvic floor muscles (vaginismus) during penetration. The tightening can be severe enough that the vagina is unable to be penetrated.


There are several causes of dyspareunia, these include:

Vaginal dryness
Inadequate lubrication can be due to a lack of sexual arousal, or a decrease in estrogen, which occurs after menopause, during and after pregnancy, and while breast feeding.

Side effects of medications
Certain medications can decrease sexual arousal and result in inadequate lubrication. These medications include antihistamines, antidepressants, birth control pills, breast cancer medication, high blood pressure medication, and some sedatives.

A bacterial or fungal infection of the vagina, genital area or urinary tract can cause pain.
Inflammation or skin problems Inflammation or severely dry skin such as eczema can lead to painful initial penetration. Skin diseases such as lichen sclerosis or lichen planus can affect the vaginal area and lead to pain. Check out this video for more info on painful sex after pregnancy.

Vulvar vestibulitis
A condition that can result in severe pain and sensitization on the area of the vestibule when touched or with initial penetration.

Allergic reaction
An allergic reaction to clothing, spermicides or douches can cause painful intercourse. It can be seen on the vuval area and or inside the vagina on the mucosal lining. referral to a dermatologist specialising in Vulvo-vaginal conditions is the ideal pathway.

Sexually transmitted infections s can cause blisters and sores that make intercourse painful. Uterine and other pelvic conditions
Certain conditions of the uterus can lead to painful intercourse. These conditions include retroverted uterus, endometriosis, pelvic inflammatory disease, fibroids, ovarian cysts, and interstitial cystitis.

A prolapse of the bladder (cystocele), uterus (uterine prolapse), rectum (rectocele), or intestine (enterocele) can cause a deep pain during intercourse.

Previous surgeries to the pelvic area can cause scarring that may lead to painful intercourse.
Childbirth tearing of deep pelvic floor muscles or fascia; or an episiotomy during vaginal delivery may lead to painful intercourse. It is wise to delay sex until after your 6-week check-up and then only when you and your partner feel ready. I encourage my mums to talk about how they feel to me and to their partner.  Often the partner is very anxious about penetration and causing ‘any pain’. take things slow, use lubrication and try being on top for this first time so that you can control the depth of penetration. Some women are not ready to have sex for a long while after a difficult vaginal delivery.
Come and see your Women’s health physio so that she can examine you and then discuss your concerns.

Treatments for cancer Chemotherapy and radiation to the pelvic area can lead to painful intercourse.

Other traumas from sport or road traffic accidents and injuries to the pelvic area can cause changes to joints and muscles around the hips and pelvis. Over time this may cause chronic muscle tensions ligament, tendon and fascial tightness in and around the pelvis. This can lead to painful intercourse. Women’s health Physios treat muscles, joints and tendons.

Emotional factors can also contribute to painful intercourse. Emotions and stress are important for sexual arousal and greatly affect the amount of lubrication and the tightness of the pelvic floor. Psychological issues such as anxiety, depression, and fear of intimacy can be a factor with dyspareunia. Additionally, any history of sexual abuse can lead to problems with dyspareunia. Women’s health physios with a special interest in treatment of this condition can, as part of a multi -disciplinary team do a great deal to help with musculoskeletal changes that impact on pain and function.

An involuntary tightening of your superficial pelvic floor muscles during initial penetration. Primary vaginismus is a spasm or dysfunction of the superficial pelvic floor muscles that can be helped with specific pelvic floor physiotherapy. Specific skills in the treatment of internal and external trigger points in muscle and releasing techniques directed to fascial and scar tissue help in the rehabilitation of this condition. Education of pelvic anatomy and an understanding of the ‘central sensitization of pain’ will all help individual women to overcome CPP.

  • Endometriosis Australia says “Endometriosis is a common disease in which the tissue that is similar to the lining of the womb grows outside it in other parts of the body. More than 730,000 (more than 10%) of Australian women suffer with endometriosis at some point in their life with the disease often starting in teenagers. Symptoms are variable and this may contribute to the 7 to 12-year delay in diagnosis. Common symptoms include pelvic pain that puts life on hold around or during a woman’s period. It can damage fertility. Whilst endometriosis most often affects the reproductive organs it is frequently found in the bowel and bladder and has been found in muscle, joints, the lungs and the brain. In an Australian government report, endometriosis is reported to cost Australian society $7.7 billion annually with two thirds of these costs attributed to loss in productivity with the remainder, approximately $2.5 billion being direct healthcare costs.



The Jean Hailes Foundation says:

“Studies suggest that endometriosis affects 1 in 10 women of reproductive age, with an estimated 176 million women worldwide having the condition.

The endometrial cells:

  • are found on organs in the pelvis
  • may start to grow and form patches or nodules on pelvic organs or on the peritoneum (the inside lining of the abdomen and pelvis; see image)
  • have the same cyclical/menstrual changes outside the uterus as inside the uterus
  • may bleed at the same time as your period (menstruation).

Endometrial cells found outside the uterus grow to form lesions or patches that bleed and leak fluid in response to your hormones at the time of the period. This leads to inflammation and scarring. These patches found outside the uterus cannot pass out of your body and remain in your pelvic cavity, on organs and other surfaces. On your ovaries, cysts called endometriomas can develop over time. These are sometimes called ‘chocolate cysts’ because of the darkish material they contain. On other surfaces the patches can form nodules.

What causes endometriosis?

We don’t really know what causes endometriosis, and possible associations or factors can be different from woman to woman. Factors that have a role in causing endometriosis include:

  • Family history: Women who have a close relative with the condition are up to 7–10 times more likely to get endometriosis. Also, it is common with twins that both may get endometriosis, particularly if they are identical twins.
  • Retrograde (backwards) menstruation: When a woman has a period, the blood flows out of the vagina but also backwards along the fallopian tubes into the pelvis (called retrograde menstruation). In 90% of women, the blood, which contains endometrial cells, is absorbed or broken down by the body and causes no symptoms. However, in women with endometriosis, this endometrial tissue starts to grow, which can cause a wide range of symptoms.
  • Metaplasia: The conversion of the normal pelvic tissue into endometriosis.

Other possible factors that may have a role in causing endometriosis are:

  • having first pregnancy at an older age
  • heavy bleeding during periods, and periods lasting longer than five days
  • first period before 11 years of age
  • regularly having fewer than 27 days between periods, or having shorter regular cycles
  • changes in the immune cells
  • low body weight
  • alcohol use

Can I prevent endometriosis?

Endometriosis can’t be prevented but is less likely to develop or progress if a woman reduces the number of menstrual cycles she experiences during her reproductive years. Factors that contribute to fewer menstrual cycles include:

  • hormonal therapy such as the combined oral contraceptive pill or progestins (may be given as tablets, an implant, an injection or an intrauterine device (IUD))
  • how many children you have – the chance of getting endometriosis may decrease with each pregnancy (this may be related to the hormone progesterone during pregnancy)
  • younger age of first pregnancy
  • breastfeeding for a longer period
  • regular exercise of more than four hours per week (this may also help with pelvic pain for endometriosis).

There may be different forms or types of endometriosis

  • Superficial endometriosis: here, superficial areas of disease appear on the lining of the pelvis and abdomen (called the peritoneum). These do not invade deeply into the tissues
  • Deep-infiltrating endometriosis: endometriosis lesions do invade deeply (more than 5mm) into the tissues and can lead to scarring and nodules. These can grow into nearby organs, such as the bladder, bowel and ovary
  • Ovarian disease: this may occur and is often considered a separate form of the disease. Here, burrowing lesions on and under the ovaries can lead to the development of ‘chocolate cysts’ or endometriomas
  • Adenomyosis: the endometrial cells grow inside the muscle of the uterus
  • Outside the pelvis: this is rare
  • Upper abdomen, eg on the diaphragm
  • In the liver, nose, eye
  • Abdominal wall often associated with previous operation scarring.

How do you know if you have endometriosis?

The symptoms of endometriosis vary from woman to woman. Some women have many symptoms and severe pain, whereas others have no symptoms. The severity of the symptoms may not reflect the severity of the condition. The types of symptoms and their severity are likely to be related to the location of the endometrial tissue rather than the number of endometrial cells growing.

Due to the varied symptoms, endometriosis can take a long time to diagnose (the average time to diagnosis is seven years). About a third of women with endometriosis discover they have it because they have not been able to become pregnant, or because endometriosis is found during an operation for another reason.

About three out of four women with endometriosis have pelvic pain and/or painful periods.

How can Physio help?

Pelvic health physios experienced in treating pelvic pain can often help in conjunction with others to treat any muscle tensions and ‘up -sensitisation” of your pain.

Make an appointment online today to see one of our women’s pelvic physios.


Spine-related pain is a very common occurrence, and research indicates that most of the population will be afflicted with back pain at some point during their lives.

This can involve the cervical spine (neck); thoracic spine (upper back); the lumbar spine (lower back), or the sacrum /coccyx (pelvis).
For most people, back pain can be managed quickly and easily with physiotherapy treatment.

Whether you have occupational neck pain from spending hours at a desk; or acute pain from a bending or lifting injury; we can help. The physios at Sports Focus are all trained to perform a biomechanical assessment of your spine; and to provide treatment for restoring normal function.

Spinal physiotherapy is offered at all our Sydney physiotherapy locations.

Sports injuries can occur during any sporting activity or gym session. The most common sports injuries include sprains and strains/tears, which can be categorised as being an acute, chronic or an overuse injury.

Physiotherapy management of sports injuries usually involves manual therapy, a tailored exercise rehabilitation program, taping, and sometimes bracing – all with the aim to return to your pre-injury level of function.

Our physiotherapists are skilled in diagnosing and managing all varieties of sports injuries and working with you to help prevent further injury.

Sports physiotherapy is offered at all our Sydney physiotherapy locations.

At Sports Focus we have experienced Massage Therapists who work to restore optimal function, wellness and health through various types of massage therapies. Relaxing and restorative or remedial and injury specific our therapists can help.

Massage therapy is offered at our Castle Hill, CBD 428 George, Liverpool, Mt Pritchard and CBD Wynyard physiotherapy locations.

At Sports Focus Physiotherapy we offer a wide range of hands-on treatments from our experienced practitioners who have an interest in Women’s Health Physiotherapy.

Learn more about our prenatal Pilates and pregnancy physiotherapy exercise class.

Womens health physiotherapy is available at Northbridge and Liverpool.

Shockwave is a safe, non-invasive physiotherapy modality that effectively treats a variety of musculoskeletal conditions. It can be a great alternative to surgical intervention, and can often treat stubborn, recalcitrant conditions.

Shockwave therapy is done in conjunction with a suitable physiotherapy program, such as an exercise or loading program, and any manual therapy.

Shockwave therapy is offered at our Liverpool, Mt Pritchard, Northbridge and CBD Wynyard physiotherapy locations.

Pilates classes tailored by our Sports Focus Physiotherapists. These classes are for all levels – beginner, intermediate or advanced. They are designed by our experienced clinical Pilates Physiotherapists with their background in muscle and joint rehabilitation exercises for all ages.

Follow the link and get started today: Active Physio Classes

Dry needling is a useful and effective technique using fine filament needles which are inserted into the fascia or muscle to correct imbalances within the tissue. Often, we target the active trigger points which elicit a twitch response and allow the muscle to release and relax. It can also be used to stimulate a weak or inactive muscle.

It can be used in the treatment of muscular pain, myofascial dysfunction, tendonitis, tension headaches and back pain.

Dry needling is offered at all our Sydney physiotherapy locations.

Aquatic Physiotherapy is a tailored programme of exercises and mobilising techniques prescribed and monitored by an Exercise Physiologist or Physiotherapist. Programmes are conducted on a 1-on-1 basis at our Willoughby and Mount Pritchard clinics.

Aquatic physiotherapy uses the buoyancy and resistance of water to decrease pain and swelling, increase function, strength and range of movement. It is helpful for orthopaedic, spinal and arthritic conditions as well as sports injuries, work related injuries and neurological conditions.

Aquatic physiotherapy is offered at our Mounties and Willoughby physiotherapy locations.

For those of you who are ‘physically isolating’ at the moment we can still help, even if you can’t come into see your Physio.
TeleHealth allows you to gain remote access to our experienced practitioners from your phone or device.
Get the physiotherapy treatment you need from the safety of your own home.

Book your Telehealth video consult

Make an appointment for 2 weeks after delivery with our experienced Women’s Health Physiotherapists.

At Sports Focus Physio, we can examine and assess: Breast problems from feeding – Mastitis; Abdominal /scar examination – Diastasis Rectus Abdominis (DRA) assessment; Pelvic Floor Muscle (PFM) assessment; Prolapse assessment; and Postural and Pelvic / lumbar spine assessment

Early assessment and advice are really valuable for a good safe recovery and return to exercise.

Postnatal physiotherapy is available at Northbridge and Liverpool.

Sports focus physiotherapy can help you manage fractures and injuries that require casting, bracing or splinting.

This service is available for people of all ages and includes the application and removal of casts, moulding thermoplastic splints and fitting braces across a wide range of joints in the body.

We use a fiberglass casting material with the option for a waterproof Delta-Dry liner, which allows the water to pass through the cast, has great ventilation properties and dries very quickly.

Casting and splinting is offered at all our Sydney physiotherapy locations except Mt Pritchard. Book online now.

The human body is complex and has many moving parts. At Sports Focus, our physiotherapists have a great understanding of the body’s anatomy and can identify biomechanical patterns or faults within the system.

Whether you’re recovering from an injury or aiming to reduce your risk, a biomechanical assessment can determine areas of weakness or tightness so that a tailor-made exercise program can be created to your specific requirements.

The biomechanics of the human body can be viewed in many different functional tasks such as walking, running, squat and overhead lifting. Whether you are struggling with repetitive injuries, poor posture or trying to ensure your body is working optimally for your sport; a biomechanical assessment can help you to achieve your goals safely.

Biomechanical analysis is offered at all our Sydney physiotherapy locations. Book online now.

It is never too early or too late to visit a physiotherapist!

Acute care

It’s important to seek help after any injury. Here at Sports Focus Physio, our Physio’s can assess your problem and decide on suitable immediate treatment or referral on for further investigations.

We can provide you with early support for soft tissue injury or mobilisation for stiff and painful joints. An exercise program tailored specifically to your injury will assist with quick recovery.

Chronic Injury/problems

Physiotherapy treatment is very effective in the later stages of a soft tissue injury or chronic joint problem.

At Sports Focus Physio we are experienced in rehabilitation of long-term sporting injuries (such as ACL reconstructions), post-operative joint replacements, as well as ongoing management of degenerative injuries such as osteoarthritis.

A mix of hands-on treatment as well as an independent exercise program will be tailored to meet your needs until you have returned to your pre-injury ability and promote ongoing self-management.

Acute care and chronic physiotherapy and rehabilitation is offered at all our Sydney physiotherapy locations. Book online now.

Our NordBord is a special piece of equipment that focuses on strengthening athletes’ hamstring muscles through different exercise techniques.

At Sports Focus Physiotherapy we specialise in providing programs that focus on strengthening muscles for athletes in premium teams, to help prevent injuries before they occur.

NordBord is offered at our CBD 428 George, Liverpool, Northbridge and CBD Wynyard physiotherapy locations.

Kinesiology tape (K-tape, kinesio tape, rocktape, dynamic tape) is a form of stretchy sports tape that’s used to dynamically assist muscle function without restricting any range of movement. Our physio’s can use kinesio tape with most athletic injuries and a variety of physical disorders in all phases of rehab.

For example, K tape can be used in early post-operative rehab, muscle injuries or in late-stage rehab assisting return to sport exercises.

Kinesio taping is offered at all our Sydney physiotherapy locations.

Manual therapy is a “hands on” approach to the body’s joints and soft tissue structures in order to restore normal function.

Our highly qualified clinicians are experienced in delivering various methods of manual therapy tailored to everyone, including shoulder physiotherapy, neck physiotherapy and women’s health physiotherapy.

With the use of palpation, our therapists are skilled in identifying whether these structures are abnormally tight, in spasm or in some cases hypermobile (too much movement).

Manual therapy can be practiced on all regions of the body.

Manual physiotherapy is offered at all our Sydney physiotherapy locations.

The purpose of a musculoskeletal athlete screen is to develop a clinical picture of an athlete’s capability regarding their sport.
Athletes require strength, range of motion and co-ordination, not only to maximise their performance, but reduce the risk of injury.

During the screening process the athlete is asked to perform a battery of tests and the results of these tests are compared to normative values to identify areas which may place the athlete at risk of injury.

Injury prevention should be the top priority for all athletes to maximise their performance, and longevity of their sporting careers.

Musculoskeletal athlete screening is offered at all our Sydney physiotherapy locations. Book online now.

Work related activity programs are designed specifically for the injured worker depending on their injury and the duties needed to be performed at work.

Our therapists provide education on injury management and prevention and provide the foundations to return to work through a range of exercise techniques.

Hydrotherapy, home exercise programs and gym programs are used to promote self-management and adherence for the injured worker.

Work related activity programs are offered at all our Sydney physiotherapy locations. Book online now.

The temporomandibular consists of two joints between your cheek bone and jawbone and it is the most used joint in your body for eating, drinking, talking, and expressing emotions.

The most common symptoms include grinding, jaw clicking, and popping, restriction of the joint or deviation while opening, and inability to clench your jaw completely. Dysfunction of this joint can cause headaches, ear pain, dizziness, upper neck pain, and ear ringing (tinnitus).

Together with help from your Dentist, Physios can assess and treat for pain relief including massage, dry needling, coordinated mobility exercises, and stretches.

TMJ treatment is offered at all our Sydney physiotherapy locations except Mt Pritchard and Macarthur. Book online now.

Our Senior services are one-on- one programs designed to improve senior wellbeing and independence.

After an assessment, our Physios can recommend either an individual treatment program or one of our ‘classes’ that specialise in Senior’s health. These include:

  • Falls prevention
  • Strength and Mobility – cardiac & respiratory
  • Balance and Bones

Senior physiotherapy is offered at all our Sydney physiotherapy locations.

Real time Ultrasound uses a diagnostic ultrasound machine to build an image on the screen.

Different layers of muscles can be viewed to see how they contract, relax and work together.

This is very relevant for your “deep abdominal muscles “core” Transverse Abdominus.

It is common for these deeper muscles to not work correctly after any episode of Back or Pelvic pain.

Real time ultrasound is offered at our Northbridge and CBD Wynyard physiotherapy locations. Book online now.

Research has shown that elderly people who participate in a safe exercise program that combines both strength training and balance are less likely to have fall related injuries and will improve overall strength.

At Sports Focus Physiotherapy, our Balance and Bones exercise class is conducted by experienced physiotherapists who will take you through a range of safe exercises each session.

Balance and Bones is offered at our Northbridge and Castle Hill physiotherapy locations.

Sports Focus Physiotherapy at Castle Hill offers specialised services for golfers, including rehab and advice for golfing injuries and a golf performance program.

Whether you are playing at professional or amateur, senior or junior levels, our expert Sports Focus physiotherapists can help you get the most out of your game.

Golf performance is offered at our Castle Hill physiotherapy location.

Do you work in the fitness industry? Interested in learning kinesiology taping techniques to help prevent client injury?

Andrew Hughes, senior partner at Sport Focus Physiotherapy and Sports & Olympic Physiotherapist regularly conducts certified taping courses for the sporting community including coaches, athletes and parents at our practices across Sydney.

Sports taping is offered at all our physiotherapy locations.

Orthotics are shoe inserts that support the foot. They are designed to assist in changing gait abnormalities that are causing pain or discomfort.

Orthotic prescription can be done after a biomechanical assessment by your Physiotherapist to determine your individual needs. First steps will often involve taping and sometimes shoe prescription to help change problematic movement issues.

Orthotic prescriptions are offered at all our Sydney physiotherapy locations. Book online now.

We provide general physiotherapy treatments to patients of all ages. Doctor referral is generally not necessary for private self-pay clients and our HICAPs system can provide you on-the-spot private health fund claiming.

Our physiotherapists also collaborate with your GP, other allied health professionals or insurance company when providing physiotherapy services via Department of Veterans’ Affairs (DVA), Medicare Chronic Disease Management (CDM) program, workers compensation or third-party insurance claims.

General physiotherapy is offered at all our Sydney physiotherapy locations.

Skiing and snowboarding both demand a lot from the muscles in the quads and lower back, and from the knees. A good conditioning program should start long before the snow season starts, and involve strength, power, flexibility, endurance and agility drills.

Evening classes run in two seasons – pre-Australian season and pre-Northern hemisphere season, 8-10 weeks, one hour.

Get Fit to Ski is offered at our Northbridge physiotherapy location.

Sport Focus Physiotherapy programs are available to cater to all your womens pelvic health needs. Find out more about our pelvic floor physiotherapy services today.

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