Chiropractic Care: Finding Relief Today from Chronic Pelvic Pain

Understand the role of chiropractic therapy in achieving lasting relief and enhancing well-being from chronic pelvic pain.

Chronic Pelvic Pain: How Chiropractic Care Can Support Pelvic, Hip, and Lower-Extremity Function

Chronic pelvic pain is more than discomfort confined to the lower abdomen or pelvis. Because the pelvis connects the spine to the hips and lower extremities, persistent pelvic pain can influence pelvic floor muscle tone, hip movement, walking mechanics, low-back function, nerve sensitivity, sleep, physical activity, and overall quality of life.

Chronic pelvic pain is generally defined as persistent or recurrent pain perceived within the pelvis that lasts for several months. It is not a single disease with a single cause. Gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, vascular, and psychosocial factors may overlap, and many patients have more than one pain generator at the same time (American College of Obstetricians and Gynecologists [ACOG], 2020; As-Sanie et al., 2026).

This complexity is why chiropractic care is best considered part of an interdisciplinary treatment strategy rather than a stand-alone treatment for every form of pelvic pain. Chiropractic and neuromusculoskeletal rehabilitation may be particularly useful when examination identifies contributing problems involving the lumbar spine, sacroiliac joints, hips, pelvic girdle, abdominal wall, myofascial tissues, movement patterns, or peripheral nerves.

Understanding the Three Major Pain Mechanisms

A useful way to understand chronic pelvic pain is to identify the mechanisms that are contributing to the symptoms.

Nociceptive Pain

Nociceptive pain originates from irritated, inflamed, overloaded, or injured tissues. Pelvic examples may include endometriosis, pelvic inflammatory disease, painful scar tissue, pelvic floor muscle strain, abdominal wall trigger points, sacroiliac irritation, hip disorders, or other musculoskeletal problems.

When nociceptive signals persist for a long time, muscles around the painful area may tighten protectively. This guarding can eventually become another source of pain.

Neuropathic Pain

Neuropathic pain develops when a nerve is injured, compressed, irritated, or sensitized. In the pelvis, possible contributors include the pudendal, ilioinguinal, iliohypogastric, genitofemoral, obturator, and other peripheral nerves.

Symptoms may include burning, tingling, electric or shooting pain, numbness, heightened skin sensitivity, pain with sitting, groin pain, or symptoms traveling into the buttocks or thighs.

Nociplastic Pain

Nociplastic pain involves altered pain processing and increased nervous system sensitivity rather than ongoing tissue injury alone. Central sensitization can make normally tolerable movement, pressure, or sensory input painful.

As a result, a patient may have widespread tenderness, fatigue, disturbed sleep, headaches, brain fog, increased sensitivity to pressure, and several overlapping chronic pain conditions even when imaging does not identify a single structural explanation (Allaire et al., 2024; As-Sanie et al., 2026).

These mechanisms can occur simultaneously. For example, pelvic inflammation may encourage pelvic floor guarding, muscle tension may irritate a nearby nerve, and persistent signaling may eventually increase nervous system sensitivity.

Muscles, Tendons, and Joints of the Pelvis

The pelvis is a mechanical crossroads between the trunk and lower extremities. It contains and anchors muscles, fascia, ligaments, joints, nerves, and tendons that must work together during sitting, standing, walking, lifting, sexual activity, urination, defecation, and exercise.

Pelvic Floor Muscles

The levator ani and coccygeus muscles primarily form the pelvic floor. The levator ani includes:

• Puborectalis
• Pubococcygeus
• Iliococcygeus

These muscles help support the pelvic organs and contribute to urinary, bowel, sexual, and postural function.

Other muscles that are closely related to pelvic mechanics include:

• Obturator internus
• Piriformis
• Iliopsoas
• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Hip adductors
• Deep hip rotators
• Rectus abdominis
• Internal and external obliques
• Transversus abdominis
• Quadratus lumborum
• Lumbar multifidus

The obturator internus and piriformis are especially important because they form portions of the internal pelvic walls while also participating in hip movement. The obturator internus also has an important relationship with the pudendal nerve pathway.

The pelvic floor is a musculofascial structure composed mainly of the levator ani and coccygeus muscles, supported by connective tissue and the perineal membrane (Bordoni et al., 2026).

Important Tendons and Fascial Attachments

Several major musculotendinous structures attach to or cross the pelvic girdle, including:

• Iliopsoas tendon
• Proximal hamstring tendons at the ischial tuberosity
• Hip adductor tendons and muscular attachments along the pubis and ischium
• Gluteal tendons around the lateral hip
• Obturator internus tendon
• Rectus femoris tendon near the anterior inferior iliac spine
• Abdominal and thoracolumbar fascial attachments
• Arcus tendineus levator ani, a fascial attachment line for portions of the pelvic floor

These structures help transfer forces between the torso, pelvis, hips, and legs. Irritation or compensation in one part of this network can increase mechanical demand elsewhere.

Pelvic and Related Joints

Important joints include:

• Right and left sacroiliac joints
• Pubic symphysis
• Lumbosacral joint at L5-S1
• Sacrococcygeal joint
• Right and left hip joints

The sacroiliac joints transfer forces from the spine and torso to the lower limbs, while the hip joints connect the pelvic girdle directly with the femurs. The pelvis therefore plays a central role in transmitting loads during standing and walking (Fisher et al., 2023).

How Chronic Pelvic Pain Can Affect the Lower Extremities

Pelvic pain can change the way a person moves long before they consciously notice the compensation.

When movement hurts, the nervous system may automatically shorten a stride, shift weight to one side, tighten the gluteal or adductor muscles, limit hip rotation, or increase abdominal and pelvic floor bracing. These adaptations may initially reduce discomfort, but persistent guarding can eventually contribute to hip, thigh, buttock, low-back, and lower-extremity symptoms.

Research has identified musculoskeletal impairments involving the hip, pelvis, trunk, pelvic floor, posture, and movement patterns in people with chronic pelvic pain, although the precise relationships vary among individuals (Harris-Hayes et al., 2019).

Lower-extremity effects may include:

• Reduced hip mobility
• Hip flexor or iliopsoas tightness
• Adductor guarding
• Gluteal trigger points
• Buttock pain
• Inner-thigh or groin pain
• Reduced tolerance for prolonged walking or standing
• Changes in gait or stride
• Pain when climbing stairs
• Reduced hip abductor or extensor endurance
• Neural tension or mechanosensitivity into the legs
• Compensation through the knees or feet because of altered load transfer

Fuentes-Marquez et al. (2019) found that women with chronic pelvic pain had more trigger points in the gluteal, adductor, and lumbopelvic muscles, increased pressure-pain sensitivity, and greater neural mechanosensitivity compared with pain-free controls.

This helps explain why treatment focused exclusively on the location where pelvic pain is felt may miss important contributors elsewhere in the kinetic chain.

Musculoskeletal Comorbidities Associated With Chronic Pelvic Pain

Chronic pelvic pain frequently overlaps with other painful conditions. These conditions do not necessarily cause one another, but their coexistence may increase muscular guarding, physical inactivity, pain sensitivity, and functional limitation.

Important musculoskeletal and overlapping pain conditions include:

Pelvic Floor Myofascial Pain

A hypertonic or poorly coordinated pelvic floor can create trigger points, painful muscle shortening, reduced relaxation, dyspareunia, urinary symptoms, bowel symptoms, and pain during prolonged sitting.

Pelvic floor dysfunction is common among people with chronic pelvic pain, and pelvic floor physical therapy can be particularly helpful when elevated resting tone or impaired relaxation is identified (van Reijn-Baggen et al., 2022).

Chronic Low-Back Pain

The lumbar spine and pelvis function as one interconnected load-transfer system. Persistent low-back dysfunction can alter pelvic movement, while pelvic pain can increase lumbar muscle guarding.

Sacroiliac and Pelvic Girdle Pain

Sacroiliac joint irritation may cause lower-back, buttock, groin, hip, or posterior-thigh symptoms. Because SI joint symptoms can resemble visceral or neurologic pelvic pain, careful differential evaluation is important.

Hip Dysfunction

Hip impingement, limited hip rotation, iliopsoas problems, gluteal tendinopathy, deep hip rotator dysfunction, and hip muscle weakness may coexist with pelvic pain or increase mechanical demand on the pelvic floor.

Fibromyalgia and Widespread Myofascial Pain

Fibromyalgia can coexist with chronic pelvic pain and may indicate a broader pattern of nervous system sensitization. Widespread pain can make local pelvic symptoms more intense and can reduce tolerance for aggressive manual treatments.

Temporomandibular Disorders, Migraine, and Other Chronic Pain Conditions

Chronic pelvic pain can occur as part of a broader pattern of chronic overlapping pain conditions that includes chronic low-back pain, fibromyalgia, migraine, temporomandibular disorders, irritable bowel syndrome, bladder pain syndrome, endometriosis, and vulvodynia.

Several overlapping conditions should prompt clinicians to look beyond a single damaged tissue and evaluate nervous system sensitivity, sleep, activity tolerance, stress, and functional capacity (Allaire et al., 2024; As-Sanie et al., 2026).

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How Chiropractic Care Can Help With Musculoskeletal Contributors

Chiropractic care does not treat every cause of chronic pelvic pain. A spinal or pelvic adjustment cannot eliminate endometriosis, infection, ovarian disease, inflammatory bowel disease, or other visceral pathology.

Its potential role is more specific: identifying and treating neuromusculoskeletal contributors that may be adding to the overall pain experience.

1. Evaluating the Entire Lumbopelvic-Hip Region

A chiropractic examination may include assessment of:

• Lumbar and pelvic mobility
• Sacroiliac joint function
• Hip range of motion
• Posture
• Gait
• Muscle tone
• Gluteal and adductor function
• Abdominal wall tenderness
• Neural tension
• Functional movement patterns

Only appropriately trained clinicians should perform a pelvic floor examination, and pelvic floor physical therapy plays an important role when internal muscle assessment or specialized treatment is indicated.

2. Improving Painful or Restricted Joint Motion

When musculoskeletal examination demonstrates mechanical restrictions, carefully selected lumbar, pelvic, sacroiliac, or hip mobilization may help restore comfortable movement.

For highly sensitive patients, low-force mobilization or instrument-assisted techniques may be preferable to aggressive manipulation.

3. Reducing Secondary Myofascial Guarding

Soft-tissue treatment can target structures such as the gluteals, hip rotators, adductors, iliopsoas region, abdominal wall, thoracolumbar fascia, and related tissues.

The objective is not simply to loosen muscles. Treatment should help the patient regain comfortable movement and then reinforce that improvement through exercise.

4. Restoring Hip-Core-Pelvic Coordination

Rehabilitation may include:

• Diaphragmatic breathing
• Hip mobility
• Gluteal activation
• Hip abductor and extensor strengthening
• Gentle core coordination
• Pelvic control exercises
• Walking progression
• Graded exposure to previously painful movements

Multimodal physical rehabilitation currently has better evidence for chronic pelvic pain than any isolated passive manual therapy. A 2025 systematic review and meta-analysis found that multimodal physical therapy improved pain in women with chronic pelvic pain, supporting treatment programs that combine movement, exercise, education, and appropriate hands-on care rather than relying on one technique alone (Starzec-Proserpio et al., 2025).

5. Addressing Neural Mechanosensitivity

When examination suggests nerve involvement, incorporate carefully dosed neurodynamic or nerve-gliding exercises.

These exercises should not aggressively stretch an irritated nerve. The goal is to encourage comfortable neural movement while gradually reducing sensitivity.

6. Reducing Fear of Movement

Persistent pain can cause patients to avoid walking, exercising, bending, sitting, sexual activity, or other movements because they expect a flare.

A gradual rehabilitation program gives the nervous system repeated experiences of safe movement. Over time, this may improve activity tolerance and reduce protective muscle guarding.

Dr. Alexander Jimenez’s Integrative Clinical Perspective

Dr. Alexander Jimenez, DC, APRN, FNP-BC, emphasizes an integrated model that combines musculoskeletal examination with rehabilitation and collaboration across healthcare disciplines.

His clinical approach considers the regional relationship among the lumbar spine, sacroiliac joints, pelvic girdle, hips, abdominal wall, and lower extremities, rather than treating the pelvis in isolation.

Consistent with the clinical framework shared through ChiroMed and his professional platform, Dr. Jimenez’s approach may include gentle joint mobilization, myofascial treatment, neuromuscular retraining, neurodynamic exercises, progressive strengthening, movement education, and coordination with other medical professionals when pelvic pain has visceral, neurologic, metabolic, or systemic contributors (ChiroMed, 2026; Jimenez, n.d.).

This approach matters because ChiroMed describes its model as multidisciplinary, integrating chiropractic care with rehabilitation, nurse practitioner services, nutrition, and collaboration with other healthcare practitioners.

Clinically, an important principle is matching treatment intensity to the patient’s pain mechanism. Someone with predominantly mechanical restriction may tolerate manual care differently than a person experiencing severe central sensitization. For the latter, gentler movement, education, pacing, sleep support, and autonomic regulation may need to precede more intensive rehabilitation.

Chiropractic Care Works Best as Part of a Team

Current evidence favors interdisciplinary care because chronic pelvic pain commonly involves multiple overlapping systems.

Depending on the individual, the healthcare team may include:

• Primary care
• Gynecology
• Urology or urogynecology
• Gastroenterology
• Pelvic floor physical therapy
• Chiropractic and musculoskeletal rehabilitation
• Physical medicine and rehabilitation
• Pain medicine
• Behavioral health
• Nutrition or lifestyle support

Pelvic floor physical therapy is especially important for patients with hypertonic pelvic floor muscles, impaired relaxation, painful trigger points, dyspareunia, or coordination problems. Systematic review evidence suggests pelvic floor physical therapy can improve symptoms in selected patients with pelvic floor hypertonicity (van Reijn-Baggen et al., 2022).

Chiropractic care can complement this process by addressing external lumbopelvic, spinal, hip, and lower-extremity contributors.

Direct clinical evidence for chiropractic manipulation specifically as a treatment for chronic pelvic pain remains limited. An early small prospective study reported short-term improvement after chiropractic care, but its design was insufficient to establish efficacy (Hawk et al., 1997). For this reason, the strongest clinical rationale is to use chiropractic care selectively for identifiable musculoskeletal contributors within a broader evidence-informed rehabilitation program.

When Pelvic Pain Needs Medical Evaluation

Persistent pelvic pain should not automatically be assumed to be musculoskeletal.

Medical evaluation is especially important when pain is accompanied by:

• Unexplained vaginal, rectal, or urinary bleeding
• Fever or chills
• Unexplained weight loss
• A palpable abdominal or pelvic mass
• Sudden severe pelvic or abdominal pain
• Progressive weakness or significant neurologic changes
• Changes in bowel or bladder control
• Suspected pregnancy complications
• New pelvic pain after menopause
• Symptoms suggesting infection or significant systemic illness

Appropriate investigation can help identify endometriosis, infection, inflammatory disease, urinary disorders, gastrointestinal disease, vascular conditions, tumors, neurologic disorders, or other causes requiring medical treatment.

A Better Goal: Restore Function, Not Just Chase Pain

Successful management of chronic pelvic pain is not always measured by whether every symptom disappears immediately.

Meaningful progress can include:

• Longer sitting tolerance
• Easier walking
• Improved hip movement
• Fewer muscle spasms
• Better sleep
• Reduced pain flares
• Greater exercise tolerance
• Improved bowel or bladder comfort
• More comfortable sexual activity
• Increased confidence with movement
• Returning to work, family activities, and recreation

The most effective plan identifies which tissues, nerves, movement patterns, and pain-processing mechanisms contribute to the individual’s symptoms and addresses them in the right sequence.

For patients with musculoskeletal involvement, chiropractic care may help improve spinal, pelvic, hip, and lower-extremity function. In contrast, pelvic floor therapy, medical care, exercise, pain education, and other interventions address the remaining contributors.

Chronic pelvic pain rarely exists in isolation. The pelvis connects the spine, hips, lower extremities, abdominal wall, pelvic floor, nervous system, and internal organs. Treatment should reflect that same interconnectedness.

References

• American College of Obstetricians and Gynecologists. (2020). Chronic pelvic pain: ACOG Practice Bulletin, Number 218. Obstetrics & Gynecology, 135(3), e98-e109. https://doi.org/10.1097/AOG.0000000000003716
• Allaire, C., Yong, P. J., Bajzak, K., Jarrell, J., Lemos, N., Miller, C., Morin, M., Nasr-Esfahani, M., Singh, S. S., & Chen, I. (2024). Guideline No. 445: Management of chronic pelvic pain. Journal of Obstetrics and Gynecology Canada, 46(1), 102283. https://doi.org/10.1016/j.jogc.2023.102283https://doi.org/10.1016/j.jogc.2023.102283
• As-Sanie, S., Ross, W. T., & Till, S. R. (2026). Evaluation and treatment of chronic pelvic pain. Obstetrics & Gynecology, 147(1), 21-43. https://doi.org/10.1097/AOG.0000000000006123
• Bordoni, B., Sugumar, K., & Leslie, S. W. (2026). Anatomy, abdomen and pelvis: Pelvic floor. In StatPearls. StatPearls Publishing.
• ChiroMed. (2026). ChiroMed – Integrated Medicine holistic healthcare in El Paso, TX.
• Fisher, M. A., Arbor, T. C., & Bordoni, B. (2023). Anatomy, bony pelvis and lower limb: Pelvic joints. In StatPearls. StatPearls Publishing.
• Fuentes-Marquez, P., Valenza, M. C., Cabrera-Martos, I., Rios-Sanchez, A., & Ocon-Hernandez, O. (2019). Trigger points, pressure pain hyperalgesia, and mechanosensitivity of neural tissue in women with chronic pelvic pain. Pain Medicine, 20(1), 5-13. https://doi.org/10.1093/pm/pnx206

• Harris-Hayes, M., Spitznagle, T., Probst, D., Foster, S. N., & Prather, H. (2019). A narrative review of musculoskeletal impairments associated with nonspecific chronic pelvic pain. PM&R, 11(Suppl. 1), S73-S82. https://doi.org/10.1002/pmrj.12209
• Hawk, C., Long, C., & Azad, A. (1997). Chiropractic care for women with chronic pelvic pain: A prospective single-group intervention study. Journal of Manipulative and Physiological Therapeutics, 20(2), 73-79.
• Jimenez, A. (n.d.). Dr. Alexander Jimenez DC, APRN, FNP-BC, IFMCP, CFMP, ATN – Professional profile. LinkedIn. Retrieved October 15, 2026.
• Starzec-Proserpio, M., Frawley, H., Bo, K., & Morin, M. (2025). Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 232(1), 42-71. https://doi.org/10.1016/j.ajog.2024.08.006
• van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Voorham-van der Zalm, P. J., Pelger, R. C. M., Hagenaars-van Miert, C. H. A. C., & Laan, E. T. M. (2022). Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment efficacy. Sexual Medicine Reviews, 10(2), 209-230. https://doi.org/10.1016/j.sxmr.2021.03.002

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