Cart 0

Pelvic Pain and Levator Ani Syndrome Explained

Posted by Jane Ziegler on


Chronic Pelvic Pain and Trigger Points - Dr. Jonathan Kuttner



If you have pelvic pain, chances are you have trigger points somewhere within or adjacent to your pelvic floor muscles

The levator ani consists of the pubococcygeus and the iliococcygeus muscles.

Together with the coccygeus muscle, these muscles form the pelvic diaphragm (the muscular floor of the pelvis).

We find that trigger points in the levator ani muscle are often implicated in low back pain, Levator Ani Syndrome, and a wide range of chronic pelvic pain syndromes.

Pelvic Disorders

Whilst trigger points may be the primary cause of pelvic pain in some patients; in others it may be a response to an underlying pelvic disorder. 

There are many mechanisms of injury that can cause spasm of the pelvic floor. These include, but are not limited to:

Child birth injury, pelvic surgery, lumbar disc surgery, prolonged driving or occupations that require prolonged sitting, gait disturbances, pelvic inflammation or infection, traumatic injury to the back or pelvis, and injuries that result from sexual intercourse.

Malalignment of the Pelvis

Malalignment of the pelvis, especially in the sacroiliac joint, due to trauma, poor posture, muscular asymmetry, or excessive sports also may contribute to muscular dysfunction of the pelvis.


Pelvic Floor Muscle Trigger Points

Male and Female Pelvic Floor Muscles 


Levator Ani Syndrome

Levator Ani Syndrome is a condition in which the pelvic floor muscles, which provide support for the vagina, bladder and rectum, are in constant or frequent, muscle spasm and tightness.

This muscle spasm is often the body’s reaction to the pain produced by Vulvar Vestibulitis Syndrome or Prostatitis.

The muscle spasm can often last long after the initial cause of pain, and the muscle spasm itself can cause pain and restrict the blood supply to the damaged tissues.

Muscle Spasm

This muscle spasm is similar to the spasm and tension people often get in the neck and shoulder muscles, but in that case, you are often aware of the tension.

You can feel your muscles tightening and see the effect as your shoulders rise up above your neck.

This enables you to use techniques to reduce the tension, such as massage, exercises, relaxation techniques or just remind yourself to let go of the muscles.

However with the pelvic floor muscles, we are often unaware that they exist, let alone aware that they might be in spasm or particularly tight.

If we are unaware of the muscles, then we are unlikely to be able to relax them or reduce the tension in them. 


Symptoms of Levator Ani Syndrome include:

  • A dull ache in the rectum, vagina or perineum
  • Constant rectal or vaginal pressure
  • A constant burning in the rectum, vagina or perineum
  • Feeling as though one is sitting on a ball or as though a ball is in the rectum

Passing feces often worsens symptoms and is difficult if you are experiencing Levator Ani Syndrome.

Sexual intercourse can also worsen your symptoms.

Levator Ani Syndrome is not thought to be psychological in origin; however, emotional stress may aggravate symptoms. 


Manual therapy is relatively successful for patients with chronic pain related to pelvic floor dysfunction, especially considering the typical outcome and persistence of symptoms for this patient population as a whole.

Only a few prospective randomized trials have been conducted, but FitzGerald et al demonstrated a 57% response rate to myofascial therapy for urologic pelvic pain syndrome among patients presenting with pelvic floor tenderness. 

The same multi-center collaborative group later confirmed these results with a 59% response rate in women treated with myofascial therapy for interstitial cystitis and painful bladder syndrome. 

Trigger Point Therapy

Weaving trigger point therapy into your treatment routines may have a profound effect.

Trigger points play a role in the vast majority of pelvic pain syndromes and in may cases they are the prime cause.

Patients should bear in mind that finding a therapist with the skill and interest to address pelvic floor dysfunction can be difficult in some geographical areas. 

Note: We produce these video blogs in order to demonstrate the techniques that we use daily in our clinics, and have found to be effective, and autonomously reproducible.

Do not attempt to perform these trigger point techniques unless they fall within your professional scope of practice.


Quick Links:  

Find a Trigger Point Professional in your area

More About Pelvic Pain and Trigger Points

Dry Needling for Trigger Points

NAT Professional Courses

Certify as a Trigger Point Therapist

Online CE/CPD/CPE Courses

Education Membership Plans




Top Physiotherapy Blog



About NAT Courses

As a manual therapist or exercise professional, there is only one way to expand your business - education!

Learning more skills increases the services that you offer and provides more opportunity for specialization.

Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.

Help Desk


About Niel Asher Education

Niel Asher Education is a leading provider of distance learning and continued education courses.

Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.

Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.  

Printed course materials and other products offered on our websites are despatched worldwide from our 3 locations in the UK (London), USA (Pennsylvania) and Australia (Melbourne).

More About Us



We are honored to have received the "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

Read Full Article 


Award Winning Instructors

Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.

Meet the Instructors


NAT Certification

If you are a qualified/licensed manual therapist or exercise/fitness professional you can expand your credentials with NAT certification.

In addition to national accreditation for continued education, each course that we offer includes "NAT Learning Credits". By taking and completing courses you can accumulate NAT credits to qualify for NAT certification.

There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.

About NAT Certification



NAT courses are accredited for continuing education by over 30 professional associations in North America, United Kingdom, Australia, and European Union countries. These include The National Academy of Sports Medicine, Physical Therapy Board of California, AAFA, National Certification Board for Manual Therapists and Bodyworkers, Sports Therapy Institute, and Myotherapy Australia.

See Full List


Niel Asher Technique

Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.

The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics.

Read More


International Students

Most of our courses are available as either "Printed" or 'Download" editions. When you purchase a download edition, you receive immediate lifetime access to all course material. Course texts can be downloaded and printed if required. 

When you purchase a "Printed" edition, you will also receive free access to the download edition.

We ship Worldwide from locations in the USA, UK, and Australia. Most items are despatched within 24 hours and shipping is FREE for all orders over US$50.




NAT CE CPD CPE Manual Therapy Courses



This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 








Share this post

← Older Post Newer Post →

Leave a comment

Please note, comments must be approved before they are published.

Words from our students



Sold Out