When we think of sports rehab, we typically envision athletes returning to the court after an ankle sprain or knee injury. But what if the same principles of rigorous assessment, load transfer optimization, movement education, and functional stability could apply to one of the body’s most critical yet under‑appreciated joints: the sacroiliac joint (SIJ)?

For clinicians working in pelvic health, embracing a sports‑rehab mindset can transform how we evaluate and treat SIJ dysfunction and pain, and recent research supports this crossover approach. Now might just be the ideal time to integrate these strategies into your practice.

Why Sports Rehab Principles Matter for SIJ/Pelvic Health

Pelvic floor rehabilitation is often associated with urinary continence or pelvic support, but recent research highlights its broader role, including significant impacts on respiratory health. Studies now suggest that combining pelvic floor muscle (PFM) training with pulmonary rehabilitation can enhance lung function, particularly in elderly patients recovering from orthopedic surgery.

Pelvic Floor Muscle Training and Pulmonary Function
A 2025 randomized controlled trial investigated the effects of combining pelvic floor muscle training with pulmonary rehabilitation in elderly patients following surgery for intertrochanteric femur fractures (Ji et al., 2025). Fifty patients were randomly assigned to either pulmonary rehabilitation alone or pulmonary rehabilitation combined with PFM training. After four weeks, both groups showed improvements in forced vital capacity (FVC), peak expiratory flow (PEF), and the FEV1/FVC ratio, with the combined intervention group demonstrating significantly greater gains. Diaphragm excursion and thickening fraction were also improved, suggesting a synergistic relationship between the diaphragm and pelvic floor muscles that enhances respiratory mechanics.

Supporting Evidence
Additional studies support the connection between PFM function and respiratory performance. A recent study using sensor-based diaphragm exercises combined with PFM training in women with stress urinary incontinence demonstrated improvements in both pelvic floor function and respiratory parameters (Yakıt Yeşilyurt et al., 2025). Similarly, pelvic floor electrical stimulation has been shown to enhance diaphragm excursion and rib-cage movement during tidal and forceful breathing and coughing (Hwang et al., 2021). Foundational work also demonstrated that co-activation of abdominal and pelvic floor muscles contributes to improved expiratory function and intra-abdominal pressure regulation (Sapsford et al., 2001). Together, these studies highlight the physiological link between the pelvic floor, diaphragm, and respiratory system.

As the holiday season approaches, Thanksgiving reminds us to pause and reflect on what we are grateful for in our personal lives and in our professional practice. For pelvic health practitioners, one of the greatest sources of gratitude is the opportunity to guide patients toward meaningful progress in their rehabilitation journeys.

Recognizing Small Wins Makes a Big Difference
Pelvic rehabilitation is often a journey of incremental improvements. While some changes may be subtle, each step forward is a win. Whether it’s a patient regaining core strength, experiencing reduced pain, improving bladder or bowel control, or building confidence in their body, these victories deserve recognition.

Celebrating small milestones can empower patients, reinforcing that their effort and consistency are yielding real results. Acknowledging progress, even the tiniest, can make a difference in adherence, motivation, and long-term outcomes.

Male pelvic cancer survivors, including those treated for prostate, bladder, penile, and testicular cancers, face a range of ongoing functional challenges that affect quality of life. Treatments such as radical prostatectomy, radiation therapy, chemotherapy, and reconstructive surgery can lead to urinary incontinence, erectile dysfunction, bowel irregularity, pelvic pain, and changes in body image or hormonal balance. These effects often overlap and require an integrated rehabilitation approach.

Prostate cancer survivors frequently report urinary leakage, urgency, and reduced bladder control. Bladder cancer patients, particularly those who undergo urinary diversion or neobladder reconstruction, may struggle with altered storage and emptying patterns. Colorectal cancer survivors treated with low anterior resection often develop low anterior resection syndrome, which is characterized by stool clustering, urgency, and incontinence (Jones et al., 2024; Kim & Oh, 2023). Penile and testicular cancer survivors may experience sexual dysfunction and hormonal disruptions that influence pelvic floor function and psychosocial well-being. Across these diagnoses, common contributors to dysfunction include pelvic floor muscle weakness or discoordination, neural disruption, scar tissue and fibrosis, and the cumulative impact of cancer treatment on mobility, confidence, and daily function.

The Role of Pelvic Floor Rehabilitation
Pelvic floor rehabilitation is an essential component of survivorship care. Randomized trials and systematic reviews consistently support structured pelvic floor muscle training to improve urinary continence after prostatectomy (Fernández et al., 2015; Chen et al., 2023; Gerlegiz et al., 2025). Supervised PFMT produces better outcomes than unsupervised exercise, particularly when initiated before surgery or early postoperatively. Confirming accurate pelvic floor activation through biofeedback or palpation is critical for optimizing treatment success (Gerlegiz et al., 2025).

Pelvic rehabilitation practitioners often focus on mechanical concerns such as diastasis recti, pelvic floor weakness, and altered load transfer. However, one foundational element that deserves equal attention in the postpartum period is the ongoing effect of hormonal shifts on connective tissues and joints.

Even after delivery, hormones such as relaxin, estrogen, and progesterone continue to influence tissue behavior, joint mobility, and the body's response to rehabilitation. Understanding how these hormones affect ligament laxity, collagen turnover, and neuromuscular control helps clinicians design safer and more effective recovery programs.

Hormonal Changes in Pregnancy and Early Postpartum
Relaxin is produced by the corpus luteum and placenta, and rises significantly during pregnancy. It is known for its role in “relaxing” muscles and ligaments, especially in the pelvis, to facilitate childbirth. Estrogen and progesterone also rise and modulate connective-tissue metabolism and receptor expression in ligaments.

Rectal sensation testing is a fundamental component in the evaluation of anorectal function, particularly in patients with constipation, fecal incontinence, and other defecatory disorders. For pelvic rehabilitation practitioners, a thorough understanding of rectal sensory thresholds and the appropriate use of rectal balloon catheters is essential for accurate assessment and effective intervention.

What Is Rectal Sensation Testing?
Rectal sensation testing assesses a patient’s ability to perceive rectal distension at incremental volumes. This procedure is typically performed using a rectal balloon catheter during anorectal manometry or as a stand-alone test. The method allows for quantification of rectal sensory function and compliance, both of which are key elements in normal defecation mechanics.

The key sensory thresholds measured include:

A prostate cancer diagnosis often brings more than concerns about survival. It can impact urinary control, sexual function, pelvic comfort, and overall quality of life. Men who undergo radical prostatectomy or radiation therapy frequently experience urinary incontinence and erectile dysfunction, sometimes lasting months or years. Pelvic rehabilitation offers structured, evidence-based strategies to restore function, manage symptoms, and rebuild confidence during recovery.

Understanding Prostate Cancer and Its Impact on Pelvic Health
Prostate cancer is among the most common cancers in men. Risk factors include advancing age, family history, genetic predispositions (such as BRCA2 mutations), race or ethnicity, and lifestyle factors including diet and obesity. Diagnosis typically involves PSA screening, biopsy, and imaging to determine disease stage.

Treatment for localized disease often includes radical prostatectomy, external beam radiation therapy (EBRT), or brachytherapy. Each approach carries potential side effects that can affect urinary, sexual, and pelvic function. Even a nerve-sparing prostatectomy can lead to neuropraxia and disruption of pelvic structures, resulting in urinary leakage and erectile dysfunction (5). Radiation therapy can induce fibrosis, vascular injury, and tissue changes that affect erectile function, bladder, and bowel coordination (3). Combined or salvage treatments can further compound these effects (2).

The sacroiliac joint (SIJ) has long been a focus of debate within musculoskeletal rehabilitation. Traditionally, clinicians were taught to view the SIJ as an isolated structure. A structure that could become “out of alignment” or “stuck,” requiring manual correction. However, emerging evidence challenges this perspective, suggesting that the SIJ functions as a dynamic part of the larger kinetic chain rather than an independent pain generator. As research continues to evolve, clinicians are being called to adopt a more contemporary, evidence-based pain science model that recognizes the interdependence of the SIJ, spine, hips, and lower limbs.

The SIJ plays a critical role in load transfer between the spine and lower extremities. As Vleeming et al. (2012) describe, effective force transmission across the pelvis depends on the coordinated function of surrounding musculature and connective tissues, rather than the mobility of the SIJ itself. This understanding aligns with the concept of regional interdependence, which proposes that impairments in one region, such as the hips, lumbar spine, or even the feet, can contribute to dysfunction elsewhere. When considering SIJ pain, clinicians should therefore assess not only the joint itself but also how altered movement patterns in the kinetic chain may influence pelvic mechanics.

Recent research supports this integrated approach. Abdollahi et al. (2023) found that athletes with SIJ pain or dysfunction had a significantly higher prevalence of prior lower-limb and pelvic-girdle injuries, emphasizing the relationship between distal mechanics and pelvic load transfer. Similarly, Yan et al. (2024) demonstrated that combining core stability exercises with manual therapy improved outcomes for patients with SIJ dysfunction, reinforcing the need for both regional mobility and neuromuscular control. Meanwhile, a 2023 systematic review by Liu et al. concluded that no single isolated intervention showed clear superiority for SIJ pain, further highlighting the importance of multimodal, functional rehabilitation approaches.

When physical therapists think about core stability, the focus often turns to individual muscles such as the transversus abdominis, multifidus, or pelvic floor. Yet at the center of this intricate system lies the diaphragm, a key player in the generation and modulation of intra-abdominal pressure (IAP). The ability to coordinate the diaphragm with the abdominals and pelvic floor through effective IAP regulation is critical not only for postural control but also for spine protection and efficient movement strategies.

IAP refers to the pressure within the abdominal cavity, bounded superiorly by the diaphragm, inferiorly by the pelvic floor, and circumferentially by the abdominal wall and spine. As the diaphragm contracts and descends during inhalation, it compresses the abdominal contents, while the pelvic floor and abdominal wall counteract this pressure to maintain balance. This pressurization acts as an internal stabilizer, creating a dynamic support system that reduces shear and bending stress on the lumbar spine. Recent biomechanical modeling by Murray and colleagues (2025) highlighted that IAP’s stabilizing role becomes particularly significant when external mechanical loads shift rapidly, emphasizing its importance for both daily and athletic movements.

Emerging evidence reinforces that IAP is not a passive byproduct of breathing; it is an active mechanism of stabilization. Kawabata and Shima (2023) demonstrated that breathing patterns and postural orientation strongly influence IAP and abdominal muscle recruitment. Their cross-sectional study revealed that forced exhalation in supine produced significant transversus abdominis and internal oblique activation, while exertion inhalation during a plank posture elicited similar effects, confirming that posture and breath type dictate how effectively the core musculature contributes to trunk stiffness.

As a new pelvic health physical therapist, you’re quickly discovering how interconnected the body’s systems truly are. Pain, bowel and bladder function, sexual health, and emotional well-being are all influenced by factors that extend beyond the musculoskeletal system. One emerging area that deserves attention is nutrition - a key player in inflammation, gut health, and even pelvic floor muscle function.

Integrating nutrition awareness into your practice doesn’t mean stepping outside your professional scope. It means understanding how diet affects the systems you already treat and collaborating effectively with nutrition professionals to optimize patient outcomes.

Why Nutrition Belongs in Pelvic Rehab
The gut and pelvic organs share complex neural and biochemical communication pathways. When the gut is inflamed or imbalanced, this “viscerosomatic crosstalk” can alter pelvic floor tone, coordination, and reflex activity, potentially amplifying pain via musculoskeletal pathways (1). Gut microbiota also influences the production of short-chain fatty acids and other byproducts that affect intestinal permeability, immune signaling, and systemic inflammation, which are key mechanisms in central sensitization and pelvic pain (2).