“The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Dr. Bessel van der Kolk is a groundbreaking book that explores how trauma affects the body and mind—and how healing is possible. It also explores ideas that trauma lives in the body and healing often requires physical approaches. Pelvic floor physical therapy is a powerful and effective way to help release trauma that can be stored in the pelvic floor muscles.
Trauma is stored in the body-particularly the pelvis
Emotional trauma often manifests in a multitude of ways, but some of the most common ways that it can show up in the body is through muscle tension and chronic pain particularly in areas of the body that are associated with shame, fear and vulnerability-the pelvic bowl.
Pelvic floor muscles are deeply tied to our sense of safety, control and bodily boundaries. After trauma, those muscles may tighten as a protective reflex causing pain and dysfunction even long after the event has occurred. Because our nervous system and brain can hold onto painful and traumatic events, chronic pain can be very real and present even after the physical injury has healed.
Pelvic Trauma: How the Body Holds the Story
Emotional trauma often takes root not only in our thoughts and memories, but in our physical bodies—particularly the pelvis. The pelvic floor, a group of muscles that supports many essential functions, is deeply connected to our sense of safety, autonomy, and vulnerability. When someone has experienced trauma, these muscles may tighten as a reflexive protective mechanism, leading to chronic tension and discomfort long after the original event has passed.
This chronic holding is not just physical. It’s a reflection of the nervous system’s ongoing perception of threat. Even in the absence of a current danger, the body can remain on high alert, contributing to pain and dysfunction that feels both elusive and persistent.
Understanding pelvic trauma in this way allows us to shift our lens—from seeing symptoms as something broken to be fixed, to viewing them as signals from a body that is trying to protect and survive.
Nervous System: A Core Piece of the Puzzle
Dr. Bessel van der Kolk, in The Body Keeps the Score, shares how trauma creates lasting imprints in the brain and body. These imprints often show up through a dysregulated nervous system. When someone is in a near-constant state of fight, flight, or freeze, the body tightens, guards, and braces—especially in the pelvic region.
This trauma loop may look like:
- Heightened anxiety and hypervigilance
- Reflexive muscle tightening
- Shallow breathing or breath holding
- Chronic pelvic pain or tension
- Disconnection from body awareness
Healing begins by gently inviting the nervous system into regulation. In pelvic floor physical therapy, this might include:
- Breath work and grounding exercises
- Mindful movement
- Gentle, non-invasive touch
- Education that helps demystify body sensations
These strategies encourage a shift in the brain’s perception: from threat to safety, from fear to curiosity.
Trauma-Informed: A Safe and Supportive Approach
Trauma-informed pelvic floor therapy honors each person’s story, pace, and boundaries. This approach is not about rushing to fix; it’s about creating a space of safety and trust where healing can unfold.
Here are a few key principles of trauma-informed care in pelvic PT:
Consent and Collaboration
- Clients are in control at all times
- Internal work is never rushed and is always optional
- External techniques can be used first: abdomen, inner thighs, lower back
Gentle Regulation
- Therapists may incorporate grounding tools
- Emphasis is placed on slowing down, feeling safe, and noticing sensations without judgment
- Breath is used as a bridge to reconnect with the pelvic floor
Empowerment over Fixing
- The focus is not just on treating muscles, but on helping clients feel more connected to their bodies
- Clients are supported in exploring body awareness with mindfulness and self-compassion
- Curiosity is encouraged over fear—inviting a new relationship with the body
Signs of Pelvic Trauma
Trauma doesn’t always announce itself clearly. It can surface in the pelvis in subtle or surprising ways:
- Chronic pelvic pain or tension
Often seen after sexual, emotional, or physical trauma. The muscles remain in a state of guarding, contributing to pain or conditions like vaginismus or dyspareunia. - Urinary or bowel dysfunction
Incontinence, constipation, or sudden urgency may be connected to nervous system dysregulation, even when trauma wasn’t pelvic-specific. - Dissociation or numbness
Some clients experience difficulty feeling sensations in the pelvic area, or a sense of disconnection from that part of their body. - Breath holding
A subtle yet powerful pattern—restricting breath can further lock the diaphragm and pelvic floor in tension.
Dr. Natalia offers a space where the body’s story is honored. Healing from trauma is not a linear process, yet with a gentle, trauma-informed approach, it is possible to restore a sense of safety, connection, and empowerment in the body.
