The Missing Secret Ingredient for Pelvic Pain : Downregulating the Nervous System to Relieve Pelvic Girdle Pain
Laurie Bickerton, PT, FCAMPT, AFCI
Registered Physiotherapist – Pelvic Health and Orthopaedic Manual Therapist
Key Takeaways :
Pelvic pain is common, and is associated with upregulation of the nervous system (aka ‘fight or flight’,’wound up’)
Pelvic physiotherapists help teach people to use many of the techniques below, as well as manual therapy and exercise to ease pelvic pain and the sense of being anxious that comes with it
There are many techniques you can learn to help calm the nervous system and manage pain
Pain is an output of the nervous system, rather than a measure of injury
Pelvic girdle pain (PGP) is a common but often misunderstood condition that can significantly impact quality of life—especially during pregnancy, postpartum, or in those with chronic musculoskeletal imbalances. While many treatments focus solely on biomechanics or manual pelvic physiotherapy, targeting the nervous system can offer profound and lasting relief.
Working at Proactive Pelvic Health Centre, in a clinic dedicated to pelvic health and function, we see a lot of people who have been to a variety of other clinicians. Sometimes they have been searching for help for years. They have tried exercises, injections, and all sorts of approaches with some success for a period of time. The most common part that has been missed ? The nervous system.
In this post, we explore how nervous system downregulation—or calming the body’s stress response—can reduce inflammation, muscle tension, and pain sensitivity in the pelvic region.
What Is Pelvic Girdle Pain (PGP)?
Pelvic girdle pain refers to discomfort in the joints, muscles, and connective tissues surrounding the pelvis. It can include:
Sacroiliac joint pain
Tailbone pain
Pubic symphysis dysfunction
Lower back and hip tension
Prostate pain
It’s often associated with pregnancy, trauma, hyper-mobility syndromes, or chronic stress. While imbalances in the pelvic floor muscles can play a role, the nervous system often amplifies pain signals, making it a key player in persistent PGP. Pelvic physiotherapists help people with this regularly - it’s a key component of what we do.
Why Target the Nervous System?
Pain isn’t just a mechanical issue—it’s also a neurological experience. Chronic stress, trauma, and unresolved emotional tension can keep the nervous system in a heightened state of alert, known as sympathetic dominance (aka fight-or-flight mode). This is an upregulated nervous system.
When your nervous system is in this state:
Muscles stay tight, especially the pelvic floor muscles
Pain perception increases
Healing is slowed
Movement becomes guarded or restricted
By downregulating the nervous system, you create the internal conditions needed for pelvic
tissues to relax, heal, and reorganize.You can literally change your brain chemistry.
Five Science-Backed Ways to Downregulate the Nervous System for Pelvic Girdle Pain
1.Diaphragmatic Breathing
A powerful tool for activating the parasympathetic nervous system, diaphragmatic breathing soothes the vagus nerve and reduces pelvic floor overactivity. A longer exhalation is key here. Slow and easy.
Try This:
· Inhale through your nose for 4 seconds, expanding your ribs, belly, and back
· Exhale slowly for 6–8 seconds through pursed lips
· Repeat for 5 minutes, twice a day
2. Somatic Movement & Gentle Neuro-Resets
Unlike traditional exercise, somatic techniques focus on retraining the brain-body connection. These can be especially helpful for relaxing chronically tense pelvic and core muscles:
· Feldenkrais Method
· Yoga, especially Hatha or Restorative
· Hanna Somatics
· Gentle rocking or pelvic tilts with awareness
These approaches interrupt pain loops and teach the nervous system that it’s safe to move.
3. Polyvagal Exercises for Vagus Nerve Stimulation
The vagus nerve plays a central role in parasympathetic regulation (‘rest and digest’, the nervous system opposite to ‘fight of flight’). Activating it can reduce inflammation, improve digestion, and ease pelvic floor dysfunction. Examples include :
· Humming or singing
· Gargling water
· Cold exposure (like splashing cold water on your face)
· Long exhales and chanting
4. Pain Neuroscience Education
Understanding that pain doesn't always mean damage can help lower fear and pain sensitivity. Studies show that education alone can reduce chronic pain by calming the brain's alarm system. This is where your pelvic physiotherapist can help you to understand what is going on.
Key Point: Pain is a protective output—not a direct measure of injury.
This is a really hard idea for many chronic pain sufferers to accept, particularly since the medical system often connects pain with damage. Pain clinicians and scientists now understand that the nervous system creates pain to warn us. Learning this reduces catastrophizing, which is common in PGP sufferers.
5. Trauma-Informed Practices (TRE®, EMDR, or Somatic Experiencing)
Chronic pelvic girdle pain often has a trauma or emotional component. Trauma-informed modalities help discharge stored stress and tension from the body—especially from the hips and pelvic region. A majority of the people I see can recall a really difficult time that preceded the onset of their injury or pain and finding the right professional to help unpack that can be an important step.
These methods create nervous system safety, a prerequisite for healing chronic pain. One of the most effective ways to downregulate your nervous system is to build a sense of internal and external safety. Try These :
· Find positions where your body feels at ease (child’s pose, side-lying with support)
· Use weighted blankets or grounding tools
· Journal or visualize safe, peaceful places
· Limit overstimulation (social media, noise, multitasking)
Final Thoughts: Nervous System Healing Is Pain Healing
Pelvic girdle pain can be incredibly frustrating, especially when it persists despite physical treatment. But by addressing the nervous system's role in pain, you unlock new pathways for recovery.