5 Expert-Approved Exercises for Pelvic Floor Pain Relief

Transform your daily comfort with these evidence-based movements that address the root causes of pelvic pain

Pelvic floor pain can be one of the most challenging conditions to live with, affecting everything from your ability to sit comfortably to your confidence in daily activities. Whether you're dealing with sacroiliac joint dysfunction, pregnancy-related discomfort, or general pelvic instability, the right exercises can make a profound difference in your quality of life.

After more than 25 years of working with patients experiencing pelvic pain, I've refined these five essential exercises that target the deep stabilizing muscles responsible for pelvic support. These aren't your typical "one-size-fits-all" routines – they're specifically designed to retrain your body's natural stabilization systems.

Understanding Your Body's Foundation

Before diving into the exercises, it's important to understand what we're working with. Your pelvic floor isn't just one muscle – it's a complex network of deep stabilizers including the transversus abdominis (TrA) and multifidus muscles that work together to support your spine and pelvis. When these muscles aren't functioning properly, pain and instability follow.

Exercise 1: Deep Core Reactivation (Transversus Abdominis and Multifidus)

This foundational exercise was originally taught to me by renowned Australian physiotherapist Paul Hodges over 25 years ago, and it remains one of the most effective techniques for pelvic stability.

What it does: Retrains your deepest core muscles to provide optimal pelvic joint stability and addresses motor control deficits that often underlie chronic pain.

How to perform it:

• Lie on your back with knees bent and feet flat on the floor, maintaining a neutral spine position

• Take a deep breath in, then as you exhale, gently draw your navel toward your spine

• Avoid tensing your surface abdominal muscles – this should feel like a gentle internal activation

• Simultaneously, imagine a slight lifting sensation in your lower back to engage the multifidus

• Hold this gentle activation for 5-8 seconds while breathing normally

• Relax completely for 10 seconds before repeating

Dosage: 10-12 repetitions, 2-3 sets, 3-4 times per week

Pro tip: This exercise is particularly effective for posterior sacroiliac joint pain. After two weeks of pain-free practice, try progressing to standing positions.

Exercise 2: Side-Lying Hip Strengthening (My Personal Favorite)

This exercise has become my go-to recommendation for almost everyone dealing with pelvic instability – the results speak for themselves.

What it does: Strengthens the gluteus medius muscle, which is crucial for pelvic stability during walking, climbing stairs, and other dynamic activities.

How to perform it:

• Lie on your unaffected side with a pillow under your abdomen for comfort (especially important if pregnant)

• Place a light resistance band above your knees

• Bend your bottom leg for stability, keep your top leg straight

• Engage your deep core, then slowly lift your top leg to 30-45 degrees

• Keep your knee straight and toes pointing forward

• Hold for 2 seconds, then lower with control

• Focus on feeling the work in the side of your hip – avoid hiking your hip up

Dosage: 12-15 repetitions, 3 sets per side, 3 times per week

Progression: After 3-4 weeks of stable performance, advance to standing clamshells or lateral band walks.

Exercise 3: Cardio-Strength Combination

What it does: Combines the pain-reducing benefits of aerobic exercise with targeted resistance training for comprehensive pelvic health.

How to perform it:

• Use a stationary bike with the seat adjusted so your hips are slightly higher than your knees

• Cycle at moderate intensity (you should be able to hold a conversation, but feel like you're working)

• Maintain your core engagement throughout the 20-30 minute session

• Follow with simple resistance exercises: seated leg extensions (10 reps, 2 sets) and chair-supported squats (8-10 reps, 2 sets)

Dosage: 20-30 minutes of cycling plus resistance exercises, 2-3 times per week. Add 30-minute brisk walks on non-cycling days if comfortable.

Important note: Adjust the resistance to avoid any pubic symphysis pain – your comfort is the guide.

Exercise 4: Bear Hover for Dynamic Stability

What it does: Restores coordinated muscle activation patterns essential for real-world pelvic stability.

How to perform it:

• Start on hands and knees with hands under shoulders and knees under hips

• Use a yoga mat for knee comfort

• Engage your deep core and pelvic floor muscles

• Lift your knees just 1-2 inches off the ground

• Hold this hover position for 10-15 seconds while breathing normally

• Lower down and rest for 10 seconds

Dosage: 8-10 repetitions, 2 sets, 3 times per week

Progression: After 3 weeks of pain-free performance, try dynamic crawling for 10 steps.

Exercise 5: Water-Based Stabilization

Aquatic therapy is having a moment – and for good reason. The water's buoyancy provides the perfect environment for pain-free movement.

What it does: Allows you to strengthen pelvic and core muscles in a supportive, low-impact environment that's ideal for severe pain or pregnancy.

How to perform it:

• Stand in chest-deep water with feet hip-width apart

• Optional: Use a pool noodle for added resistance

• Engage your core and perform lateral side steps, taking 10 steps in each direction

• Keep your knees soft and pelvis level

• Follow with aquatic marching (high knees) for 30 seconds, 2 sets

Dosage: 1