The State of Pelvic Floor Physical Therapy 2025

Historically overlooked areas like pelvic health and women’s musculoskeletal care are emerging as some of the most promising frontiers in preventive health, offering an enormous opportunity to improve outcomes and close long-standing gaps.

As longevity becomes one of the most pressing frontiers in modern healthcare, musculoskeletal health has taken on new significance, especially for women and individuals assigned female at birth.

Women live about five years longer than men, yet they spend more of those years in poor health, facing higher rates of mobility limitations, osteoporosis-related fractures, and chronic pain that often begins in midlife and accelerates after menopause. More than 1 in 3 women experience pelvic floor dysfunction—a figure that rises to over 50% after age 55. Despite its prevalence, this problem isn’t an inevitable part of aging.

Too often dismissed as merely incontinence or sexual discomfort, pelvic floor dysfunction is now understood to impact posture, core strength, and chronic low back and hip pain—key markers of musculoskeletal decline. Women with both pelvic floor dysfunction and overactive bladder also face a significantly higher risk of falling. And with falls being the leading cause of injury-related death in adults 65 and older, addressing pelvic floor health is critical to preserving long-term mobility and independence.

But the transformation can’t stop there. Women’s physical health is multifaceted, and musculoskeletal conditions beyond the pelvic floor can profoundly affect quality of life. From stress injuries to chronic joint pain, full-body physical therapy plays an essential role in restoring strength, improving function, and supporting healthy aging.

Yet, pelvic floor health and women-focused orthopedic care remain siloed from mainstream musculoskeletal and aging care—not because the science isn’t there, but because our systems haven’t evolved to reflect the evidence. Clinical frameworks still tend to overlook key variables like hormonal shifts, pelvic biomechanics, and gendered patterns of pain and injury, treating symptoms in isolation rather than as part of an interconnected system.

This oversight is critical, especially as menopause accelerates bone loss and muscle decline, compounding pelvic floor vulnerability. The result? Millions of women are living longer, but with diminished mobility, increased pain, and reduced independence, creating one of the most urgent and addressable opportunities in preventive healthcare today.

At Origin, we’re here to change that. By providing access to both pelvic floor and full-body physical therapy, we’re on a mission to help women and individuals with vaginal anatomy to feel their best through every stage of life.

This year’s Annual State of Pelvic Floor Physical Therapy Report explores the latest data and research at the intersection of pelvic health, musculoskeletal care, and longevity. We’re uncovering how a more integrated approach to physical therapy can help more women live not just longer, but healthier as we age.

Musculoskeletal Disorders: The Hidden Strain on Women

Numerous studies have shown that musculoskeletal disorders (MSDs) disproportionately affect women, and the disparity only increases with age. One study found that the prevalence ratio of symptoms among women was roughly 50% higher than men. Prevalence for self-reported symptoms was highest for neck (58%), shoulder (57%), and lower back (51%) for women compared to men, and women with MSDs have a moderately increased risk of chronic issues.

Another review found that neck pain, chronic low back pain, osteoarthritis, and rheumatoid arthritis (RA) more frequently and more severely affected women compared to men. Women also report higher rates of musculoskeletal pain overall, with symptoms that are typically more persistent and more likely to coexist with other MSDs. But why? Emerging research points to a combination of biomechanical, physiological, psychological, hormonal, and even genetic and cellular factors.

Sidebar: Sex Differences in Musculoskeletal Health

An under-researched system meets an underserved population

Despite experiencing musculoskeletal pain at significantly higher rates than men, women have long been treated with a one-size-fits-all approach. While they’re often included in research, most studies have failed to account for critical sex-specific differences, from hormonal fluctuations to anatomical and biomechanical variation. The result? A diagnostic and treatment gap that’s left millions of women navigating chronic pain, mobility issues, and injury risk without adequate support.

But that’s starting to change. Researchers are now uncovering how these sex-based differences shape musculoskeletal aging and pain presentation across a woman’s lifespan.

Hormones & Musculoskeletal Health

Often thought of solely as a sex hormone, estrogen also plays a critical role in musculoskeletal health, supporting bones, cartilage, muscle, and connective tissue.

• Osteoarthritis is 2–3x more common in women than men after age 45.
• Postmenopausal women often experience a 15% decrease in muscle mass and a 20% reduction in grip strength within five years.
• Hormonal shifts during puberty, pregnancy, and menopause affect tendon elasticity, muscle function, and injury risk, especially in the knees and hips. Research shows that during the menstrual cycle, grip strength was 8% higher during the high-estrogen ovulatory phase than the low-estrogen luteal phase. There was also a decrease in muscle strength and increased muscle fatigue during the luteal phase.
• Some studies suggest that estrogen-progesterone contraceptives might maintain or slightly enhance muscle strength, but progesterone-only contraceptives were associated with a slight decline in muscle performance.

Anatomy Drives Injury Risk

Women’s skeletal and muscular structures are not just scaled-down versions of men’s. They function differently.

• Stress fractures: Physically active women are at a two-to-four times higher risk of developing stress fractures than men, which may be due to bone anatomy and density.
• ACL injuries: Female athletes are 2–8 times more likely to suffer ACL injuries than their male counterparts in similar sports. This increased risk is attributed to factors such as greater ligament laxity influenced by hormonal fluctuations, a wider pelvis, and a greater Q-angle, all of which affect knee alignment and stability.
• Chronic neck pain: Women are 1.38 times more likely to experience cervical neck pain than men, which may be because females have smaller cervical vertebrae and less robust neck musculature compared to males, contributing to decreased spinal stability and a higher risk of traumatic injury.
• Lower back pain: Globally, women have about a 50% higher prevalence of lower back pain than men. However, lifetime differences are likely influenced by age, with a higher prevalence for women after menopause.

Biomechanics & Movement Strategy

Because of these anatomical differences, women tend to move differently, and those movement patterns can affect musculoskeletal outcomes:

• Knee injury: Women demonstrate greater knee valgus (when the knees collapse inward) during jumping, landing, and pivoting, which are linked to higher injury risk.
• Fall risk & mobility loss: Women have a higher fall risk (29.1%) compared to men (23.5%), with sex-specific risk factors including incontinence and frailty. The loss of bone mineral density after menopause may also contribute to the higher fracture rates seen in women.
• Overuse injuries: Women show different muscle activation patterns than men during landing and cutting, with men relying more on their hamstrings, which may contribute to a higher risk of overuse injuries like ACL tears in women.

MSK Disorders Hit Women Harder

Musculoskeletal disorders aren’t just a pain problem — they’re a healthspan problem, a workforce problem, and a mental health crisis hiding in plain sight. And women bear the brunt. From navigating pain in pregnancy to managing mobility loss in later life, MSDs can limit independence, strain mental health, and chip away at everyday quality of life.

Mental Health Implications

• Increased emotional distress: Women with MSDs report higher levels of anxiety, depression, and lower quality of life compared to men. This is often linked to lower social support and fewer coping mechanisms, exacerbating their mental health challenges.
• Delayed diagnosis or misdiagnosis: Women with musculoskeletal disorders often face delays in diagnosis, and 32% of women who were initially told their symptoms were psychological were later diagnosed with a physical condition. This kind of medical gaslighting can increase morbidity, intensify symptom distress, and contribute to worsening mental health outcomes.

Workforce Challenges

• Higher occupational burden: Globally, women have 1.30 times more incident cases, 2.24 times more deaths, and 1.45 times more disability-adjusted life years due to MSDs compared to men. Although some research may suggest that men have higher rates of MSDs depending on occupation and injury type, women performing the same tasks as men experience substantially higher muscular activity relative to capacity and a greater prevalence of neck and upper extremity musculoskeletal disorders.
• Insufficient workplace support: Women report higher rates of work-related musculoskeletal symptoms and sickness absence. Studies also show that women receive less workplace support and express a greater interest in modifying their work environments, highlighting the need for more accommodating occupational health strategies for women.

Quality of Life Deterioration

• Menopause-related symptoms: More than 70% of women will experience musculoskeletal symptoms, and 25% will be disabled by them through the transition from perimenopause to postmenopause. These symptoms, driven by hormonal changes, significantly affect quality of life and place a heavy financial burden on women through ongoing healthcare costs.
• Pregnancy-related MSDs: Approximately 25% of pregnant women experience disabling musculoskeletal pain, adversely affecting their quality of life and daily functioning.

Economic Impact

• Healthcare and productivity costs: In the US, MSDs account for substantial healthcare expenditures and productivity losses, with high BMI-related MSDs alone costing $180.7 billion globally in 2019.
• Workplace disability: MSDs are the leading cause of work disability, resulting in billions of dollars in financial losses due to decreased productivity and increased healthcare costs.

“Women’s health physical therapy is a vital part of healthcare. Women have distinct anatomical, physiological, and emotional needs that require specialized care. By addressing these needs, we can help women achieve optimal health and wellness at every stage of life.” - Dr. Jill Boissonnault, Associate Professor at the University of Wisconsin-Madison and founder of the Wisconsin Physical Therapy Association’s Women’s Health Special Interest Group

Source: https://www.uwhealth.org/news/why-womens-health-physical-therapy-is-so-important/51628

Musculoskeletal Conditions That Demand a Broader Lens

Even as women make up the majority of those affected by musculoskeletal disorders, many of their most common pain points continue to be mischaracterized, misdiagnosed, or under-treated, often because symptoms are viewed in isolation and the influence of hormonal and pelvic health is overlooked.

Take hip instability after childbirth. Shoulder stiffness during menopause. Postural pain and pelvic floor dysfunction following breast cancer treatment. These aren’t separate issues, they’re part of a complex, interconnected system. And treating them effectively requires a full-body, hormonally informed, and pelvic-aware approach to care.

What follows are three high-impact conditions that disproportionately affect women and highlight the need for physical therapy that treats not just symptoms, but systems. Each demonstrates why the integration of pelvic floor and full-body musculoskeletal care isn’t optional; it’s essential.

Hip Pain and the Pelvic Floor Connection

The Issue

Hip pain is prevalent among women, particularly during perimenopause, menopause, and the postpartum period. Over 50% of women experience pregnancy-related lumbopelvic or hip pain. Furthermore, over 95% of women with lumbopelvic pain also have pelvic floor dysfunction, suggesting that what presents as hip pain may, in many cases, be driven or perpetuated by pelvic floor impairment. Without addressing both, physical therapy risks missing the root cause of pain and limiting long-term recovery.

Why It Uniquely Impacts Women

• Anatomical differences: Women have a wider pelvis, a deeper acetabulum (hipbone socket) with greater femoral anteversion than men. This greater anteversion can overload the hip joint, which may lead to hip instability and hip abductor muscle weakness. Conversely, women with hip osteoarthritis also have a high prevalence of pelvic floor disorders.
• Hormonal influences: Increased hormone levels during pregnancy can lead to ligament laxity in the pelvis, predisposing pregnant women to lumbopelvic pain. Conversely, the drop in estrogen during perimenopause can lead to pelvic floor muscle and ligament atrophy, which may contribute to pelvic and hip pain.
• Biomechanical factors: Women’s greater femoral anteversion and increased hip internal rotation, coupled with their higher prevalence of hip dysplasia, can also alter gait mechanics, increase hip joint stress, and may contribute to hip pain, labral tears, and pelvic floor dysfunction.

How Physical Therapy Helps

Women’s health physical therapists assess and address both hip and pelvic floor dysfunctions through:

• Comprehensive evaluations that consider the interconnectedness of pelvic and hip structures.
• Targeted exercises to strengthen and coordinate hip and pelvic floor muscles.
• Manual therapy techniques to release myofascial restrictions.
• Education on posture and movement strategies to reduce strain on affected areas.

Frozen Shoulder in Menopause: The Hormonal Connection

The Issue

Frozen shoulder (adhesive capsulitis) affects 2-5% of the general population, with women developing the condition 2.18 times more often than men. This condition leads to excruciating pain and stiffness, limiting shoulder mobility and impacting daily activities.

Why It Uniquely Impacts Women

• Hormonal changes: The decline in estrogen levels during menopause is associated with decreased collagen production and joint elasticity, contributing to the development of frozen shoulder.
• Comorbid conditions: Women have higher incidences of thyroid disorders and diabetes, both of which are recognized risk factors for frozen shoulder.
• Stress and inflammation: Midlife stressors can elevate systemic inflammation, potentially exacerbating musculoskeletal conditions like frozen shoulder.

How Physical Therapy Helps

Physical therapy plays a crucial role in managing frozen shoulder, especially when tailored to the unique needs of menopausal women:

• Reduces pain and stiffness through manual therapy and controlled movement.
• Restores shoulder mobility with stage-specific range-of-motion exercises.
• Supports posture, sleep, and daily activities affected by frozen shoulder.
• Customized exercises that account for fatigue, sleep changes, and other menopausal symptoms.
• Provides education to manage symptoms and prevent compensation patterns.

Breast Cancer: Comprehensive Rehabilitation for Survivors

The Issue

Breast cancer affects 1 in 8 women, and more than 4 million women in the US are breast cancer survivors. Research shows that 62% of those treated experience ongoing pain and functional problems in the shoulder, arm, underarm, or chest, limiting daily activities and diminishing quality of life.

Why It Uniquely Impacts Women

• Treatment side effects: Surgical interventions and radiation can lead to scar tissue formation and reduced upper limb mobility. As many as 91% of women treated with breast cancer will experience shoulder weakness, restricted motion, stiffness, and pain.
• Hormonal therapies: Estrogen suppression treatments can cause joint pain and pelvic floor dysfunction. Up to 50% of women taking an aromatase inhibitor have joint pain or stiffness.
• Lymphatic system disruption: Lymph node removal increases the risk of lymphedema, which carries possibly debilitating consequences, including impaired limb mobility, pain, swelling, and heaviness. Persistent lymphedema affects more than 1 million breast cancer survivors worldwide.

How Physical Therapy Helps

Women’s health physical therapists support breast cancer survivors through:

• Preoperative education to prepare for postoperative rehabilitation.
• Post-surgical interventions to improve shoulder mobility and reduce scar tissue adhesions.
• Lymphedema management techniques to control swelling and maintain limb function.
• Pelvic floor rehabilitation to address urinary, sexual, and bowel health affected by cancer treatments.

The Future of Musculoskeletal Care is Connected, Not Compartmentalized

For too long, musculoskeletal disorders in women have been treated in silos — back pain here, hip pain there, pelvic pain somewhere in between. But the future of MSK care is moving toward integration, and pelvic floor therapy is central to that shift.

“The future of women’s MSK care requires practitioners who understand the interrelated systems of the female body—from hormonal influences on tissue healing to the biomechanical connections between the pelvic floor and distant regions like the shoulders or jaw,” says Liz Miracle, PT, MSPT, WCS. “This isn’t just about specialization—it’s about recognizing that women’s health physical therapy is whole-body physical therapy.”

Mounting evidence supports pelvic floor therapy not only for pelvic-specific conditions but for musculoskeletal dysfunction more broadly. One systematic review of randomized controlled trials found that pelvic floor muscle training significantly reduced lumbopelvic pain, especially in postpartum women, while improving function and mobility. Another study showed that pelvic floor muscle training combined with stabilization exercises improved trunk endurance and reduced pain in women with lower back pain, a condition that often overlaps with pelvic floor dysfunction.

These links aren’t coincidental. The pelvic floor acts as a foundation for spinal, hip, and core stability, influencing alignment and load transfer throughout the musculoskeletal system. Dysfunction here has been connected to conditions as diverse as pelvic girdle pain and even temporomandibular joint (TMJ) disorders. Yet, most women with these symptoms still receive fragmented or incomplete care. “Now that pelvic floor health has entered the mainstream, we have an opportunity to push the conversation further and explore the critical role that women’s health PTs can play in supporting full body MSK health across the lifespan,” says Carine Carmy, Co-Founder and CEO of Origin.

Origin is leading this transformation. With over 100,000 patient visits in 2024 and insurance partnerships covering 50 million lives, Origin delivers pelvic floor and full-body physical therapy built specifically for women. By combining deep clinical expertise with an accessible, scalable care model, Origin is redefining what MSK care can and should look like for women.

What’s Needed Now

To raise the standard of musculoskeletal care for women, the system must shift from one-size-fits-all protocols to precision care informed by women’s real physiology. That means investing in education, evaluation, and care delivery models that reflect how women’s bodies move, age, and recover.

What’s missing from the current standard of care:

• Practitioner training that reflects women’s anatomical and biomechanical differences
• Sex-specific screening tools and assessment protocols
• Interventions and treatment options tailored to life stage, hormonal status, and long-term musculoskeletal risk
• A multidisciplinary care model that connects pelvic, breast, and full-body MSK health

What Origin Is Already Doing

Origin is already building the model others need to follow — one that integrates pelvic floor care into a broader framework of full-body musculoskeletal treatment. Rather than treating women’s health concerns in isolation, our clinical approach connects hormonal, surgical, pelvic, and full-body MSK health into one unified care experience.

How we’re leading the shift:

• Training physical therapists in comprehensive, whole-body musculoskeletal care designed specifically for women
• Evaluating each patient holistically while factoring in life stage, hormonal health, pain history, and movement patterns
• Addressing full-body pain and dysfunction while recognizing the pelvic floor’s role in core, spine, and joint stability
• Providing specialized rehab for women recovering from pregnancy, menopause, orthopedic injuries, and pelvic/breast surgeries

What’s Next

Expanding this model of care will take more than individual action, it requires system-wide change. That means educating both patients and providers on the value of referring to, or seeking out, women’s health physical therapy (including pelvic floor PT) for musculoskeletal concerns. It means ensuring that women’s health training is built into physical therapy graduate programs, not treated as an elective. And it means integrating occupational therapists into interdisciplinary care teams to help meet the growing demand and close workforce gaps. With these changes, we can move closer to a future where proactive, personalized care isn’t the exception — it’s the standard.

Let’s work together to enhance the care women deserve.

Whether you’re a clinician looking to refer a patient for specialized physical therapy or a woman seeking to improve your musculoskeletal health, Origin is here to support you. Our team is dedicated to providing comprehensive, whole-body care that addresses the unique needs of women across all life stages.

For clinicians: Contact us at providers@theoriginway.com to discuss how we can work together to support your patients.

For patients: Ready to get started? Book your evaluation today. We’re here to help you feel your best.