Connecting the dots

The pelvic floor advice you were given was written for a different body

Most hypermobile women are told to strengthen. Many of them have a pelvic floor that has not switched off in years. Squeezing harder makes it louder, not better.

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AHPRA-registered physiotherapist Pelvic health and continence hEDS and HSD Perth, Western Australia
Who this is for

You have already been told four things

None of them were wrong exactly. They were answers to a question nobody had asked properly.

Your scans are clear.

They usually are. Connective tissue laxity does not show up on imaging, and normal results are often where the investigation stops.

Just keep doing your Kegels.

If the pelvic floor is already holding on, more squeezing adds tension to a muscle that cannot release. Symptoms worsen and it looks like non-compliance.

You are probably deconditioned.

Many of the women I see are the most active people in the room. The fatigue has a mechanism, and it is not a lack of effort.

It might just be anxiety.

Nervous system involvement is real and worth treating. It is not the whole explanation, and it should not be the first one offered.

Six clinicians. And not one of them asked whether you were hypermobile.

The approach

Connecting the dots

Hypermobility does not stay in the joints. Neither should the assessment.

01

Tone before strength

Working out whether the pelvic floor is weak or simply never letting go. The two can look identical from the outside and need opposite treatment.

02

Coordination before load

Proprioception in hypermobility is genuinely different. If you cannot feel where a joint is, you cannot feel this either. Sensing comes first.

03

Hormones, cycle, connective tissue

The pattern where everything feels worse for a fortnight belongs in the plan rather than in the notes.

Free guide

The Hypermobile Pelvic Floor

Why standard advice backfires and what actually helps. Written for women who have already tried the obvious things and want the reasoning, not the reassurance.

  • ― How to tell a high-tone pelvic floor from a weak one
  • ― The questions to ask before your next appointment
  • ― What down-training is and why it comes before strengthening
  • ― Where the evidence is solid, and where I am telling you it is not

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    Courses

    Work through it properly

    All three assume you are capable of understanding the mechanism. None of them will tell you to relax and breathe and leave it there.

    In development

    The Hypermobile Pelvic Floor: A Self-Management Course

    Self-paced. The full reasoning behind why the usual protocol does not fit this body, and what to do instead. Tone, proprioception, hormones, load management.

    In development

    The Hypermobile Woman: A Complete Guide to Pelvic Health Across Your Lifespan

    The comprehensive program. Pelvic floor, hormonal load, prolapse, pelvic pain, and how the picture shifts across the decades.

    In development

    Birth Prep for the Hypermobile Woman

    Preparing a hypermobile body for labour and the fourth trimester, with the connective tissue picture built in from the start.

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      Caitlin McPhee, Women's Health Physiotherapist
      About

      I specialise in the cases that don't resolve the usual way

      I'm Caitlin McPhee, a women's health physiotherapist and Pilates instructor with close to a decade in practice. Hypermobility runs through most of my clinical work, and it's where I focus almost all of my research and continuing education.

      The patient I see most often is someone who's done everything right. She's seen a physio. She's done the exercises. She's been told her pelvic floor is weak and she needs to strengthen it. Nothing has worked, and in some cases, it's made things worse.

      What she usually doesn't know is that a hypermobile pelvic floor behaves differently from the population most clinical protocols are written for. The standard framework doesn't fit. My work is about building a framework that does.

      I also see the broader picture. Hypermobility affects the whole musculoskeletal system, and most of my patients are managing more than just pelvic floor symptoms. I work with joint instability, pain, load management, and movement rehabilitation across this population, not only women's health presentations.

      AHPRA registered physiotherapist Pilates instructor Postgraduate training in continence and pelvic health, Curtin University Specialist clinical focus: hEDS & HSD