Evolving Pelvic Health Care: Why a Biopsychosocial-Spiritual Approach Is Essential—And How to Integrate It Into Practice
By: Carolyn Vandyken, BHSc (PT)∙ Estimated reading time: 5 minutes

Evolving Pelvic Health Care

Featuring insights from Carolyn Vandyken and an invitation to her upcoming webinar series

Pelvic health physiotherapy is undergoing an important transformation. As clinicians, we’re increasingly asked to move beyond a biomechanics-first mindset and toward whole-person care—care that honours the biological, psychological, social, and even spiritual dimensions of human health.

In a recent session, renowned physiotherapist and educator Carolyn Vandyken unpacked what this shift truly requires. Her message was clear: persistent pelvic and low back pain cannot be “fixed” with tissue-focused strategies alone. The future of pelvic health lies in embracing a biopsychosocial-spiritual (BPSS) model and adopting a facilitation mindset that empowers patients rather than positioning clinicians as fixers.

This approach forms the foundation of Carolyn’s upcoming webinar, A (Much Needed) 2025 Update on a Biopsychosocial Approach in Pelvic Health, a two-part series designed to give clinicians practical tools to implement BPSS care with confidence.

From Fixer to Facilitator: A Necessary Mindset Shift

Traditional physiotherapy often reinforces a “fixer” identity—find the biomechanical fault, correct it, resolve the pain. But for persistent pelvic and low back pain, this model falls short.

Most ongoing pain in these regions is nociplastic in nature, driven by nervous system hypersensitivity, not structural tissue damage. Trying to “fix” tissue that isn’t broken leads to ineffective treatment, frustrated clinicians, and disempowered patients.

Carolyn emphasizes that modern practice requires shifting to a facilitator role—one that supports patients in understanding their pain, making informed lifestyle changes, and gradually restoring function.

This shift can feel uncomfortable, especially for clinicians accustomed to offering concrete biomechanical

explanations. But embracing uncertainty, curiosity, and collaboration ultimately leads to better patient outcomes.

Trauma-Informed Care Isn’t Optional—It’s Foundational

One of the most powerful themes Carolyn highlights is the pervasiveness of trauma among people with pelvic pain. Many have experienced sexual, emotional, or medical trauma that shapes how they perceive safety, control, and bodily sensations.

A universal trauma-informed approach creates:

• Safety

• Collaboration

• Choice

• Empowerment

Rather than prescribing or correcting, clinicians learn to partner with patients, honour lived experience, and avoid language or treatments that could unintentionally retraumatize.

This is not only compassionate—it’s evidence-based practice.

Understanding Nociplastic Pain and Central Sensitization

Persistent pelvic pain frequently involves altered nociception. There may be little to no identifiable tissue pathology, yet pain is very real. The nervous system—not the tissues—is sensitized.

Recognizing nociplastic pain prevents overuse of:

• Manual trigger point therapy

• Repeated internal examinations

• Surgery

• Overly biomedical explanations

Instead, Carolyn encourages clinicians to use validated tools such as:

• The Central Sensitization Inventory (CSI)

• Psychosocial questionnaires

• Pain science education

• Lifestyle medicine screening

These tools help identify nervous system contributors, guide intervention, and support more accurate communication with patients.

Why Multimodal Treatment Outperforms Monotherapy

Evidence is clear: multimodal, biopsychosocial physiotherapy produces better long-term outcomes than monotherapies that target tissue alone.

Effective multimodal care integrates:

• Pain neuroscience education

• Lifestyle medicine (sleep, nutrition, stress regulation)

• Movement strategies

• Cognitive and behavioural approaches

• Nervous-system aware exercise progression

• Social and spiritual well-being

This shift away from isolated trigger point techniques may challenge entrenched norms, but it aligns practice with what the research—and patient stories—consistently show.

A Case Study: When Facilitation Changes Everything

Carolyn shared the story of a patient, “Jules,” who struggled for years with pelvic pain despite multiple rounds of tissue-focused therapy. What changed her trajectory wasn’t more hands-on treatment—it was a holistic plan that included:

• Pain education

• Gentle nervous-system-calming practice (e.g., yin yoga)

• Sleep and stress interventions

• Graded strengthening

• Collaboration and autonomy

Jules improved not because her tissues were “fixed,” but because her nervous system was supported, her lifestyle aligned with healing, and she finally felt empowered rather than pathologized.

The Parallels Between Pelvic and Low Back Pain

Persistent low back pain and pelvic pain share much more than anatomic proximity. Both are often nociplastic, highly influenced by psychosocial factors, and misunderstood through outdated biomedical narratives.

Shifting our language—from “damage” and “instability” to “sensitivity” and “capacity”—helps both groups of patients move toward functional restoration.

Join Carolyn’s Upcoming Webinar: Learn Practical Tools for Level Three BPSS Care

If you are ready to deepen your understanding and confidently apply a biopsychosocial-spiritual model in practice, Carolyn’s upcoming training will be invaluable!

An Update for Assessing and Treating Nociplastic Pain Mechanisms in Low Back and Pelvic Pain (Two-Part Webinar Series)

Instructor: Carolyn Vandyken
Hosted on: Embodia
🔗 Learn more and register here

In this two-part webinar series, Carolyn will walk through:

• How to assess nociplastic pain in pelvic and low back populations

• Practical use of tools like the 3PSQ, CSI, and psychosocial screens

• Treatment frameworks grounded in lifestyle medicine and modern pain science

• How clinicians can prevent burnout while transitioning to BPSS care

• Level three care strategies for complex patients

Whether you are new to biopsychosocial practice or refining an already big perspective, this series will help you build confidence and clarity in treating persistent pain.

The Future of Pelvic Health Is Whole-Person Care

Carolyn’s message is a call to action:

If we want better outcomes for patients—and greater sustainability for clinicians—we must let go of outdated fixer

identities and embrace facilitation, safety, and whole-person healing.

Her upcoming webinar series offers a roadmap. We hope to see you there.