Polyvagal Theory: Pelvic Health Physical Therapy Applications

Nervous System Care Comes First.

Authored by Dr. Karah Charette, PT, DPT, RYT, and Bodyful PT and Wellness

How Trauma-Informed Care Supports Healing in Pelvic Pain

It is fair to assume that most people understand we are social creatures. If it was not clear before, the pandemic illuminated just how interconnected we truly are. We affect each other. We regulate with each other. And this connection plays a critical role in our health—especially when living with persistent pain.

You may have felt intuitively that being seen, heard, and supported feels healing. There is now a physiological framework that helps explain why. That framework is Polyvagal Theory, and it deeply informs trauma-informed pelvic therapy, trauma PT, and somatic approaches to movement and healing.

Polyvagal Theory and the Nervous System

Developed by Stephen Porges, Polyvagal Theory explores the evolution of the autonomic nervous system, with particular attention to the vagus nerve.

There are three primary nervous system states:

• Dorsal vagal (shutdown / immobilization)
  The oldest circuit, associated with collapse, numbness, slowed heart rate, and disconnection.

• Sympathetic (fight or flight)
  Mobilization, alertness, protection, and action. This state is not “bad”—it can support play and engagement as much as defense.

• Ventral vagal (social engagement / safety)
  The most evolved circuit, responsible for communication, facial expression, vocal tone, and relational connection.

The nervous system is constantly scanning for cues of safety or threat. What differentiates play from anger—or curiosity from fear—is often the presence of ventral vagal support.

This understanding is foundational to trauma-informed pelvic therapy and trauma PT, because pain does not exist in isolation from the nervous system.

Why Nervous System Regulation Matters in Pelvic Pain

Research continues to show that chronic stress is a significant contributor to persistent pain and inflammation. When the nervous system is overwhelmed:

• Stress hormones increase

• Blood flow to digestion and pelvic organs may decrease

• Muscles—including the pelvic floor—may hold excess tension

• Healing capacity becomes limited

Understanding Polyvagal Theory offers a roadmap for how we can support regulation—both individually and relationally.

One of the most important implications is co-regulation.

Healing does not happen in isolation.

The relationship between provider and client—tone of voice, pacing, presence, and consent—is not “extra.” It is part of the treatment.

This is why trauma-informed pelvic therapy emphasizes safety, collaboration, and choice.

Breath, Movement, and Co-Regulation

In one study conducted by Dr. Porges, participants faced one another while speaking. One group inhaled more slowly; the other exhaled more slowly.

• Those who inhaled longer perceived their partner as more critical.

• Those who exhaled longer perceived their partner as more benevolent.

Longer exhales support ventral vagal dominance—creating greater feelings of safety and social engagement.

This is why breath-centered practices, somatic movement therapy, and Pilates for pelvic pain can be so powerful when taught through a trauma-informed lens.

Movement is not just mechanical.
It is relational.
It is nervous-system driven.

Why Somatic Movement and Pilates Support Trauma Recovery

Polyvagal research also shows that music, chanting, synchronized movement, and group rhythm support regulation.

This may explain why in-person yoga or Pilates often feels different than doing the same movements alone online.

Somatic movement therapy and trauma-informed Pilates for pelvic pain emphasize:

• Slowing down

• Breath-supported movement

• Awareness of internal cues

• Choice and agency in how movement unfolds

Rather than robotically “performing,” these approaches invite the nervous system into safety—where healing can actually occur.

Trauma-Informed Pelvic Therapy Is Relational Care

One of the most radical ideas Polyvagal Theory offers—especially in a highly individualistic medical culture—is that our power lies in our ability to regulate together.

For clients living with pelvic pain, trauma, or chronic symptoms, this means:

• You are allowed to interview your providers

• You are entitled to safety, consent, and trust

• The therapeutic relationship matters

In the words of Dr. Porges:

“Polyvagal theory shifts our own personal documentary from events to feelings. Our life narrative is based on global physiological states.”

Trauma-informed pelvic therapy moves away from asking only what happened and instead makes space for how it felt, how it lives in the body, and how regulation can be restored.

You Are a Collaborator in Healing

Polyvagal-informed care challenges the idea that healing comes solely from something being “done” to you.

Instead, it invites you into collaboration—where your sensations, story, and pacing matter.

When your experience is validated and supported, you may find that the solution was never something to fix—but something to reconnect with.

If you’d like to learn more about how we apply Polyvagal Theory, somatic movement therapy, and trauma-informed pelvic care to chronic pain, explore our related blog on somatics and pain.

Bodyful Physical Therapy and Wellness is located in Oakland, CA.

We offer trauma-informed pelvic therapy, Pilates for pelvic pain, and telehealth services throughout California.

Interested in working with a Polyvagal-informed, trauma-sensitive provider?

Book with us today!