PT Training Using Beh Mod

Research Review: Is Pelvic Floor Muscle Training Physical Therapy or Behavioral Therapy?

An article by Frawley et al. (1) explores an important concept: Pelvic Floor Dysfunction (PFD) treatment is both physical and behavioral in nature. While this may feel familiar to many pelvic health providers, the authors highlight that the behavioral and psychological aspects of Pelvic Floor Muscle Training (PFMT) are often under-recognized and under-reported.

PFMT, as outlined in Cochrane reviews, involves repeated, voluntary muscle contractions taught and supervised by a healthcare provider to improve pelvic floor strength, endurance, and coordination. But it goes beyond exercise—it also requires teaching patients to recognize and shift behavioral patterns and responses, like urgency and bladder habits. Techniques like the knack, urge suppression strategies, and even self-talk can play a key role.

The article urges physical therapists to be more aware of cognitive and emotional patterns that may impact a patient’s symptoms and outcomes. Cognitive therapy can help patients reframe limiting beliefs (like “nothing can help my incontinence”) with evidence-based reassurance and behavior change strategies.

This blend of physical and behavioral approaches—the so-called “Exercise Behavior Zone”—is where real transformation happens. The authors encourage providers to use accurate terminology and document behavioral components of care clearly. You can find behavioral reporting guidelines on the EQUATOR website (2).

👉  Bottom line: To treat the whole patient, we must consider both muscle training and mindset.

1. Frawley H. Dean S. Slade S. Hay-Smith E.J.C. Is Pelvic Floor Muscle Training a Physical Therapy or Behavioral Therapy? A Call to Name and Report the Physical, Cognitive, and Behavioral Elements. Physical Therapy. 2017;97:425-436.
2. Enhancing the QUAlity and Transparency Of health Research. Equator network website. equator-network.org/. Accessed July 10, 2017.