Induction

Endometriosis is increasingly recognised as a complex, systemic condition that impacts far more than just the reproductive system. With its effects extending to the nervous, gastrointestinal, musculoskeletal, and even psychological domains, the management of endometriosis requires an integrated, whole-person approach to care. Among the deeply impactful members of the care team are physiotherapists, particularly those with advanced expertise in pain science and pelvic health.

As a pelvic health physiotherapist with a special interest in persistent pelvic pain and endometriosis, I’ve seen firsthand how targeted physiotherapy can dramatically improve quality of life for those navigating this chronic condition. In this article, I will explore the unique role physiotherapists play in endometriosis care, how digital health solutions can complement our work, and why we must continue to foster interdisciplinary collaboration.

Endometriosis: A Whole-Body Disease

Far from being a localised gynaecological issue, endometriosis is now understood to be a systemic inflammatory condition. It is characterised by symptoms including pain, bladder and bowel dysfunction, heavy and/or painful bleeding, fatigue, and infertility.

The literature suggests that one of the most common symptoms of people with endometriosis is pain, with many also reporting pain during urination, bowel movements, intercourse, and general abdominal or pelvic discomfort.

The average global diagnostic delay for endometriosis remains high at around 6.5 years, during which time patients often consult multiple providers and receive fragmented care. Within this fragmented landscape, physiotherapists can offer a consistent, evidence-based and compassionate foundation, and hopefully disrupt the cycle of persistent pain, which can sometimes result in a sensitised nervous system.²

“I often imagine a world where adolescents who experience pelvic pain, are educated and treated early, with the hope that they don’t spend years searching for answers and treatments that work.”

The Unique Role of Physiotherapy in Endometriosis Care

Physiotherapists play an integral role in endometriosis care.

Often spending the most time with patients, physiotherapists are uniquely positioned to listen, validate, and guide. Their expertise extends beyond muscles and movement— they help individuals understand their pain, restore function, and reconnect with their bodies.

With the understanding of the complex interplay between pelvic floor dysfunction, musculoskeletal imbalances, nervous system sensitisation, and emotional health, physiotherapists are often among the first to identify issues requiring further referral. They collaborate closely with gynaecologists, psychologists, and dietitians, and empower patients with tools they can use daily, such as breathwork, graded movement, or pain education.

Physiotherapists contribute to endometriosis management across several domains:

• Regulating the Nervous System:
  Some people with endometriosis who have experienced persistent pain can develop central sensitisation, a state where the nervous system becomes hyper responsive to stimuli.² This can be likened to a security light that is “ultra-sensitive” to perceived threat. Physiotherapists trained in pain science can help patients understand their pain³, build safety in movement, and provide strategies to calm the nervous system. This approach has been associated with reduced pain catastrophising and improved function.
• Pelvic Floor Muscle Assessment and Treatment:
  Pelvic floor dysfunction, difficulties with contracting and/or relaxing the pelvic floor muscles, is common in those with endometriosis and can contribute to dyspareunia (pain during intercourse), bowel or bladder symptoms, and general pelvic discomfort. Physiotherapists use internal and external techniques such as manual therapy, biofeedback, and functional retraining, to address these issues.
• Bladder and Bowel Optimisation:
  Endometriosis often impacts gastrointestinal and urogenital function. Physiotherapists provide guidance on toileting posture, pelvic floor control and diet and laxative recommendations (in collaboration with a dietitian) to improve symptoms like constipation, bloating, urinary and/or faecal urgency, urinary incontinence or incomplete voiding.
• Movement and Exercise Prescription:
  Tailored exercise programs improve circulation, reduce inflammation, and foster pain resilience.¹ A graduated movement plan, often integrating yoga, breath-work, and/or low-intensity cardio (walking or swimming), can be life-changing, particularly when fear of movement is a barrier.
• Lifestyle and Behavioural Coaching:
  Physiotherapists often spend more time with patients than other clinicians, allowing for deeper exploration of stress, sleep, nutrition, and pacing strategies. This positions them to ‘connect the dots’ and refer appropriately, facilitating a truly biopsychosocial approach.
• Prehabilitation and Postoperative Recovery:
  For patients undergoing laparoscopic surgery for diagnosis or excision of endometriosis, physiotherapists support optimal outcomes both before and after surgery by preparing tissues, reducing anxiety, and guiding safe return to activity.

Digital Health as a Companion Between Appointments

Despite best efforts, physiotherapy appointments are often constrained by time, location, and cost. Digital tools, such as Matilda’s Surgery Optimisation Program and QENDO’s endometriosis support app, provide an invaluable adjunct.

Diving deeper into one of these options, Matilda’s eight-week program, delivered through a user-friendly mobile platform, supports patients in the four weeks before and four weeks after surgery, delivering:

• Educational content on movement, nutrition, mental wellbeing, and sleep
• Guided sessions for movement and mindfulness to regulate the nervous system
• Weekly community support calls and peer connection
• Tools for habit tracking and self-monitoring

From a physiotherapy perspective, Matilda acts as a clinical extension, reinforcing key messages around movement safety, nervous system regulation, bowel and bladder health, and patient empowerment through education. It’s especially beneficial for:

• Reinforcing exercises and strategies between appointments
• Providing daily support when flare-ups occur outside of clinic hours
• Bridging access gaps for patients in rural or regional areas
• Enhancing patient engagement through confidence and shared language before consultations

Physiotherapists can confidently refer patients to programs like Matilda, knowing they are grounded in multidisciplinary input and designed to complement, but not replace face-to-face care. This hybrid model of digital and in-person care represents the future of chronic condition management.

A Collaborative, Whole-Person Model is the Future

Endometriosis care is gradually evolving from a primarily surgical and hormonal-only model to a multidisciplinary, biopsychosocial approach. In this new paradigm, physiotherapists are not optional extras but essential team members.

With expertise in pain modulation, pelvic floor rehabilitation, movement science, and whole-person care, physiotherapists:

• Reduce pain and improve quality of life
• Optimise surgical outcomes
• Address modifiable lifestyle factors
• Empower patients to take an active role in their care

We also act as “super connectors”, linking gynaecologists, GPs, dietitians, psychologists, and surgeons around the patient’s needs. With longer and often more frequent sessions, physiotherapists build relationships that can uncover important diagnostic and therapeutic clues.

Conclusion

As healthcare evolves towards more integrated, equitable, and patient-centred models, physiotherapy must be recognised as a frontline—not downstream—component of endometriosis care.

Digital health innovations, such as Matilda, help extend this care beyond the clinic walls, ensuring patients are supported at every step of their journey.

Whether it’s regulating the nervous system, restoring pelvic muscle balance, improving bladder and bowel health, or simply listening with compassion, physiotherapists play a vital role.

As endometriosis continues to be recognised as a whole-body disease, it is clear: we need a whole-body team.

Disclaimer: This article was written by Joanna Morris in her capacity as a pelvic health physiotherapist with a special interest in persistent pelvic pain. As co-founder of Matilda Health, she references Matilda as an example of how physiotherapy and digital technologies can work together to support people with endometriosis. While Matilda is used as a case example, this article is intended for general education and reflection and does constitute clinical advice or product endorsement.