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275 4th Ave, Brooklyn, NY
Hours: Mon-Thurs: 9-8PM
Fri: 9-6PM Sat: 11-4PM

At Inspira Physical Therapy in Park Slope, we specialize in complex orthopedics and pelvic floor physical therapy. Our approach is rooted in osteopathic and holistic treatments, including:

  • Craniosacral Therapy
  • Visceral Manipulation
  • Vagus Nerve Manual Therapy
  • Pilates Rehabilitation

Our practice is dedicated to treating chronic pain, Ehlers-Danlos syndrome/hypermobility spectrum disorder, and providing the highest level of whole-body care. Dr. Melanie Carminati, our founder, is also an adjunct professor of anatomy and kinesiology in the Fordham-Alvin Ailey BFA program and a presenter on pelvic physical therapy at SUNY Downstate OB/GYN.

Understanding Endometriosis and Its Impact on the Pelvic Floor

Endometriosis is a condition where endometrial tissue grows outside the uterus, causing chronic pain and various pelvic floor dysfunctions. It affects the pelvic floor by leading to:

  • Hypertonic (non-relaxing/spasm) pelvic floor muscles
  • Pelvic floor muscular weakness
  • Diaphragm dysfunction
  • Myofascial restrictions in the abdomen
  • Tightness in iliacus and psoas muscles
  • Mesentery and scar tissue restrictions

Common Symptoms Include:

  • Painful intercourse (dyspareunia)
  • Pain with urination
  • Urinary frequency/urgency
  • Bloating
  • Painful periods
  • Back and hip pain

The Pelvic Floor: Anatomy & Physiology

The pelvic floor comprises layers of muscles supporting the abdominopelvic organs and the lumbopelvic-hip anatomy. It has five key functions:

  1. Support: Holding up pelvic organs.
  2. Sphincteric: Controlling the passage of urine and stool.
  3. Sexual: Aiding in reproduction, childbirth, and sexual activity.
  4. Stability: Providing structural support for the lumbar spine and hip function.
  5. Respiration & Mobility: Controlling intra-abdominal pressure and promoting organ mobility.

Pelvic Wall Muscles:

  • Piriformis
  • Obturator Internus

These muscles stabilize the pelvic organs and influence their mobility.

Deep Functional Core:

  • Diaphragm
  • Transverse Abdominis
  • Lumbar Multifidi
  • Pelvic Floor

These muscles work together to maintain intra-abdominal pressure (IAP), stabilize the spine, and support internal organs. Imbalances in IAP can lead to dysfunctions like urinary incontinence and back pain.


Pelvic Floor Physical Therapy: Assessment and Treatment


  • A thorough subjective history covering sexual health, trauma, fertility, pregnancies, urination, bowel movements, exercise, sleep, energy levels, periods, and pain.
  • External and internal assessments with patient consent, including:
    • Muscle tension and specific regions of tightness.
    • Muscle strength and function testing.
    • Posture and gait analysis.
    • Abdomen, hip, and lumbar spine assessment.
    • Perineal tissue integrity check.


  • Manual Therapy: Techniques to release fascial restrictions and restore organ mobility.
  • Visceral Manipulation: Gentle osteopathic technique by French osteopath Jean Pierre Barral.
  • External & Internal Pelvic Floor Work: Passive stretching, use of dilators and wands, neuromuscular re-education, and core retraining.
  • Winback TECAR Therapy: Uses radiofrequency to stimulate tissue regeneration and provide pain relief.

Incorporation of Osteopathic Techniques

Osteopathy focuses on treating diseases caused by musculoskeletal system deviations. Techniques include:

  • Craniosacral Therapy
  • Vagus Nerve Manual Therapy
  • Visceral Manipulation

These techniques help regulate the central nervous system, often overactive in chronic pain states.

Winback TECAR Therapy for Pelvic Pain

Case Study Highlights:

A 37-year-old patient with superficial primary dyspareunia received seven pelvic floor physical therapy sessions using Winback TECAR therapy. Significant improvements were noted, including reduced pain during intercourse, improved pelvic floor muscle tone, and enhanced diaphragmatic breathing.


Winback TECAR therapy provides a therapeutic option for reducing pain and improving pelvic floor function in patients with dyspareunia.

Exercise Considerations for Endometriosis

Effective exercises include:

  • Diaphragm breathing
  • Progressive relaxation
  • Meditation
  • Pelvic floor stretching with prescribed wands or dilators
  • Hip and core strengthening
  • Self-abdominal massage
  • Bowel and bladder retraining
  • Pilates-based exercises for spinal mobility

Building Your Care Team

Endometriosis requires a multidisciplinary approach involving:

  • Pain psychologist
  • Pain physiatrist
  • Pelvic floor physical therapist
  • Acupuncturist
  • Endometriosis surgeon
  • Gastroenterologist
  • Urologist
  • OB/GYN

Your experience is real, and support is available through your care team and the endometriosis community.

Specialized Physical Therapy Brooklyn NYC

Contact Information

Inspira PT & Pilates

275 4th Avenue, Brooklyn, NY 11215 (Between Garfield & 1st) Park Slope


Contact Us:

  • Call/Text: 929-295-6566
  • Front Desk Email:
  • Dr. Melanie Carminati’s Email:

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  1. Abril‐Coello, R., et al. (2023). “Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta‐analysis.” International Journal of Gynecology & Obstetrics, 162(1), 233-243.
  2. Ahn, S. H., Singh, V., & Tayade, C. (2017). “Biomarkers in endometriosis: challenges and opportunities.” Fertil Steril, 107(3), 523-532. doi:10.1016/j.fertnstert.2017.01.009
  3. Del Forno, S., et al. (2023). “Effects of Pelvic Floor Muscle Physiotherapy on Urinary, Bowel, and Sexual Functions in Women with Deep Infiltrating Endometriosis: A Randomized Controlled Trial.” Medicina, 60(1), 67.
  4. Harlow, B. L., & Stewart, E. G. (2003). “A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia?” J Am Med Womens Assoc, 58(2), 82-88.

For more information and support, feel free to reach out to us at Inspira PT & Pilates. We are here to help you on your journey to better health and wellness.