The Voice and the Pelvic Floor: Why Three Diaphragms Belong in Your Assessment

A faculty spotlight on Dr. Ginger Garner and her upcoming remote course at Herman & Wallace.

The respiratory diaphragm and the pelvic floor have been clinical neighbors in pelvic rehab for decades. The vocal diaphragm, sitting at the top of the same fascial highway, has been largely missing from the conversation. Dr. Ginger Garner, PT, DPT, ATC-Ret, is changing that with her Voice to Pelvic Floor (V2PF) Method, and her short-format remote course at Herman & Wallace returns on Saturday, June 27, 2026.

What is the Voice to Pelvic Floor Method?

The Voice to Pelvic Floor approach is a systems-based, trauma-informed framework for evaluating and treating three connected diaphragms: the vocal and oropharyngeal complex, the respiratory diaphragm, and the pelvic diaphragm. These structures share fascial connections, neuromuscular pathways, and pressure regulation responsibilities. Vocalization, continence, and core stability all depend on how those three systems coordinate.

Dr. Garner developed V2PF to give pelvic health clinicians a more comprehensive lens, particularly for complex cases involving trauma, hormonal transitions, hypermobility, and persistent pain that has not responded to standard pelvic interventions.

The respiratory diaphragm has been part of pelvic rehab for decades. The voice has been missing from the same conversation.

Why should pelvic health clinicians assess the voice?

The voice is a clinical biomarker for pressure regulation. Hormonal shifts, particularly the estrogen decline of perimenopause and menopause, alter vocal endurance, pitch range, and tissue hydration in patterns that mirror changes in pelvic tissue elasticity and continence. Trauma also leaves footprints on the voice, with research linking psychogenic voice disorders to traumatic stress histories (Baker, 2003). When voice is missing from the assessment, those signals get missed too.

Polyvagal pathways and the emotional motor system connect vocalization to the same autonomic and somatic networks that govern pelvic organ function (Holstege, 2016). For patients carrying trauma histories, pressure pain conditions, or stress-driven voiding patterns, the voice is often the clearest window into the system you are already trying to treat.

What will you learn in this course?

The Voice and the Pelvic Floor is a short-format remote course delivered through Zoom, with didactic content followed by interactive lab activities. Participants leave with:

• The anatomy and physiology of the three diaphragms and the fascial and neuromuscular links between them
• A four-pronged V2PF assessment covering respiratory mechanics, core and pelvic floor, orofacial and vocal function, and psychosocial determinants
• Evidence-based vocal techniques you can apply as clinical interventions for pelvic floor and core dysfunction
• A trauma-informed, polyvagal-informed framework for sensitive cases, including survivors of intimate partner violence, sexual trauma, and birth trauma

References

Baker, J. (2003). Psychogenic voice disorders and traumatic stress experience: A discussion paper with two case reports. Journal of Voice, 17(3), 308 to 318.

Garner, G. (2024). The voice and the pelvic floor. The Pelvic Rehab Report, Herman & Wallace Pelvic Rehabilitation Institute.

Holstege, G. (2016). How the emotional motor system controls the pelvic organs. Sexual Medicine Reviews, 4(4), 303 to 328.

Holstege, G., & Subramanian, H. H. (2016). Two different motor systems are needed to generate human speech. Journal of Comparative Neurology, 524(8), 1558 to 1577.