There are many things that influence low back pain. There is a growing body of evidence showing the relationship between low-back pain and pelvic floor dysfunction.
Low back pain is one of the most common musculoskeletal problems people experience. We see clients with a wide variety of issues ̶ everything from an acute injury such as a lower back strain to more chronic issues like degenerative disc disorder facet joint osteoarthritis. We employ an active physical therapy approach to help clients get back to their full routine.
Unfortunately, in a handful of people the pain can persist for months, if not years, despite treatment focused on the low back, including physiotherapy, massage therapy, acupuncture and doctor visits. However, these treatments have not led to a complete resolution of their symptoms and other causes need to be considered. Pelvic floor dysfunction might be the missing piece.
In this article, we will review how the pelvic floor impacts the back, how common the link is between low back pain and pelvic floor dysfunction and how pelvic health physiotherapy can help someone return to normal functioning.
Table of Contents:
- The pelvic floor dysfunction and low back pain connection
- The role of pelvic floor physiotherapy in low back pain
- Pelvic floor strengthening exercises
- Self-screening for pelvic floor dysfunction
- Conclusion
The Pelvic Floor Dysfunction and Low Back Pain Connection
The pelvic floor muscles play a key role in the support and function of the low back. Some ways pelvic floor muscles impact the low-back include:
- Back Mobility: Many of the pelvic floor muscles attach around the tailbone. Since the tailbone acts a connecting point between the pelvic floor and low back, if there are mobility restrictions in any of the muscles this can than result in changes in mobility in the low back.
- Referral Pain of the Muscles: Many of the muscles can refer pain into the low back, hips, abdomen, legs or tailbone. If you are experiencing pain in your low back, hips or abdomen, this might actually be your pelvic floor trying to get your attention!
- Core/Stability: The pelvic floor plays a part of our core /stability system, along with the diaphragm, transverse abdominal muscles and small back stabilizing muscles (i.e., the multifidus). If this system is not working well during movement, it can result in compensatory patterns and/or extra stress on the pelvic floor muscles.
In addition to these reasons, it is important to note that although individuals may not have the “typical” symptoms that allude to a pelvic floor issue, it is still possible that there is dysfunction in these tissues. For example, on internal examination, you might notice that some areas feel tight or are more sensitive than others.
You may also enjoy reading: 5 Important Roles Pelvic Floor Muscles Play
The Role of Pelvic Floor Physiotherapy in Low Back Pain
It is often believed that Kegels are the only exercises involved in pelvic floor retraining. However, this is far from the truth. Your physiotherapy will take a look at your posture, breathing pattern, functional movements, and your low back and hip range of motion to get an appreciation of what might be contributing to your pain.
In addition, pelvic health physiotherapists have additional training in internal examination. They can determine if there are any tender points that could be contributing to the back pain, determine the tone in the muscles of the floor (often, but not always, increased tone in the muscles can lead to sensitive areas that may refer to the low back) and the coordination of the pelvic floor with core activation and breathing pattern.
After the assessment, your physiotherapist will help you determine a treatment plan. The plan may include relaxation exercises (if there is more tone or pain in the pelvic floor), pain education, manual therapy and strengthening exercises. In fact, lots of research has shown a positive impact on pelvic floor muscle training reducing low back pain.[i]
The addition of pelvic floor strengthening into a low back stability program has been shown to significantly reduce pain and improve function more than doing the stabilization exercises alone.[ii]
You may also enjoy reading: Lower Back Pain Treatment
Pelvic Floor Strengthening Exercises
Your exercises will focus on coordinating your breath and the contraction of your muscles (the core and pelvic floor). The “inner core unit” is made up of the diaphragm on top, the pelvic floor on the bottom, the core muscles (namely the transversus abdominis) in the front and the multifidus in the back.
Often, exercises begin with trying to coordinate the breath with the relaxation (inhalation) and contraction (exhalation) of the pelvic floor. The exercises then progress to coordinating this with functional movements such as deadlifts and squats.
Exercise 1: Crook Lying Pelvic Floor Contractions
Lie on your back with your knees bent and feet flat on the ground. Hands on the inside of your hip bones breathing in, think of relaxing the pelvic floor. This will help with seeing if the transverse abdominal muscles are engaging. You should not feel any contraction under your fingertips at this time.
As you exhale, contract the pelvic floor. Think of pulling in a ping-pong ball. Think of pulling the ping pong ball up a little more and contract your transverse abdominal. You should feel a contraction under your fingertips at this time.
Relax and repeat.
Exercise 2: Squat
Slightly stick your bum out as you go into a squat, as you go down the pelvic floor muscles lengthen. Inhale as you go down into a squat. Keep the transverse abdominal muscles engaged. As you return to standing contract the pelvic floor muscles.
You may also enjoy reading: Pelvic Floor Exercises for Incontinence
Self-Screening for Pelvic Floor Dysfunction
If you have been experiencing low back pain and you have also noticed any of the symptoms below, a pelvic floor assessment would be beneficial for you.
- Pelvic pain: this would include things such as painful intercourse or general pelvic pain.
- Leakage/incontinence: if you find yourself having to run to the bathroom to avoid an accident, or experience any leakage during physical activity, coughing, and/or sneezing.
If you are still wondering if pelvic health physiotherapy is for you, contact the clinic to schedule a consult call with one of our pelvic health physiotherapists to discuss the potential involvement of the pelvic floor.
You may also enjoy reading: Prolapsed Uterus Treatment
Conclusion
The pelvic floor muscles play a key role in the support and function of the low back. Therefore, it is important to consider the connection to pelvic floor dysfunction in individuals who have experienced low back pain for a prolonged period of time.
A pelvic floor physiotherapist can look at your posture, breathing pattern, functional movements, and range of motion, in addition to an internal examination of pelvic floor muscles to get an appreciation of what might be contributing to your pain.
Our pelvic health physiotherapists will work with you to create a plan that gets you get back to doing what you love! Contact us to book a complimentary consultation to find out how we can help you.
References
[i]Kazeminia M, Rajati F, Rajati M. The effect of pelvic floor muscle-strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials. Neurol Sci. 2023 Mar;44(3):859-872. doi: 10.1007/s10072-022-06430-z. Epub 2022 Oct 7. PMID: 36205811.
[ii]Abdel-Aziem AA, Abdelraouf OR, El-Basatiny HMY, Draz AH. The Effects of Stabilization Exercises Combined With Pelvic Floor Exercise in Women With Nonspecific Low Back Pain: A Randomized Clinical Study. J Chiropr Med. 2021 Dec;20(4):229-238. doi: 10.1016/j.jcm.2021.12.008. Epub 2022 Apr 6. PMID: 35496721; PMCID: PMC9051137
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