Bringing Things into Balance: The Relationship Between Low Back Pain and the Pelvic Floor

By: Katie Parrotte, PT, DPT, OCS, CFMT

Adapted by Fiona McMahon PT, DPT

Back Pain or Fitness (2)

Low back pain is common. Almost a quarter of the population in a one month period will experience low back pain and 11.9% of people will experience low back pain on any given day. Back pain can be so frustrating both to experience and to treat because we don’t yet have clearly defined risk factors for the development of low back pain, nor predictors of its outcome. Most patients don’t present with significant physiological or anatomical findings and the pain from low back pain can jump around to different locations and may change in intensity and or character.

So how do we treat low back pain?

There are honestly many different ways to go about treating low back pain and treatment depends on both how you present as well as your clinician’s area of expertise. Spinal manipulation ( high velocity thrusts), trunk coordination and stabilization, endurance exercise, and patient education have all been shown to be helpful in improving pain and function in people with low back pain. Sometimes, these interventions may not be the be all end all to curing back pain. When this happens, it is time to look at another area of the body that plays a significant role in stabilizing the low back, the pelvic floor.

The Pelvic What? How does that affect low back pain?

The pelvic floor is the group of muscles that live between your pubic bone in front and your tailbone in back. Basically, it is the area that you sit on when you ride a bicycle. Several studies listed below have investigated adding in gentle pelvic floor strengthening into standard back pain rehabilitation. These studies found that both isolated strengthening and strengthening the pelvic floor together with core muscles to be effective in reducing low back pain and decreasing episodes of urinary leakage in individuals with urine leakage.

The Relationship Between the Pelvic Floor and the Low Back

From a pelvic floor physical therapist’s perspective it makes logical sense that addressing the pelvic floor would help with back pain. The pelvic floor is one of the key muscle groups that contributes to the stability of your back. The other muscles that are involved are your diaphragm (respiratory muscle), transverse abdominis (deep core muscle), and the deep muscles of the low back. We have seen in the research that the pelvic floor will act to stabilize the spine with arm or leg movement, just prior to that movement in pain free women. An unhealthy pelvic floor that lacks strength will not be able to do its part to contribute to back stability.

To Wrap it all up: TLDR

The pelvic floor is an important stabilizer of the spine and pelvis, and activates just prior to movement to allow for efficient function. Addressing the pelvic floor is often an important component to addressing back pain in addition to conventional physical therapy approaches.

If you or someone you know is struggling with unresolved low back pain, make an appointment with a pelvic floor physical therapist today for further assessment. Feel free to contact our midtown office at 212-354-2622 or our downtown office at 212-267-0240, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

Sources

1. Beattie PF. 2016. Current concepts of orthopedic physical therapy – the lumbar spine: physical therapy patient management using current evidence, 4th edition. (p. 3) Orthopedic Section – APTA.

2. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64 (6): 2028-2037. doi:10.1002/art.34347.

3. Ghaderi F, Mohammadi K, Sasan RA, et al. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and on urinary incontinence in women. Urology. 2016; 93: 50-54.

4. Mohseni-Bandpei MA, Rahmani N, Behtash H, et al. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork & Movement Therapies. 2011; 15: 75-81.

5. Bi X, Zhao J, Liu Z, et al Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research. 2012; 41 (1): 146-152.

6. Sjodahl J, Gutke A, Ghaffari G, et al. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the active straight leg raise in women with and without pelvic girdle pain: an experimental study. Clinical Biomechanics. 2016; 35: 49-55.

7. Stuge B, Saetre K, Hoff BI. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. Manual Therapy. 2013; 18: 327-332.

8. Sjodahl J, Kvist J, Gutke A, et al. The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain. Clinical Biomechanics. 2009; 24: 183-189.

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