Low back pain is a common ailment. It can affect people at any age, and most people will experience it at some point in their lives.  According to the World Health Organization, low back pain is the single leading cause of disability worldwide. It can lead to lost time from work, decreased participation in recreational activities, and reduced quality of life. It is considered a significant public health concern and creates a large financial burden on individuals and society.

There is mounting evidence that the pelvic floor may play a key role in the management and treatment of low back pain. But you may be asking, how are they connected?

First, let’s talk about the pelvic floor. The pelvic floor is a group of muscles that span the bottom of the pelvis. With contraction, they elevate, and with relaxation they soften and lower. They move up and down, like the movement of a trampoline. While good strength in these muscles is important, so is mobility – the ability to move and work through their full range of motion.

Over the past several years there seems to be an increase in public interest in the pelvic floor, particularly on social media. You may have heard of its role in preventing urine leakage. That is an important part, but not the only job of the pelvic floor. 

The pelvic floor plays several key roles:

1. Sphincteric – the pelvic floor works to prevent the leakage of urine, stool, and gas. It relaxes to allow for urination and bowel movements.
2. Stability – the pelvic floor is a part of our “inner core” muscles, which also include the diaphragm, deep abdominal muscles, and some of the spinal muscles. These muscles work together to stabilize the back and pelvis, and transfer load from one side of our trunk to the other.
3. Support – the pelvic floor provides support for pelvic organs, working with ligaments and pelvic fascia to keep the organs in place.
4. Sexual – the pelvic floor muscles contribute to arousal and reflexively contract during orgasm.
5. Sump pump – contraction and relaxation of the pelvic floor helps to move blood and lymphatic fluid up into the trunk.

A study carried out by a team of Canadian researchers helps us begin to understand the relationship between lower back pain and the pelvic floor. Their study determined that 95% of women presenting for physiotherapy treatment for lower back or pelvic pain were found to have some form of pelvic floor dysfunction. A large majority of these women presented with either weakness, or increased tension in their pelvic floor muscles.

There is also some evidence showing us that the reverse needs to be considered. People with symptoms such as urine leakage, pelvic pain, and bladder urgency, should also be well-screened for lower back involvement. Some studies have shown that specific interventions for the lower back can change urinary symptoms.

So, we know that there is a connection between low back pain and the pelvic floor. However, the ‘why’ behind this link is not yet fully understood and is likely due to a variety of factors. Anatomically for example, part of the pelvic floor attaches to the tailbone, or coccyx, which is at the very bottom of the spinal column.  As mentioned earlier, there is also a motor connection between the pelvic floor, and the trunk and spinal muscles. These muscle groups are meant to work together as a well-timed system. Additionally, the pelvic floor seems to have an innate protective response. The pelvic floor muscles have been shown to hold tension when our brains perceive we are being threatened.

If lower back, pelvic, or hip pain is an ongoing issue, an evaluation by a physiotherapist with training in pelvic health could shed some light on contributing factors that have not yet been considered. It is possible that changing muscle tension, or strength in the pelvic floor, could impact lower back symptoms. Looking at the ‘bigger picture’ has the potential to result in decreased pain and improved outcomes.

Jan Plumb, BScPT, Registered Physical Therapist, Pelvic Floor Rehabilitation

Core Connection Mobile Physiotherapy
Victoria BC
Admin@coreconnectionphysio.com 
250-999-0568

See all articles by Jan Plumb