• Lisa Shaw PT, DPT, PHC

When Low Back Pain May Not Be Low Back Pain (and some good news to help)

I want to let you in on a little secret. (Secret? Great! I love secrets!) I know, exactly!

Have you ever experienced low back pain? Don’t be afraid to say yes. In fact, 80% of people will have low back pain at some point in their lives.

Have you ever experienced low back pain that recurs or does not completely go away? Again, this is common. Recurrent low back pain remains a problem even though many interventions, including physical therapy, have been shown to help people resolve, manage and prevent pain.

Why does low back pain recur?

Wait for it…

One reason is that low back pain is often not just a low back problem. In fact, one study showed that 95% of women who presented to physical therapy with lumbopelvic pain had…you guessed it…pelvic floor dysfunction!!! This included pelvic tenderness (71%), weakness (66%) and pelvic organ prolapse (41%).1

How is pelvic floor dysfunction related to low back pain?

The 3 layers of pelvic floor muscles, and attachments into the base of the spine. Image used by permission of Pelvic Guru, LLC.

The muscles of the pelvic floor have many functions, including bowel / bladder control, support of pelvic organs and sexual function. The pelvic floor muscles are part of the core. Wait -isn’t the core the abs? Yes, the abdominal muscles are part of the deep core, but they work in concert with the back muscles, diaphragm and yes, the pelvic floor muscles to support the spine and provide control for dynamic movement.

Research shows that in the presence of pain or injury, the muscles of the core lose their ability to work together as a team. In addition, events such as surgery, pregnancy, and childbirth may also affect the normal function of the core muscles. The muscles may be weak, tight or just lose the ability to communicate properly with other muscles in the core and the rest of the body. They may have painful trigger points. Sometimes the pelvic floor muscles can be overactive; similar to how some people carry stress in their neck and shoulders. Overactivity can also affect the function of the pelvic floor muscles.

In any case, dysfunction in the pelvic floor muscles disrupts core control and how we initiate movement. Many research studies support a correlation between low back pain and pelvic floor dysfunction. Some people speculate that pelvic floor dysfunction may be one cause of low back pain. While that has not been clearly demonstrated, there is certainly a strong association between the two. Pelvic floor symptoms such as stress incontinence, bladder urgency, painful intercourse, and others may be obvious or subtle. But where there is pelvic floor dysfunction, the spine is often affected, and vice versa. If pelvic floor impairments are not addressed, a cycle of dysfunction can develop, leading to persistent or recurrent low back pain.

Can physical therapy help with this? The good news is…

Absolutely. Just because your pelvic floor muscles have not been previously evaluated

The pelvic floor, the diaphragm, the hip, and some of the spinal muscles attaching into the pelvis and the spine. Image used by permission of Pelvic Guru, LLC.

does not mean you are destined for a life of low back pain, sacral pain, tailbone pain, and/or hip pain. The key to successful treatment is to evaluate both the pelvic floor and surrounding regions and determine how each area of the body affects the function of the others. Because the hips, pelvis and lumbar spine are so closely related it is not sufficient to simply evaluate or treat one region without respecting the others.

Stay tuned for an upcoming post describing how a patient’s back pain of 10 years was resolved with treatment that included her pelvic floor as part of her treatment plan.

Think your pelvic floor may be a part of your persistent or recurrent low back pain?

Don’t use a “wait and see” approach, contact us today and schedule an evaluation with one of our physical therapists.

Have a friend who you think would benefit from this information? Share this article and spread the word!

1. Darfour S, et al. Association between lumbopelvic pain and pelvic floor dysfunction in women: a cross sectional study. Musculoskeletal Science and Practice. 2018;24:47-53.

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