Why the pelvic floor muscles may be the “missing link” in chronic low back pain

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I’m a physical therapist that has a unique specialty: pelvic health and women’s health. I work in an office surrounded by orthopedic physical therapists who sometimes struggle to understand why I became interested in the pelvic floor.

I had been a physical therapist for many years when I began to need a change of direction in my career. I began to have children which allowed me to transition from outpatient physical therapy focusing on neurological conditions and chronic pain to post-surgical inpatient physical therapy during the early years of my children. I then began to transition back into outpatient physical therapy. It was after the birth of my third daughter that I realized I had pelvic floor problems. After her delivery I had been struggling with pelvic pain related to a precipitous labor—which means a very rapid labor under three hours—in which my pelvic floor muscle tore from the force of labor. One afternoon about six weeks into my recovery, I was placing a somewhat heavy box on the floor when I felt something drop in my pelvic area. It caused me to feel a bit queasy in my stomach—I knew something was definitely wrong. After I drudged up enough courage to see my physician, I found out I had uterine prolapse. It was during this recovery time that I was asked by my manager to attend a pelvic health class to start a women’s health program. I reluctantly agree to attend the course, wondering if this type of therapy was for me. Once I was at the course, I was enthralled with the topic of pelvic health and in awe at how physical therapists can help women. In fact, I began to heal from pelvic pain at that course and embarked on a several year journey where I revitalize my career, healed my body, and developed a passion for helping men, women, and children with pelvic dysfunction or pregnancy/postpartum conditions.

As I began treating women with pelvic dysfunction, I often noticed how much their long standing back and sacroiliac (SI) pain improved even though I was treating their pelvic floor. Addressing the pelvic floor muscles in women with chronic low back pain has been an amazing addition to my “toolbox”. There is research is that supports the strengthening of pelvic floor muscles with chronic low back pain:

  • Bhatnagar in 2017 found that comparing pelvic floor exercises combined with routine treatment provided significant benefits with pain and disability over routine treatment alone (Bhatnagar and Manisha)[1]
  • Ghaderi in 2016 found that women who perform core stabilization exercises including pelvic floor muscles improved both low back pain and incontinence (Ghaderi, Mohammadi and Sasan)[2]

The pelvic floor muscles are part of the anticipatory core, which includes the respiratory diaphragm, pelvic floor muscles, transversus abdominis, and multifidi back muscles. This means that these muscles tighten before other muscles begin to work. For instance, if I think about moving my arm, my anticipatory cores are already contracted then I use the muscles for moving my arm.

When I evaluate someone for pelvic floor dysfunction, I may also include elements of a vaginal or rectal pelvic floor muscle evaluation if indicated. This is examination looks at how the muscles function externally by observing the perineum, and internally palpating the pelvic floor muscles. My examination is different than your physician, who is looking at organ health from a physician’s perspective. I look at strength, endurance, coordination, and general fitness level of your pelvic floor muscles. If appropriate, I will show you how to use your pelvic floor muscles with your core muscles for whole different type of core stabilization. Incorporating the pelvic floor muscles can really be the missing strength component of your home program and road to recovery.

All of our physical therapists at Integral Physical Therapy are trained to identify those patients who may have pelvic floor dysfunction that may be impacting their back pain. If your physical therapist refers you to me, know that this may be the piece of the puzzle you have been missing to addressing your back pain.