Low back pain (LBP) is one of the most common musculoskeletal symptoms people experience, shared by more than 500 million people globally, according to a 2020 data analysis (1). The burden of LBP goes beyond the economic costs of doctor visits, imaging, testing, and interventions. It also manifests in the form of missed social activities and recreation, and disruption of daily routines. It is associated with worse mental health and is a leading contributor to missed work and job-related disability.
It is not uncommon for people to experience low back pain that lingers despite typical treatments including physical therapy and exercise, chiropractic care, massage, acupuncture, medications, injections, or surgery. In these cases, the pelvic floor muscles may be the missing piece in relieving pain and returning to normal life.
Connection Between Lower Back Pain and the Pelvic Floor
Most research that evaluates the connection between low back pain and pelvic floor dysfunction has included female participants, and several studies have found correlations between the presence of low back pain and pelvic floor dysfunction. A 2018 study of 182 participants showed that 95% of those who were experiencing lumbopelvic pain also had pelvic floor dysfunction (2). If the pelvic floor component of low back pain is missed or untreated, there is a chance the back pain will continue.
Furthermore, there is an abundance of research to show that imaging findings of the lumbar spine, such as X-rays, are poorly correlated to pain. Most people who have degenerative spine changes, such as degenerative disc disease or signs of arthritis, have no pain at all. This points to the fact that often, normal age-related changes to the spine are not the primary driver of pain (3). Therefore, it is essential to consider other influences that may be contributing to ongoing pain, such as the pelvic floor muscles.
Why Would Pelvic Floor Muscle Dysfunction Contribute to LBP?
There are several connections between the pelvic floor muscles and the lower back. This may explain the correlations found in research and the importance of evaluating the pelvic floor muscles when back pain does not resolve with typical treatments.
However, there is a gap in research when it comes to determining the exact mechanisms behind the correlation between the pelvic floor and LBP. Most likely, there are different factors at play for each individual and in many cases, multiple physical and psychosocial contributors to ongoing pain. Examples of psychosocial contributors include:
- Sleep
- Social support
- Stress management
- Health-related beliefs
- Prior experiences.
The pelvic floor can also influence symptoms in the lower back via attachments to the tailbone, pain referral patterns, the role of the pelvic floor as part of our ‘core’ system, and the role of the pelvic floor in bowel function.
- Tailbone attachment: All pelvic floor muscles attach either directly or indirectly to the tailbone and can cause mobility restrictions, position changes, and pain in this area. The tailbone, therefore, is a structural connection point between the pelvic floor muscles and the lower back.
- Pain referrals: Tender points in the pelvic floor due to overuse or excessive tension can create patterns of pain that travel elsewhere in the body. This can include the lower back, tailbone, hips, abdomen, legs, and pelvic organs (bladder, rectum, uterus and ovaries, prostate).
- Core system: Most people think of their core as consisting only of the abdominals. However, the core system is made up of the abdominal muscles, back muscles, diaphragm, and pelvic floor muscles. This system is responsible for managing pressure within the body and creating stability from our center to support movement. If a component of this system is not working properly, or the entire system does not work well together, it can result in altered movements and pain.
- Bowel function: A healthy pelvic floor is essential for going to the bathroom normally. If the pelvic floor muscles have difficulty relaxing during a bowel movement, or we habitually hold in bowel movements, this can result in constipation. Constipation is associated with increased lower back pain (4).
Self-Screening for Pelvic Floor Dysfunction
If you are experiencing lingering low back pain, it can be valuable to consider if you have any other symptoms that may indicate pelvic floor dysfunction. If you notice that you are having any of these symptoms, talk to your physician about seeing a pelvic floor physical therapist to evaluate the pelvic floor muscles.
- Bladder symptoms - incontinence, needing to rush to the bathroom, or trouble urinating.
- Bowel symptoms - incontinence, constipation or needing to strain to have a bowel movement.
- Other pain symptoms - painful intercourse or other pelvic pain.
- Pelvic-organ prolapse symptoms – the feeling of heaviness or something ‘falling out’ of the vagina or feeling a bulge at the vaginal opening.
Seeking Treatment
The
Spaulding Outpatient Center for Pelvic Health at Care New England has multiple providers throughout Rhode Island who can assess and treat pelvic floor dysfunction. To be seen by a pelvic therapist, you will need a physician referral. To learn more information or schedule an appointment, click here:
https://www.carenewengland.org/spaulding-pelvic-health-rehabilitation
Disclaimer:
The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
References:
1. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth FM, Smith E, Buchbinder R, Hoy D. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299. doi: 10.21037/atm.2020.02.175. PMID: 32355743; PMCID: PMC7186678.
2. Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskelet Sci Pract. 2018 Apr;34:47-53. doi: 10.1016/j.msksp.2017.12.001. Epub 2017 Dec 9. PMID: 29268147.
3. Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021 Feb 12;372:n291. doi: 10.1136/bmj.n291. PMID: 33579691; PMCID: PMC8023332.
4. Arai YC, Shiro Y, Funak Y, Kasugaii K, Omichi Y, Sakurai H, Matsubara T, Inoue M, Shimo K, Saisu H, Ikemoto T, Owari K, Nishihara M, Ushida T. The Association Between Constipation or Stool Consistency and Pain Severity in Patients With Chronic Pain. Anesth Pain Med. 2018 Aug 11;8(4):e69275. doi: 10.5812/aapm.69275. PMID: 30250817; PMCID: PMC6139698.