The Hidden Link: How Pelvic Floor Health Impacts Lower Back Pain

Introduction

Lower back pain (LBP) is one of the most common musculoskeletal complaints worldwide, affecting up to 80% of people at some point in their lives. While many treatments target the spine, muscles, and posture, emerging evidence highlights a lesser-known but crucial contributor: pelvic floor health.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles, ligaments, and connective tissues located at the base of the pelvis. These muscles support the pelvic organs (bladder, bowel, and uterus in females), assist in core stability, and play vital roles in continence and sexual function.

The Pelvic Floor–Lower Back Connection

1. Shared Core Function

The pelvic floor is a key part of the body’s deep core system, working alongside the diaphragm, deep abdominal muscles (transversus abdominis), and deep spinal muscles (multifidus). This group stabilizes the spine and pelvis during movement and load.

• Research Insight: Studies (e.g., Sapsford et al., 2001; Hodges et al., 2007) show that pelvic floor muscles activate in anticipation of trunk movements, suggesting their vital role in spinal stability.

• Implication: Weak or overactive pelvic floor muscles can disrupt core coordination, potentially increasing the strain on the lower back.

  
  

2. Muscle Imbalance and Compensation

When pelvic floor dysfunction is present—such as muscle tightness, weakness, or poor coordination—it can lead to compensation patterns in surrounding structures, including:

• Hip muscles (e.g., gluteals, piriformis)

• Lumbar spine muscles (e.g., erector spinae)

• Abdominals

  
  

These compensations can create imbalances, joint stress, and altered biomechanics, all of which contribute to or exacerbate lower back pain.

3. Postural and Breathing Patterns

The pelvic floor and diaphragm move in sync during breathing. Dysfunction in either (e.g., shallow chest breathing or pelvic floor tightness) can alter posture and increase lumbar spine load.

• Study Insight: A 2013 study published in Manual Therapy found that women with pelvic floor disorders demonstrated altered posture and breathing patterns associated with chronic back pain.

  
  

Common Scenarios We See

• Postpartum women experiencing persistent lower back pain often have underlying pelvic floor weakness or injury.

• Athletes with pelvic floor overactivity may develop back pain due to chronic muscle tension and poor load transfer.

• Office workers with prolonged sitting habits often present with both low back discomfort and pelvic floor dysfunction due to poor posture and lack of movement.

Assessment and Treatment

A comprehensive physiotherapy assessment should include evaluation of:

• Pelvic floor function (strength, coordination, and relaxation)

• Breathing mechanics

• Posture and movement patterns

• Core stability and muscle balance

  
  

 Treatment may involve:

• Pelvic floor exercises (both strengthening and relaxation techniques)

• Core retraining (using real-time ultrasound or biofeedback)

• Manual therapy for tight or overactive muscles

• Education on posture, ergonomics, and breathwork

• Integration with other therapies such as Pilates or yoga

  
  

When to Seek Help

If you experience lower back pain with any of the following, pelvic floor involvement may be contributing:

• Urinary urgency, leakage, or incontinence

• Constipation or bowel changes

• Pelvic heaviness or prolapse symptoms

• Pain during intercourse

• Difficulty activating or relaxing your core

  
  

Final Thoughts

Lower back pain isn’t always just about the spine. The pelvic floor is an integral—yet often overlooked—part of the puzzle. By addressing both musculoskeletal and pelvic health together, we can achieve better outcomes and longer-lasting relief.

References:

1. Sapsford R, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation. 2001.

2. Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics. 2007.

3. Smith MD, Russell A, Hodges PW. The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women: a longitudinal cohort study. Manual Therapy. 2013