By Karah Charette, DPT, PHRC Berkeley
People with pelvic floor symptoms often ask if their back and hip pain is related to their pelvic floor dysfunction. The answer a majority of the time is an unequivocal YES!
Pelvic floor physical therapists are first and foremost physical therapists– meaning we can and do work with the whole body! We start with advanced training in pelvic floor mechanics after evaluating the pelvic floor muscles and the pelvic girdle. However, we also evaluate the low back and lower extremities to achieve a truly holistic approach to your pain.
Low Back Pain
With the increase of sitting and working from home, back pain is on the rise. When you look at the anatomy of the human skeleton, you will see that the spine is directly connected to the pelvis. You may have heard that one of the most common treatments for low back pain is improving deep core strength. What most people do not recognize is that the pelvic floor muscles are part of the deep core.
The most common muscle rehabilitated with low back pain is the transverse abdominis. This is a corset-like muscle that lies deep to the rectus abdominal muscles (otherwise known as the “six pack” abs). What is not talked about enough is the fact that the pelvic floor muscles can and should be turning on with the transverse abdominis in order to create more stability at the low back and pelvis. Oftentimes in patients with low back pain, the strength and coordination of both the transverse abdominis and the pelvic floor muscles is dysfunctional and needs to be rehabilitated.
Try this at home:
- Lay on your back with knees bent and your spine in neutral.
- Inhale through your nose and exhale through pursed lips.
- As you exhale, imagine drawing your transverse abdominis in while also allowing the pelvic floor muscles to draw up.
Difficult to do or still unsure on how to do this? That is where a pelvic floor physical therapist can help!
Another issue with low back pain is that it is often misdiagnosed and people are led to believe their spine is the driver of the pain, when in reality up to 30% of low back pain cases are actually sacroiliac joint dysfunction. The sacroiliac joint (SIJ) is a joint that exists between the sacrum (flat triangular bone in your pelvis) and ilium (hip bone). Though there is still debate if this joint truly has movement, there is evidence that this joint does have pain sensitive structures and needs to be addressed more specifically in therapy.
Where do pelvic floor specialists come in? The SIJ is specifically stabilized in part by pelvic floor muscles! If you have any weakness or abnormal tightness in these muscles, your SIJ can continue to be painful and dysfunctional. A pelvic floor specialist will look more closely at this joint structure and give you the tools you need to start moving with less pain.
Hip Pain
If you are someone who has been struggling with hip pain and has gone the orthopedic physical therapy route only to plateau with progress, do not give up yet! The hip joint is directly linked to the pelvic floor and pelvic floor physical therapy can help.
When you look at the pelvic floor muscles, you will find that there are some muscles that interweave into the hip joint and work as stabilizers. There is one muscle in particular called the obturator internus that does a lot of work as both a pelvic floor and hip muscle, and therefore can often get quite tight. You may have also heard of the pesky piriformis muscle that causes a lot of hip and/or sciatic pain, and guess what? It is a pelvic floor muscle too!
These muscles are quite difficult to treat without an internal assessment and without a rehab plan that includes the pelvic floor. Working with a pelvic floor specialist can be just what you need to make that final leap of progress to eliminate your hip pain.
How Do I Choose Who To Work With?
In the medical world, a team is always better! If you are already working with a chiropractor or orthopedic physical therapist- awesome! Two pairs of eyes is better than one. With different perspectives from multiple clinicians, more can be accomplished in your journey towards healing.
If you are someone who does not feel comfortable with a pelvic floor examination, still consider working with a pelvic floor physical therapist. An internal assessment does not always need to be performed in order to address pelvic floor issues. Working with someone who knows how to guide you through exercises and cue you to increase awareness of this area is still extremely valuable when it comes to back or hip pain. You can request a session with a therapist at one of our locations here.
If you are someone who is more interested in learning how to manage movement with your pain or even begin to return to classes such as yoga or Pilates, you may also want to consider doing virtual movement sessions with me available here. One of the most important things when dealing with pain is learning how to continue to move your body safely with confidence and still have the ability to find joy and curiosity with movement.
You may find yourself saying “I’ve tried everything.” It can be exhausting to constantly search and try different methods of relief. Take a moment to ask yourself- have you tried this? Pelvic floor focused physical therapy might just be that missing piece you have needed all along. One thing’s for certain- it will not hurt you to try. You will only walk away feeling more connected to and empowered about an important and often overlooked part of your body. There is always more to learn.
______________________________________________________________________________________________________________________________________
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page or call our admin in Los Angeles, who can schedule you with any of our physical therapists: 424-293-2305.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Need a PT pelvic who knows how to work on a male — sexual issues – painful erection, bladder incontinence issues and some low back/hip issues
I live in Waco tx but we do not have any such person
Need names/contact info on experienced pelvic floor PT for male issues
Hello, We do not have a specific recommendation but this is a list of some connections we have in the surrounding area:
https://beyondtherapyandwellness.com/
https://pelvic-health-solutions.com/
North Star Abdominopelvic Physical Therapy
You can also try the pelvicguru directory or pelvicrehab.com
In my case, the pain in my groin and lower back was caused by a failed hip joint. Once the hip joint was replaced, the back and joint pain was gone.
Ruth,
Eliminating pain is a great feeling- that is wonderful to hear your replacement helped!
Regards,
Emily
Have had PT, needling, , SI joint injection
Hi Beverly, how did the PT and joint injections work out for you?
Do you have a recommendation for a Louisville, Kentucky therapist that specializes in PNE?
Thanks so much,
John
Hi John, please use the following to help locate a therapist in your area
International Pelvic Pain Society Find a Provider
Herman and Wallace Find a Provider
Pelvic Guru Provider Directory