By Karah Charette, DPT 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.
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 book 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. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page or call Kristin 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.