The Link Between Lower Back Pain and Pelvic Health
Lower back pain is incredibly common, particularly during pregnancy, after having a baby, and as our bodies change throughout life. But if you've been experiencing lower back pain alongside pelvic health symptoms, you may have wondered whether the two could be connected.
The answer isn't always straightforward.
Your lower back and pelvis work together whenever you sit, stand, walk, lift, exercise, or simply move through your day. The muscles around your abdomen, back, hips and pelvic floor also work together to support movement and manage pressure. This doesn't mean that lower back pain is always caused by a pelvic floor problem. It simply means that looking at the whole picture can sometimes help us understand why symptoms are persisting.
How Are the Lower Back and Pelvic Floor Connected?
The pelvic floor is a group of muscles at the base of your pelvis. These muscles help support the bladder, bowel and pelvic organs. They also contribute to continence, sexual function and movement.
The pelvic floor doesn't work on its own. It works alongside the diaphragm, abdominal muscles, back muscles and muscles around the hips to help support your body and manage pressure as you move.
For example, when you lift something heavy, cough, sneeze or exercise, several muscle groups coordinate to respond to the increased pressure through your abdomen and pelvis.
This is one reason why pelvic health physiotherapy isn't always just about the pelvic floor.
Does Lower Back Pain Cause Pelvic Floor Problems?
It's important not to assume that one problem automatically causes the other.
However, persistent pain can change the way you move and use your muscles. You may unconsciously brace or tense certain muscles because your body is trying to protect an area that feels uncomfortable.
For some people, this may include the pelvic floor.
The opposite can also happen. Changes in pelvic floor function may occur alongside altered movement or muscle coordination elsewhere in the body.
There isn't one simple relationship between the lower back and pelvic floor. Instead, they are part of a larger movement system.
What About Pelvic Pain and Lower Back Pain?
Pelvic pain and lower back pain can sometimes occur together.
Some women may notice discomfort across the lower back, hips and pelvis at the same time. Others may experience pain in one area that seems to affect another.
There can be many possible contributing factors, including musculoskeletal conditions, pregnancy-related changes, previous injuries, pelvic floor muscle dysfunction and some pelvic health conditions.
This is why it can be difficult to identify the cause based on symptoms alone.
A thorough history and assessment can help determine what may be contributing.
Can Pelvic Floor Muscles Be Too Tight?
Yes.
When people hear "pelvic floor", they often immediately think about weak muscles and strengthening exercises.
But pelvic floor muscles also need to relax.
For some women, the muscles may be overactive or have difficulty relaxing and coordinating normally. This can sometimes be associated with pelvic pain, discomfort with intercourse, difficulty emptying the bladder or bowel, or other pelvic health concerns.
If this is contributing to your symptoms, simply doing more strengthening exercises may not be the most appropriate approach. The goal may instead be improving relaxation, coordination and the ability to respond appropriately to different activities.
What Does Breathing Have to Do With It?
Breathing is another part of the picture. Your diaphragm and pelvic floor work together as part of your body's pressure management system.
When you breathe in and out, the diaphragm moves, and the pelvic floor responds as part of this coordinated system. If you're experiencing pain or regularly holding your breath and bracing your abdominal muscles, this coordination may change.
Learning to breathe normally and coordinate your breathing with movement can therefore be useful for some people. This doesn't mean that breathing exercises are a universal solution for back or pelvic pain. As with any treatment strategy, they need to be appropriate for the individual.
Pregnancy Can Change the Relationship Between Your Back and Pelvis
Pregnancy places additional physical demands on the body. As your baby grows, your centre of mass changes, your abdominal wall stretches, and your joints and muscles adapt to accommodate your changing body.
You may also experience changes in your activity levels, sleep, posture and movement.
Lower back and pelvic pain are common during pregnancy, but that doesn't mean you have to simply put up with significant or persistent discomfort. A physiotherapist can help you understand what's contributing to your symptoms and provide strategies for movement, activity modification and symptom management.
What About After Having a Baby?
The physical changes don't stop when your baby is born.
Your body is recovering from pregnancy and, depending on your birth experience, may also be recovering from vaginal birth, caesarean birth, perineal trauma or surgery.
At the same time, caring for a newborn can involve a lot of lifting, feeding, carrying and prolonged positions.
Sleep deprivation can make everything harder too.
If you're experiencing ongoing lower back or pelvic pain after birth, it may be helpful to consider how your whole body is recovering rather than focusing on one muscle group.
Could My Hips Be Part of the Picture?
They could be.
The hips, pelvis and lower back work closely together during everyday movement.
Walking, climbing stairs, getting up from a chair, lifting your child and exercising all require coordination between these areas.
Hip strength, mobility and movement patterns may therefore be relevant when assessing someone with lower back or pelvic symptoms.
This doesn't mean that every pelvic health problem is caused by weak hips.
It means that a comprehensive assessment considers the areas that may be contributing to your individual symptoms.
What Can Help?
The most appropriate approach depends on what's causing or contributing to your symptoms.
Depending on your situation, management may include:
Staying active within your current level of comfort
Gradually modifying activities that aggravate your symptoms
Strengthening appropriate muscle groups
Improving muscle coordination
Learning strategies for lifting and everyday movement
Addressing pelvic floor muscle tension or weakness where relevant
Improving confidence with movement
Managing contributing bladder or bowel symptoms
Working with your GP or other healthcare professionals when needed.
The aim isn't necessarily to avoid every movement that causes discomfort.
Instead, it's often about finding ways to move that are appropriate for your current capacity and gradually building from there.
When Should You Seek Help?
Consider speaking with a healthcare professional if your lower back or pelvic pain:
Persists or keeps returning
Interferes with work or daily activities
Makes exercise difficult
Affects sleep
Is affecting your sexual function
Occurs alongside bladder or bowel changes
Is limiting your confidence with movement
Isn't improving despite the strategies you've tried
You don't need to wait until your symptoms become severe before asking for help.
If you're experiencing new, severe or unexplained symptoms, particularly neurological symptoms or changes in bladder or bowel control, seek appropriate medical assessment promptly.
How Harmony Pelvic Health Approaches Lower Back and Pelvic Symptoms
At Harmony Pelvic Health, we don't look at the pelvic floor in isolation.
Ndapile combines her expertise in pelvic health and musculoskeletal physiotherapy to consider how different parts of your body may be contributing to your symptoms.
Your assessment may include discussion of your pelvic health symptoms alongside your movement, lower back, hips, breathing, activity levels and medical history.
The goal isn't to find one body part to blame.
It's to understand the bigger picture and work out what may be contributing to your symptoms.
Your treatment is then tailored to your goals, your symptoms and what you feel comfortable with.
Frequently Asked Questions
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Pelvic floor exercises may be appropriate for some people, particularly when pelvic floor weakness is contributing to their symptoms. They aren't a universal treatment for lower back pain, however. The right approach depends on your individual assessment.
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Hormonal changes can affect the vaginal and surrounding tissues, making them drier, thinner and less elastic. Pelvic floor muscle tension and other factors may also contribute.
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An overactive pelvic floor may contribute to pelvic pain and other symptoms, and it can occur alongside changes in muscle coordination elsewhere in the body. However, it's important not to assume that a tight pelvic floor is the cause of someone's back pain without assessment.
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Yes. A physiotherapist with pelvic health and musculoskeletal training can assess both areas and consider how they may be interacting. Treatment will depend on what's contributing to your symptoms.
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Not necessarily. In many situations, staying active and gradually adapting exercise can be helpful. However, the appropriate level and type of activity depends on your symptoms and overall health.
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Not necessarily. If you're experiencing back pain without pelvic health symptoms, a standard musculoskeletal assessment may be appropriate. If you're also experiencing bladder, bowel, sexual or pelvic symptoms, discussing these with a pelvic health physiotherapist may provide a more complete picture.
Key Takeaways
Your lower back, pelvis, hips and pelvic floor work together during everyday movement.
Lower back pain doesn't automatically mean you have a pelvic floor problem.
Pelvic floor muscles can be weak, but they can also be overactive or have difficulty relaxing.
Pregnancy, childbirth, activity levels and musculoskeletal factors can all influence symptoms.
Looking at the whole body can sometimes provide useful information when lower back and pelvic symptoms occur together.
Treatment should be based on your individual symptoms rather than assuming one exercise or approach will work for everyone.
