Back Pain and the Pelvic Floor

Back Pain & the Pelvic Floor

Spine and pelvisby Clare Dingle, Physiotherapist – Women’s Health

 

Almost 50 percent of people who have back pain have weak pelvic floor muscles.  The Pelvic Floor is a deep, internal sling of muscles running between your pubic bone at the front of your pelvis, and your coccyx at the back. These muscles may be weak for a number of reasons including childbirth, if you have had surgery (eg. prostatectomy or gynaecological surgery), if you are overweight, or if you perform maximal load strength training without first engaging these muscles.

Having back pain can also lead to weakness of the pelvic floor muscles – some of the nerves from the lower vertebrae and the sacral levels of our spine supply the pelvic floor muscles. Urinary urge, stress incontinence or internal pelvic pain can be an indication that your pelvic muscles are not working well. It is important to consult a physiotherapist who specialises in women’s or men’s health to find out how to strengthen your pelvic floor muscles to eliminate this as a factor contributing to your back pain.

 

How do I know if I have weak pelvic floor muscles?

The following factors may indicate you have weak pelvic floor muscles:

  • If you have had a baby either recently or many years ago or when you have had more than three children there is a high correlation between back pain and weakened pelvic floor muscles.
  • If you experience episodes of ‘leaking’ when you cough or sneeze, which is called stress incontinence.
  • Urge incontinence; when your bladder is full you have to empty it immediately – you cannot “hold on”.
  • If you have had some form of gynaecological surgery.
  • If you are overweight.
  • If you experience respiratory problems, eg a persistent cough.

 

Helpful cues for engaging your pelvic floor muscles

Different cues will work for each person. The main thing to know is that your pelvic floor muscles may be weak at the front, middle or back. In fact they may be weak on one side and not the other but it is still helpful to retrain both sides together. If you have recently given birth, the muscles in the middle and at the front of the pelvic floor tend to be weak. The simplest way to start connecting with your pelvic floor muscles is to contract or tighten these muscles. You will feel a deep internal squeeze and lift of the whole muscle (as if stopping your urine mid stream). You should do this contraction without bracing your tummy, squeezing your glutes or holding your breath.

 

water droplet

Try this analogy:

Imagine a pebble dropping into a pool of water – pebble drops, ripples go out…

Now imagine it in reverse… ripples come in, pebble lifts.  (This is a Pelvic Floor contraction)

 

There are many other helpful cues, but if you are unsure  if you are contracting your pelvic floor muscles correctly, I highly recommend you consult a physiotherapist who can assess your pelvic floor muscles using Real time Ultrasound Imaging. For females it may also be necessary to do an internal assessment to be totally sure you are engaging your pelvic floor muscles correctly.

 

Caution: It is important not to continue to practise stopping your urine flow too frequently as this can start to over-train your pelvic floor muscles in an incorrect manner and make them tight. Tight pelvic floor muscles can create an entirely different set of symptoms. If you are uncertain of how to do a pelvic floor contraction consult a physiotherapist who specialises in pelvic floor problems.

 

 

If you are interested in reading more on this and other conditions, Francine St George’s book New Bodyworks offers further explanations and exercises for daily aches and pains.

Nerve Release

Nerve Mobility (and why it’s so important!)

Nerves

 

Your nervous system goes from the top of your head right down to your finger tips and toes. The nervous system allows us to feel both pain and sensation (sensory nerve) and allows us to contract muscles, creating movement (motor nerve).  All nerves have a definite length and this is why injury anywhere in our body can cause problems in other parts of our body. For example, a disc bulge in our lumbar spine can create tension in one or both legs – which in turn can cause pain, pins and needles, numbness or weakness.

 

The below exercise will help keep our nervous system mobile through a process called “neural flossing”.  Imagine each nerve as a piece of dental floss that glides through our muscle tissues as we move. Following injury, surgery or periods of poor or repetitive postures –  the nerve can be restricted somewhere along its path and this is where pain or nerve symptoms can start.

 

The exercise below will help you to maintain a healthy nervous system, and is of particular help if you are experiencing any of these issues:

  1. Low back pain (with or without leg symptoms)
  2. Sacro Iliac Joint (SIJ) or pelvic pain
  3. Glute (buttock) pain or spasm
  4. Recurrent hamstring or calf muscle strains
  5. Achilles or plantarfascial (sole of the foot) pain

 

Lower Limb Nerve Release

Lie on your side with both knees bent up and a towel between them.

 

Place one hand around and feel the muscles on either side of your spine. Check they are relaxed. If they are not, take your legs backwards a little until you can feel that your back muscles are totally relaxed. There must be absolutely no back pain or referred pain into the buttocks or legs in this starting position. If there is, place a small rolled up towel under your waistline until you feel your back is totally relaxed. Now flex your foot and extend the top leg at the knee, and stop as soon as you feel tightness. You may feel the back start to tighten or you may experience this as tightness in the calf or hamstring muscles. As soon as you feel this tightness, back off this tension by bending the knee, that is backing off a fully extended position. The tension wherever you are feeling it should decrease.

 

Now flex and point the foot from the ankle to loosen the nerve. Do this ankle movement five times, then rest the foot back onto the other foot in the starting position. Repeat this exercise with the foot, keeping the hips in this same position three times. Once you feel it getting a little easier then bring both your knees a little closer to your chest (a little more into flexion). Again extend the knee, and flex and point the foot.

 

Do not do the foot flexing with the nerve on full tension as this can aggravate your pain. If you experience latent pain, namely an ache that starts approximately 30 minutes after doing this exercise, then you are either doing the exercise incorrectly or it is not appropriate for you. I would recommend you consult a physiotherapist to learn how to do this exercise correctly.

58a Lower Limb Nerve Mobility_1              3b Lower Limb NM_2

 

Exercises extract from New Bodyworks, Copyright PPFC 2013

Hamstring Stretches

Are you cheating with your hamstring stretches?

Alex Sherborne, Physiotherapisttouch toes

 

Consider yourself fit but can’t touch your toes anymore?

Hamstring tightness results from both repetitive exercise and long periods of sitting. Longer, relaxed hamstrings can relieve knee and back pain, and can improve your performance when running, kicking or dancing. When it comes to lengthening and relaxing these muscles, I find people are very good at cheating (whether they mean to or not!). We have two hamstring muscles on the inside of the leg and only one on the outside, so people tend to turn their leg out to make it easier.

While you are standing, bend forward and try to touch your toes. Take a mental note of how far you get. Recheck this after doing the stretch below… If you take a few minutes to do this stretch 3 times a week, you will see a huge improvement in your hamstring flexibility over time.

Lying Hamstring Stretch

Lying Hamstring Stretch
Extract New Bodyworks – PPFC 2013

Lying Hamstring Stretch

Lie on you back with one leg bent and one straight.

Loop a belt or towel around the foot of the straight leg. Use your arms to pull the leg up until a stretch is felt behind the knee – keeping the leg straight. This should be firm, but not painful.

Once the stretch has started to relax in this position, slowly rotate the leg in- you will feel an increased stretch on the inside of the knee, then rotate the leg out to decrease the stretch- all the time keeping the leg up using your belt/towel.

Repeat for 10 – 15 seconds, relax a little, then increase the stretch by moving the straight leg a little further towards your head.

Be sure to relax your neck and shoulders, and keep breathing as you do this stretch.