Back Pain and the Pelvic Floor

by 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.

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.