The Missing Link: Pelvic Health Physical Therapy

Did you know that there is a strong relationship between low back pain and pelvic floor symptoms in women?

A recent study identified that in more than 95% of women with low back pain, some sort of pelvic floor muscle dysfunction is present (1). This relationship also works in reverse, with findings that low back pain is more likely to develop if you have pre-existing urinary incontinence, gastrointestinal problem, or other breathing problems. Additionally, female low back pain can be linked to gynecological health, suggesting there is a stronger link between back pain and breathing, bladder or bowel health than there is even to BMI (2).

The reason for this perhaps has something to do with the unique anatomy of the Pelvic Floor Muscles. They are responsible for a wide variety of functions including engaging in breathing, supporting pelvic organs, maintaining continence, providing a role in sexual function, and interacting with the lumbopelvic region to contribute stability in our daily movements. The Pelvic Floor Muscles are also the only group to transfer loads from both above and below and have a strong relationship between the hips and abdominals (3) To illustrate the relationship to the hips, imagine the pelvic floor muscles as a hammock and your hips as the trees it is tied to. When the rope and trees are pulling very tight, they will contribute to increased tension in the pelvic floor muscles; however, if they are weak, they will decrease tension in the hammock. Muscles tend not to work to the best of their ability when they are overly taught or overly weak; and oftentimes a tight muscle is also weak. Weakness in one area of the body can directly cause overcompensation, stress, and pain in another. Also in your normal day to day movement, your pelvic floor muscles interact with your abdominals and lumbar spine through a variety of direct connections. This interrelationship provides a pivotal connection between the upper and lower body possibly explains why pelvic issues are often intertwined with all too common complaints of back pain. 

What can you do if you are experiencing persistent back pain?

Given all of this, our Physical Therapists follow recommendations to screen patients with lumbopelvic pain for signs and symptoms of pelvic floor muscle dysfunction by asking about difficulty regarding bowel and bladder problems (4). If you are experiencing back pain, you can also perform some of the tests yourself! You can find a number of functional tests that you can try at home below. In addition, our Pelvic Health PT’s have specialized training in assessment of the pelvic floor muscles to correctly identify the underlying problem(s) contributing to your symptoms. If you are concerned about your pain or dysfunction, our specialists can help!

Self-Screening Tests

Consider trying one or all of the following tests to test your pelvic floor muscle function, breathing ability, and hip mobility.


1. Dufour, Sinéad & Vandyken, Brittany & Forget, Marie-Josée & Vandyken, Carolyn. (2017). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice. 34. 10.1016/j.msksp.2017.12.001. 
2. Smith MD, Russell A, Hodges PW. Do incontinence, breathing difficulties, and gastrointestinal symptoms increase the risk of future back pain? J Pain. 2009 Aug;10(8):876-86. doi: 10.1016/j.jpain.2009.03.003. Epub 2009 May 5. PMID: 19409859. 
3. Foster et al (2021) Hip and pelvic floor muscle strength in women with and without urgency and frequency-predominant lower urinary tract symptoms. Journal of Women’s Health Physical Therapy. Volume 45, Number 3, July/September 2021 
4. Kongsted A, Ris I, Kjaer P, Hartvigsen J. Self-management at the core of back pain care: 10 key points for clinicians. Braz J Phys Ther. 2021 Jul-Aug;25(4):396-406. doi: 10.1016/j.bjpt.2021.05.002. Epub 2021 May 24. PMID: 34116904; PMCID: PMC8353288 

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What Happens During a Pelvic Physical Therapy Examination?

Pelvic Floor Physical Therapy