Pelvic Health Tip of the Week: Low Back Pain and Pelvic Floor Dysfunction Are Connected – But Possibly Differently Than You Think
As you know, our team hosted the 3rd annual PelviCon conference back in September. We were able to bring over 600 pelvic floor therapists together for a weekend of learning and community. We had amazing speakers-- experts from around the world! We covered topics from exercise progressions postpartum to uterine fibroids and PCOS to post-prostatectomy rehabilitation to hypermobility and the pelvic floor... and honestly, so so much more! As we move forward over the next few months, I am excited to slowly start sharing some of the important nuggets from this conference with all of you in our community.
The relationship between low back pain and pelvic floor muscle dysfunction
Today, I want to focus on some of the information presented by the incredible Dr. Sinead Dufour on low back pain and pelvic floor dysfunction. The relationship between low back pain and pelvic floor muscle dysfunction has been well-established in the literature. Sinead and her colleagues explored and published a landmark study on this in 2018 – and this study is well-quoted by pelvic floor therapists across social media and beyond. In this study, they found that 95% of people with lumbopelvic pain had some form of pelvic floor dysfunction, the majority of which had a combination of pelvic floor muscle weakness and tenderness on palpation.
This relationship is often explained by therapists in a very biomechanical sense. I would be lying if I told you that I hadn't personally explained it this way in the past! This has to do with the established relationship we know the pelvic floor muscles have with the muscles of the low back, lower abdomen and respiratory diaphragm. These muscles together help to modulate pressure in the abdomen and pelvis and also provide dynamic stability to the spine and pelvis during movement. We know that these relationships exist, however, interestingly enough-- as more research has grown, we have learned that these relationships do not necessarily explain the true relationship we see between lumbopelvic pain and pelvic floor dysfunction – particularly pelvic floor muscle tenderness.
Recommended Reading
So, Sinead and her colleagues went on to study specific predictors of pelvic floor muscle dysfunction amongst people with lumbopelvic pain. What they found was that pelvic floor muscle tenderness was predicted by complaints of urinary urgency as well as a Central Sensitization Inventory Score above 40. What is the Central Sensitization Inventory? This is a form that patients complete that helps us identify how protective their nervous system is. We know that the nervous system is very important when it comes to understanding pain. If this is new to you – I would encourage you to check out some of the past blogs we've written:
common threat response to the nervous system
So, jumping back to Sinead's study... These results help us to see that the correlation between low back pain and pelvic floor muscle tenderness may be less biomechanical and more related to a common threat response to the nervous system. This common "threat" response makes a lot of sense if we remember the prior research regarding the pelvic floor muscles. Van der Velde's study in 2001 (which is one of my favorite studies!) found that viewing a "threatening" video clip led to increased pelvic floor activity amongst women with and without vaginismus (painful sex). We also see the relationship between central sensitivity (high threat response) and pelvic floor muscle tenderness in other populations as well, as was shown by Cardaillac and colleagues in 2021 for people with chronic pelvic pain.
So, what does this mean in practice?
It means that the providers you are working with HAVE to consider what is happening across you as a full-person--- not focus solely on a specific structure. The reality is that we are people--with brains, nerves, muscles, fascia etc – and our body is interconnected. So, when we look at someone dealing with pain, we can't just focus on the painful structure, but we have to explore what is happening around the body that is contributing to that pain. Sometimes, this means diving in to body mechanics. Sometimes, this means addressing the whole nervous system. Sometimes, it means exploring habits- sleep- nutrition. And sometimes, it means something else all together!
If you've been struggling with pain and want a fresh look, reach out and let me know! We have an awesome team and we'd be happy to help you!!
Get In Touch With Dr. Jessica Reale
Southern Pelvic Health offers services in Atlanta as well as remote virtual consultations.