Low Back Pain That Won’t Go Away? Your Pelvic Floor Might Be Involved
Persistent low back pain may not always come from the back itself, but from poor pelvic floor and deep core coordination that forces the low back to compensate.
Key Points
Persistent low back pain is not always caused by the back itself; sometimes the back is compensating for poor support from the deep core system.
The pelvic floor is part of the deep core, along with the diaphragm, deep abdominals, and spinal stabilizers, and it helps manage pressure and support the spine.
Pelvic floor dysfunction can involve weakness, excess tension, or poor coordination, so treatment should focus on restoring how the pelvic floor and deep core work together.
When Low Back Pain Keeps Coming Back
Have you tried resting, massages, stretches, exercises, or literallyanything to help treat your low back pain but it does not seem to go away? There have been many patients who have come into physical therapy with this nagging low back pain they have been experiencing for weeks, months, or years. They usually share with me how they have tried different exercises or treatments to get some sort of relief. Some of these patients will get a little relief but their pain will quickly return. Some of these patients will not get any relief at all.
But sometimes low back pain persists not because the back itself is injured, but because another part of the body responsible for stability, like the pelvic floor, is not functioning properly. Your pelvic floor is part of the deep core system that stabilizes the spine. When it is not working properly, the low back often compensates.
Your Core Is More Than Just Your Abs
Some patients have come into physical therapy and have shared that they have been working on sit ups to help strengthen their core. While this does target a part of our core, it is important to understand that there are many components that contribute to our core. Specifically, we have our deep core that is meant to stabilize our trunk.
We have touched on this in a previous blog post, but for a quick recap, our deep core system includes:
Diaphragm
Deep abdominals; transverse abdominis
Spinal stabilizers; multifidi
Pelvic floor
Our deep core system manages pressure and stability by coordinating their muscle activity to manage the load our spine endures through day to day activities. This system helps support the spine during movement and when one part is not working well, other areas compensate. With the pelvic floor forming the base of this system, it directly plays a role in how your spine is supported during daily movement.
How The Pelvic Floor Supports Your Spine
When it comes to the pelvic floor, the muscles may be underactive, overactive, or poorly coordinated. Any of these patterns can affect how well the deep core stabilizes the spine. When the pelvic floor is not functioning properly, the low back often works overtime to compensate.
Sometimes the back is not the source of the problem - it is the area trying to make up for missing support.
An underactive pelvic floor may lack the ability to contract effectively to support surrounding structures like the pelvis, hips, and low back. Think of it like the foundation of a house. If the foundation is unstable, it struggles to support everything built on top. In the same way, when the pelvic floor cannot provide enough support, the low back may become overworked.
An overactive pelvic floor is a little different. Instead of lacking strength, the muscles may be holding too much tension. Imagine making a tight fist and holding it all day. At first the muscles are working, but over time the hand becomes tired, stiff, and less functional. If someone asked you to squeeze even harder, you probably could not. An overactive pelvic floor behaves similarly. The muscles are already tightly contracted, which makes it difficult for them to relax, coordinate, or generate strength when needed.
A pelvic floor that lacks coordination may struggle with timing. The muscles may be strong enough, but they do not contract or relax at the right moment. Think of the deep core like an orchestra. The diaphragm, abdominal muscles, spinal stabilizers, and pelvic floor all have their own instruments to play. When they work together, movement feels smooth and controlled. But if one section comes in too early, too late, or not at all, the music sounds off. A lack of coordination in the pelvic floor works the same way - the system loses harmony, and the body may compensate elsewhere.
Signs Your Pelvic Floor Might Be Contributing To Your Back Pain
Pelvic floor dysfunction does not always present with obvious pelvic symptoms. In many cases, low back pain may be the primary complaint, which is why the pelvic floor is often overlooked. However, there are certain signs that may suggest the pelvic floor is involved.
You may notice:
Persistent or recurring low back pain
Pain that continues to return despite stretching, strengthening, or rest may indicate that the deeper stabilizing system of the spine is not functioning optimally.
Hip or pelvic discomfort
Tension or pain around the hips, pelvis, or tailbone can sometimes be related to pelvic floor dysfunction.
Leaking with coughing, sneezing, running, or exercise
Urinary leakage during higher-impact activities can indicate that the pelvic floor is struggling to manage pressure effectively.
Pelvic heaviness or pressure
A sensation of heaviness or pressure in the pelvis may suggest that the pelvic floor is not adequately supporting the pelvic organs.
Constipation or difficulty emptying the bladder
When the pelvic floor muscles cannot relax properly, bowel and bladder function may also be affected.
While these symptoms may not always occur together, their presence alongside persistent low back pain may indicate that the pelvic floor is playing a role.
Addressing The Root Of The Problem
If the pelvic floor is contributing to persistent low back pain, treatment focuses on restoring how the deep core system works together. Pelvic floor physical therapy does not just focus specifically on the pelvic floor. Instead, it looks at your whole deep core system. That is right - we will have to take a deeper dive into looking at how your diaphragm, deep abdominal muscles, spinal stabilizers, and pelvic floor muscles are functioning.
Treatment may include:
Improving breathe mechanics
The diaphragm and pelvic floor move together with each breath. Learning how to use diaphragmatic breathing helps regulate pressure in the abdomen and reduces unnecessary strain on the low back.Restoring pelvic floor balance
Depending on the individual, the pelvic floor may need to become stronger, learn to relax, or improve its timing during movement. Treatment focuses on restoring this balance rather than simply strengthening the muscles.Rebuilding deep core coordination
Exercises are designed to retrain the deep core muscles to work together again so the body can create stability more efficiently.Improving movement patterns
Daily movements such as lifting, bending, or exercising are often adjusted to help the body manage pressure and load more effectively.
When the deep core system begins working together again, the low back no longer has to compensate as much. Over time, this can reduce pain and improve overall stability during everyday activities.
The Takeaway
If low back pain continues to return despite stretching, strengthening, or rest, it may be worth looking deeper than the back itself. The pelvic floor plays an important role in supporting the spine as part of the deep core system. When these muscles are underactive, overactive, or not coordinating well with the rest of the core, the low back often works overtime to compensate.
Addressing how the pelvic floor and deep core function together can help restore stability and reduce strain on the low back. Sometimes the missing piece to persistent back pain is not the back at all - it is the foundation supporting it.
DISCLAIMER
This article is for educational purposes only and is not intended to diagnose, treat, or replace individualized medical care. Low back pain, pelvic floor symptoms, urinary changes, bowel changes, or pelvic pressure can have many possible causes, so if you are experiencing persistent pain or new symptoms, consult a licensed healthcare provider or pelvic floor physical therapist for a proper evaluation and treatment plan.
