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  • Danielle Khoury, DPT

Chronic Low Back Pain? What's the deal?

Do you deal with low back pain that has been present despite seeing a physical therapist, chiropractor or massage therapist? Low back pain is one of the most common reasons to seek out physician care. Over 80% of the population will experience an episode of low back pain at one point in their life. Recurrences of LBP are also common with the percentage of subsequent LBP episodes ranging from 20–44% within 1 year for working populations to lifetime recurrences of up to 85%. Low back pain can include the back, buttock and also referral down the leg. A big missing piece to the treatment of low back pain is the deep core, which consists of your pelvic floor, transverse abdominus muscle and multifidi. The spine starts at the coccyx(tailbone) and ends in your neck. Your pelvic floor muscles make a supporting sling from your iliums (hip bones) to your pubic bone to your coccyx. So, if you are experiencing chronic low back pain despite other treatment and have not been assessed by a pelvic floor physical therapist there is most likely your missing link!

As pelvic floor physical therapists we are assessing the function of the pelvic floor as it relates to strength, coordination and connection to the sacrum, hips and low back. We are orthopedic therapists first and foremost, as we see the importance of the connection of the hips, low back and core for optimal pelvic floor function. One study found of women reporting low back pain, 95% of them also had pelvic floor dysfunction. This included pelvic tenderness (71%), weakness (66%) and even pelvic organ prolapse (41%). Other research has tied low back pain to urinary incontinence, with nearly 80% of women with chronic back pain reporting at least occasional incontinence. The pelvic floor muscle has muscular referral points to the low back, sacrum and lower abdomen.

Now just because only women were looked at in this study does mean men are off the hook. Men have pelvic floors as well and often know less about their pelvic health due to taboo and lack of education. A major role of the pelvic floor is to stabilize the core and low back, provide support and allow for pain free mobility. It is not always clear which issue comes first; because of the pain-tension cycle if there is back pain, the pelvic floor may respond with tension to try to protect the painful area. Just like any muscle, if a tight muscle is unable to relax it will cause trigger/tension points. If you have had a back injury due to the nerve innervation, relationship of muscles and fascial connections you could be experiencing recurring back pain because the pelvic floor is holding onto tension trying to stabilize. In other cases the pelvic floor dysfunction may have first come after prostatectomy or child birth for example, and the muscle imbalance is causing more pressure and stress on the global muscles of the low back, and therefore causing back pain.


Nicole Cozean, DPT at Pelvic Sanity

Image credit : Pelvic Sanity

Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–258. doi:10.1001/archinternmed.2008.543

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