Health promotion / Prolapse

What is the link between pelvic floor and back pain?

19. June 2019

Very often, we associate the pelvic floor to urinary leaks or intimacy, but the pelvic floor, which is situated around the anus and genital orgasms and that spreads from the pubis to the front of the coccyx is far more essential than what many of us think. It can be the source of several health problems like the painful low back pain.

The back is subject to constraints in the day because of activities of the daily life but also during the night because of the lying position maintained for several hours. Even if generally speaking, the back appreciates the movement and doesn’t like the maintained immobility, it influences and is influenced by different factors. Lower back pain can have many causes, that are often misidentified, and many consequences among which some are linked to the pelvic floor.

Here are the main ones:

Posture, lower back pain and pelvic floor:

Back pain can modify the posture and a bad posture can provoke lower back pain. A bad posture can have consequences on the pelvic floor. Indeed, the vagina has an oblique orientation: the top is oriented backwards, and the bottom is oriented frontwards, as you can see on the following diagram:

When this organization is associated to a normal lumbar curve, it protects the organs of the lesser pelvis, which rely on top of each other, and more generally, on the pelvic floor. In case of a bad posture, the forces applied on these organs can be modified and troubles can appear in the long term.

In case of a too curved lumbar, the vagina’s axis loses its usual orientation (from the back to the front) and becomes vertical. The cervix goes on top of the vagina. Associated to other factors (bad position, strong abdominal push, chronical cough, pelvic floor weakness…) it can start to collapse slowly: this can lead to a prolapse.

When the back is curved forward, this is what we call a kyphosis. The diaphragm presses on the abdominal organs, the pelvic pressure increases, and the organs apply pressure on the pelvic floor (we can notice an impression of heaviness in the lower abdomen).

Here, in the case of a pregnant woman, the idea is the same and the size of the blue (demander à Marie) arrows depends on the applied force.

Better understand the muscle chains

The pelvic floor muscles, like other muscles in the body, don’t function independently. They are linked to other muscles in the form of “muscle chains”

For example, the most known muscle chain is the leg posterior muscle chain that gathers hamstrings, calves, and foot arches. It is because of the chain that it is complicated to rise a straight leg because all the muscles are stretched, whereas it is much easier to raise it with a slightly bended knee (that would de-stretch the hamstrings).

The pelvic muscles work simultaneously with back muscles and abdominals. The pelvic floor is once again the center of it, because it is located in the intersection between the 2 biggest muscle chains: the posterior chain and the front chain.

The muscle chains were described by Françoise Mézières, a French physiotherapist. She has developed a care concept based on stretches. According to her, muscular retractions can provoke pain or further compensations on these chains.

So, a lack of flexibility or a bad tonus can affect the pelvic floor, and inversely.

This list of links between the pelvic floor and the lower back pain is a non-exhaustive list, but it helps to understand that the body is more than just a gathering of independent organs. Each organ is influenced by others and the body must be represented as a whole.

How to avoid lower back pain?

Back pain can occur because of a bad move, an over-requirement, etc. It can be interesting to take a few minutes to analyze pain:

  • Does it come in the morning? During the night? In the evening, after a long workday?
  • Is it caused by a particular move? A special posture?
  • Is it improved by massage? Heat? Stretching?

 These indications will help you identify what causes the pain and what relieves it.

In any case, the back likes and has to move! But be careful not to do painful movements, because the worst is not moving, being immobilized. Let’s not forget that the word “physiotherapist” comes from the old Greek and means “heal by movement”.

The sports we recommend you are soft sports like walking, swimming, gym, and you can try yoga or pilates as well.

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