How are my low back, hip, and pelvic floor connected?

July 5, 2024 | Author: Katie Zerr, PT, DPT, PRPC



As a pelvic health physical therapist, I’ve encountered many patients who suffer from persistent low back and hip pain despite trying various treatments like chiropractic care, acupuncture, massage therapy, and even physical therapy. When a patient comes in with this type of history, I am curious about how the pelvic floor might be a contributor to their symptoms, as the functions of the low back, hips, and pelvic floor are interconnected. Understanding the relationship between low back, hip, and pelvic floor is crucial to treating and managing the issue effectively. In this post, I’ll explain why we often link these conditions together and share insights on how pelvic health physical therapists assess and treat these issues.


How are they all connected?

The pelvis and lower back are deeply interconnected both anatomically and functionally. The lumbar spine (lower back) and the pelvis share many muscles, ligaments, and nerves. For instance, the gluteal muscles, hip flexors, and pelvic floor muscles all contribute to pelvic stability and lower back support. When there is an issue in one area, it often affects the other. Here are some primary examples:

Muscle Imbalances and Weaknesses
  • Core and Pelvic Floor: Weak core muscles, including the pelvic floor, can make the pelvis unstable, putting extra stress on the lower back. At the same time, low back pain can weakencore and spinal muscles, forcing your body to compensate. This can lead to pelvic floor muscle problems, creating a cycle of pain and dysfunction.
  • Gluteal Muscles: Weak or tight gluteal muscles can change pelvic alignment, affecting your movement and contributing to low back or hip pain. Additionally, overactive gluteal muscles can also increase pelvic muscle tension.
Postural and Biomechanical Issues
  • Sitting and Standing Posture: Ideally, standing evenly on both legs is the best for your body’s alignment. However, if there’s been an injury, patients often tend to sit or stand in ways that help them avoid pain, usually putting more weight on one side. This uneven weight distribution can increase muscle tension on that side and cause weakness on the other, affecting the low back, hip, or pelvic floor muscles.
  • Movement Patterns: Poor movement patterns, like improper lifting techniques or faulty gait mechanics (how you walk), can cause pain in the hips, low back, and pelvis. Correcting these patterns is crucial for relieving the pain.


Common conditions and diagnoses

There are many different conditions that involve the connection between the low back, hip, and pelvic floor. Here are a few of the most common ones we see:

Sacroiliac Joint Dysfunction:

The sacroiliac (SI) joint connects the sacrum (a triangular bone at the base of the spine) to the iliac bones of the pelvis. Dysfunction here can cause pain in the low back, hip, and pelvic floor due to changes in muscle tension.

Piriformis Syndrome:

The piriformis muscle runs from the sacrum to the top of the femur and passes through the sciatic notch. If this muscle spasms or becomes tight, it can compress the sciatic nerve, causing pain in the lower back, buttocks, and down the leg. The pudendal nerve, which innervates many of the pelvic floor muscles, also exits the sacrum in the same area, and can also become irritated in this area.

Pelvic Floor Dysfunction:

This can manifest as pelvic pain, hip or lower back pain, urinary urgency or incontinence, and pain during intercourse. Some patients will report pain that is hard to find by touching directly at the low back or hip. During a pelvic muscle assessment, they are surprised that the pain they have been feeling in the low back is coming from somewhere much lower than they thought.


How is it treated?

It’s important to utilize a holistic and integrative approach to managing low back, hip, and pelvic pain to get a complete picture and accurately treat the issue. Here are some of the strategies we use:

  1. Comprehensive Assessment: A thorough evaluation can identify the root causes of the pain by assessing posture, movement patterns, muscle strength, and flexibility. A pelvic muscle assessment can also be particularly helpful when other treatment strategies haven’t worked, as it often reveals the “missing link” to finding pain relief.
  2. Mobility and Stretching Exercises: Deep breathing combined with pelvic muscle, hip, and low back stretching to can help improve overall mobility.
  3. Strengthening and Stabilization Exercises: Depending on the causes of the pain, specific exercises focused around the core, pelvic floor, and hip muscles can provide better support and alignment.
  4. Postural Training: Education on proper posture and breathing during daily activities and exercises can improve coordination of the pelvic, core, and hip muscles, reducing stress on the low back, hips, and pelvis.
  5. Manual Therapy: Techniques like massage, myofascial release, and joint mobilizations can address muscle tightness and joint dysfunction.
  6. Lifestyle Modifications: Making ergonomic adjustments as needed to help maintain an active lifestyle and support overall musculoskeletal health.
  7. Mind-Body Connection: By identifying the specific stress and mental health impacts on muscle tension in various areas of the body, we can incorporate stress management techniques such as mindfulness and relaxation exercises to further treat the issues.


Putting it all together

The relationship between low back/hip pain and pelvic pain is intricate and multifaceted. We, as pelvic health therapists, can provide more effective and holistic care by understanding the connections between various areas. By addressing the underlying causes and taking a comprehensive approach to treatment, we can more effectively alleviate pain, improve function, and enhance the quality of life for those dealing with these interconnected issues.

If you are experiencing low back, hip, or pelvic pain, don’t hesitate to contact us for more information and learn how you can get started with a thorough evaluation and personalized treatment plan. Together, we can work towards a pain-free healthier you!

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