Low back pain and sacroiliac (SI) joint pain work hand in hand with pelvic floor dysfunction. Low back pain and sacroiliac pain can be the result of pelvic floor muscle weakness or pain, or the low back pain and sacroiliac pain can cause problems for the pelvic floor muscles and functioning. Therefore, it is important to be examined by a physical therapist who can specifically analyze the symptoms to get to the root of the problem. In many cases, the pelvic floor is exactly what needs to be assessed if back pain persists after all other orthopedic based treatments or if there is pelvic pain in addition to the low back or sacroiliac joint pain.
Symptoms
– Low back pain
– Sacral pain
– Sacroiliac joint pain (SI joint)
– Pain throughout front or back of hip
– Pain into the butt or legs
– Feeling of instability throughout the pelvis and pain in back/hips with activity
Causes
As stated above, musculoskeletal pain can either cause pelvic floor disorders such as pelvic floor muscle spasms, or the pelvic floor dysfunction can cause musculoskeletal pain. When the pain starts as pelvic floor dysfunction, the pain can refer to various areas including the back, sacroiliac joint, and the abdominals. This is known as referred pain. In some cases, the pelvic floor dysfunction may be weakness or spasms of the pelvic floor muscles and the symptoms are low back pain with activity. The pelvic floor muscles are in fact the deepest layer of the core muscles, so they provide a lot of support for the low back and sacroiliac joints. If they are too weak, they cannot properly support the lumbar spine and pelvis during activity.
In other cases, patients may have had low back pain for a period of time and eventually developed pain with sex, pelvic pain, or new hip pain. Many times, patients think that it is referred pain from the back, but it actually may be pelvic floor spasms that are a result of the low back pain. Therefore, it is important to be upfront with any and all symptoms, even if you are not sure they are related, to be certain you get the correct treatment.
Diagnosis
Your physical therapist will perform a thorough evaluation to assess your symptoms and identify the cause of the problem. Being the evaluation will be internal and external, you and your therapist will work together to ensure your comfort throughout the entire process. The internal portion of the evaluation will include an internal assessment of the muscles of the pelvic floor to check for pain, tightness (or spasm), and strength. If your therapist feels you may need further examination or testing, she will refer you to an MD.
Treatment
Treatment for musculoskeletal pain will depend on your presentation. Your therapist is also an orthopedic trained physical therapist who will be able to target treatment to the overlap of orthopedic and pelvic floor symptoms, with a focus on the actual cause. She will address both the pelvic floor and musculoskeletal pain through manual and therapeutic exercise, as needed. Manual therapy may include release of the pelvic floor muscles through manual pressure to the targeted muscles and/or strengthening of the pelvic floor muscles. Exercises will focus on your specific needs and home exercises will be discussed to further your gains and get you pain free again.