Written By: Dr. Carol Beck, PT, DPT

There is a children’s song called ‘The Skeleton Dance’ that I often think of while explaining the connections to the pelvis and pelvic floor. It sings, “The hip bone’s connected to the backbone, the backbone is connected to the neck bone, the neck bone’s connected to the head bone” and so on through the body. Although this song may be simplified and not use all the proper terminology, it is a good reminder of the interconnectedness of the musculoskeletal system. Within physical therapy, we call this principle the “kinetic chain,” which explains how a movement or change along any point in our body’s system will have effects up and down that chain.

Although many areas of the body can affect the pelvic floor, the hips, and lower back play especially pivotal roles that directly influence the pelvic floor’s health and function. Understanding this intricate relationship is crucial for anyone looking to improve their overall well-being, which is why we emphasize a whole-body approach to pelvic floor issues such as incontinence, pelvic pain, and pelvic organ prolapse.

The Pelvic Floor: A Quick Overview
The pelvic floor muscles are a small group of muscles that sit at the base of the pelvis and help support the bowel, bladder, and reproductive organs. When these muscles function correctly and have good strength, mobility, and coordination, they contribute to urinary and fecal continence, sexual health, and the stability of the pelvis and spine.

The Hip Connection
Your hips are central to maintaining the alignment and balance of your pelvis and supporting the pelvic floor. Since many of the muscles that control the hip attach to the pelvis and tailbone, imbalances in these muscles can shift the position of the pelvis and, in so doing, affect the pelvic floor’s position, causing compensations. The hips and pelvic floor muscles are closely linked, with imbalances or weaknesses in one area often reflected in the other. For example, tight hip flexors (the muscles at the front of the hips) can tilt the pelvis forward, putting extra strain on the pelvic floor. The gluteal muscles, located in the buttocks, and the adductors, located in the inner thigh, are considered synergists with the pelvic floor, which means that because of the shared nervous system connections, they often work in conjunction with the pelvic floor. These muscle groups also have fascial connections to the pelvic floor, which increases their relationship. If these muscles are weak, they may provide insufficient support to the pelvic floor, or if they are tight, they may create increased tension on the pelvic floor, both of which can contribute to pelvic floor dysfunction such as pain or leakage. As we work with patients, we ensure that their hips can move comfortably through various motions and have enough strength to support the pelvis and pelvic floor.

The Role of the Low Back
The lower back, or lumbar spine, is another critical player in pelvic floor health. Like the hips, the lower back directly attaches to the pelvis and connects the abdominals, lower back musculature, and pelvic floor muscles. Therefore, imbalances here can affect how well the pelvic floor works. The nerves that control the pelvic floor muscles also originate in the mid and lower back, so weakness or stiffness can affect pelvic floor function.

Low back pain and pelvic floor dysfunction are strongly related, with evidence suggesting that issues in one area can significantly impact the other. In one study, up to 95% of women with low back pain also had pelvic floor dysfunction (Dufour 2018), and pelvic floor issues and breathing issues are more strongly related to low back pain than obesity or physical activity (Smith 2006). Chronic low back pain can lead to compensatory patterns that weaken pelvic floor function. Conversely, pelvic floor issues such as incontinence and pelvic pain increase the risk of developing lower back pain because the pelvic floor muscles work to stabilize the back and play a crucial role in how our body manages pressure and if the pelvic floor is not functioning well it affects the low back (Smith, 2014; Eliasson, 2008). These findings underscore the importance of a comprehensive treatment approach that addresses both the pelvic floor and low back to manage and alleviate symptoms effectively.

The Importance of a Holistic Approach
By recognizing how these parts of the body influence one another, you can take proactive steps toward maintaining balance, strength, and flexibility in all three areas. Whether through physical therapy or targeted exercise routines, addressing the health of your hips and lower back is a powerful way to support your pelvic floor and enhance your overall quality of life. Incorporating exercises that target these areas can not only alleviate existing discomfort but also prevent future issues. By addressing the health of your lower back and hips through posture correction, strengthening, and flexibility exercises, you can support your pelvic floor muscles, which can help support your lower back and reduce the risk of future issues.

If you visit us, you can feel confident that we can assess your musculoskeletal system to find any root causes and create an individualized treatment plan! Because we work outside the traditional insurance-based model, we can look at any area of your body and treat it as needed to ensure that your whole body system is moving optimally and working in harmony. We can work on anything from head to toe that is contributing to your concerns. If you have hip, lower back, or pelvic floor problems, call us at 801-702-8475 to set up an evaluation at one of our clinics in Utah and see the difference in having a whole-body approach for yourself!

Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross-sectional study. Musculoskelet Sci Pract. 2018 Apr;34:47-53. doi: 10.1016/j.msksp.2017.12.001. Epub 2017 Dec 9. PMID: 29268147.

Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008 Jun;13(3):206-12. doi: 10.1016/j.math.2006.12.006. Epub 2007 Mar 23. PMID: 17363318

Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52(1):11-6. doi: 10.1016/s0004-9514(06)70057-5. PMID: 16515418.

Smith MD, Russell A, Hodges PW. The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women: a longitudinal cohort study. Clin J Pain. 2014 Feb;30(2):162-7. doi: 10.1097/AJP.0b013e31828b10fe. PMID: 23486234