Is Your Pelvis the Key to Unlocking Chronic Lower Back, Hip and Foot Pain?

Many people are aware of the benefits of physical therapy to treat common orthopedic conditions such as back and hip pain. However if your condition isn’t resolving with traditional orthopedic PT intervention, your pelvic floor may be at the root of your pain.

Most of us can talk to friends and family about our back pain, exchanging symptoms and helpful suggestions at a cocktail party, but we hardly ever mention symptoms involving sexual and genitourinary issues such as vaginal, rectal or lower abdominal pain.

Some of the most common “orthopedic” conditions that may be due to an underlying pelvic floor dysfunction include lower back, hip and foot/ankle pain.

1. Low Back Pain

Based on the type of discomfort you feel in your low back, you may be able to tell if the cause is pelvic floor. In his article Musculoskeletal Causes of Chronic Pelvic Pain, Dr. Anthony Gyang reports when back pain feels vague and poorly localized, unilateral, aching, throbbing, and/or heavy this might indicate that pelvic dysfunction is the cause.

In addition, you may experience a sensation of pelvic floor heaviness or pressure. Signs that your pain may be connected to a “hypertonic” or “tight” pelvic floor include acute

attacks of pain that awaken you at night, radiation of the pain to your sacrum, and pain with sex. In women, this is often referred to as dyspareunia. For men it may manifest as erectile dysfunction. Low back pain that starts in the afternoon and get progressively worse as the day goes on may indicate the presence of Levator Ani Syndrome, overly tight pelvic floor muscles. These flares may be constant for days at a time, or occur suddenly with short duration.

The reason for this relationship has to do with the role the
pelvic floor plays in stabilizing your low back. During many activities, your Multifidus, Transverse Abdominis and Pelvic Floor work together as a 3-point brace to keep your spine in line. When one of these muscles malfunction, it can put stress on the other two, resulting in pain.

2. Hip Pain

The muscles that provide stability and allow motion of the hip attach to the pelvic floor muscles so if you’re experience hip pain, there may be underlying pelvic floor dysfunction.

Three common causes of hip pain include hip osteoarthritis, labral tears and femoroacetabularimpingement (hip impingement). Each condition reflects a deviation from proper hip biomechanics, and may be influenced by dyssynergic (improperly functioning) musculature. Two of the muscles that are both part of the pelvic floor and help control our hips are the Piriformis and the Obturator internus. Both of these muscles assist in rotating the leg out and in stabilizing the head of the femur into the hip socket. If the hip socket is unstable, it can cause stress to these muscles, thereby causing stress to the pelvic floor as a whole, and vice versa.

3. Foot & Ankle Pain

Though you are more likely now to hear from your PT about how your ankle and foot issues may be affecting joints and muscles throughout your leg and lower back, the connection between ankle/foot and pelvic floor are addressed much less frequently. In the case of treating athlete's foot there are many ways to do this at home, read this article to learn more. Several studies now link increased activity of the ankles to increased activity of your pelvic floor muscles.
When the mechanics of your lower legs are changed due to an ankle sprain, flat feet, fractures, orother foot and ankle conditions, it’s likely that the activity of your pelvic floor musculature may be affected as well.

In addition, if you’re experiencing foot pain and having difficulty identifying the cause, there may be a phenomenon known as “smudging” happening in the brain.

Your brain has a virtual map of your body on an area called the sensorimotor cortex. Hundreds of thousands of brain cells or neurons represent different body parts. To find the foot on our virtual map, see that it’s in-between the knee and genital/pelvic region. With prolonged foot pain or disuse, the brain cells of the foot recruits the cells that lie next to that body part on the virtual map. Therefore, when you are experiencing foot pain for long periods of time, your brain may begin to smudge the “pelvic area” or vice versa.

If you feel that you may fall into one of the categories listed above, or if you have any other reason to believe that your pelvic floor may be involved in your current condition, we would recommend seeing a physical therapist that specializes in pelvic health. The good news is that the brain and nervous system can be retrained (due it’s neuroplasticity) so healing can be achieved no matter how long you may have suffered with persistent pain.

References: 1.

  1. Chen, H., Lin, Y., Chien, W., Huang, W., Lin, H., & Chen, P. (2009). The Effect of Ankle Position on Pelvic Floor Muscle Contraction Activity in Women. Journal of Urology, 181(3), 1217-1223. doi:10.1016/j.juro.2008.10.151
  2. Prather, H. (2002). Musculoskeletal Evaluation for Pelvic Pain. Female Pelvic Health and Reconstructive Surgery, 241-261. doi:10.3109/9780203908938-16
  3. Pelvic, Sexual Intercourse, and Abdominal Pain can be Simple or Complex. (n.d.). Retrieved
  4.  February 22, 2019, from
  5. Muscolino, J. (n.d.). Muscles of the Pelvis. Retrieved February 22, 2019, from
  6. Vandyken, C., & Hilton, S. (2019). The Puzzle of Pelvic Pain: A Rehabilitation
  7. Framework for Balancing Tissue Dysfunction and Central Sensitization II: A Review of
  8. Gyang, A., Hartman, M., & Lamvu, G. (2013). Musculoskeletal Causes of Chronic Pelvic Pain. Obstetrics & Gynecology, 121(3), 645-650. doi:10.1097/aog.0b013e318283ffea Treatment Considerations. Journal of Womenʼs Health Physical Therapy, 36(1), 44-54. doi:10.1097/jwh.0b013e31824e0ab4

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