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Understanding the Overlap Between Back Pain and Urinary Issues: How Pelvic Physical Therapists Bridge the Gap

Admin on January 7, 2025

Understanding the Overlap Between Back Pain and Urinary Issues: How Pelvic Physical Therapists Bridge the Gap

Back pain and urinary issues often seem like unrelated concerns. Back pain may conjure thoughts of strained muscles or herniated discs, while urinary issues may point to bladder or pelvic dysfunction. However, these two conditions frequently intersect due to the body’s complex musculoskeletal and nervous system connections. Pelvic physical therapists (PTs), who are also trained as orthopedic PTs, are uniquely equipped to address this overlap.

The Connection Between Back Pain and Urinary Dysfunction

The pelvis and spine share critical anatomical and functional relationships. The pelvic floor muscles, which play a key role in urinary control, are intricately linked to the lumbar spine, sacrum, and hip joints. When one area is dysfunctional, it can directly or indirectly impact the other.

Here are some common scenarios:

Nerve Involvement: The lumbar and sacral spinal nerves (particularly the pudendal nerve) control pelvic floor function. A herniated disc or lumbar stenosis may compress these nerves, causing both back pain and urinary symptoms such as urgency, frequency, or leakage.
Muscle Imbalances: Chronic low back pain often leads to compensatory muscle patterns, which can overburden or weaken the pelvic floor. This may result in incontinence or pelvic organ prolapse.
Postural Changes: Poor posture, whether from prolonged sitting or injury, can misalign the pelvis and lumbar spine. This alignment issue can stress the bladder or pelvic floor muscles, creating urinary symptoms.
Stress and Tension: Stress-related conditions such as pelvic floor hypertonicity can manifest as both low back pain and bladder discomfort, as the pelvic floor muscles are in constant overdrive.

The Role of Pelvic Physical Therapists in Treating the Overlap

Pelvic PTs are uniquely qualified because they are also trained in orthopedic physical therapy principles. This dual expertise enables them to assess and treat both the musculoskeletal and visceral aspects of pain and dysfunction.

Comprehensive Evaluation

Pelvic PTs take a holistic approach to understand the root cause of your symptoms. They assess:

Spinal mobility and alignment
Pelvic floor muscle function (strength, endurance, and coordination)
Posture and gait patterns
Core stability and breathing mechanics

Tailored Treatment Plans

Treatment often involves a combination of techniques, such as:

Manual Therapy: To release tight muscles, improve joint mobility, and address fascial restrictions.
Pelvic Floor Training: Strengthening or relaxing the pelvic floor as needed to restore balance.
Core Stabilization Exercises: Targeting deep abdominal and back muscles to support the spine and pelvis.
Neuromuscular Re-education: Retraining the brain and body to work together more effectively.
Behavioral Modifications: Guidance on bladder habits, posture, and ergonomics to prevent recurrence.

Why Choose a Pelvic PT for Back and Urinary Issues?

While many orthopedic PTs can treat back pain, not all are trained to address the nuanced relationship between the pelvis and urinary system. Pelvic PTs bridge this gap, offering a unique skill set that can address both conditions simultaneously, reducing the time to recovery and improving overall quality of life.

If you’re experiencing back pain with urinary symptoms, you don’t have to manage them separately. A pelvic PT can provide the specialized care you need to uncover the connections and restore your health holistically.

Ready to take the next step?
If you’re dealing with overlapping back pain and urinary concerns, consult our pelvic physical therapists to regain control of your body and comfort in your life.

Get Started with a Pelvic Floor Specialist Today

The Truth about Kegels

Kegels have long been touted as the go-to exercise for pelvic floor health, especially for people dealing with issues like incontinence or postpartum recovery. While they can help isolate and strengthen the pelvic floor muscles, Kegels alone often fall short of delivering true functional benefits.

Why? Because our bodies don’t operate in isolation. For your pelvic floor to function optimally, it needs to work in harmony with your entire core and adapt to the dynamic movements of daily life. Without this integration, Kegels can become an exercise in futility.

The Problem with Kegels

Lack of Functional Application:
Kegels focus on contracting and releasing the pelvic floor muscles, but this movement rarely mirrors real-life demands. Your pelvic floor isn’t just called upon when you’re sitting still; it’s working when you lift, squat, walk, and breathe.

Over-Isolation of Muscles:
By isolating the pelvic floor without addressing its relationship with surrounding muscles (like the diaphragm, deep core, and glutes), you risk creating imbalances. Overly tight or weak pelvic floor muscles can lead to dysfunction, just like any other muscle in the body.

Failure to Address Coordination:
The pelvic floor works as part of a team. It should naturally contract and relax in response to movement and changes in intra-abdominal pressure (like when you sneeze or lift something heavy). Kegels don’t train this coordination, which is essential for functional pelvic health.

The Functional Alternative

To truly improve pelvic floor function, exercises must integrate the pelvic floor into whole-body movements. Here’s how:

Link the Pelvic Floor to Breathing:
Your pelvic floor and diaphragm are closely connected. Practicing diaphragmatic breathing can help you engage the pelvic floor naturally during inhalation and exhalation, training it to respond to pressure changes.

Incorporate Functional Movements:
Exercises like squats, lunges, and deadlifts—when performed with proper alignment and core engagement—naturally involve the pelvic floor. These moves train the pelvic floor to support your body during the activities you perform daily.

Focus on Stability and Coordination:
Exercises like bird dogs, bridges, and planks can help integrate the pelvic floor into larger movement patterns, ensuring it works cohesively with other muscles.

Final Thoughts

Kegels aren’t inherently bad—they’re just not the whole story. Isolating the pelvic floor can be a useful first step for some, especially in early stages of rehab. But if you want lasting results and improved function, you need to think bigger.

Train your pelvic floor to move and respond as part of a coordinated system, and you’ll not only strengthen this critical muscle group but also improve your overall movement and quality of life.

Say goodbye to endless Kegels and hello to functional movement for true pelvic floor health!