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  • Nicole Cozean, PT, DPT, WCS

The Reason Your Low Back Pain Won't Go Away

Updated: Jul 29, 2022

Low Back Pain that Won't Go Away?

If you have lingering low back pain or sciatica that just won't go away, you're likely missing an important component. You've probably been to an orthopedic physical therapist and done a few exercises for your low back. Or a chiropracter, who cracked and aligned the back. Or maybe massage or acupuncture for pain relief. Many times these treatments don't stick, and a few days later (if that) your low back or sciatica pain returns. You aren't getting to the underlying "why" of your symptoms for lasting relief, and a big part of that is the pelvic floor.

Pelvic Floor Dysfunction Causing Chronic Low Back Pain

The missing piece is often the pelvic floor and pelvic floor dysfunction; this is the reason the pain won't go away.

Muscles that attach to and support your pelvis and tailbone include back muscles, abdominal muscles, glutes and other hip muscles, as well as a small set of muscles at the base called your pelvic floor. If your pelvic floor is not getting assessed and treated, you are missing a huge piece of the puzzle that is chronic low back pain.

These pelvic floor muscles are secondary stabilizers for the back, and often spring into action when the back is in pain. They can then be actually CAUSING more pain themselves, and are the reason orthopedic treatment doesn't "stick."

As pelvic floor physical therapists, we’ve always known there is a close relationship between the pelvic floor and low back pain. For many of our patients, one of the first symptoms they notice is sciatica or other low back pain; often, they don’t realize it might be related to their pelvic floor until their initial evaluation. Recent research has shown this is even more prevalent that we realized.

How Do I Know if Pelvic Floor Dysfunction is Causing My Low Back Pain?

First of all, it's extremely likely that pelvic floor dysfunction is at least contributing to back pain symptoms that won't go away. In one study of chronic low back pain, 95% of people also had pelvic floor dysfunction! They had been getting treatment for years - orthopedic physical therapy, chiropracters, acupuncture, and even surgery - without results!

Because they weren't getting to the underlying "why" of what was going on for lasting relief!

Other research has tied low back pain to urinary incontinence, with nearly 80% of women with chronic back pain reporting at least occasional incontinence.

Low Back Pain and Pelvic Floor Dysfunction
Is the Pelvic Floor the Reason Your Back Pain Won't Go Away?

Do You Have Any Pelvic Floor Symptoms?

Do you have any pelvic floor symptoms you didn't realize were related to your low back pain? These can include pain with intercourse, constipation, urinary urgency/frequency (having to urinate more than 6 times daily), incontinence, and other symptoms.

Take the free Cozean Screening Protocol to check for pelvic floor dysfunction!


Who are We at PelvicSanity?

At PelvicSanity, it's our mission to support patients with pelvic pain and pelvic floor symptoms, regardless of where you live. We can help with:


Does Pelvic Floor Dysfunction or Back Pain Come First?

It’s not always clear which comes first. A major role of the pelvic floor is to help stabilize the core and lower back, so when the back is in pain, the pelvic floor muscles may tighten to try and protect the sensitive area. This can overwork the pelvic floor, causing trigger points to form in the muscles and creating additional symptoms (see graph below). In other cases, the pelvic floor dysfunction may have come first and altered the spine's mobility and stability, thus triggering low back pain. Either way, there is a feedback loop where low back pain and pelvic floor dysfunction reinforce each other. Both must be addressed for full resolution of symptoms.

Graph of Low Back Pain and Pelvic Floor Dysfunction
95% of People with Low Back Pain have Pelvic Floor Dysfunction!

Resolving Chronic Low Back Pain and Sciatica

This is why it’s so important to address both the internal and external causes. A traditional orthopedic physical therapist will address the common causes of low back pain and prescribe some stretching and strengthening exercises for the low back. However, many patients will find that the treatment doesn’t ‘stick’ - they feel better for a few days, but lasting relief is elusive. In these cases, the pelvic floor dysfunction isn’t being addressed, so the low back regresses and gets pulled back into dysfunction.

Low Back Stretch

The same issues arise when only the internal pelvic floor muscles are treated. Even if the trigger points in the pelvic floor are cleared out and a strengthening program put in place to resolve weakness, if the lower back isn’t addressed the pelvic floor dysfunction will simply reoccur. For true healing to occur, both the pelvic floor and low back must be addressed together.

How to Get that Back Pain to Finally Go Away!

So what does this mean for the treatment of low back pain? Our philosophy is that complex low back and pelvic floor patients need at least an hour of hands-on physical therapy with a pelvic PT who can address both the internal and external aspects of the issue.

However, it can be difficult to find this kind of hands-on treatment philosophy in today’s medical world. Some patients do well when working with both a skilled orthopedic and pelvic floor physical therapist concurrently, treating both components of the problem at once. A massage therapist can also be a valuable tool in conjunction with a traditional, internal-only pelvic floor physical therapist. The massage can focus on the glutes, low back, and hamstrings while the pelvic PT resolves internal trigger points.

For sustained relief of lower back pain, often both the pelvic floor and lower back must be looked at together. Not finding a qualified professional in your area or need to create an action plan so you can improve? Schedule a remote consultation with the experts at PelvicSanity today!

Nicole Cozean

Dr. Nicole Cozean is the founder of PelvicSanity Physical Therapy in Orange County, CA. PelvicSanity treats patients from all over the world with remote consultations and the Immersive Out of Town Program. She also runs Pelvic PT Rising, training other pelvic PTs to better serve patients.

Named Physical Therapist of the Year, Dr. Nicole is author of the award-winning book The Interstitial Cystitis Solution and the first PT to serve on the ICA Board of Directors, Her passion is helping those with pelvic health issues - regardless of where they live - find lasting relief.

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