The pelvic floor muscles (PFM) refer to a group of muscles inside the pelvis running from the pubic bone to the tailbone and sides of the pelvis. These muscles are most famous for their sphincteric role—meaning they hold back urine and stool. What many people do not realize, however, is that the pelvic floor muscles have other equally important functions. The PFM also work with ligaments and fascia to support the organs of the pelvis, play a crucial role in sexual functioning, and activate in coordination with a team of muscles to properly stabilize and support the spine and the pelvis. At One on One Physical Therapy, we are fortunate to have a fantastic team of skilled clinicians who specialize in treating pelvic floor dysfunction.pic1

The pelvic floor muscles work with the transverse abdominis (deep lower abdominal muscles), multifidus (back muscles), and diaphragm (breathing muscle) to create what is known as the “anticipatory core.” These muscles fire together before a person bends, moves, lifts, walks, etc. to control pressures through the abdomen and the pelvis and to stabilize the spine and pelvis with movement. A study by Hodges and Sapsford in 2007 found that the pelvic floor muscles worked with the diaphragm to preactivate before a person performed arm movements. This helped in the understanding that the pelvic floor was not just a “bathroom muscle,” but rather played a crucial role in the movements of the rest of the body.

Our team of physical therapists at One-on-One Physical Therapy strive to provide comprehensive patient care. In short, we treat the person—not just the muscle or joint. Often times we find that patients presenting with a problem in one area (i.e. Low back, hips, etc.) may have dysfunction in another area that is contributing to the current problem—and this area may include the pelvic floor muscles. So, how do you know if you have a pelvic floor muscle problem contributing to an orthopedic problem?

Dysfunction in the pelvic floor muscles often presents in a few different ways:

1. Underactivity/Weakness: This is a common occurrence in men and women with generalized low back pain or hip pain, and is often present in people with global joint hypermobility. This can also occur after having multiple surgeries in the abdomen or pelvis.

2. Overactivity/Tension:This is a common occurrence in men and women with low back pain, hip pain, sacroiliac joint pain and pelvic pain. Trigger points in the pelvic floor muscles and obturator internus (a deep hip rotator sitting next to the pelvic floor within the pelvis) can refer to the low back, lower abdomen, sides of the hips, fronts and backs of the thighs and the buttock. Often times, these trigger points are very treatable and can lead to a significant reduction in pain for the people experiencing them.

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3. Poor Timing: This is also a common occurrence in men and women with pain in the spine (cervical, thoracic, or lumbar), rib pain, hip or pelvic pain, and many more. In this situation, the pelvic floor muscles are able to activate and relax, but they are not working together as a team with the other muscles of the anticipatory core. This can lead to other muscles being “overworked” and create pain for the patient. Often times, retraining the proper sequencing of these muscles helps significantly in improving functional movement patterns and reducing pain.

Some people believe that if a person has pelvic floor muscle problems, he or she will definitely have urinary or bowel problems too. Although this is sometimes the case, it often is not. If you are a current patient in physical therapy and you think your pelvic floor muscles are involved with your problem, talk to your physical therapist and he or she may refer you for consultation with a skilled pelvic PT. If you are not in physical therapy and you think you have a pelvic floor problem, consider contacting us to see Anisha or myself for an evaluation.

Evaluation will include an examination of the pelvic floor muscles along with the associated muscles around the pelvis. Examinations can be performed with palpation externally near the perineum, but is best performed with an internal vaginal or rectal examination. This allows the physical therapist to assess the flexibility of the pelvic floor muscles, localize any trigger points/painful areas, assess strength/endurance, and evaluate how the pelvic floor muscles are working with the rest of the “team.” These examinations are highly beneficial in truly discovering where dysfunction is present and in identifying the best possible treatment techniques to aid in speedy recovery. (Note: If you are feeling uncomfortable with an internal exam, do not let that limit you from coming in! Talk with your physical therapist to modify the exam and treatment to your needs.)

Following the consultation, your physical therapist will discuss her findings with you and develop a plan with you to help you achieve your goals and see results! If you are seeing another physical therapist, we will partner together to design the most optimal strategy for you!

As always, know that our ultimate goal is to partner with you for your recovery and help you reach your goals as quickly as possible!If you have any questions or would like to speak with me or another one of our pelvic specialists, please feel free to call our office!

Jessica Reale, PT, DPT, WCS is a doctor of physical therapy and board-certified specialist in Women’s Health. She treats men, women and children with pelvic floor dysfunction and orthopedic problems. Jessica writes regularly on all issues related to pelvic health at her blog, www.jessicarealept.com.