common causes of lower back pain in women
Low back pain (LBP) and pelvic pain are both incredibly common in women. Actually, they are both more common in women compared to men and the prevalence, unfortunately, increases as we get older.
Regardless of your age, women are more likely than men to experience low back and pelvic pain. Around 29% of adults have LBP with a 61% of these results being in women and only 39% in men. And the prevalence of pelvic pain is around 39% or 1 in 7 women compared to only 16% of folks that identify as male. So why the huge difference?
Unfortunately, we still don’t know what we don’t know because historically there has been much less medical research dedicated towards women’s health. We have a smaller understanding as a society of the huge differences that exist for medical conditions that more commonly affect people that identify as female, but there are some things that we do know and things that can help if you are struggling with low back and pelvic pain.
Lower back pain (LBP) is pain that occurs between the bottom of the ribcage and the buttocks and can be acute where it lasts less than six weeks, subacute where it lasts six to 12 weeks, or chronic where it lasts for at least 12 weeks. Pelvic pain is pain in the lower abdomen below the level of the umbilicus (or belly button) and can include the low back, buttocks, and area of the genitals.
As if having low back pain or pelvic pain wasn’t enough of a nuisance, it is also incredibly common for folks to experience both pelvic pain and lower back pain together. Studies have shown that as many as 95% of people who experience low back pain have some form of pelvic floor muscle dysfunction which can also cause pelvic pain. Yay.
Common reasons why pelvic pain and lower back pain occur together include:
Overlapping bony anatomy: bones and joints in the pelvis and lower back frequently connect to each other and, likewise, can cause pain in both areas
Nerves: nerves responsible for sensation or feeling and functioning of the pelvic anatomy originates from the lower back which can cause referred pain if there are issues arising at the low back
Overlapping muscles: the pelvic floor muscles, which can frequently cause pelvic pain when issues like tension are present, have a lot of muscles from the lower back inserting into the pelvic area. When tension in one muscle is present, it can frequently cause tension and pain in the surrounding muscles to occur.
Picture of the pelvis and pelvic floor muscles
There are a few key differences for why women (or people who identify as female) may have a higher prevalence of low back and pelvic pain including:
Pelvic anatomy: pelvic anatomy is quite different for people that identify as female compared to those that identify as male due to reproductive purposes. The sacroiliac joint (SIJ, the joint that connects the pelvis to the spine) has a larger surface area and is less mobile in males compared to people that identify as female which can also play a role in how we move and can potentially trigger low back and pelvic pain
Hormonal fluctuations:
During menstruation (having a period) and menopause people that identify as female experience a significant reduction in the hormone estrogen which can actually cause issues in the tissues that support the pelvic floor and low back which can cause changes in how we move and cause pain
During menstruation and menopause we also see an uptick in prostaglandins which are chemicals that stimulate uterine contractions which can impact the muscles of the low back and pelvis causing pain
Pregnancy, childbirth, and postpartum: hormonal changes that occur during these major life events in women’s health and for birthing people can change the way that we move throughout the day which can increase the amount of stress placed on the muscles of the low back and pelvic floor and can lead to pain
Reproductive anatomy: people who identify as female have different pelvic organs, including the uterus, fallopian tubes, and ovaries, which are susceptible to different medical conditions including endometriosis, fibroids, and cysts which can cause pelvic and low back pain
Shows the muscles of the low back and hips attaching to the pelvis.
So what can we do for pelvic and lower back pain?
Medication: different medications like Tylenol, ibuprofen, or naproxen can be helpful for some folks to improve pain and inflammation. Sometimes antidepressants can also actually be prescribed to help with pelvic pain.
Using hot or cold modalities: this is something I frequently recommend to clients while working with them during pelvic floor physical therapy treatment. Heat is typically helpful for muscle tension or if the pain you are experiencing feels crampy, tight, or achy. Ice is usually recommended for nerve pain which can feel like numbness, tingling, or electricity.
Lifestyle modifications: a lot of times clients that I work with for low back and pelvic pain have super unregulated nervous systems which can occur with high levels of stress, as well as not getting enough sleep or physical activity during the week. By making gradual and manageable changes in some of these areas, as well as creating more space for self-care, can be another incredibly helpful intervention for clients who are struggling with low back and pelvic pain.
Education about pain and how it can impact the nervous system: simply providing clients with education about their nervous system, what it is, and how it can impact the body and contribute to pain can be incredibly helpful for pain reduction and research shows that education alone can significantly improve the low back and pelvic pain that a person experiences. Obviously if you are struggling with pelvic and/or low back pain your pain is very real. But education alone can significantly help with coping mechanisms and how to better manage pain.
Pelvic Floor Physical Therapy: this one is obviously my favorite as a pelvic floor physical therapist.
Research shows that one of the top line of treatments that is effective in the treatment of both low back and pelvic pain is physical therapy treatment! And for those struggling with pelvic pain, specifically working with a pelvic floor physical therapy specialist.
If you are struggling with low back pain, pelvic pain, or both, by working with a pelvic floor physical therapist we are able to take a holistic approach in how we treat your pain. Not only are pelvic floor physical therapists experts in the treatment of lower back pain, but we are clinically trained in how to comprehensively assess your pelvis and pelvic floor muscles and work together with you to come up with a treatment plan to help resolve your pain.
I frequently work with clients who are struggling with low back pain that won’t resolve and they have worked with multiple physical therapists and other types of providers who have helped with temporary pain-relief, but not lasting results. For many of these clients, once we complete a full pelvic floor muscle assessment we not only find that they have pain and tension in their pelvic floor muscles, but that upon feeling the muscles the pain that they have been experiencing in their low back is reproduced by touching the muscles in the pelvis. Then once we address any tension, weakness, and pain in their low back and pelvic floor muscles we are able to treat and resolve their pain. Because we got to the root of the problem
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re looking for treatment for low back or pelvic pain or are struggling with pelvic floor issues and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor treatment for pelvic pain and lower back pain.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
Thinking that you may benefit from pelvic floor physical therapy treatment? Or know someone else struggling with low back or pelvic pain that you think may need care? Reach out here to schedule a pelvic floor physical therapy appointment with me today. At Flora Physical Therapy I am passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
