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6 yoga poses for back pain: the association between lower back pain and the pelvic floor


wheelchair bound person due to lower back painusing hand to push wheelchair

There I was, sitting in the pool with my friend having a conversation. All I was doing was leaning to my left, and when I brought my upper body back up to neutral, I felt it. Something was off. I stood up so we could go to the hot tub, and could feel the strain. What the heck!? I was just sitting down. After we finished our pool day with our kiddos, I went back home and began to self-massage my lower back. I figured I’d be okay with some rest. The next morning I woke up in the most pain I’ve been in since giving birth.


I’ve been a Licensed Massage Therapist for 15 years and know all the things to do to help make myself – and countless others – feel better, and in this moment I felt completely helpless. I couldn’t stand for more than two to three minutes at a time before my lower right back would spasm, causing searing pain that incapacitated me. Yet, as a mom, I had to move. I had to function.

After I suffered through getting my daughter to preschool, I did what any other sane human would do – I took myself to the Emergency Room.


After spasming half way to the door, the security guard asked me if I needed a wheelchair. Out of pride I said no. I eventually hobbled myself to the check in area, where they told me that I needed to sit in a wheelchair. I’ve never felt so debilitated in my entire life. So helpless. And my empathy began to grow, yet again. This is the existence that so many people live in every single day. At the mercy of others to care for them because they are, quite literally, in too much pain.


I sat there, in a crowded ER after a long holiday weekend, waiting to be seen. It hurt to sit, it hurt to move. It hurt to do anything besides lay flat on my back. Eventually I was seen at Providence St. Vincent’s, and they ran some basic tests for a herniated disc. They asked questions like if I had any incontinence, urinary or fecal, to which I jokingly replied that if I had I would have been hauled in by an ambulance.


Ultimately, there wasn’t really anything they could do aside from offer me narcotics. I declined and opted for an NSAID shot so it would bypass my gastrointestinal tract. I can’t take oral NSAIDS because I have been healing from a peptic ulcer. They gave me that, a lidocaine patch, and a prescription for muscle relaxers, and sent me on my way. After I was discharged, I still couldn’t walk, so one of the nurses walked me to my car. I am incredibly grateful for that small act of kindness. I’ve always had a great experience at Providence, and the way their nurses and staff treated me that day, as well as on several other occasions, never ceases to astound me.


It took me more than 2 weeks to heal from this awful stint of lower back pain, which resulted from merely a strained muscle. But…every physical experience, as painful as it might have been, has helped me to learn, grow, and connect more to this human experience. This particular experience helped me to re-learn the anatomy of the entire pelvic bowl (pelvic girdle and pelvic floor), and how they can impact lower back pain.


I’ve self-determined that the main muscle that was impacted was the coccygeus muscle because of where I was feeling the pain. For me, the pain started in lower back right along the coccyx, and when it would spasm it would go about mid-way up my lower back, rendering me immobile. Only my right side was affected, which is in line with a strained coccygeus muscle, as usually only one side is affected. My entire right pelvic girdle area felt inflamed, and rest and ice were the only things that truly helped, which was contrary to what I knew as well as the advice I was given at the hospital. The typical advice is to stay mobile and use heat and ice. But in this case, with a strained coccygeus, you want to rest as much as possible, not move very much, and use ice. When I finally started doing that, it got better much faster.


Whether you are a postpartum mom, prenatal, a weekday warrior, or struggling with osteoporosis, this blog will help you understand the many moving parts of lower back pain. So without further adieu, I wanted to share with you the knowledge that I relearned throughout this painful journey so that it can hopefully help you.


What is my lower back pain from?

Your lower back pain can be from many different causes. If you have spinal stenosis, osteoporosis or arthritis, then it could be from that. If you have a bulging disc or have ever endured spinal surgery, then you could have residual pain from that. However, what I’ve seen throughout my 15 years’ experience as a Licensed Massage Therapist is that many of my clients’ lower back pain is due to chronically strained muscles. This can be due to poor posture in conjunction with weak muscles.


Nerves can also become damaged over time and can create painful sensations through the process of nerve enervation. There are other potential causes of lower back pain as well that are beyond my scope of expertise as well as the intention for this article. If you have been experiencing lower back pain for a while, please seek medical advice from you primary care doctor.

 

What is the difference between the pelvic floor and the pelvic girdle?

The bony anatomy of the pelvic girdle includes three bones: the ilium, ischium, and pubis, and three joints: the sacroiliac joints, the pubic symphysis, and the hip joints. The pelvic floor muscles primarily consist of the levator ani muscles, which receive somatic innervation from the lumbosacral plexus.

 

What are the pelvic floor muscles?

The pelvic floor is a group of muscles that form the base of the pelvis, providing support for pelvic organs, aiding in urinary and fecal continence, and contributing to core stability. These muscles play a vital role in daily activities and overall health. In this blog post, we'll explore each muscle of the pelvic floor, including their origin, insertion, function, what it feels like when they are strained, and how they can impact other parts of the body, such as the lower back.


Levator Ani

The levator ani is a broad, thin muscle group comprising three parts: the pubococcygeus, puborectalis, and iliococcygeus.

 

Pubococcygeus

 

Origin: Pubis and the fascia of the obturator internus

Insertion: Coccyx and anococcygeal ligament

Function: Supports pelvic organs, maintains continence, and assists in pelvic floor stability

Strain Sensation: A strained pubococcygeus can cause a dull ache or sharp pain in the pelvic area, discomfort during bowel movements, or pain during sexual activity

Impact on Other Parts: Strain can lead to lower back pain due to the interconnected nature of pelvic and lumbar muscles

 

Puborectalis

 

Origin: Pubic symphysis

Insertion: Forms a sling around the rectum

Function: Maintains fecal continence by creating an angle between the rectum and anus

Strain Sensation: Discomfort during bowel movements and a sensation of incomplete evacuation

Impact on Other Parts: Can lead to straining and increased pressure on the lower back

 

Iliococcygeus

 

Origin: Ischial spine and the fascia of the obturator internus

Insertion: Coccyx and anococcygeal ligament

Function: Supports pelvic organs and stabilizes the pelvic floor

Strain Sensation: General pelvic discomfort, feelings of heaviness, or a dragging sensation

Impact on Other Parts: Strain can lead to pelvic floor dysfunction, affecting the lower back and abdominal muscles

 

Coccygeus (Ischiococcygeus)


coccygeus muscle of the pelvic floor and pelvic girdle

Origin: Ischial spine

Insertion: Lateral margins of the sacrum and coccyx

Function: Supports pelvic organs and flexes the coccyx

Strain Sensation: Pain in the lower back and tailbone area, especially when sitting

Impact on Other Parts: Strain can exacerbate lower back pain and impact sitting posture

 

External Urethral Sphincter

Origin: Surrounds the urethra

Insertion: Blends with other pelvic floor muscles

Function: Controls the release of urine from the bladder

Strain Sensation: Urinary incontinence or difficulty urinating

Impact on Other Parts: Can lead to pelvic floor dysfunction and increased abdominal pressure

 

Deep Transverse Perineal Muscle

Origin: Ischial rami

Insertion: Perineal body

Function: Stabilizes the perineal body and supports pelvic organs

Strain Sensation: Pain or discomfort in the perineal area, especially when sitting

Impact on Other Parts: Strain can lead to pelvic instability and lower back discomfort

 

Bulbospongiosus

Origin: Perineal body

Insertion: Male: corpus spongiosum and perineal membrane; Female: bulb of the vestibule and perineal membrane

Function: Male: aids in erection and ejaculation; Female: constricts the vaginal orifice

Strain Sensation: Discomfort during sexual activity or pain in the perineal area

Impact on Other Parts: Can contribute to sexual dysfunction and pelvic pain

 

Ischiocavernosus

Origin: Ischial tuberosity

Insertion: Crus of the penis or clitoris

Function: Maintains erection of the penis or clitoris by compressing outflow veins

Strain Sensation: Pain in the perineum and discomfort during sexual activity

Impact on Other Parts: Can lead to sexual dysfunction and pelvic pain

 


The muscles of the pelvic floor are essential for various bodily functions, from supporting pelvic organs to aiding in continence and sexual function. When these muscles become strained, they can cause discomfort not only in the pelvic region but also in the lower back and other connected areas. Understanding these muscles can help in recognizing the importance of pelvic health and the need for proper care and exercise to maintain their function.


11 Muscles of the Pelvic Girdle

The pelvic girdle is a critical structure in the human body, connecting the trunk to the lower limbs. It comprises several muscles that play essential roles in movement, stability, and support. In this blog post, we will explore the origin, insertion, function, and potential issues associated with each muscle in the pelvic girdle.

 

Gluteus Maximus

Origin: Ilium, sacrum, and coccyx

Insertion: Iliotibial tract and gluteal tuberosity of the femur

Function: The gluteus maximus is responsible for the extension, external rotation, and abduction of the hip. It is the primary muscle used when rising from a sitting position, climbing stairs, and running.

Strain Sensation: A strained gluteus maximus can cause a deep ache or sharp pain in the buttocks, particularly during movement.

Impact on Other Parts: A strained gluteus maximus can lead to lower back pain due to compensatory mechanisms and altered gait.

 

Gluteus Medius

Origin: Outer surface of the ilium

Insertion: Lateral surface of the greater trochanter of the femur

Function: The gluteus medius abducts and medially rotates the thigh. It stabilizes the pelvis during walking.

Strain Sensation: Pain on the outer aspect of the hip, which may radiate down the leg.

Impact on Other Parts: Weakness or strain can lead to hip drop on the opposite side, causing lower back pain and gait issues.

 

Gluteus Minimus

Origin: Outer surface of the ilium, below the origin of the gluteus medius

Insertion: Anterior surface of the greater trochanter of the femur

Function: The gluteus minimus assists in the abduction and medial rotation of the thigh.

Strain Sensation: Pain deep in the hip, often felt during weight-bearing activities.

Impact on Other Parts: Can contribute to hip instability and affect lower back alignment.

 

Piriformis

Origin: Anterior surface of the sacrum

Insertion: Superior border of the greater trochanter of the femur

Function: The piriformis laterally rotates and abducts the thigh.

Strain Sensation: Deep buttock pain, which can sometimes mimic sciatica.

Impact on Other Parts: Piriformis syndrome can compress the sciatic nerve, causing pain and tingling down the leg.

 

Iliacus

Origin: Iliac fossa

Insertion: Lesser trochanter of the femur, via the iliopsoas tendon

Function: The iliacus flexes and externally rotates the thigh.

Strain Sensation: Pain in the front of the hip or groin, often aggravated by hip flexion.

Impact on Other Parts: Can cause lower back pain and affect posture due to its role in hip flexion.

 

Psoas Major

Origin: Lumbar vertebrae (T12-L5)

Insertion: Lesser trochanter of the femur, via the iliopsoas tendon

Function: The psoas major flexes the hip and assists in lateral rotation.

Strain Sensation: Lower back pain and discomfort in the groin area.

Impact on Other Parts: Tightness in the psoas major can lead to lower back pain and postural issues.

 

Tensor Fasciae Latae

Origin: Anterior iliac crest and anterior superior iliac spine (ASIS)

Insertion: Iliotibial tract

Function: The tensor fasciae latae stabilizes the knee, abducts, and medially rotates the thigh.

Strain Sensation: Pain on the outer aspect of the thigh, which can extend to the knee.

Impact on Other Parts: Can contribute to iliotibial band syndrome, causing knee pain.

 

Obturator Internus

Origin: Inner surface of the obturator foramen

Insertion: Medial surface of the greater trochanter

Function: The obturator internus laterally rotates the thigh.

Strain Sensation: Pain deep in the buttock, potentially radiating to the inner thigh.

Impact on Other Parts: Can affect hip stability and gait.

 

Obturator Externus

Origin: Outer surface of the obturator foramen

Insertion: Trochanteric fossa of the femur

Function: The obturator externus laterally rotates the thigh.

Strain Sensation: Pain in the groin and inner thigh area.

Impact on Other Parts: Can influence hip joint stability and movement efficiency.

 

Quadratus Femoris

Origin: Ischial tuberosity

Insertion: Intertrochanteric crest of the femur

Function: The quadratus femoris laterally rotates the thigh.

Strain Sensation: Deep buttock pain, often worse with hip rotation.

Impact on Other Parts: Can contribute to hip joint and lower back discomfort.

 

Gemellus Superior and Inferior

Origin: Ischial spine (superior) and ischial tuberosity (inferior)

Insertion: Medial surface of the greater trochanter

Function: These muscles laterally rotate the thigh.

Strain Sensation: Deep pain in the buttock region, aggravated by hip movement.

Impact on Other Parts: Can cause discomfort and instability in the hip joint.

 


Understanding the muscles of the pelvic girdle is crucial for recognizing their roles in movement and their impact on the body. Strains and imbalances in these muscles can lead to discomfort and pain in various areas, including the lower back. Proper care, including stretching, strengthening, and addressing imbalances, is essential for maintaining pelvic and overall musculoskeletal health.


Can weak glutes cause lower back pain?


Yes, weak glutes can indeed cause lower back pain. The gluteal muscles, particularly the gluteus maximus, gluteus medius, and gluteus minimus, play a vital role in stabilizing the pelvis and supporting the lower back during movement. When these muscles are weak, other muscles, including those in the lower back, have to compensate to maintain stability and movement. This compensation can lead to overuse, strain, and eventually pain in the lower back. For example, weak gluteus medius muscles can cause the pelvis to drop on one side during walking, leading to an imbalance that stresses the lumbar spine.

 

Moreover, weak glutes can contribute to poor posture and alignment, which further exacerbates lower back pain. When the glutes are not strong enough to support proper hip extension and rotation, the lower back may arch excessively, leading to increased lumbar lordosis and stress on the vertebrae and discs. This can also cause piriformis syndrome, which many mistake for sciatica. Strengthening the gluteal muscles through targeted exercises can help improve pelvic stability, enhance posture, and reduce the strain on the lower back, ultimately alleviating pain and preventing further injury.


How to strengthen pelvic girdle muscles


Strengthening the pelvic girdle muscles is crucial for maintaining stability, mobility, and overall health. These muscles support the pelvic organs, assist in various movements, and contribute to core strength. Yoga is an excellent way to strengthen these muscles through specific poses that target the pelvic girdle and pelvic floor. Here are six yoga poses that can help:

 


prenatal yoga class bridge pose in yoga studio in beaverton oregon

Description: This pose strengthens the glutes, hamstrings, lower back, and pelvic floor muscles.

How to Perform:

 

Lie on your back with your knees bent and feet flat on the floor, hip-width apart.

Press your feet and arms into the floor as you lift your hips towards the ceiling.

Hold the position for several breaths, then slowly lower your hips back to the floor.



yoga students practicing yoga at the park Warrior II pose at Earth Breath Yoga in Beaverton Oregon

Description: Warrior II strengthens the legs, glutes, and hips, contributing to pelvic stability.

How to Perform:

 

Stand with your feet about four feet apart.

Turn your right foot out 90 degrees and your left foot slightly in.

Bend your right knee over your right ankle.

Extend your arms out to the sides and gaze over your right hand.

Hold for several breaths, then switch sides.



Description: This deep squat pose stretches and strengthens the hips, groin, and pelvic floor muscles.

How to Perform:

 

Squat down with your feet as close together as possible.

Press your elbows against your inner knees and bring your palms together in front of your chest.

Hold the pose for several breaths.



Description: This restorative pose stretches the inner thighs and pelvic floor muscles while promoting relaxation.

How to Perform:

 

Lie on your back and bring the soles of your feet together, allowing your knees to fall open.

Place your arms by your sides with palms facing up.

Hold the pose for several breaths.



chair pose to strengthen pelvic floor and lower back

Description: Chair Pose engages the glutes, thighs, and pelvic floor muscles, promoting strength and stability.

How to Perform:

 

Stand with your feet together.

Bend your knees and lower your hips as if sitting in a chair.

Raise your arms overhead and hold the position for several breaths.



prenatal yoga class in Beaverton Oregon practicing cat cow pose in yoga studio

Description: This gentle flow between Cat and Cow poses helps to strengthen the lower back and pelvic muscles while improving flexibility.

How to Perform:

 

Start on your hands and knees.

Inhale as you drop your belly towards the mat and lift your head and tailbone (Cow Pose).

Exhale as you round your back towards the ceiling and tuck your chin to your chest (Cat Pose).

Repeat for several breaths.



Incorporating these yoga poses into your routine can help strengthen the pelvic girdle and pelvic floor muscles, enhancing overall stability and reducing the risk of pain and injury. Regular practice can lead to improved posture, better support for the pelvic organs, and increased core strength. Always remember to perform these poses with proper form and to listen to your body to avoid strain or injury.


INTEGRATING WHAT I LEARNED ABOUT LOWER BACK PAIN AND THE PELVIC FLOOR


Lower back pain is something that, in most cases, can be prevented with proper self-care. Although we’re all human and will have ailments from time to time, when you practice self-care consistently, you’ll keep your muscles strong. That’s why we offer a host of different classes for you to choose from. If you’re recovering from an injury and are still in the acute phase, but able to move around, I would suggest you try out our gentle yoga classes. We’re also now offering them virtually, so you don’t even have to drive to us! If you’re in the chronic phase of your condition, or want to prevent any issues from arising, our Hatha Flow classes will help you lengthen and strengthen your body to prevent injuries. If you have any long standing injuries, you can always talk to Maddie prior to the start of class and she will make sure to offer modifications specific to you, as she is also a Yoga Therapist. You can book a yoga class here!


However, if any form of yoga is too much for your body right now, then you can always schedule a massage. I cater to your needs during the session, and will tailor the session based on your symptoms and what you are looking for. I can use a variety of techniques, including deep tissue massage, Swedish massage, and hot stone massage. Book your session today and get your healing journey off to a great start!




References:


Disclaimer

The information provided in this article is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The authors and publishers of this article are not responsible for any adverse effects or consequences resulting from the use of any suggestions, exercises, or procedures described in the article.

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