How Pelvic Floor Therapy Manages Chronic Back Pain

POSTED: 22 Feb, 2026

Your pelvic floor is a vital part of your deep core system. It works together with your diaphragm, deep abdominal muscles, and spinal stabilisers to support your spine and allow your body to move efficiently.
When this system is not functioning properly, the lower back often compensates. Over time, this increased strain can lead to persistent pain, stiffness, and reduced mobility. Many people living with chronic back pain are unaware that pelvic floor dysfunction may be contributing to their symptoms.

How the Pelvic Floor Affects Back Pain

The Core System

A healthy core involves much more than strong abdominal muscles. The core functions as a coordinated pressure and stability system that:
• Supports and stabilises the spine
• Pressure regulation between the diaphragm, abdomen, pelvic floor, and spinal stabilisers
• Allows smooth, controlled movement
• Protects the body during lifting, bending, and physical activity
When the pelvic floor is either weak or overactive, this system becomes unbalanced. As a result, the muscles in the lower back often work harder to maintain stability, which can lead to fatigue, tension, and ongoing discomfort.

Weak vs Overactive Pelvic Floor

Pelvic floor dysfunction can present in different ways, and both weakness and excessive tension can contribute to back pain.

Weak Pelvic Floor and Lower Back Pain

When pelvic floor muscles lack strength or coordination:
• Core stability may be reduced
• Lower back muscles may take on increased workload
• Muscle fatigue and persistent discomfort can develop
• Postural changes and poor movement patterns may occur

Overactive (Tight) Pelvic Floor and Lower Back Pain

When pelvic floor muscles remain overly tense or unable to relax:
• Muscles stay contracted instead of lengthening normally
• Pain may radiate into the lower back, hips, or sacroiliac (SI) joint
• Movement can become restricted or uncomfortable
• Symptoms may be complex and difficult to identify
Research suggests that combining pelvic floor muscle rehabilitation with physiotherapy treatment for back pain can improve long-term outcomes. Addressing pelvic floor function helps target the underlying cause of pain rather than focusing solely on the back.

What Happens During Pelvic Floor Therapy?

Comprehensive Assessment

Pelvic floor physiotherapy begins with a detailed assessment designed to identify the source of dysfunction. Your physiotherapist may evaluate:
• Pelvic floor sensation, pelvic floor muscle strength, endurance, and tension levels
• Coordination between breathing, pelvic floor, and deep core muscles
• Posture, canister position, movement patterns, and spinal alignment
• Overall muscle control and body mechanics
This assessment helps determine whether pelvic floor weakness, overactivity, or poor coordination is contributing to your back pain.

Personalised Treatment Plan

Treatment is tailored to your individual needs and goals. Your rehabilitation program may include:
• Targeted strengthening exercises to improve pelvic floor support
• Down-training techniques to relax overactive or tense muscles
• Postural and movement retraining to reduce lower back strain
• Breathing and core coordination training to improve deep stabilisation
• Manual therapy to release tight pelvic floor, hip, and lower back tissues
Pelvic floor therapy focuses on addressing the root cause of dysfunction to support long-term recovery.

Why Specialist Pelvic Floor Physiotherapy Matters

Pelvic floor rehabilitation is often most effective when combined with targeted core stability training and movement retraining. By improving both pelvic floor and spinal function, many patients experience:
• Reduced chronic back pain
• Improved spinal stability and support
• Better posture and movement efficiency
• Increased comfort and confidence during daily activities
• Improved return to exercise or sport

For individuals whose back pain has not responded to traditional treatment approaches, pelvic floor physiotherapy can provide a valuable and often overlooked pathway to recovery.