What is the Pelvic Floor?

​When we think of chronic pain, whether it’s in the hips, lower back, neck, jaw, or head, the pelvic floor is rarely the first place that comes to mind. However, emerging research and clinical insights reveal that the pelvic floor plays an integral role in the body’s overall function, alignment, and pain patterns. Understanding this connection not only sheds light on the causes of persistent pain but also offers new pathways for effective treatment.
 
Think of the pelvic floor as the foundation of a house: if the foundation is unstable or dysfunctional, it can throw off the alignment and stability of the entire house. Similarly, when pelvic floor muscles are tight, weak, or imbalanced, this can lead to a cascade of issues throughout the body, often manifesting as chronic pain.
 
The Pelvic Floor and Chronic Pain
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1. Hip Pain
The pelvis and hips are intricately connected. The pelvic floor muscles attach to the bones of the pelvis and connect with the deep hip rotators. Dysfunction in the pelvic floor, such as tightness or weakness, can create imbalances that pull on the hip joints, causing pain and discomfort. Many individuals with hip pain have underlying pelvic floor tension that exacerbates their symptoms. Common conditions associated with this include, pelvic floor hypertonicity, hip impingement leading to labral tears, and sacroiliac joint dysfunction.
 
2. Lower Back Pain
The pelvic floor is a key player in core stability, working in tandem with the diaphragm, deep abdominal muscles (transverse abdominis), and multifidus (deep back muscles). When pelvic floor muscles are weak or overly tight, they can destabilize the core and place excess strain on the lumbar spine, leading to chronic lower back pain. Research has shown that up to 95% of people with low back pain have some degree of pelvic floor dysfunction (1). Addressing the pelvic floor can help restore proper core function and alleviate back pain.
 
3. Neck Pain
At first glance, it might seem unlikely that the pelvic floor could affect the neck. However, the body operates as a connected kinetic chain. Poor posture or instability in the pelvis causes compensations further up the spine, often resulting in forward head posture, muscle imbalances in the upper body, and neck strain. For example, a misaligned pelvis can lead to rounding of the lower back (posterior pelvic tilt), which then causes the head and shoulders to shift forward. This posture increases tension in the neck muscles as they work harder to keep the head upright, resulting in chronic neck pain.
 
4. Jaw Pain (TMJ Dysfunction)
The connection between the pelvic floor and the jaw is less obvious but equally significant. The body’s myofascial system creates lines of tension that link seemingly unrelated areas. One such connection exists between the pelvic floor and the jaw through the deep front line of fascia. When pelvic floor muscles are tight or dysfunctional, they can contribute to a reflexive tightening of the jaw muscles. This relationship becomes particularly evident in individuals with a history of chronic stress, as both the pelvic floor and jaw tend to hold tension during times of emotional or physical stress.
 
5. Headaches
The pelvic floor’s relationship with posture, muscle tension, and the body’s fascial network can also contribute to chronic headaches. Poor pelvic alignment and dysfunction can lead to compensatory patterns throughout the spine, resulting in increased muscle tension in the neck, shoulders, and head. Over time, this strain can trigger tension-type headaches or exacerbate migraines.
 
Key mechanisms include:
Postural Compensation: Misalignment in the pelvis can cause the head and neck to shift forward, placing strain on the suboccipital muscles and contributing to headaches.
 
Fascial Connections: The body’s fascial system links the pelvic floor to the diaphragm, neck, and even the scalp. Dysfunction or tightness in the pelvic floor can create tension along this line, affecting head and neck muscles.
 
Breathing Patterns: Pelvic floor dysfunction often disrupts normal diaphragmatic breathing, leading to shallow, upper-chest breathing that places strain on the neck and head.
 
Addressing pelvic floor dysfunction can improve posture, release tension throughout the fascial network, and reduce headache frequency and severity.

 
The Role of Posture and Alignment
Proper posture depends on the alignment and coordination of multiple muscle groups, including the pelvic floor. When the pelvic floor isn’t functioning optimally, it can alter the tilt of the pelvis (posterior or anterior), leading to poor posture, compensate for weak core muscles, creating strain throughout the spine, and disrupt normal movement patterns, leading to pain in the hips, back, neck, or jaw.
 
Pelvic floor dysfunction often results from a combination of factors, such as sedentary lifestyles, heavy lifting or intense exercise, pregnancy and childbirth, trauma, or repetitive strain. Addressing pelvic floor issues can improve alignment, posture, and muscle balance, ultimately relieving chronic pain.

 
Treatment: A Holistic Approach
Understanding the pelvic floor’s connection to chronic pain requires a holistic approach to treatment. Pelvic floor physical therapy is one of the most effective ways to address dysfunction and restore balance.
 
Key components of pelvic floor physical therapy treatment may include:
1. Assessing and treating pelvic floor muscle imbalances through manual therapy, targeted exercises, and biofeedback techniques.
2. Posture Correction: Improving pelvic alignment and core stability to reduce compensatory patterns contributing to pain.
3. Breathwork: Breathing techniques such as diaphragmatic breathing help coordinate the diaphragm and pelvic floor, reducing tension and improving function.
4. Fascial Release: Techniques like myofascial release can address tension along the body’s myofascial lines, including the jaw and pelvic floor.
5. Stress Management: Since emotional stress often manifests in the pelvic floor and jaw, practices like mindfulness, yoga, and relaxation techniques can help.
 
Conclusion
Chronic pain in the hips, back, neck, and jaw can often be traced back to dysfunction in the pelvic floor. Recognizing this connection allows for a more comprehensive understanding of pain patterns and opens the door to effective, lasting relief. By addressing the pelvic floor through physical therapy, posture correction, and holistic interventions, individuals can restore balance, improve alignment, and finally find freedom from chronic pain.


 

1. Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskelet Sci Pract. 2018 Apr;34:47-53. doi: 10.1016/j.msksp.2017.12.001. Epub 2017 Dec 9. PMID: 29268147.