The Journal of Women’s Health Physical Therapy, Jan/April 2013 published a research study which showed the importance of Physical Therapists evaluating the pelvic floor muscles (PFM) in women with low back pain (LBP), as well as asking questions regarding urinary incontinence.  They cited the following statistics:

  • Low Back Pain is the most common type of pain reported by US adults with one in four adults reporting the experience of low back pain in the past three months.
  • 70-85% of adults will experience low back pain sometime in their lifetime.
  • Between 44-78% of individuals experience a relapse of low back pain and between 42-75% of individuals still have low back pain after 12 months.
picture of core abdominal muscles and diaphragms

diagram of pelvic and respiratory diaphragm and muscles that make up our core


Another valuable point in the above mentioned article:

“Physical Therapy and Massage Therapy represents the largest direct care cost for low back pain and chronic low back pain tends to not improve over time and is a significant economic burden on individuals and society” There are many studies which show a relationship between low back pain and urinary incontinence.  Low back pain is the most common diagnosis treated by Physical Therapists.  A recent study cited in the above mentioned article surveyed women who were receiving Physical Therapy for low back pain and reported that 78% of those women also reported urinary incontinence.  Yet, most Physical Therapists do not look at the the pelvic floor muscles or ask questions regarding incontinence when evaluating low back pain.

Most low back pain is non-specific, which means it is not attributable to a specific pathology.  Since most people will have several instances of low back pain before they seek treatment, there are generally multiple factors contributing to their pain patterns as well as individual life style choices.  The trunk muscles and especially the abdominals are generally part of a Physical Therapy evaluation.  The reported high incidence of urinary incontinence associated with low back pain indicates the need for all healthcare professionals  and especially Physical Therapists to include the pelvic floor muscles when evaluating low back pain.

Reading the recent article in the Women’s Health Physical Therapy journal pleased and shocked me.  I was fortunate to be trained by John F Barnes, PT in Myofascial Release very early in my Physical Therapy career.  Myofascial Release, as taught by John Barnes, teaches us to identify and treat the imbalances that we find in the structural and muscular alignment.  We do not treat diagnoses.  We look and feel for the underlying problem. The information that the Women’s Health Physical Therapy Journal cited is not new.  Articles that I read 27 years ago quoted similar statistics alerting us to the upcoming problem.

Urinary incontinence has become an epidemic and the information for proper treatment has been available to us, however, it has been over shadowed by the big pharmaceutical money makers as well as adult sized diapers.  Putting sarcasm and skepticism aside, the evidence is clear.  We need to pay attention to the role of the pelvic floor muscles not only in providing continence in women and men but also in low back pain.

As a Physical Therapist of 27 years, I have treated my fair share of clients with both low back pain and urinary incontinence.  I stand behind Myofascial Release as one of the most effective techniques for decreasing pain and improving long term function.  If you suffer with low back pain or urinary incontinence and have been told that the symptoms are as good as they will get and have not been evaluated by someone trained in pelvic floor treatment using Myofascial Release, you may be missing a valuable tool to  a more effective recovery.

The therapists at Verde Valley MFR are experts in Myofascial Release.  We have been using it to effectively treat our clients with many different diagnoses.

Do you have any questions or comments or your own personal stories of using Physical Therapy to treat pelvic floor dysfunction or urinary incontinence?  Post your comments below and let’s share this valuable information.

Jody Hendryx, PT, LMT