Head, Shoulders, Knees - and the Pelvic Floor: How Everything’s Connected

By: 
Jessica Reale, PT, DPT, WCS

I spent my first few years of my practice as a Physical Therapist going deep into the pelvis, and my most recent few years, desperately trying to get out. Now, I know that may seem like a strange statement to read coming from me, the pelvic floor girl. But bear with me.

I love the pelvic floor, I really do. I enjoy learning about the pelvis, treating pelvic floor issues like bowel/bladder problems, helping my patients with their most intimate of struggles. I like to totally “nerd out” reading about the latest research related to complex nerve pain, hormonal and nutritional influences, and complicated or rarely understood diagnoses.

However, the more I learned about the pelvic floor, the more I discovered that in order to provide my patients with the best care I can possibly provide, I needed to journey outside the pelvis and integrate it with the rest of the body.

You see, the pelvic floor does not work in isolation. It is not the only structure preventing you from leaking urine. It is not the sole factor in allowing you to have pleasurable sexual intercourse. It is not the only structure stabilizing your tailbone as you move into a yoga pose. It is simply one gear inside the fascinating machine of the body. The incredible thing about the body is that a problem above or below that gear, can actually influence the function of the gear itself. And that is pretty incredible!

One of the patients that most inspired me to really start my journey outside of the pelvis was an 18-year-old girl I treated 4 years ago. She was a senior in high school, and prior to the onset of her pelvic pain, she had been an incredible athlete—playing soccer, volleyball and ice hockey. Since developing pelvic pain, she had to stop all activities. Her pain led to severe nausea, and was greatly impacting her senior year.

When I examined her, I noticed some interesting patterns in the way she walked. With further questioning, she ended up telling me that a year ago, she experienced a fracture of her tibia (the bone by her knee) while playing soccer. She was immobilized in a brace for about a month, and then cleared to resume all activity. (Yep, no physical therapy).

Looking closer, I saw that she had significant weakness around her knee that was influencing the way she moved, and leading to a compensatory “gripping” pattern in her pelvic floor muscles to attempt to stabilize her hips and legs during movement. So, we treated her knee (She actually ended up having a surgery for a meniscal tear that had not been discovered by her previous physician), and guess what? Her pelvic pain was eliminated. BOOM.

What Else Is Connected to the Pelvic Floor?

  • Poor mobility in the neck and upper back can actually lead to neural tension throughout the body—including the nerves that go to the pelvic floor. (I’ve had patients bend their neck to look down and experience an increase in tailbone pain. How amazing is that?)

  • Being stuck in a slumped posture can cause a person to have decreased excursion of his or her diaphragm, which can then put the pelvic floor in a position in which it is unable to contract or relax the way it needs to.

  • Grinding your teeth at night? That increased tension in the jaw can impact the intrathoracic pressure (from glottis to diaphragm), which in turn, impacts the intra-abdominal pressure (from diaphragm to pelvic floor) and, you guessed it, your pelvic floor muscles!

  • An ankle injury may cause a person to change the way he or she walks, which could increase the work one hip has to do compared to the other. This can cause certain muscles to fatigue and become sore and tender, including the pelvic floor muscles!

Pretty cool, right? And the amazing thing is that this is simply scratching the surface! The important thing to understand here is that you are a person, not a body part! Be cautious if you are working with someone who refuses to look outside of your “problem” to see you as a whole. And if you have a feeling in your gut that something might be connected to what you have going on, it really might be. Speak up!

Read more about pelvic floor pain from YogaUOnline and Jessica Reale, PT - Pelvic Floor Problems in the Adult Athlete: Help for Muscle-Related Pain.

Want to learn more about pelvic floor health? If so, take this course - Pelvic Floor Health with YogaUOnline and Leslie Howard - The Root of All Things: Pelvic Floor Health for Men and Women

Reprinted with permission from Jessica Reale, PT.

Jessica Reale

Jessica Reale, PT, DPT, WCS is a board-certified specialist in Women’s Health and treats pelvic floor disorders in men, women and children at One on One Therapy in Atlanta, GA. She received her doctorate in physical therapy (DPT) at Duke University School of Medicine and was the director of the largest pelvic floor rehabilitation program in South Carolina prior to relocating to Atlanta in 2015. Jessica is passionate about helping her patients achieve optimal health through individualized treatment plans integrating the most current research. She is actively involved in educating the community and other professionals, and has lectured at support groups, conferences and universities. Jessica writes regularly about all issues related to pelvic health at her blog, www.jessicarealept.com