Low Back Pain 101

What Causes Low Back Pain?

What causes low back pain? There are so many possible answers to this question. In this article we’re going to narrow it down to the most common ones we see here at Revitalize Physical Therapy. We often hear from our patients that they've tried so many things to get relief for their back and NOTHING works. Well, our minds tend to jump straight to blaming the pelvic floor. Keep reading to learn about how the pelvic floor can be what causes low back pain!


Most women are unfamiliar with female anatomy, especially their own! The main components of female anatomy include the labia majora, labia minora, clitoris, and vagina. Beyond that, you have superficial pelvic floor muscles, lots of nerves, the perineal body, and your deep pelvic floor muscles. All of these could be potential sources of pain, so it is important to have a good understanding of their location. Check out the video if you want to learn a little more about anatomy and where pain sources can occur.    

Causes for Low Back Pain

Pelvic Floor. One of the major culprits for low back pain (but often overlooked) is the pelvic floor!  Since the pelvic floor attaches to all aspects of the pelvis, the coccyx, and the sacrum, it has a major impact on the spine and the stability of our low back.  Here are a couple of ways the pelvic floor can cause low back pain:

  • If the pelvic floor muscles are tight or painful, it can refer pain to the back or abdomen with trigger points—just like any other muscle in your body. Think of your upper trap muscles above your shoulders. Many people experience tightness in these muscles, which can lead to neck pain or even headaches. Have you experienced that before? The pelvic floor muscles work similarly. Trigger points in the pelvic floor may cause you to feel pain in your back.
  • Overactivity in the pelvic floor muscles can also “pull” on the bony structures such as the coccyx and sacrum.  This will put them in a less than ideal position. This can lead to low back pain due to the alignment issues. If you only try to fix the alignment of the bones without addressing the tight pelvic floor, it will keep getting pulled back into a poor position.
  • For some people, they can have low back pain if the pelvic floor muscles are weak or uncoordinated.  Since the pelvic floor provides a lot of stability for the pelvis and spine, if they aren’t working properly, then the spine has to do extra work and this can lead to pain.

Joint Mobility.  We see a lot of patients who deal with back pain as a result of poor joint mobility. People who sit all day with poor posture tend to get stiffness throughout their spine. That can lead to pain and limited range of motion. Gently adding movement throughout your day is the best way to prevent that stiffness from setting in. Try light exercising and stretching.

Sacroiliac (SI) joint. The SI joint can very easily shift out of ideal position. This happens when there is muscle tightness or weakness present among the pelvic stabilizers. This poor positioning of the SI joint can be one sided or happen on both. It can also cause pain along the top of the buttocks.

More Causes

Core Weakness. With all four layers of our abdominal muscles wrapping around and attaching onto the spine and pelvis, they provide a lot of support for the spine. If these muscles are weak or uncoordinated, they won’t be able to provide the trunk support we need for activity and everyday movements.  Then, this added stress gets added to the spine and can lead to low back pain.

Fascia. Fascia is the layer of connective tissue in-between the skin and muscle that connects the abdomen, low back, and pelvis. If tightness develops in any of those areas, it causes increased tension across the rest of the fascia. This can cause the sensation of tightness or limitations in movements and can also cause limitations in joint movements.

Diastasis Rectus Abdominis (DRA). This is a condition we see in pregnant and postpartum women who are experiencing low back pain. This occurs when the two muscle bellies of your abdominals are separated. Therefore, they are unable to functionally stabilize your spine and pelvis during movements. The lack of tension across the core muscles puts extra pressure on the spine and back muscles.

What to Do When Nothing Seems to Help

If you’ve repeatedly tried stretching, core exercises, yoga, chiropractic or traditional Physical Therapy with no relief for your back pain—it might be time to book your consultation with a pelvic floor physical therapist. Those other things might not be working for you because they aren’t addressing the root of your pain (i.e.: the pelvic floor). The pelvic floor is too often brushed aside when looking for the root of low back pain. You deserve a physical therapist who has been specially trained to assess all of the possibilities INCLUDING the pelvic floor.