Are you sure the problem is coming from your pelvis?
Pelvic pain can be absolutely debilitating, and is unfortunately relatively common. In this country and beyond, there are many physiotherapists who specialise in treating pelvic floor dysfunctions, who do internal examinations of the muscles that control the vagina and rectum. (I am not one of those physios, so please don’t come to me expecting the rubber glove treatment – if you need an internal specialist, I may be able to recommend someone.) However, as I have previously explained, everything in the body is connected, and almost no area is quite as connected as the pelvis – so if your pelvic symptoms don’t respond to pelvic floor physiotherapy and pelvic floor exercises, then it might be worth looking at your body a bit more globally.
While of course there are lots of local pelvic issues that can cause pelvic pain (for example, pregnancy, hormones, pelvic inflammatory disease, urinary tract infections, endometriosis, adhesions etc) non-pelvic areas and issues that I find frequently upset the pelvis include:
When you have a normal breathing pattern, as you inhale, both the pelvic floor and diaphragm should lower; and as you exhale, both the pelvic floor and diaphragm should rise, helping to maintain even pressure throughout your abdomen. However, if your diaphragm is not working optimally, it frequently gets stuck in the descended position, causing sustained pressure on the pelvic floor. I have seen several cases recently where working on the breathing pattern have helped to reduce pelvic floor symptoms.
Asymmetrical sacroiliac joint movement
There is supposed to be a very small amount of movement at the sacroiliac joints, at the back of the pelvis, as you transfer weight from one foot to the other, and this helps with shock absorption. Research suggests that the precise amount of movement in these joints is less important than the symmetry of the movement; and in my experience, this can be directly affected by dysfunction in any of the 35 muscles that attach to the pelvic bones – whose attachments at the other end range from the top of the shin (quadriceps, adductors and hamstrings) to the T4 vertebra (iliocostalis and longissimus) – around 2/3 of the length of your body.
The craniosacral system is a hydraulic system encompassed by a membrane which surrounds the brain and the spinal cord. Restrictions in this system – thought to be due to either psychological or physical trauma – can affect the pelvis; and craniosacral therapy techniques have been shown to help with chronic pelvic pain.
It’s not unexpected that local trauma such as giving birth or falling on to your coccyx could cause pain in your pelvis; but how about pelvic pain that results from falling and hitting your knee, or from a stiff back? This is another situation in which the muscular and fascial attachments between your knee or your spine and your pelvis can transmit problems; but in this situation we might be treating the knee or the spine rather than the muscle.
Sustained poor posture
If you habitually sit with your head forward, peering at your phone or your computer screen, your back muscles are likely to get fatigued from holding your head up and stopping you from face planting onto your phone or keyboard. As your long spinal muscles (iliocostalis and longissimus) are anchored to your pelvis at the bottom, your dodgy neck posture can eventually cause a pain in the pelvis! Again, in this situation, treating your pelvis directly isn’t going to solve the problem, but altering your habitual posture might.
An issue I see very commonly is weakness of the foot and calf muscles, resulting in early pronation of the foot while my patients are walking. In some people, dropped arches can lead to an internal rotation of the shin and the thigh at each step, with a knock-on effect into the pelvis, resulting in pelvic pain. In this situation, there’s no point trying to treat the pelvis until we’ve sorted out the feet – definitely with foot exercises, and potentially with the addition of temporary or permanent insoles.
So… what should we do about it?
Understanding the cause of pelvic girdle pain all comes down to going through a thorough assessment. Sometimes the problem really is local and requires internal assessment and a treatment plan, or even surgery if there’s a structural defect that physiotherapy can’t fix – and sometimes your pelvis will be the “victim” of an issue elsewhere, such as the (extremely non-exhaustive) list above. It’s completely fine and sensible to get an internal assessment first, and/or to see a specialist doctor such as a gynaecologist or a urologist to exclude structural causes for your pelvic pain – in fact, I often find it extremely helpful to have had such issues ruled out before I look at you!
Pelvic Floor Physiotherapy London
But if you’ve seen a consultant, and/or tried specialist pelvic health physiotherapy and your pain still isn’t going away, don’t give up! Instead, why not call my team on 0207 175 0150 and come to see me to find out if your pelvis is the victim, rather than the cause, of the problem.