Understanding Low Back Pain and Pelvic Health

Low back pain is a leading cause of disability worldwide. This article explores the connection with pelvic health, principles of integrated assessment, and evidence-based management strategies.

Dealing with lower back pain

Low back pain (LBP) is a condition almost everyone will experience at some point in life. It is one of the leading causes of disability globally and represents a significant portion of consultations in primary care. While most episodes are self-limiting, many patients experience persistent or recurrent pain, which can impact function, work, and overall quality of life.

A critical but often overlooked factor in managing low back pain is the role of pelvic health. The lumbar spine and pelvis function as a unit, and dysfunction in one often affects the other. Recognising this connection is essential for accurate diagnosis and effective management.

The Spine-Pelvis Connection

The pelvis and lumbar spine work together to support movement, load transfer, and stability. Disruption in pelvic function – whether due to pregnancy, musculoskeletal injury, or chronic pelvic floor dysfunction – can contribute directly to low back pain.

For example, pregnancy-related pelvic girdle pain results from increased joint laxity and altered biomechanics, placing additional stress on the lumbar spine. Chronic pelvic floor dysfunction may alter spinal loading and muscular balance, leading to persistent back pain that is not resolved with standard lumbar interventions. Even referral patterns from pelvic structures can mimic or mask lumbar pathology, complicating assessment.

Clinical Assessment

A comprehensive assessment should include:

• Detailed history of back pain and potential pelvic health contributors, such as continence issues, previous trauma, or pregnancy-related changes.
• Functional evaluation of both lumbar spine and pelvic stability, including observation of gait, posture, and muscle activation.
• Identification of biomechanical imbalances that may link lumbar and pelvic dysfunction.

Supplementary Clinical Insights:

• Weakness in the pelvic floor or core muscles can exacerbate low back symptoms.
• Malalignment or asymmetry in the pelvis may contribute to chronic strain patterns.
• Lifestyle factors, including sedentary behaviour or poor ergonomics, often play a compounding role.

Management Principles

Evidence-based management of low back pain and associated pelvic dysfunction includes:

• Education and reassurance: Encouraging activity and addressing fear-avoidance behaviours.
• Exercise therapy: Targeted core and pelvic stability exercises.
• Manual therapy: Optional adjunct in selected patients for symptomatic relief.
• Ergonomic and lifestyle interventions: Supporting sustained improvement and preventing recurrence.

For patients with significant pelvic floor dysfunction, referral to a specialist pelvic health physiotherapist may be indicated. Approaching the spine and pelvis as an integrated system allows clinicians to address the root causes of symptoms rather than only the presenting complaint.

In conclusion.

Low back pain remains one of the most common and challenging conditions encountered in clinical practice. By integrating pelvic health into assessment and management, clinicians can deliver more effective care, improve outcomes, and reduce recurrence. Recognising the interdependence of the lumbar spine and pelvis is essential for a holistic, patient-centred approach.