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

I spent my first few years of my practice as a physical therapist going deep into the pelvis. In the most recent few years, I’ve been desperately trying to get out. That may seem like a strange statement. But 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’s not the only structure preventing you from leaking urine. Nor is it the sole factor in allowing you to have pleasurable sexual intercourse. It’s not the only structure stabilizing your tailbone as you move into a yoga pose. The pelvic floor 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!

Can a Tibia Fracture Affect the Pelvic Floor?

One of the patients that most inspired me to start my journey outside of the pelvis was an 18-year-old girl I treated four years ago. She was a senior in high school. 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. Upon further questioning, she told me that a year ago, she experienced a fracture of her tibia while playing soccer. She wore a brace to immobilize her leg for about a month. After that the doctor cleared her 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. It led to a compensatory “gripping” pattern in her pelvic floor muscles in an 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 her previous physician hadn’t discovered.) And guess what? Her pelvic pain went away. BOOM.

What Else Can affect the Pelvic Floor?

• Poor mobility in the neck and upper back can actually lead to neural tension throughout the body. This includes 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. This can 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). This, 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. This could increase the work one hip has to do compared to the other. It can cause certain muscles to fatigue and become sore and tender, including the pelvic floor muscles!

Find the Connections

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!