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Strong Back, Strong Core: Pilates and Pelvic Floor Workouts

Pilates for low back pain and pelvic floor strength exercise.

Low back pain is one of the world’s most common ailments, with the rates of low back pain in Australia at an all-time high. Common physio treatment to manage low back pain includes hands-on therapy (manual therapy), a graded exercise and strengthening program (resistance exercises, clinical Pilates and mobility drills), movement re-education, and addressing lifestyle and biomechanical factors. However, have you ever considered that your pelvic floor muscle function may also be playing a significant role in your back pain? Recent research shows that this group of muscles may play a significant role in effectively treating low back pain.

What Are The Pelvic Floor Muscles?

The pelvic floor muscles are a group of skeletal muscles and connective tissues that form a basin-shaped diaphragm within the pelvis. These muscles play essential roles in supporting organs such as the bladder, bowel, and internal reproductive organs. Imagine them as the unsung heroes—holding everything in place while allowing for urination, defecation, and sexual function. Their functions include providing support for abdominopelvic viscera, resisting increases in intra-pelvic or abdominal pressure (like during coughing or heavy lifting), and ensuring urinary and fecal continence. So, next time you laugh, lift, or go to the loo, thank your pelvic floor—it’s working hard behind the scenes!

The Link Between Low Back Pain and Pelvic Floor Muscles

Research from Ontario, Canada, has found an significant link between lumbopelvic pain and pelvic floor dysfunction in women. 95.3% of subjects who had low back pain and pelvic pain were found to have some form of pelvic floor dysfunction. 66% of those with back pain had pelvic floor weakness, 71% had pelvic floor muscle tenderness and 41% experienced pelvic organ prolapse. Participants with combined low back pain and pelvic girdle pain presented with higher levels of disability and increased characteristics of pelvic floor dysfunction(1).

There has also been research from Norway and Sweden looking at pelvic floor activation in women with no pain during movements that involved taking the armand/or leg away from the body. Results showed that the pelvic floor muscles activate just prior to arm or leg movements in women without pain. This shows us that when the pelvic floor is working correctly, it provides trunk and pelvic stability to allow for functional movements and postures to occur(2).

So, we now know that when the pelvic floor muscles are weak or you do not know how to activate them effectively, they fail to adequately support the pelvic organs and maintain pelvic alignment, leading to increased stress on the lumbar spine. Conversely, hypertonic (overly tight) pelvic floor muscles can lead to poor pelvic control, causing compensatory movements and muscle recruitment patterns that contribute to low back and pelvic pain.

Other reasons that your lingering back pain may have something to do with a weak or overactive pelvic floor is that tender points in the pelvic floor due to overuse or excessive tension can cause patterns of pain that refer (i.e. travel) elsewhere in the body. This can include the lower back, tailbone and hips.

Can Pelvic Floor Strengthening Exercises Help Low Back Pain?

The good news is, results based on a 2023 meta-analysis (the highest quality type of study you can attain) showed that pelvic floor muscle-strengthening exercises significantly reduced the intensity of low back pain. Therefore, pelvic floor muscle exercises should be considered for inclusion as a part of a comprehensive low back pain management plan(3). There are several ways to strengthen your pelvic floor, with Pilates being among the most popular.

What are Pelvic Floor Exercises?

When people talk about pelvic floor exercises, you generally think of the well-known “Kegel’s”. But in our Clinical Pilates sessions at Central Performance, we know that not only do you need to know how to activate your pelvic floor, but you also need to know how to use it during movement, lifting, carrying and everyday life. Integrating pelvic floor muscle activation with optimal movement control is a major aspect of our individual clinical Pilates sessions.

A study from the American Journal of Obstetrics & Gynaecology reinforced this notion, showing us that bridges are 56% more effective than Kegels, 4-point hovering is 49% more effective, lunges 42% more effective, squats 30% more effective, and clams 25% more effective than Kegels at activating your pelvic floor muscles(4).

Sometimes, overly tight pelvic floor musculature can also contribute to low back pain. In this circumstance, guidance surrounding the correct ways to relax your pelvic floor musculature and increasing the mobility of certain muscles around your hip is necessary.

Pilates for pelvic floor muscle strength and low back pain treatment. Physio Pilates in Surry Hills, Sydney CBD.

Pilates Exercise for Pelvic Floor strength and Low Back Pain Treatment

During our physio-led clinical Pilates sessions, you will re-learn how to correctly activate and use your deep core muscles, including your pelvic floor. You will first be assessed by a Physiotherapist and asked about your history of low back pain or pelvic girdle pain. Your Pilates physio will then take you through a personalised assessment to determine the function, strength, length and movement control of different parts of your body, as well as taking you through functional Pilates assessments on some of our Pilates equipment. This will include the reformer, Cadillac, chair and spine corrector.

Following your initial assessment, your physiotherapist will give you a personalised program targeting the
main areas for improvement identified in your first session. For someone with low back pain, this may include re-learning how to activate your pelvic floor, using your pelvic floor in conjunction with your diaphragm and core during movements, and any specific mobility or strength deficits you may have discovered to address your personalised goals.

Please note, if you are experiencing significant pelvic floor muscle dysfunction, prolapse or urinary
incontinence and have not yet seen a specialist or Pelvic Floor Physiotherapist, you need to do this first before booking in for an Initial Pilates Assessment.

Booking Pilates at Central Performance – Surry Hills / Sydney CBD

The Clinical Pilates program at Central Performance is delivered by Sonja and Brigitte, who are both physios with advanced training in all areas of Pilates including mat, studio and reformer Pilates. By combining their physiotherapy knowledge with professional Pilates training they are able to provide clients with effective exercise programs that progress through all stages of injury management, from early rehab to end-stage functional training including complex whole-body movements.

The wide variety of Pilates equipment we have available at Central Performance means that our Pilates sessions are very adaptable to meet the needs of each client. It also means that sessions are engaging and challenging due to the wide variety of exercises available. The equipment we use includes the reformer, Cadillac, Wunda chair and spine corrector.

Our Pilates program also covers exercise sessions for general health and fitness. Often, once clients progress past the injury management stage of the Pilates program (i.e. the more “clinical” stage of Pilates), they continue on with Pilates sessions to continue improving their strength, stability, flexibility and overall fitness. This can include private (1:1), semi-private (2:1) and small group sessions.

Central Performance is conveniently located in Surry Hills, near Sydney CBD and Central Station. Our flexible session times and HICAPS on-the-spot health fund rebates for private sessions make getting your Pilates routine in place easy and convenient. For more information on Clinical Pilates at Central Performance click the buttons to read more, make an enquiry or to book online.

  1. 1. Sinéad Dufour, Brittany Vandyken, Marie-Jose Forget, Carolyn Vandyken (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice. Volume 34, pages 47-52. ISSN 2468-7812 https://doi.org/10.1016/j.msksp.2017.12.001.2.
  2. 2. Sjödahl J, Kvist J, Gutke A, Oberg B. The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain. Clin Biomech (Bristol, Avon). 2009 Feb;24(2):183-9. doi: 10.1016/j.clinbiomech.2008.11.004. Epub 2009 Jan 3. PMID: 19121881.
  3. 3. Kazeminia, M., Rajati, F. & Rajati, M. The effect of pelvic floor muscle- strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials. Neurol Sci 44, 859–872 (2023). https://doi.org/10.1007/s10072-022-06430-z
  4. 4. Crawford B. Pelvic floor muscle motor unit recruitment: Kegels vs specialized movement. American Journal of Obstetrics & Gynecology. April 2016:S468.