May is Pelvic Pain Awareness Month, in which organizations strive to raise and improve public awareness of issues in the area of chronic pelvic pain. As a physical therapist with a special interest and years of experience in the treatment of patients with pelvic girdle related pain, I hope you find that this blog article increases your knowledge of the role our pelvic floor muscles play in pelvic girdle, pelvic, buttock, low back, and hip pain and stiffness and stress urinary incontinence (urinary leakage).
Men and women have a pelvic floor. It is not really a floor, but a collection of muscles, ligaments, nerves, tendons, blood vessels, fascia, and connective tissue at the bottom of the pelvis. Several layers of muscles make up our pelvic floor muscles (“PFM”). Some of these muscles connect the tailbone to the pubic bone while others spread outward and connect to pelvic bones and the hips. Thoracolumbar fascia connects these muscles to the low back. The deeper layer of muscles supports the vagina, bladder, uterus, and rectum. The outer, or more superficial layer, surrounds the bladder, vagina, and anal openings.
The transversus abdominis, pelvic floor, deep lumbar multifidi, and diaphragm muscles form our deep muscle system, known by many as the inner core. For more information on these muscles, please refer to my blog post, “The Deep Muscle System (“Inner Core”). The transversus abdominis, pelvic floor, and deep lumbar multifidi muscles have been found in research studies to stabilize our spine before movement of the legs and arms occur. However, their activation is often delayed or absent and the muscles may contract too much or too little. They may also fail to work together as they should. If these co-contraction patterns aren’t corrected, they may lead to degeneration of the underlying joints due to loss of stability and control of motion. The activation patterns of these muscles generally won’t change without guidance from a trained professional such as a physical therapist.
The terms, "inner core muscles", "inner core", and "the deep muscle system", are often used interchangeably in rehabilitation, fitness, and wellness settings. However, what does one really mean when he or she refers to this group of muscles? A Google search shows many different descriptions, lists, and explanations of muscles that make up our deep muscle system.
Many physical therapists refer to the deepest muscles located in the region between our pelvis and diaphragm as "the inner core" muscles. When we help patients train and strengthen these muscles, we focus on the following: the breathing diaphragm in the upper most part of the core; the deep and superficial muscles of the pelvic floor located in our pelvis; the transversus abdominis in the front abdominal muscle wall; and the deep lumbosacral multifidi in the low back.
