Whenever I speak with folks who reach out and ask me about pelvic floor therapy, they typically share the pelvic floor symptoms they experience such as leaking, heaviness, or constipation. They also have almost always heard something about an internal pelvic floor muscle assessment. If they have been to pelvic floor therapy before, sometimes they have had a pelvic floor muscle assessment and are expecting to come in and just have their breathing and pelvic floor muscles assessed.

Although we absolutely do assess breathing and pelvic floor function and coordination (often with an internal pelvic floor muscle assessment) at Absolute Kinetics, we also do a full orthopedic assessment on our patients with pelvic floor dysfunction. Your pelvic floor doesn’t work alone! In fact, it plays a major role in maintaining proper pressure throughout your thorax and abdomen, and also translates forces during things like walking, jumping, and even upper body movements. 

The foot: a common missing piece in pelvic floor therapy

What is the first thing that touches the ground when you walk, run, or jump? Your feet, of course! If you have ever had foot pain, you know it changes the way you walk which can eventually lead to things like back pain, hip pain, and/or knee pain. So you can imagine that it could also have an effect on your pelvic floor muscles, which play a major role in translating forces when we move.

When we walk, run, and jump, our feet should be able to absorb and translate forces efficiently as well. Imagine if you tried to jump on a stiff stilt, you would probably notice more impact through your joints, including your hip and back. Now imagine jumping on a pogo stick instead – the pogo stick absorbs force upon your landing, then translates it back up.

In order for your foot to absorb forces efficiently when landing, your midfoot needs to be able to pronate. This absorbs an appropriate amount of force, then allows your foot to translate an appropriate amount of force back up as you walk, run, or jump. The amount of force your pelvic floor needs to absorb and translate in this situation is much less compared to jumping on a stiff foot that doesn’t pronate, or a painful foot that won’t absorb force.

Just look at the anatomy

It is also important to note that there are anatomical connections between the foot and pelvic floor.

Let’s talk about nerve connections first. The nerve roots that innervate some of the foot and ankle muscles are S1 and S2, which are sacral nerve roots. These nerves originate in the sacrum (tailbone area) and also innervate muscles such as the glute max, piriformis, obturator internus, and hamstrings - all muscles that also have a major impact on pelvic floor function.

For patients with urinary urgency, I will often recommend they try doing some heel raises or curling their toes when they feel a strong urinary urge. This often reduces the sensation of urgency because of these neural connections.

There is also a line of fascia (connective tissue) that runs down the back of the body, connecting the pelvis to the foot. Therefore tightness and restriction in the fascia of one area could have an impact on all of the areas it has connections with.

The bottom line: it’s all connected

Internal pelvic floor muscle assessment, breathing, and pressure management are all key components of pelvic floor therapy. However, a thorough orthopedic assessment that looks at functional movements, as well as strength and mobility of the feet, hips, and thoracic spine is equally important in helping patients improve their pelvic floor function and reduce things such as pelvic pain, pelvic organ prolapse symptoms, stress urinary incontinence, and more.

If you want to learn more about why you may be experiencing leaking with things like running, jumping, and lifting, check out our free PDF download “Yes, You Can Run, Jump, and Lift Without Peeing Your Pants” here.

Interested in learning more about our holistic approach to pelvic floor therapy? Set up a free 15 minute phone consult with one of our therapists here or learn more about working with us here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS