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Finding Relief: How Pelvic PT Can Help Complex Back Pain

Back pain is one of the most common reasons people seek physical therapy—and for many, it’s also one of the most frustrating. You may have tried traditional orthopedic physical therapy, chiropractic care, massage, injections, or exercise programs, only to find that relief is partial, temporary, or nonexistent.


This is often because complex back pain isn’t just a “back” problem.


At Auria Pelvic Health, we specialize in identifying and treating the missing pieces of back pain—especially those rooted in the pelvis, deep hip muscles, and the nervous system. Pelvic floor physical therapy offers a more complete, precise approach for people whose pain hasn’t resolved with standard care.


Person holding lower back in discomfort at home, illustrating chronic back pain that may be linked to pelvic floor or deep hip muscle tension.

When Back Pain Is More Than the Spine


Many back pain treatment models focus primarily on the lumbar spine: discs, joints, posture, and surface-level muscles.


While these factors matter, they don’t tell the whole story—especially when pain is persistent, one-sided, radiating, or aggravated by sitting, standing, walking, or activity.


What’s often overlooked is that the pelvis is the foundation of the spine.


Key muscles that influence back pain:

  • Attach directly to the pelvis

  • Cross the hip joint

  • Interface with the sacrum and tailbone

  • Interact with the pelvic floor

  • Surround or directly affect the sciatic nerve


If these structures aren’t assessed and treated, pain can linger despite “doing everything right.”


Direct Access to the Root of the Problem

One of the most important distinctions of pelvic floor physical therapy is access.


Pelvic PTs are trained to evaluate and treat:

  • Deep hip and pelvic muscles that cannot be fully accessed externally

  • Muscle attachments at the pelvis and sacrum that strongly influence spinal mechanics

  • The pelvic floor muscles, which play a major role in spinal support, load transfer, and movement control


Many of these muscles—such as the obturator internus, levator ani, and deep rotators—are intimately connected to both back pain and hip pain, yet are not addressed in standard orthopedic physical therapy.


Sciatic Pain: Why the Pelvis Matters

Sciatic pain is a common reason people seek care, and it’s frequently attributed to disc issues or spinal compression.

Woman with neck discomfort, representing musculoskeletal tension connected to chronic back pain and pelvic floor issues.

While those causes are real, the sciatic nerve also runs directly through the pelvis, where it can be affected by:

  • Pelvic floor muscle tension

  • Deep hip muscle restriction

  • Scar tissue or connective tissue tightness

  • Poor coordination between the core and pelvic floor


Pelvic PT allows us to assess the nerve’s pathway through the pelvis itself—not just where it exits the spine. This is a critical distinction for people with:

  • Persistent or recurrent sciatica

  • Pain that worsens with sitting

  • Pain that shifts sides

  • Symptoms that don’t match classic disc patterns

By addressing both muscular and neural contributors, we can often reduce irritation at the source rather than chasing symptoms downstream.


Why Traditional Ortho PT Isn’t Always Enough

Orthopedic physical therapists are highly skilled—but their scope typically does not include internal pelvic assessment or treatment.


This means they may not be able to fully evaluate:

  • Pelvic floor muscle tone (overactive vs underactive)

  • Internal muscle trigger points affecting the back or hips

  • Pelvic asymmetry driven by deep muscular imbalance

  • Coordination between breathing, core function, and pelvic stability


As a result, patients may strengthen muscles that are already overactive, stretch areas that need stability, or miss the primary driver of their pain altogether.


Pelvic PT fills this gap.


A Whole-Body, Integrated Approach

At Auria Pelvic Health, complex back pain is never treated in isolation.

Our evaluation looks at how your:

  • Pelvic floor

  • Core and diaphragm

  • Hips

  • Spine

  • Nervous system

  • Movement patterns

  • Daily habits and load demands

are working together.


Treatment may include:

  • Manual therapy to deep pelvic and hip muscles

  • Nervous system downregulation

  • Targeted mobility or stabilization work

  • Breath and pressure management

  • Functional movement retraining

  • Education that helps you understand your pain—and trust your body again


When to Consider Pelvic PT for Back Pain

Pelvic physical therapy may be especially helpful if you have:

  • Chronic or recurrent low back pain

  • Back pain with hip, pelvic, or tailbone pain

  • Sciatica that hasn’t resolved with traditional care

  • Pain with sitting, transitions, or prolonged standing

  • A history of pregnancy, childbirth, pelvic surgery, or trauma

  • Back pain paired with bladder, bowel, or sexual symptoms


Relief Starts with the Right Lens

Complex back pain often persists not because you haven’t tried hard enough—but because the right structures haven’t been addressed. Pelvic floor physical therapy offers a more complete understanding of how the pelvis, spine, muscles, and nerves interact. When those connections are treated thoughtfully and directly, real relief becomes possible.


At Auria Pelvic Health, we’re here to help you move beyond symptom management and toward lasting change—by treating the whole system, not just the spine.




Auria Pelvic Health

8929 S Sepulveda Blvd., Ste. 412

Los Angeles, CA 90045

Phone: 310-505-6096



Article Written By Dr. Sasha Speer, DPT


 
 
 

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