Low Back Pain that Radiates to the Pelvis: What’s Causing It and How to Treat It

Low back pain is incredibly common and usually goes away on its own. But if your back pain radiates to your pelvic area, you may wonder if something serious is going on. There are many reasons low back and pelvic pain are connected, says Lori Walter, PT, DPT, a pelvic health physical therapist at Hinge Health. “The back and the pelvis share a lot of common structures — nerves, ligaments, joints, and muscles — so you may feel pain in both places at once,” she says.

Radiating back pain like this is typically treatable with conservative methods like exercise and lifestyle changes. If your pain isn’t responding to home remedies, see a professional who can ask questions and may perform tests to understand the underlying contributors to your pain, says Dr. Walter.

Here, learn more about what causes back pain that radiates to the pelvis, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

Common Causes of Low Back and Why It Might Radiate to the Pelvic Area 

Pain can travel in multiple ways, says Dr. Walter. Radiating pain usually refers to pain that travels from a specific point down a particular nerve path, often resulting from compressed or irritated nerves. Pain may also “travel” because it’s along shared structures (like muscles) that support two different areas. When pain is chronic, the nervous system also tends to get amplified, with more and more neighboring nerves becoming sensitive to pain signals that make it seem like pain is spreading.

Here are some specific conditions that often present as back pain radiating to the front pelvic area:

Herniated discs. Your spine consists of 33 vertically stacked bones (called vertebrae), which are separated by strong, fibrous discs that are about a half-inch thick and cushion the spinal bones. A herniated disc occurs when its center pushes against the outer ring, causing pressure that can, at times, contribute to back pain. You may experience a sharp or burning pain, along with numbness, tingling, and weakness. If nerves around the lumbar (lower) spine are irritated,  pain may radiate into the pelvic area.

Spinal stenosis. This occurs when the spinal canal narrows and puts pressure on the bones and nerve roots. It can contribute to aching, numbness, and burning pain that radiates down the buttock and leg.

Sacroiliac joint pain (sacroiliitis). The sacroiliac (SI) joints are among the largest in the body, connecting the lower back to the hips. If the joint becomes inflamed due to factors like arthritis, pregnancy, or a traumatic injury, it can lead to pain that ranges from sharp to dull and achy. You may feel the pain in your low back, hips, or thighs. Pain most commonly radiates down the back of the leg, but in some cases, it may also travel to the groin or abdomen. Sacroiliac joint pain is an often overlooked cause of low back pain, even though it may contribute to up to 25% of cases.

Pelvic floor muscle imbalance. This is another underappreciated-but-common cause of back pain, says Dr. Walter. You may think the pain is in your back, but it’s actually possible that it’s originating from weak, tight, or stretched pelvic floor muscles. “If the pelvic floor muscles are strained, the back muscles often have to overcompensate,” says Dr. Walter. Weak pelvic floor muscles may also lead to prolapse, which is when organs like the uterus, bladder, and rectum shift position. “If your pelvic organs are not well supported by the pelvic floor muscles, your back muscles may tighten up in an attempt to help provide support,” says Dr. Walter.

Body changes during pregnancy. When you’re expecting, your body releases hormones that relax the pelvic area to prepare for giving birth. This may cause the sacroiliac joint to stretch and widen, resulting in sacroiliac joint pain (see above). The pelvic floor muscles also have to work to support a growing baby. As the baby grows, your posture shifts forward, causing the low back muscles to tense up to maintain stability. That strain may cause pain that travels from the pelvis to the lower back. This type of muscular pain is often mistaken for lower back pain even though it originates in the pelvis, says Dr. Walter.

When to See a Doctor

Most cases of back pain aren’t serious and get better with conservative remedies. If you’re getting better using home remedies, continue what you’re doing. “The key: You should be seeing progress,” says Dr. Walter, though it’s normal for progress to ebb and flow. If pain plateaus and stops improving over six to 12 weeks, consider seeing a doctor. You should also see a doctor right away if you notice any of the following:

• Sudden onset of increased weakness

• Change in balance in coordination

• Sudden loss of bowel and bladder control

• Fever, or other systemic symptoms

Prevention Tips

If you’re prone to pain in the low back and pelvis, there are many things you can do to manage and prevent it.

If you smoke, get support to try cutting back. Regular smokers are more likely to report back pain than nonsmokers, according to a study of over 34,000 adults. Nicotine may amplify pain perception by stimulating the central nervous system. Smoking also causes inflammation and accelerates the degeneration of the discs that cushion the bones of the spine. Just remember: You don’t necessarily have to quit cold turkey to get benefits. Anything that helps you cut back is progress.

Aim for your exercise “sweet spot.” Too little exercise has been linked to lower back pain, as has overly strenuous exercise leading to overexertion. Finding your sweet spot means finding the right balance for your body’s health and your own pain tolerance. “Some pain is fine, just keep an eye on it. If it returns to baseline in 24 hours, you can continue to move more,” says Dr. Walter. “Try to avoid not doing exercise or activity altogether. Understand there will be ups and downs.” If you’re sedentary, build up to 150 minutes of moderate aerobic activity a week (about 20 minutes a day), the amount recommended by the American College of Sports Medicine.

Relax your core. Although strong muscles are important for recovery, tensing your core and pelvic muscles too much or too often can put pressure on sensitive structures in the back and pelvis. Learning to relax your muscles while you move and sit can be important for many people suffering from back and pelvic pain.

Watch how you lift heavy objects. We are naturally stronger in certain positions, and it can be useful to take a moment to assess your body position and find a firm stance before lifting a heavy load. A combination of squatting with your legs and hinging your chest toward the floor could work well for you, since these are positions where we are strongest. When lifting something heavy, it may help to keep the weight close to your body and directly in front of you to reduce the overall load of the object.

Treatment for Lower Back Pain that Radiates to Front Pelvic Area

The following tips from our Hinge Health physical therapists and medical doctors can provide relief for low back and pelvic pain.

• Physical therapy and home exercises. Physical therapy is a first-line remedy for many causes of back pain that radiates to the pelvis. A physical therapist will design exercises that target your needs in specific areas. These may improve blood flow, strength, flexibility, and mobility in tight tissues. You may also need to increase core strength and build support through the hips and back. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Ice and heat therapy: Ice often quells inflammation in acute injuries. Heat reduces chronic pain by relaxing tight muscles and tissues, which may lessen pressure on compressed nerves. Learn more about when to use ice versus heat.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful. It’s important to make sure that you are safely able to take these medications, based on your medical history.

While all of the above steps can help, one of the most effective is exercise therapy. Here are a few gentle moves from Hinge Health physical therapists that target areas involved in back pain that radiates to the pelvis.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Pillow for Your Back, Towel for Your Butt

Many people think to support their lower back with a pillow, but don’t think about supporting the sit bones, says Dr. Walter. “Elevating the sit bones raises the pelvis above your knees and tilts the pelvis forward, which may be more comfortable for your back.” She recommends rolling up a towel and placing it under your buttocks, toward the back, and adjusting to your comfort.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Buchanan, B. K., & Varacallo, M. (2022). Sacroiliitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK448141/

3. Chhatre, A. (2022, June 9). Lower Back Pain: What Could It Be? Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/lower-back-pain-what-could-it-be

4. Dydyk, A. M., Ngnitewe Massa, R., & Mesfin, F. B. (2022). Disc Herniation. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441822/

5. Green, B. N., Johnson, C. D., Snodgrass, J., Smith, M., & Dunn, A. S. (2016). Association Between Smoking and Back Pain in a Cross-Section of Adult Americans. Cureus, 8(9), e806. doi:10.7759/cureus.806

6. Park, D. K. (2021, August). Low Back Pain. OrthoInfo—American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/low-back-pain/

7. Park, D. K. (2021, August). Lumbar Spinal Stenosis. OrthoInfo—American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/lumbar-spinal-stenosis/

8. Physical Activity Guidelines Resources. (n.d.). American College of Sports Medicine. https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

9. Park, D. K. (2021, August). Sciatica. OrthoInfo—American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/sciatica/

10. Anatomy of the Spine. (2018, September). http://www.mayfieldclinic.com/pe-AnatSpine.htm