What Does My Midback Have to Do With My Pelvic Floor

By Dr. Christine Martirez PT, DPT on 11/7/2024

The pelvic floor and thoracic spine may seem worlds apart, but they are intricately connected in ways that affect our daily function and overall pelvic health. The alignment and mobility of the thoracic spine (mid-back) have a major influence on pelvic floor function, impacting factors like posture, muscle tone, and pressure management. Beyond mechanics, the thoracic spine houses nerves that control parts of the bladder, meaning issues in this area can contribute to urinary urgency and frequency. Fortunately, pelvic floor physical therapy can be an effective approach for addressing these connections and restoring healthy function.

How Thoracic Spine Posture Affects Pelvic Floor Function

The thoracic spine forms the middle part of the back, encompassing the 12 vertebrae between the cervical spine (neck) and the lumbar spine (lower back). When posture in the thoracic spine is misaligned—like excessive rounding or stiffness—the entire spine and pelvis are affected, influencing how the pelvic floor muscles work. The pelvic floor relies on a specific balance of tension and relaxation to function effectively, which is referred to as its length-tension relationship. When the thoracic spine is out of alignment, it disrupts this balance.

The Length-Tension Relationship of Pelvic Floor Muscles

The pelvic floor muscles support the pelvic organs and help control urinary, bowel, and sexual functions. For optimal function, these muscles need to maintain an ideal length-tension relationship, where they are neither too stretched nor too contracted. Postural deviations in the thoracic spine, such as excessive rounding (thoracic kyphosis) or overextending (thoracic lordosis), can shift the alignment of the spine, pelvis, and even the ribcage.

This misalignment changes the length and tone of pelvic floor muscles, causing them to become overactive (tight) or underactive (weak). For instance, when the thoracic spine rounds excessively, it can tilt the pelvis backward, flattening the lumbar curve and potentially increasing strain on the pelvic floor. This strain can lead to issues like urinary urgency, frequency, or even pelvic pain due to increased pressure on the muscles and organs.

Pressure Management and the Pelvic Floor

The relationship between the thoracic spine, diaphragm, and pelvic floor is crucial for maintaining proper intra-abdominal pressure. When we inhale, the diaphragm moves downward while the pelvic floor expands to support pressure. Conversely, when we exhale, the diaphragm moves up, and the pelvic floor contracts. If the thoracic spine is stiff or misaligned, it restricts the movement of the ribcage and diaphragm, which can interfere with this natural coordination. Poor pressure management can result in increased pressure on the pelvic organs and muscles, leading to issues like urinary incontinence, prolapse, or even constipation.

The Sympathetic Nervous System, Thoracic Spine, and Bladder Function

Beyond postural alignment, the thoracic spine also plays a role in bladder control through the sympathetic nervous system. The nerves responsible for sympathetic innervation of the bladder stem from the thoracic and lumbar regions, specifically T10-L2. This sympathetic innervation controls bladder relaxation and the sensation of fullness.

If the thoracic spine is compromised—through injury, poor posture, or tension—these nerves may become irritated or less effective, leading to symptoms such as urinary urgency and frequency. For individuals experiencing these symptoms without a clear urological cause, the thoracic spine may be contributing to the problem.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy provides targeted support to improve alignment, muscle function, and nerve health from the thoracic spine to the pelvic floor. Here are several ways pelvic floor therapy addresses these connections:

1.

Postural Assessment and Correction

A thorough postural assessment is key to determining how the thoracic spine may be impacting the pelvic floor. A therapist will assess for signs of misalignment, ribcage positioning, and thoracic flexibility. They then guide you through corrective exercises that align the spine, open the ribcage, and help return the pelvic floor to a balanced length-tension state.

2.

Breath and Pressure Management Training

Therapists teach breathing techniques that enhance coordination between the diaphragm, thoracic spine, and pelvic floor. By learning to inhale and exhale with proper support and pressure distribution, patients can reduce unnecessary strain on the pelvic floor, manage symptoms of incontinence or prolapse, and improve their overall stability.

3.

Thoracic Mobility and Flexibility Exercises

In cases where the thoracic spine is stiff or restricted, a therapist may introduce specific mobility exercises, such as thoracic rotations and stretches. These movements help restore range of motion in the mid-back, supporting a neutral spine and improving the way the pelvic floor muscles respond to movement and pressure changes.

4.

Neuromuscular Re-education

For those with urinary urgency and frequency related to thoracic spine dysfunction, pelvic floor physical therapy can include neuromuscular re-education. Techniques like biofeedback can improve the connection between the nervous system and pelvic muscles, calming overactive muscles or restoring tone to those that are weakened. This re-education can reduce symptoms of urgency and help regain control.

5.

Holistic Approach to Pain and Pelvic Health

Since the pelvic floor is deeply connected to surrounding muscles, bones, and the nervous system, therapy often involves a holistic approach. Alongside posture and alignment work, therapists address areas of tension in the hips, abdomen, and spine, providing relief and enhanced function across the entire pelvic region.

The Path to Healthier Function Through Thoracic and Pelvic Floor Care

The connection between the thoracic spine and pelvic floor shows how intricately our body systems work together. Misalignment or dysfunction in one area can ripple through other regions, affecting bladder control, stability, and comfort. Through pelvic floor physical therapy, individuals can address these underlying issues, learning how to move, breathe, and align in ways that protect the pelvic floor and improve quality of life.

Looking for guidance with postural education and pelvic floor health? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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