I recently saw a patient who was referred to me by her OBGYN. At the time, she was a few months postpartum and presented with pelvic pain that began during pregnancy. Her OBGYN felt the culprit was weakness of her pelvic floor muscles and requested that I provide her with exercises for pelvic floor strengthening, such as Kegel exercises.

Now, in my practice, I don’t keep a stack of exercises on my desk to give to patients. Instead, I assess conditions using the McKenzie Method, with the aim of figuring out their problem and outlining the best course of care.

When I took this patient through her assessment, I encountered a phenomenon I routinely see in my practice. I learned that her pelvic pain was primarily influenced by her spine, meaning that there was a clear relationship between spinal movements and her symptoms. This connection was determined by having her repeatedly move her spine in different directions and observing the effect that these movements had on her pain. This correlation ruled in a spinal influence, and further investigation revealed a single direction of spinal movement that completely abolished her pain.

The specific spine movement we discovered through assessment became her treatment and enabled her to completely overcome her problem. In her case, pelvic floor exercises were unnecessary in the treatment of her persistent pelvic pain.

This wasn’t the first patient I’ve seen who ended up having a spinal source for pelvic pain. In fact, it has been estimated that roughly half of those with similar symptoms, whether felt in the lower abdomen, pelvis, or perineum, have a spinal influence and respond favorably to interventions directed at the spine.

Without a properly conducted McKenzie Method assessment, it can be challenging for providers to determine if the spine is to blame for a patient’s pelvic pain. Most other methods of investigation are unable to establish this relationship, meaning it goes largely unrecognized in the broader medical system. This lack of understanding becomes a problem when determining which intervention to prescribe to patients with pelvic pain. By default, many are given exercises to strengthen their pelvic floor; a fantastic choice when pelvic floor weakness is the reason for pain, but not when the spine is the cause.

Some unfortunate pelvic pain patients with an unrecognized spinal influence will undergo treatment after treatment directed at the wrong source. They will often be escalated up the medical chain after failing to improve, eventually receiving costly and invasive procedures such as nerve blocks and surgeries. A common operation for chronic pelvic pain patients is a hysterectomy, with over 200,000 procedures performed each year for those with treatment-resistant symptoms. Unfortunately, 1 in 4 women continue to experience pelvic pain following surgery.

Thankfully, the patient who was referred to me didn’t end up going that route. The cause of her symptoms was identified, accurate treatment was prescribed, and she was provided with the tools for self-management if her pain ever returns. With that being said, if you have pelvic pain and have tried traditional pelvic floor interventions with little or no relief, your pain may very well be driven by your spine. In this instance, a McKenzie Method assessment should provide the answers you are looking for.

Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.