Pelvic Floor Training for Chronic Low Back Pain: What Does the Evidence Tell Us?

A 2025 systematic review and meta-analysis examined eight randomized controlled trials investigating pelvic floor muscle training (PFMT), alone or combined with other exercises, in people with chronic non-specific low back pain

Key Findings:

• Pelvic floor training in combination with exercises showed a greater reduction in pain than without PFMT

• There were also improvements in functional disability, with greater improvements reported in the PFMT groups in several trials. However, the evidence for changes in pelvic floor strength and transversus abdominis strength was inconclusive. Quality-of-life outcomes also appeared to improve, but these were mainly assessed in women who also had urinary incontinence, making the findings less applicable to low back pain alone.

Why could the pelvic floor matter?

The pelvic floor works together with the transversus abdominis, diaphragm, and deep spinal muscles to regulate intra-abdominal pressure and contribute to lumbopelvic stability. Persistent low back pain may alter motor control within this system, potentially affecting both spinal stability and pelvic floor function.

What does this mean for your rehabilitation?*

• PFMT may be a useful, low-risk addition to an individualized exercise programme, particularly when pelvic floor dysfunction or urinary symptoms are also present.

• Effective rehabilitation should include education, accurate assessment of pelvic floor activation, coordination with trunk muscles, progressive exercise, and sufficient training duration.

  
  

The evidence is promising, but not definitive. The available studies were generally small, used different protocols, and provided limited information on adherence and long-term outcomes.

Importantly, PFMT was rarely delivered as a stand-alone treatment. Interventions often included core or spinal stabilization exercises, and some studies also used electrotherapy, heat, or ultrasound. This means the current evidence supports pelvic floor training primarily as one component of a broader rehabilitation programme, rather than as an isolated treatment.

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Source: Thuramalla, Madhavi & Nallamalla, Krishna & Leo, Antony & B, Sathyaprabha & K, Soundararajan & Male, Yanadi. (2025). The Effect of Pelvic Floor Muscle Training Along with an Exercise Intervention in Non-specific Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of South Asian Federation of Obstetrics and Gynaecology. 17. 462-474. 10.5005/jp-journals-10006-2691.

*Disclaimer: This document contains a summary and interpretation of scientific material and does not constitute an official representation of the original publication. No guarantee is made regarding the accuracy, completeness, or interpretation of the information presented. All responsibility for verifying the content and drawing conclusions from the original source rests with the reader. I expressly disclaim any liability for errors, inaccuracies, omissions, or any direct or indirect consequences arising from the use or reliance on this document.