I want to introduce you to my friend, Kelli Wilson PT, DPT, FAAOMPT, OCS.
We met in grad school back in 2005. We worked three physical therapy jobs together after that. We learned to do pelvic floor physical therapy together. We started Alcove Education together.
And now…we can’t stand each other.
(Just kidding. No I’m not. Yes, I am. Not. Kidding. But, I am kidding.)
I want to share a post from her blog. It’s called Pain and Simple. (click on the name to read it) I thought she did a fantastic job of explaining one reason for foot and pelvic pain. Cuz you know, if you let pelvic pain go long enough, eventually you will have foot pain.
Every body part is connected to another body part, even if they are not anatomically in proximity to each other.
If you have pain in one area of your body, it will span to another area with time.
We all know that our feet are attached to our lower legs, then our knees, then our thighs, then our hips to finally end at the pelvis.
Would you be surprised if I said that foot pain could be correlated with pelvic pain and/or incontinence?
I know this seems far reaching, so let’s step back and simplify it. You would be surprised with how many patients question why they started having hip pain after a long spell of knee pain. Well….it originates from the same bone, the femur, so pain can easily be interchanged between the joint above and below this bone.
Let’s span out and expand this a little more……
Pelvic pain can affect your feet and vice versa. It has been an amazing “feat” how far we have come in medical research with pain management and all medical specialties, for real. But as we gain more knowledge in a certain specialty, sometimes the big picture gets lost. We stop looking at a patient holistically and focus on their specific symptoms with their particular body part. And when that happens, we are chasing symptoms instead of finding the driver for the pain.
Our body is made up of a complex framework of nerves.
But did you know (great Saturday night factoids to impress your friends)…..
Our body is made up of 46 miles of nerves.
Our nerves transmit signals from our brain at a pace of 170 miles per hour!
Nerves are our electric factory keeping us energized. They are always on. They never sleep.
Nerves come out of our spinal cord and feed our muscles, joints, and even themselves. They are oxygen eating fiends, too! Which is why physical activity is so important in helping to reduce pain.
Nerves branch off from our spinal cord and they pass down like rivers to become tributaries then streams to end in their final placement in the muscles.
The sacrum is our upside-down triangle that is sandwiched between our lumbar spine and tailbone. The sacrum gives off five spinal nerve segments and out of those five: S2, S3, and S4 are our generators for pelvic floor muscles. While similarly, S2 and S3 supply the small muscles in our feet.
So, if you have pelvic pain or even urinary incontinence try to spread your toes…. you might find it difficult to do because they share a similar originating home.
There has been a study published on this exact topic. The link is here.
Many people believe that urinary incontinence is due to getting old and their bladder not working properly. Or it is their diet. Or it is because they had too many kids.
Although it is true that all of the above can be factors to incontinence, the main culprit is due to some muscular component, whether it be the muscles in the pelvic floor being too weak or too overactive. Our pelvic floor is muscles shaped like a bowl inside our pelvis that provides support to our organs to ensure a proficient way to expel our undesired excrement and keeps everything inside, among many other duties.
But like all muscles in the body, they are supplied by nerves. And nerves run from our pelvis to our feet.
If a nerve is restricted, compressed, or compromised in any way, then the muscle will become under or overactive, as well.
Let’s go on a tangent. I love to go on tangents…. just ask my co-teacher, Sara Sauder, who sees me do it all the time in our educational courses.
Let’s start with the sacrum, particularly the nerves from S1-S3. They give rise to the posterior femoral cutaneous nerve which supplies our sensation to the female labia majora (the skin fold that surrounds our vaginal opening), parts of the scrotum and penis, and the back of the upper thigh and leg.
Nerves can be very gossipy and interact with other nerves. Like plant roots, they can grow and connect to other nerves. And the posterior femoral cutaneous nerve has been commonly known to connect to the pudendal nerve (S2-S4) and the sural nerve (L5-S1) through what is called, communicating branches.
The pudendal nerve supplies the majority of the muscles in the pelvic floor. They assist with us being able to hold our urine in when we sneeze or cough among other things.
The sural nerve starts below the knee and reaches all the way to the outside of the foot. This nerve is commonly used for neural stimulation (similar to electrical stimulation) to assist with many bladder dysfunctions.
The take home message is this…..nerves need a stable environment to work properly. If there is any hitch, catch, injury…. this can cause a snag that affects the whole nerve.
An ankle sprain.
A back injury.
High arches in your feet and not wearing supportive shoes.
Pain at your sit bones increased with sitting.
Burning with urination.
This huge array of traumatic injuries and repetitive microtrauma can result in a compromised nerve making it very pissy. Meaning you can start having pain anywhere above or below where this nerve irritation is located. And before you know it, you have plantar fasciitis on your left foot. And you also notice your urinary leakage with coughing has slowly increased from monthly to daily. It is a domino effect.
Don’t discount these parallelisms, this isn’t just chance.
So, if you suffer from plantar fasciitis, Achilles tendon pain, or heel pain…. find a practitioner that will assess you all the way from the foot to the back. Because if they aren’t doing this, they could be missing a big piece of the puzzle in managing your care.
Now, an attempt to share a moment from my personal life:
I am a true blood Houstonian. I was born and raised in Houston. Nothing has been more devastating than watching the destruction my state has suffered this past week. My mother, who still lives in Houston, was fortunate to not flood. But she had refused to leave her home. One of her greatest or smallest (for that matter) attributes is not cooking or having food in her house. I talked to her the day before Hurricane Harvey hit and asked her what she had done to prepare herself. She said, “I will be fine. I bought 10 sausage burritos for $4.00 from McDonald’s.” Who has ever heard of anyone preparing for a Category 4 Hurricane this way you ask? Well, my mother, of course! About 3 days into Houston being flooded and not being able to leave her house, she admitted she was getting tired of those sausage burritos. Luckily, she had neighbors that were gracious enough to share their food with her.
Blessings and prayers to all my fellow Texans!
And Floridians…..please be careful and evacuate if required with impending Irma on her way.