Head and Shoulders, Knees and Toes…and Pelvic Floor (Re-post)

My Father-in-law’s favorite joke is to lift his arm only to shoulder level and say “Hey doc! I can only lift my arm this high.” Then as he raises his arm to straight overhead, he says “But I used to be able to lift it this high.”After ruling out the need for a psyche consult, a doctor would likely send a patient with a shoulder issue to see a physical therapist. Shoulder problems come in many forms. Regardless of the cause, in order to fully rehabilitate a shoulder, the pelvic floor needs to be a part of the rehab plan.

Pardon me? Psyche consults all around!

You can’t address a shoulder problem without addressing joint alignment, and shoulder joint alignment relies on postural alignment. Postural alignment needs a strong Core, and you can’t have a strong Core without a strong pelvic floor. Cancel that consult!

In 2007, a research team lead by Paul Hodges (1) compared how the pelvic floor and shoulder muscles interacted when a study participant lifted their arm in different directions. One of the things they observed was that the pelvic floor engaged before the arm lifting deltoid muscle every time, no matter which direction the arm went. In a nutshell, the pelvic floor, along with the other inner Core components (Diaphragm, Transverse Abdominis, and Multifidus), secure our physical center to create a sturdy anchor for the muscles that support and create shoulder motion before we start moving our arm, every time we move our arm, no matter which way we move our arm.

A paraphrased “Dem bones, dem bones, dem dry bones” ditty highlights this relationship with an anatomy lesson that works from the outside-in. The shoulder bone’s connected to the shoulder blade  The shoulder blade’s connected to the ribcage. The ribcage’s connected to the spine, and the spine’s connected to the pelvis. Muscles help make all of those connections. However, Hodges research demonstrated that the timing of the muscular connections should follow the pattern of the pelvic floor first, securing the pelvis before all other muscle work begins. So we have to reverse the “dry bones” anatomy lesson and move from the inside-out. Secure the pelvis first with our pelvic floor then rehabilitate and train the muscular and structural chain back out to the shoulder. Who’s crazy now??

The pelvic floor’s claim to fame is its role in keeping us from leaking, and it gets a lot of press for providing better sex. However, It is also a powerful ally in the health of our musculoskeletal system. I have highlighted the particular relationship it has with shoulder motion here-if the pelvic floor isn’t working well then the shoulder won’t work well either. The pelvic floor also works in the same way with other body parts- hips, knees, necks, etc. to optimize the function.

So what is a woman who has had a few kids and has a few leaks when she coughs or laughs  to do about her achey shoulder? Start by understanding how the two issues, leaking and achy shoulders, are connected. Also, know that when you go to the doctor to talk to him/her about what are historically perceived as two separate issues- you too may be considered a nut job!  Hand them a copy of this blog with the research reference below. Then ask for an Rx for a physical therapist in your area who can help you from the inside-out!

1. Hodges PW, Sapsford R, and Pengel LH. 2007. “Postural and respiratory functions of the pelvic floor muscles.” Neurourology And Urodynamics 26, no. 3: 362-371

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3 thoughts on “Head and Shoulders, Knees and Toes…and Pelvic Floor (Re-post)”

  1. Bryan says:


    Very interesting/good article! We weren’t taught a lot about how to exactly strengthen the pelvic floor or good interventions on how to do so. I would greatly appreciate any insight/tips/suggestions on how to so. Feel free to send me an email!

  2. Antony Lo says:

    Great post! Totally agree. Didn’t know about that hodges research so thanks!

    One of my posts at my blog makes the case for checkin the pelvis when you have shoulder problems. If you cannot secure the base of support for you shoulder muscles, how can you use your shoulder properly?

    A quick screening test will be able to see what regions are dysfunctional during shoulder/arm movements. If your pelvic floor is not working properly, then your pelvis, hips, lumbar spine and thorax will likely show signs of dysfunction as well.

    Awesome work! Keep it up 🙂 if you go to the psych ward, you will at least have me to keep you company!

    1. Julie Wiebe says:

      Thanks for weighing in Antony! Agreed that we can see dysfunction in other regions when the pelvic floor isn’t working well, incontinence is not the only signal that the pelvic floor is dysfunctional! getting folks to attribute that to pelvic floor is the trick! I think there is plenty of room at the looney bin if anyone else wants to join us!

      All the best! Julie

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