Episode 49: The Foot–Pelvic Floor Connection: A Missing Link in Rehab

We explore a connection most clinicians overlook: the link between the feet and the pelvic floor. Whether you treat pelvic health directly or not, understanding this relationship can drastically improve patient outcomes, especially for those with chronic tightness, pain, or pelvic floor dysfunction. You'll learn how fascia, the nervous system, and postural mechanics all play a role—and why traditional Kegels alone often miss the mark.

What You’ll Learn:

• The fascial connections from feet → diaphragm → pelvic floor
• Why tight calves, foot swelling, or poor toe mobility may signal deeper pelvic or lymphatic issues
• How the homunculus explains the foot–genital sensory link 
• How foot pressure and posture influence pelvic floor contraction
• Why traditional Kegels often miss the mark, especially for urinary leakage
• How to use weight distribution cues (big toe, pinky toe, heel) to improve pelvic floor recruitment

0:00 Introduction to Feet and Pelvic Floor Connection

01:00 Fascial Connections: The First Link

07:38 Homunculus: The Brain-Body Map

10:12 Kegels and Pelvic Floor Mechanics

14:34 Practical Tips for Clinicians

18:08 Conclusion and Final Thoughts

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I’ll see you in a week!

Transcript

0:00

Welcome back to TMI talk with Dr. Mary. I'm your host, Dr. Mary. In this episode, we're gonna go over the three ways the feet and pelvic floor related. This is super crucial for all movement and rehab and healthcare professionals to know in order to help efficiently give our clients the results that they deserve. And. We're gonna dive into each one and how it affects us clinically. Even if you're not a internal pelvic health therapist, it's super important that we know these things as a global understanding of the pelvic floor, even if we don't do those internal assessments, because it can still maximize our benefits with our clients. I personally don't do a ton of internal treatments. I do a lot externally because that's where we'll find the. Source of pelvic floor dysfunction often is, is understanding how the body is moving. So without further ado, we're gonna jump into the episode. I hope you enjoy it. Welcome back to TMI talk with Dr. Mary where we dive into non-traditional forms of health that were once labeled as taboo or dismissed as Woo. I'm your host, Dr. Mary. I'm an orthopedic and pelvic floor physical therapist who helps health. Movement and rehab professionals integrate whole body healing by blending the nervous system into traditional biomechanics to maximize patient outcomes. I use a non-traditional approach that has helped thousands of people address the deeper roots of health that often get overlooked in conventional western training. And now we are gonna be starting our next episode. All right, so the first way your feet are connected to the pelvic floor is gonna be through our fascial connection. So again, if you look at Tom Meyer's work, you can google some different pictures, but basically the the tongue all the way down to the feet, there's a connection from the fascia. But today we're gonna be talking about mainly the pelvic floor and feet connection, but. There's a connection directly from the diaphragm to the pelvic floor to the feet. So that's gonna be the first connection. And why does that matter? Well, there's plenty other fascia connections too, so there's different planes of fascia as well. And so if you look at all of those different planes, you'll see why there's that direct connection. So first of all. With that fascial connection, you've got other muscles around that area too. So if the fascia is restricted, the muscles along that area are likely restricted. So I would be looking at mobility all along the the quads, so the thighs anterior tip along the posterior aspect. So the gastroc and hamstrings, adductors. Abductors looking at the facia and how all that tissue is moving around there. In addition to the, we also have nerves underneath of there as well, and so we know that the sciatic nerve comes out of the hips and goes down into the feet. It actually. Splits behind the knee, but just for understanding how the nerves come out of the back and into the legs. Just looking at that from that perspective. And so if we know that there's a fascial connection from the pelvic floor to the feet, we know that underneath of that and surrounding that are gonna be nerves. And muscles and lymph as well. So we need to be looking at all of these things and how they relate to the pelvic floor. For example, if somebody has real, really tight gastrocs, right, and maybe they're swollen in their feet or they're swollen in their calves, their lymph return is probably limited, actually. It likely is. And so what that means is we need that gastroc, so we need that calf to be pumping that lymph back up into the pelvis, into the thoracic duct, and up into back into the bloodstream. And so if their calves are really tight, they're likely limited in that lymph circulation. So you might see some pooling of fluid around the pelvis. You may not directly see it, but they may feel their tissues may just feel more full. They may feel more warm. They may complaint of heaviness. They may feel like they're not. C digesting well, they may feel like they're more constipated. So it's super important that we're looking at how all of that is connecting, because the more we're getting that lymphatic movement, the more that's gonna help with reducing the pressure in the pelvis and help our immune system stay functional. And with that, thinking about the fascia mobility. So a lot of times I find. As, especially as PTs, you know, I'm not as familiar in other professions if they do this, but I know in massage they don't as much either because I've gotten a lot of massages. We ignore the abdomen, especially the lower abdomen. We need to be assessing this area because if we're not looking at how the tissues in the abdomen are moving as. Especially the visceral tissues. So we've got the bladder there, the uterus, we've got the colon, you've got a bunch of organs there. And if we're not looking at, those are how those are moving, that's gonna affect the pelvis, which can affect our lymphatic flow, which can affect our feet, right? So all of that is gonna be interconnected. And those are all additional trainings to take, but it's, it's very important that we're looking at that because if you think about the way the body is held up, it's not, we don't have our organs just sitting in there. They're being held up by fascia. And fascia is a, is responsive to the nervous system. So if somebody's going into fight or flight that. Fascia's not gonna be as flexible. It's not gonna be as resilient. It's not this stagnant tissue that we were taught in school. You're gonna start seeing more information coming out about this. So we need to know as movement and and rehab professionals about the fascia. So now say if somebody's dehydrated, the fascia's gonna be dehydrated, so then we're not gonna get as much of that resiliency in the tissues. So maybe you'll see that their calf isn't loosening up. Maybe you'll see that their hamstrings are always tight. These are all things to look at, potentially the fascia to understand. And again, underneath of that, the, the nerve tension coming out of the pelvis and into the posterior aspect of the leg. And into the rest of the leg. Right? So we've got your femoral nerve, we've got your ator. We've got a bunch of different nerves coming out of the pelvis and into the legs, and then they all split off, right? And become different nerves all the way down the chain. But they're all related, right? You wouldn't say that. A tree isn't related to its roots, right? There's a direct connection. It just might be further away. It just might have to travel more, but it's still there. And then we have electrical pulses that are bringing that information to the different parts of our body. And now if our lymph is stagnant, we're not able to get as much movement of flow through the muscles. So the impulses. So that electrical impulse is gonna be stagnant. So you might hear this in Eastern medicine almost as stagnant energy. And so the way that we look at this in the rehab world is, well, what tissues do we need to be moving? Let's pull out, let's start looking beyond just the muscles and bones and tendons. We need to be looking at lymph. We need to be looking at fascia. If we're not looking at this, we're missing a lot. And, um, not to shame anybody. I mean, I've definitely ignored these areas for a long time, but the more you wake up to them, you can realize, oh wow, these are really fascinating ways to help our clients. So the second way of the feet connected to the pelvic floor is through the homunculus. So the homonculus is where we interpret messages from different parts of our body to the brain. And so when you look at the Homonculus, you will see that the feet and genitals are right next to each other. And so if we're getting electrical impulses and we're getting synapses onto the feet, it's gonna overlap and get the genital area as well. This is why you'll find sometimes with the feet curl with orgasm, you'll find that sometimes people can, when they engage their feet or their arch, they can engage their pelvic floor a bit more. So you'll see a drastic connection with that simply because of where it synapses on the brain, pull it up. It's really fascinating. So you can use that as a clinician or movement professional if somebody is really having trouble in engaging their pelvic floor muscles. By the way, not all Kegels are created equal. I'll jump into that in a second, but. It might be helpful to start to get them to get, improve their toe mobility, maybe the fascial mobility between their toes, because the more movement and resilience we get in the feet, the more movement and resilience we're gonna get in the pelvic floor. And so it's just important that we are looking at that so then why are KE goals just not all created equal? Well, I should have a whole nother podcast episode on this, but this is important to know. We should know this regardless of if you treat the pelvic floor internally or not, I treat the pelvic floor internally, but it is such a small part of my session because I know how the full body works together, and so that's why it's important If you know how the full body works together and you don't want to. Necessarily do internal assessments. You can still do a lot for your clients. Just simply noticing these things.'cause there are still some clients that don't want an internal assessment. So I have to treat them externally based on their symptoms. So, and this will kind of go into the third way that the pelvic floor and feet are related, but in that third way. The pressure on our feet are going to affect how we contract our pelvic floor. So if you shift your weight forward, so if you wanna stand up or just do this later, if you're driving or whatever, the way that we stand is gonna affect how our, we contract our pelvic floor. So let's talk about this for a minute. Let's go back to what a pelvic floor contraction is. So if you look at the pelvic floor, you'll see where the lator anai is. So the lator anai, there's gonna be like this little U opening right at the front of the pelvic floor if you're treating somebody that has a vagina. And so in this. You will see that a Kegel doesn't necessarily help with urinary incontinence, so accidental leakage. So pull up the anatomy and look at it, because what you'll see is that. Oftentimes the traditional Kegel is gonna affect more of the muscles around the anus than it will the muscles around the urethra. There are different muscles around the urethra than the ones that are around the rest of the pelvic floor. So go ahead and just look at the anatomy there. So if you are contracting the pelvic floor more posterior than the backside, you're likely only helping with. The muscles around the external anal sphincter basically, and the levator an I there. But so what you're doing is you're contracting more of that aspect. And if you look at the anatomy, you're actually not affecting the front part of the pelvic floor as much. Not saying it's, it's not contracting. I don't believe you can truly isolate any muscle group, but you're not biasing the front as much. And so that's gonna be in, you know, a couple different ways. Well, first of all. When you're assessing, say, if you are assessing somebody externally for a pelvic floor, you'll see they call it the clitoral wink. So if you're assessing somebody with a vagina, you'll see it kind of nods down and you can know that they're contracting more of that front of that pelvic floor, but they'll get most of their. Feedback from when they are urinating. So if they stop their urine. So now we know, hey, if somebody is having urinary incontinence, a traditional Kegel isn't gonna be as efficient. What you're gonna need is that direct biofeedback for that client. So if they're peeing after a few seconds of peeing, I want you to try to get them to stop. If they can't stop, it's likely because the muscles around the urethra, so that external urethral sphincter. And the compressor urethra, those are not. Efficiently blocking the flow. And that's likely because one of two things, those muscles are intrinsically, intrinsically weak. They may be able to do it other times, but not maybe first thing in the morning, simply because if you think about the, the bladder is a balloon, right? And then you have the opening, the bigger the balloon with the bigger the water, the more force it's gonna take for the urethra and the compress, the external urethral sphincter and the compressed urethra to contract. So they might be able to do it and they might not. So my point is, if they're just doing Kegels and activating that posterior aspect of the pelvic floor, they're not getting that front aspect as much. I. And this also comes into play with the feet. So if they're standing up and have them look at their feet when they're standing, are they turning their feet out? Where is the pressure in their feet? You can ask them. I find most people are kind of putting most of their pressure through their heels. But again, that's not everybody. Everybody's a little bit different. Some people put it more on their forefoot. Um, but I would say look at them. Ask them where they're feeling, where their feet are, where is most of the pressure? I. Look at the bottom of their shoes. What do their feet look like? Where are they wearing more on their feet? Because technically we want equal distribution between the big toe, the pinky toe, and the heel. All right. And so if we have equal distribution during all of those, it's gonna be easier to contract the pelvic floor from the front and the back. Now if you start leaning forward, so you might even see people, um, posting videos about how if somebody's having urinary linkage. Leaning more forward on their toes. That's because that's helping to activate more of the anterior aspect. So that front aspect of the pelvic floor. Now when you shift back, they might feel it more in that backside, right? And so you, some people may feel it a little bit differently, but overall you'll notice that kind of shifting back and forth. So if you have somebody that's leaking during exercise, and maybe you're not a mo, maybe you're not a pelvic health professional. But you know, oh, well, maybe they need to be putting more of their forefoot or their toes, more pressure in their toes, and then have them do a contraction there as if they are stopping the flow of urine. Right. That's a really good cue for them. If they don't know, they can practice that every time they use the restroom. I know an old wives tale, we were told, oh, don't stop the flow. It's gonna cause this backup, and then they're gonna get UTIs. It is the fastest and easiest way to get people to understand their pelvic floor because it's just so easy to do. I find that when I would give people vaginal weights, and I still do that. It's just, it's a whole effort to be able to do that. So if you are working with somebody that doesn't have as much time, this is super key to help them with that. So then they can start noticing how they're standing, right? So say if they're standing and they're putting more forefoot, more weight through, they're maybe, maybe they're putting more weight through their forefoot or their heels. Either way, kinda see how they feel. Most often I see people are kind of shifted more, their pelvis is more forward. The thoracic spine is back, and now we're kind of getting this crunching motion in our lumbar spine, so we're getting extra compression along the lumbar facets. And then now they're sneezing. Well, now we don't have our ribs stacked over our pelvis, and then our feet are unstable. So our core muscles are really trying to figure out where they are, what's going on. So they're not likely gonna be as a able to contract. So making sure that they're aware of how it. Feels. What I'll do in the clinic, to be honest, is I'll have them stand how they normally stand and I, I put pressure over their shoulders and I have them and I push down and you'll see they kind of get a little bit of a give. Then I have them stand with ribs stacked over pelvis. An equal distribution with that big toe, little toe and heel and push down and they can feel immediately that difference. And so they've got that buy-in right there. I find it super important that people can feel it in their bodies before we tell them to do something because trust goes way up when you can show them these really cool tricks with their body, but. Anyways. I hope you all enjoy this quick episode. I really think it's jam packed with a lot of information to help you with your clients, I will see you next week. Thank you so much for listening. Thank you so much for listening to my podcast. It would be a huge help if you could subscribe and rate the podcast. It helps us reach more people and make a bigger impact. I would also love it if you could join my email list, which is LinkedIn, the caption for podcast updates, upcoming offers and events. You can also find me on TikTok, YouTube and Instagram at Dr. Mary pt. Thanks again.