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Lower Back and Pelvic Pain in Females: Why Misdiagnosis Delays Effective Treatment

By Dr. Akasia Nelson, DAc
Lower Back and Pelvic Pain in Females: Why Misdiagnosis Delays Effective Treatment, image of woman holding her lower back in pain.

The Overlooked Cause of Chronic Lower Back Pain in Women

Lower back pain is one of the most common chronic pain conditions, but did you know that many women diagnosed with chronic lower back pain are actually suffering from undiagnosed chronic musculoskeletal pelvic pain (CMP)? Research shows that 15% of women experience chronic pelvic pain annually, yet musculoskeletal causes are often overlooked[3]. In fact, at least 22% of women with chronic pelvic pain have musculoskeletal dysfunction—yet it is often missed in gynecological evaluations[8].

Because lower back and pelvic pain share overlapping pain patterns, many women end up misdiagnosed, delaying effective treatment. Women with pelvic pain often first see a gynecologist to rule out endometriosis, ovarian cysts, or fibroids, but when no visceral cause is found, musculoskeletal dysfunction is rarely considered[5].

At AcuGroup, we specialize in treating chronic musculoskeletal pelvic pain using Dry Needling, Acupuncture, and PBM Therapy (laser therapy)—proven, non-invasive treatments that address the root cause of pain and improve function. If you’ve been struggling with unexplained lower back and pelvic pain, it’s time to consider a musculoskeletal approach.

The Link Between Lower Back Pain and Chronic Musculoskeletal Pelvic Pain

Key Differences Between Chronic Musculoskeletal Pelvic Pain and Other Conditions

ConditionSymptomsCommon MisdiagnosisBest Treatment
Chronic Musculoskeletal Pelvic PainPain in pelvis, hips, lower back, thighsSpinal issues, sciatica, endometriosisDry Needling, Acupuncture, PT
EndometriosisCyclical pelvic pain, painful periodsIBS, fibroids, ovarian cystsHormonal therapy, surgery
SI Joint DysfunctionPain in SI joint, lower back, hip painHerniated disc, arthritisJoint mobilization, PT, SI belt (short-term benefit)

Many women diagnosed with chronic lower back pain actually have a primary issue in the pelvis.

Why Does This Happen?

  • Pain Overlap & Referral Patterns: Pelvic pain can radiate to the lower back, sacroiliac (SI) joints, hips, and thighs, making it easily confused with spinal issues[2].
  • Visceral Causes Are Prioritized First: Gynecologists focus on ruling out endometriosis, fibroids, and ovarian cysts, but musculoskeletal causes of pelvic pain are often ignored[6].
  • Imaging Limitations: X-rays show joints, but not muscle, ligaments, or nerves. X-rays and MRIs may appear “normal” because musculoskeletal (and especially myofascial) dysfunction is often not visible on imaging[4][9].

Research Findings:

  • Up to 70% of chronic pelvic pain patients do not receive an accurate diagnosis or effective treatment[3].
  • Myofascial pain and muscle dysfunction are the most common causes of pain in patients who receive “negative” laparoscopies, meaning no visceral pathology is found[5].

How Chronic Musculoskeletal Pelvic Pain Mimics Lower Back Pain

Chronic lower back and pelvic pain in women may also be influenced by dysfunction in the abdominal wall and gluteal muscles, including the rectus abdominis, obliques, gluteus maximus, gluteus medius, gluteus minimus, and piriformis[7][10], which can create referred pain patterns that mimic spinal or joint-related conditions. These muscle-related pain sources are often misdiagnosed or overlooked, but they respond well to dry needling, acupuncture, and manual therapy.

Pain Sources in Chronic Pelvic Pain (CMP):

  • Muscle Dysfunction: Pelvic floor, gluteal, iliopsoas, quadratus lumborum[2].
  • Ligamentous Strain: Sacroiliac joint, pubic symphysis[8].
  • Nerve Entrapment: Pudendal nerve, ilioinguinal nerve[6].
  • Joint Instability: SI joint, lumbar spine[9].

When the pelvic floor muscles become tight, weak, or dysfunctional, they can refer pain to the lower back and hips. This is why women diagnosed with chronic lower back pain often don’t improve with traditional back pain treatments—because the real source of pain is in the pelvis[4].

The Role of Physical Medicine in Treating Lower Back and Pelvic Pain in Females

Effective, Research-Backed Treatment Approaches:

Study-Proven Results: A randomized clinical trial found that acupuncture was superior to standard treatment for pelvic girdle pain relief[1].

Why Choose AcuGroup for a Musculoskeletal Approach to Chronic Lower Back and Pelvic Pain in Women?

  • Specialized Expertise: Our pain team has extensive experience treating lower back and pelvic pain using dry needling for over twenty-five years. In particular, Dr. Akasia Nelson is a dry needling expert with a clinical focus on lower back and pelvic pain, providing cutting-edge treatments at our San Francisco and Marin locations. Learn more about Dr. Akasia Nelson. 
  • Advanced, Non-Invasive Solutions: We offer Dry Needling, Acupuncture, and PBM Therapy, targeting the root causes of pain with precision and effectiveness—without the need for medication or surgery.

Take the First Step: Book an Appointment 

If you’ve been suffering from chronic lower back and pelvic pain, don’t wait to receive a musculoskeletal exam. Musculoskeletal pelvic pain is common—but it requires a different diagnostic and treatment approach than traditional lower back pain.

📅 Book an appointment with Dr. Akasia Nelson in San Francisco or Marin.

📞 Not ready for a full appointment? Schedule a free 15-minute phone consultation here.

Sources
  1. Elden, Helen, et al. Effects of Acupuncture and Stabilising Exercises as Adjunct to Standard Treatment in Pregnant Women with Pelvic Girdle Pain. BMJ, 2005, vol. 330, no. 7494, pp. 761.
  2. Fitzgerald, Colleen. Let’s Get Physical! Musculoskeletal Pelvic Pain. PainWeek, Podcast. https://www.painweek.org/media/podcast/lets-get-physical-musculoskeletal-pelvic-pain.
  3. Gyang, A., Hartman, M., Lamvu, G. Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know. Obstet Gynecol. 2013 Mar;121(3):645-650. doi: 10.1097/AOG.0b013e318283ffea.
  4. Herbert, Bettina. Chronic Pelvic Pain. Integrative Pain Management, Weil Integrative Medicine Library (New York, 2016). https://doi.org/10.1093/med/9780199315246.003.0048.
  5. Jarrell, J. Gynecological Pain, Endometriosis, Visceral Disease, and the Viscero-Somatic Connection. Journal of Musculoskeletal Pain, 2008.
  6. Jarrell, J. Myofascial Dysfunction in the Pelvis. Curr Pain Headache Rep, 2004, vol. 8, no. 6, pp. 452-6.
  7. Nazareno, G., et al. Long‐term Follow‐up of Trigger Point Injections for Abdominal Wall Pain. Canadian Journal of Gastroenterology and Hepatology, 2005.
  8. Sanses, T.V., et al. The Pelvis and Beyond: Musculoskeletal Tender Points in Women With Chronic Pelvic Pain. Clin J Pain, 2016, vol. 32, no. 8, pp. 659-65.
  9. Waldman, Steven D. SI Joint Pain. Atlas of Common Pain Syndromes, Elsevier, 2016.
  10. Waldman, Steven D. Abdominal Wall and Pelvis Pain. Physical Diagnosis of Pain, Elsevier, 2016.