Have you ever felt a nagging ache in your hips that just won’t go away? Maybe you’ve tried stretching, foam rolling, strengthening, or even resting for days, but the pain sticks around. What if I told you that your hip pain might actually be coming from somewhere else entirely — the pelvic floor?
The pelvic floor often gets overlooked in discussions about hip health, but it plays a surprisingly important role. I have seen MANY patients who have tried almost everything for hip pain, only to find that the real problem wasn’t the hip at all!
In this post, we’ll dive into how the pelvic floor can contribute to hip pain, what signs to watch for, and how pelvic floor physical therapy might just be your new secret weapon for addressing it!
What Exactly is the Pelvic Floor?
The pelvic floor is a group of muscles that sit at the base of your pelvis. Think of them as a hammock or sling that supports important organs like the bladder, uterus (for women), prostate (for men), and rectum. These muscles control basic functions like urination, bowel movements, and even sexual function (read more here).
The pelvic floor has many jobs, but doesn’t work alone — it’s part of a team of muscles, ligaments, and tissues that make up your "core." Why does this matter for hip pain? Because the pelvic floor is so closely connected to the muscles around the hips and lower back, when it’s not working well, those nearby muscles can get thrown off too.
How the Pelvic Floor and Hips Are Connected
Let’s talk about how the pelvic floor and your hips team up (or clash!) when it comes to pain and mobility.
Shared Muscles and Tissues:
The pelvic floor muscles have connections to other important muscles and tissues around the pelvis, including the hips! The most direct connection is via a muscle called the obturator internus (AKA the O.I.). This is part of a group of muscles called the deep hip stabilizers. They engage (or at least should engage) every time you bear weight on that side. When your pelvic floor is tense, weak, or uncoordinated it can limit the hip’s ability to do its very important job of supporting your body.
Stability and Core Strength:
The pelvic floor also works with the core muscles — including the abdominal muscles, lower back muscles, and diaphragm — to keep your spine, pelvis, and hips working together. Muscle dysfunction in any of these areas can impact how the rest of the system is operating, creating non-optimal forces through the tissues.
Nerves That Link the Pelvis and Hips:
Key nerves run through both the pelvis and the hips, like the sciatic nerve, the pudendal nerve, and the obturator nerve. When the pelvic floor is tense, it can irritate or compress these nerves, potentially leading to pain that radiates to the hips, groin, lower back, down the leg, or into the genital areas.
Posture and Gait:
How you stand, walk, and move can be influenced by the health of your pelvic floor. For instance, if your pelvic floor muscles are weak or tense, it might affect your posture and walking pattern, which can put extra strain on the hips. Over time, this additional strain can cause hip pain.
Why Pelvic Floor Problems Might Lead to Hip Pain
You may be wondering how a problem in your pelvic floor could result in hip pain. Here are some common scenarios that we see at Bonneville Pelvic in those with hip pain and pelvic floor dysfunction:
Pelvic Floor Tension:
If the pelvic floor muscles are overly tight, they can pull on other muscles and tissues around the pelvis. Think of it like this: if you clench your jaw for a long time, eventually your neck or even shoulders might start to hurt. The same thing can happen with the pelvic floor. When those muscles are tense, they can create a chain reaction that causes tension or pain in the hips.
Pelvic Floor Weakness:
On the flip side, weak pelvic floor muscles can lead to excess mobility in the pelvis (and other things, like pelvic organ prolapse). The body tries to compensate by overworking other muscles, such as the hip muscles, which can result in pain. Weakness in the pelvic floor can also cause an imbalance in your core control, which may lead to poor posture and hip discomfort.
Chronic Conditions:
Conditions like endometriosis, pelvic inflammatory disease, or chronic constipation can lead to prolonged pelvic floor tension or weakness, which, in turn, can contribute to hip pain. Even stress can lead to pelvic floor dysfunction, as we often carry tension in these muscles without realizing it!
Signs Your Hip Pain Might Be Linked to Pelvic Floor Issues
If you’re experiencing hip pain and wondering if it could be related to the pelvic floor, here are some clues to watch for:
Pain with Sitting:
Discomfort in the hips, pelvis, “sit bones”, or lower back when sitting might suggest a problem with the pelvic floor muscles.
Pain Radiating Down the Leg:
Since the pelvic floor can affect the sciatic nerve, some people experience pain that travels down the leg.
Urinary or Bowel Symptoms:
If you have hip pain combined with issues like frequent urination, constipation, or leakage, the pelvic floor could be involved.
Difficulty with Certain Movements:
If movements like squatting, lunging, or bending cause pain or feel awkward, pelvic floor dysfunction could be a factor.
Pain during sexual activity:
Since the pelvic floor and hip are so closely connected, hip pain can often be exacerbated during or after sexual activity.
How Pelvic Floor Physical Therapy Can Help
Now that you know how closely the pelvic floor is connected to hip health, you may be wondering what can be done about it. That’s where pelvic floor physical therapy comes in.
Evaluation:
During your first session, a Dr. Bailee will do a thorough evaluation. She’ll assess not just your pelvic floor, but also your hip function, core stability, and movement patterns. This helps her pinpoint the root of your pain and create a tailored treatment plan.
Muscle Release Techniques:
If tight/tense pelvic floor muscles are contributing to hip pain, I may use gentle techniques to help relax these muscles. This might involve external work around the hips, as well as internal techniques to release tension in the pelvic floor itself.
Strengthening Exercises:
If weakness is an issue, we will work through exercises that target both the pelvic floor and the surrounding core and hip muscles. Over time, this helps build stability and balance, reducing pain.
Posture and Movement Retraining:
We can also help you improve your posture, gait, and movement patterns, so you don’t place unnecessary strain on your hips or pelvic floor.
Breath Work and Relaxation Techniques:
The pelvic floor works closely with the diaphragm, so learning proper breathing techniques can actually help with muscle relaxation and stress reduction, both of which are essential for pelvic floor health. Bonus, diaphragmatic breathing has been shown to reduce heart rate and blood pressure too. A win-win!
When to Seek Help
If you’re dealing with hip pain that just won’t go away, especially if it’s paired with any pelvic symptoms, pelvic floor PT may just be the answer you’ve been looking for. At Bonneville Pelvic, Dr. Bailee is specially trained to navigate this very complex area to get to the bottom (pun intended 😂) of your issue!
Final Thoughts
The body is a connected system, and the pelvic floor is a big part of that system. When it’s not functioning well, it can significantly impact other areas, like the hips. Luckily, pelvic floor physical therapy offers a safe, effective approach to addressing these issues. So if hip pain has been giving you trouble, don’t overlook the possibility that the pelvic floor might be part of the puzzle. If you’re still unsure if your pelvic floor is impacting your hips, Dr. Bailee is more than happy to discuss your symptoms over the phone to determine if pelvic floor PT is an appropriate next step for you!
Board-Certified Specialist in Women's Health Physical Therapy
Certified Pelvic Rehabilitation Practitioner
Owner of Bonneville Pelvic Health
As an expert in pelvic floor rehabilitation, Dr. Bailee Burningham brings extensive experience in treating complex pelvic floor disorders, including persistent hip and pelvic pain. She is dedicated to providing compassionate, patient-centered care.
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