Nagging Hip Pain That Won't Go Away? Check Your Pelvic Floor!

By Dr. Christine Martirez PT, DPT on 10/31/2024

If you’re dealing with persistent hip pain that doesn’t seem to improve with stretching or strengthening, it might be worth looking beyond the hip itself. Pelvic floor dysfunction is an often-overlooked cause of hip pain that can create imbalances and tightness in the surrounding musculature. With the hip and pelvic floor sharing muscles, ligaments, and fascial connections, dysfunction in one area can quickly lead to discomfort in the other. Let’s dive into the relationship between the hip and pelvic floor, the anatomy involved, and how pelvic floor physical therapy can address nagging hip pain.

Anatomy of the Hip and Pelvic Floor Connections

The hip is a ball-and-socket joint known as the femoroacetabular joint, where the femur (thigh bone) meets the acetabulum of the pelvis. This joint allows for a range of motion in multiple planes, making it highly mobile and a critical player in everyday movements.

Just behind the hip joint is the sacroiliac joint (SIJ), where the sacrum and pelvis meet. The SIJ provides stability for the spine and pelvis, helping to transfer weight from the upper body to the lower body. Given its close proximity to the pelvic floor, dysfunction in this area can directly impact the hip and surrounding muscles.

Key Muscles in the Hip-Pelvic Region

Several muscles work around the hip and pelvic region, providing both stability and mobility. Here’s a look at some key muscles that connect the pelvic floor and hip:

• Glutes (Gluteus Maximus, Medius, and Minimus)

  : These muscles provide primary support for the pelvis, stabilize the hip, and enable movements such as walking and squatting. Tightness or weakness in the glutes can affect pelvic stability and lead to strain on the pelvic floor.

• Piriformis

  : Running from the sacrum to the top of the femur, the piriformis is a hip stabilizer that also helps externally rotate the thigh. It lies close to the pelvic floor muscles, and tightness here can compress the sciatic nerve, leading to referred pain in the hip and pelvic floor.

• Obturator Internus

  : This muscle lines the internal portion of the pelvis and assists with external rotation of the hip. It also has a strong connection to the pelvic floor, working alongside pelvic muscles to maintain core and pelvic stability. Dysfunction in the obturator internus can contribute to both hip and pelvic pain.

These muscles share fascial and ligamentous connections that link the pelvic floor and hip. For example, fascia, a connective tissue that encases muscles and organs, runs throughout these structures, creating interconnected movement patterns. When one muscle is tense or weak, it can pull on the fascia, impacting other muscles and contributing to pain.

How Pelvic Floor Dysfunction Contributes to Hip Pain

The pelvic floor muscles, which lie at the base of the pelvis, support internal organs, stabilize the core, and assist in bowel, bladder, and sexual function. The muscles of the pelvic floor don’t work in isolation, and when they are either too tight (hypertonic) or too weak (hypotonic), it can lead to pain or dysfunction in nearby structures — including the hip.

Some of the ways pelvic floor dysfunction can cause or exacerbate hip pain include:

• Muscle Imbalances

  : When pelvic floor muscles are too tight, they can pull on the muscles and fascia connected to the hip, including the piriformis and obturator internus. This tension can result in referred pain in the hip and lower back.

• Fascial Restrictions

  : Fascial restrictions in the pelvic floor can limit movement in the hip, leading to a sense of tightness or pain during activities that involve hip flexion or rotation, like sitting or walking.

• Nerve Irritation

  : The pelvic floor and hip region contain several nerves, including the sciatic and pudendal nerves. When muscles like the piriformis become tight due to pelvic floor dysfunction, they can irritate these nerves, causing radiating pain in the hip and leg.

• SI Joint Dysfunction

  : The sacroiliac joint plays a critical role in transferring load from the upper to the lower body. When the pelvic floor isn’t functioning correctly, the SI joint may compensate, leading to imbalances and pain that can radiate to the hip.

Symptoms of Pelvic Floor-Related Hip Pain

Hip pain related to pelvic floor dysfunction often presents with symptoms that distinguish it from other types of hip pain:

• Deep, aching pain in the hip or glute region, often radiating down the leg.

• Discomfort when sitting, standing for long periods, or performing activities that involve hip rotation.

• A feeling of tightness in the hip that doesn’t respond to stretching.

• Pain or discomfort in the SI joint or low back that accompanies hip pain.

• Symptoms of pelvic floor dysfunction, such as urinary incontinence, constipation, or pelvic pressure, that coincide with hip pain.

How Pelvic Floor Therapy Can Help with Hip Pain

Pelvic floor physical therapy can address hip pain by treating the root causes related to pelvic floor dysfunction. A skilled pelvic floor therapist will evaluate your posture, pelvic alignment, muscle strength, and any fascial restrictions in the hip-pelvic region. Here’s how pelvic floor therapy can help:

1.

Muscle Release Techniques

Pelvic floor therapists use manual therapy techniques to release tight muscles and fascia in the pelvic floor, glutes, piriformis, and obturator internus. These techniques help reduce muscle tension and improve blood flow, relieving hip pain and tension.

2.

Stretching and Strengthening Exercises

Your therapist will guide you through targeted exercises to stretch tight muscles and strengthen weak ones, improving overall balance in the pelvic and hip region. Strengthening exercises for the pelvic floor and core can help stabilize the SI joint and reduce compensatory patterns that may contribute to hip pain.

3.

Neuromuscular Re-education

Pelvic floor therapists help retrain the body to coordinate and activate the right muscles during movement. Neuromuscular re-education can improve coordination between the hip, pelvic floor, and core, allowing for better support and function.

4.

Postural and Alignment Training

A pelvic floor therapist will assess and address any postural imbalances that may be contributing to hip pain, especially in the SI joint and lower back. Correcting posture and alignment can alleviate strain on the hip, helping to prevent pain from recurring.

5.

Education on Body Mechanics

Learning proper body mechanics can be incredibly beneficial for avoiding hip pain, especially if you’re performing repetitive movements or exercise. Pelvic floor therapists provide guidance on lifting techniques, posture, and hip alignment, helping you to protect both your hip and pelvic floor.

Hip pain isn’t always caused by a problem within the hip itself. In some cases, pelvic floor dysfunction — whether from muscle imbalances, fascial restrictions, or nerve irritation — is a hidden contributor. Pelvic floor physical therapy can offer lasting relief by addressing the root causes of hip pain, improving alignment, reducing muscle tension, and restoring strength. If you’re struggling with persistent hip pain that hasn’t responded to conventional treatments, consider exploring pelvic floor therapy as an effective, whole-body approach to relief.

Seeking guidance for guidance for nagging hip pain? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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