Your Pelvic Floor & Hips Relationship....
The entire body is connected as we are one unit but the relationship between some specific areas is stronger than others. While something happening in your shoulder could definitely impact your foot, you might not see the correlation as often as say your neck and your upper back. The pelvic floor and hips relationship is one of those pairs that’s difficult to separate. What happens in one of them usually will impact the other. Let’s explore why.
Why do your hips affect your pelvic floor?
We need to look at anatomy for a minute to help you see this relationship….anatomy can be fun! It helps you understand your body 🙂
The hip joint attaches into your pelvic bone which you can see in the photo I’ve made for you below. The pelvis has a nice socket carved out just for the ball of the hip joint to fit into it. You have a bunch of hip muscles that basically work to keep this joint in it’s socket. Some hip muscles that you may be familiar with are your glutes and your hip flexors, but we also have deep stabilizing muscles that surround the hip. Your pelvic floor muscles run from the front of your pelvis to the back of your pelvis. The pelvis is like a bowl with no bottom, so basically your pelvic floor is there to keep organs like your bladder from falling out. Graphic but hey, the visual helps us to learn.
So now you know that both the hip muscles and pelvic floor muscles are in the pelvic region, but how close are they really?
Well, to access the deep pelvic floor muscles, they need to be assessed internally; this can be done rectally or vaginally. Your hip muscles can also be assessed internally because they are that interconnected with the pelvic floor. A hip muscle called your obturator internus can easily be palpated with an internal examination. So you can be palpating a pelvic floor muscle and move your finger one inch and then be on a hip muscle. Based on anatomy alone, the pelvic floor and hips relationship is inseparable! When you’re experiencing an issue with one of these areas you can’t just ignore the other.
The Obturator Internus Muscle
A muscle called your obturator internus makes the pelvic floor and hips relationship crystal clear.
The obturator internus (OI) is the main hip muscle that is related to the pelvic floor. This muscle attaches from your hip to the inside portion of the pelvis. This is why the two are so closely related, because the OI is right near your pelvic floor muscles.
One of the main actions of the OI muscle is to externally rotate your hip when the hip is extended. This would look like if you were standing and kicked one leg back while turning your toes out. This motion shortens the OI because as a muscle activates, it shortens. I always like to use the bicep as an example for this because I think it makes it easier to learn. The bicep is the muscle in the front part of your upper arm. When you bend your elbow, the bicep activates and is shortened (like when you do a bicep curl). When you straighten your elbow, the bicep muscle is lengthened.
When you externally rotate your hip from hip extension, your obturator internus shortens. Because of the hips proximity and ties to the pelvic floor muscles, this motion will also cause some of the pelvic floor muscles to shorten. Just like when you bend your elbow there is more tension in the bicep, when you move your hip in this way there will be more tension in the pelvic floor. (The tension that occurs in the pelvic floor with hip external rotation depends on the angle of hip flexion/extension, but I don’t want to bore you with details on angles, I just want you to see the relationship here.)
The OI muscle demonstrates further how the pelvic floor and hips are so interconnected. Just the rotation of our hips can change the length in the pelvic floor muscles.
Hip Flexors & The Pelvic Floor
The hip flexors show another example of the interaction between the hips and the pelvis. Your hip flexor muscles are the muscles that allow you to lift your leg up. Hip flexor tightness, particularly in a muscle called your iliopsoas, can also relate to tightness in the pelvic floor. This is because the psoas is fascially connected with the pelvic floor. Fascia is basically connective tissue under your skin but above your muscles. So you have your skin, then your fascia, then your muscles. Your fascia helps to keep everything in place but it also needs to be flexible to allow you to move.
Fascia is another way to look at the interconnectedness of our body. But back to the hip flexors, I’ve seen individuals with pelvic pain that have experienced resolution of their pain with only work on the iliopsoas. Surprisingly (maybe), I’ve seen this more frequently in men with pelvic pain, where work on the psoas was really all they needed. I’m not saying this is the case for everyone, but I include it here to help you see this relationship further.
Pelvic Floor Issues
If you’re experiencing issues with your pelvic floor muscles, be it tightness or weakness, your hip muscles should also be taken into consideration.
If your pelvic floor is tight, what’s happening in the hips? Are they also tight because your entire pelvic region is in protection mode? Or are the weak because your pelvic floor is doing all of the stabilizing so the hip muscles decided to take a break?
If the pelvic floor is weak, are hip muscles like the glutes tight because they’re trying to compensate for this weakness? Or are the hip muscles also weak?
These are things that can be looked at when having a pelvic floor issue that can help boost your recovery.
Most of the time, if you’re having a pelvic floor issue and you see a pelvic floor physical therapist, they probably will be looking at your hips as well. I can’t speak for all pelvic physical therapists but from experience in the field, I would say most will also look at your hips.
Hip Issues
When you have hip issues on the other hand, and are going to physical therapy, there’s no guarantee that you’re physical therapist (PT) is going to look at your pelvic floor. And this is because your PT might not be a pelvic floor specialist. The pelvic floor is something PTs can choose to specialize in after graduation from physical therapy school.
If you are experiencing unresolved hip issues, it might be worthwhile to see a pelvic floor PT to assess what’s going on with your pelvic floor.
Remember how closely related these two parts of the body are; the pelvic floor might be the missing piece in your healing.
Final Thoughts
The connections in our body are amazing. And this post didn’t even go into the mind/body connections that we have! I think when you see the connections within us, it opens your eyes to the many possibilities you have in terms of healing.
I hope this post helped you learn more about the pelvic floor and hips relationship and about your body in general!
You should be educated on your body. It doesn’t need to be to the extent of say going to medical school, but I think it’s important that we all have a basic understanding about what’s going on with our physical bodies.
Keep learning everyone 🙂
Sources:
Esegbona, Gloria. “The Impact of External Hip Rotation during Pushing on Pelvic Floor Dysfunction and Injury.” ICS, 14 Oct. 2021, www.ics.org/2021/abstract/104.
Evan, Oscar. “The Pelvic Floor and Its Relationship to the Psoas.” Lotus Publishing, 6 Nov. 2017, www.lotuspublishing.co.uk/blog/2017/11/06/evan-osar-discuss-relationship-pelvic-floor-psoas/.
Larson, Maddy R., and Weston Ryan. “Anatomy, Abdomen and Pelvis, Obturator Muscles.” StatPearls Publishing LLC, 17 Jan. 2023.
Marques, Simone A.A., et al. “Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial.” Journal of Manipulative and Physiological Therapeutics, vol. 43, no. 3, 2020, pp. 247–256, https://doi.org/10.1016/j.jmpt.2019.01.007.
Tim, Sabina, and Agnieszka I. Mazur-Bialy. “The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor.” Life, vol. 11, no. 12, 2021, p. 1397, https://doi.org/10.3390/life11121397.
Wallace. “Hip Flexors & Pelvic Dysfunction.” Herman & Wallace Pelvic Rehabilitation Continuing Education, 17 Aug. 2021, hermanwallace.com/blog/hip-flexors-pelvic-dysfunction#:~:text=When%20the%20hip%20flexors%20are,prolapse%2C%20and%20so%20much%20more.
