When patients reach out to me interested in pelvic floor therapy, it is typically because they are experiencing symptoms such as urinary leaking, painful intercourse, constipation or other bowel dysfunction, or are pregnant or postpartum. Patients with hip pain typically think to see an orthopedic physical therapist or a physician. However, the pelvic floor may actually play a major role in reducing and eliminating hip pain.

It's all connected

We often think of hip pain as being just a hip problem, back pain as being a back problem, pelvic floor dysfunction as being a pelvic floor problem (and so on). However, if we really consider anatomy, there are many muscular, ligamentous, and fascial connections between joints throughout your body. It’s also important to consider vascular and nerve connections throughout your body as well.

The hip and pelvic floor muscles are closely connected, and I often see the obturator internus muscle specifically being involved with both hip and pelvic floor dysfunction. The obturator internus (OI) muscle is a hip external rotator, and it has also been shown to be active during hip extension and abduction. It works alongside other hip rotator muscles to help stabilize the hip joint.

The OI has fascial connections and attachments to the pelvic floor muscles, which means the OI can affect pelvic floor muscle function, and pelvic floor muscles can affect the OI (and hip). This means it is key that the OI is assessed and treated in patients with both pelvic floor dysfunction and those with hip pain. This is a muscle that many orthopedic physical therapists (myself included before I completed courses to learn more about the pelvic floor) miss in their assessments.

How do you treat hip pain at Absolute Kinetics?

It is so important to take a whole-body assessment and treatment approach when it comes to hip pain. The hip joint itself should be assessed for strength and range of motion limitations, as well as the lower back and SI joint. The foot should be assessed in patients with hip pain, as it is key to have a strong and mobile foot to prevent increased strain or compensations at the hip and pelvis. Assessing breathing mechanics and thoracic mobility is also important to optimize pelvic floor function.

Organ assessment (visceral manipulation) can also be key in reducing hip pain. Restrictions throughout the abdominal and pelvic organs can cause muscle guarding and tension as well as discomfort in the hip joints.

And finally, a thorough screening and pelvic floor assessment should be completed. Pelvic floor dysfunction often presents with some symptoms of urinary, bowel, and sexual dysfunction, but not always. Some patients may not have bowel, bladder, or sexual dysfunction, but have a history of a tailbone injury, back pain, SI joint pain, hip pain, or pain with prolonged sitting. Check out the Cozean Pelvic Floor Dysfunction Screening Protocol. If you have hip pain and check 3 or more of the descriptions listed, you may benefit from an assessment with a pelvic floor therapist.

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Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS