You’ve stretched your hips. You’ve foam rolled your glutes. You’ve strengthened, rested, and maybe even had imaging. And the hip pain still lingers, or it keeps coming back when you ramp up training.
Your hip pain and your pelvic floor may be apart of the same problem. Not always, but often enough that we check it with every hip patient at IdealFit.
Your hip and pelvic floor are neighbors that share muscles
The pelvic floor is a group of muscles that forms the bottom of your deep core. It supports your bladder, bowel, and pelvic organs, helps control pressure when you lift and cough, and plays a role in stability and sexual function. This applies to everyone, regardless of gender.
It also sits right next to your hip. One of your deep hip rotators, the obturator internus, runs along the inside wall of the pelvis and shares fascial connections with the pelvic floor. Other hip muscles, like the piriformis, adductors, and glutes, attach to the same bony ring. When one area is stressed, the others often feel it.
That’s why the hip and pelvic floor can be treated as a single system, not just two separate problems.
How the connection shows up
Research has found that pelvic floor symptoms are more common in people with certain hip conditions, including femoroacetabular impingement (FAI) and labral tears. That doesn’t mean one always causes the other. It means they often coexist, and if we only treat the hip, we can miss half the picture.
Here’s what that can look like in active adults:
- Hip or groin pain plus pelvic floor tension. The muscles around the pelvis guard against pain by clamping down. Over time, that tension becomes its own source of pain.
- Limited hip motion that shifts load to the pelvis. If the hip can’t move well, the pelvis and low back compensate, and the pelvic floor works overtime.
- Pressure management problems. Holding your breath, bracing too hard, or “sucking in” during lifts and runs can overload both the hips and the pelvic floor.
- Weak or poorly coordinated muscles. Hips and pelvic floor can both struggle to produce force and to relax.
Signs your hip pain may involve your pelvic floor
Hip pain on its own is worth addressing. But if it comes with any of the following, the pelvic floor deserves a closer look:
- Leaking urine with running, jumping, lifting, sneezing, or laughing
- A strong or frequent urge to urinate
- Pain with sex or with tampon use or pelvic exams
- Tailbone, low belly, or deep pelvic pain
- Constipation or straining
- A feeling of heaviness or pressure in the pelvis
- Hip pain that lingers or keeps returning despite good strength and mobility work
These symptoms are common. They are not something you simply have to live with, and they are very treatable.
Why “just do Kegels” is not the answer
A lot of people hear “pelvic floor” and assume it needs to be tighter. But really, so many people we see have a pelvic floor that is already overactive, meaning it can’t fully relax. Adding Kegels to that just makes things worse.
A healthy pelvic floor needs to do three things well: contract, lengthen, and coordinate with your breathing and movement. Strength matters, but so does the ability to let go. The right plan depends on what your body is actually doing, which is why a hands-on evaluation matters.
What you can start this week
This isn’t a substitute for an evaluation, but these are good first moves.
- Breathe like it matters. Practice slow breaths that let your ribs and belly expand, with a gentle relaxation of the pelvic floor on the inhale. Try 5 minutes a day.
- Stop gripping. Notice if you clench your glutes, tuck your pelvis, or hold your belly tight all day. Let it soften.
- Check your pressure strategy. If you hold your breath or leak during lifts, try exhaling through the hardest part of the movement and lower the load until it feels controlled.
- Work the hips in more than one direction. Include rotation, side-to-side, and single-leg work, not just straight-ahead squats and lunges.
- Keep moving. Complete rest rarely helps. Modify what aggravates your pain and stay active.
When to get it looked at
Schedule an evaluation if hip pain lasts more than 2 to 3 weeks despite smart modifications, if you have any of the pelvic floor symptoms above, or if your pain is limiting training, work, or intimacy.
Get seen sooner for pain with significant swelling, trouble bearing weight, numbness in the groin or saddle area, or new loss of bladder or bowel control. Seek urgent care for sudden severe pain after a fall or trauma, or if these symptoms come with fever.
You don’t have to figure this out alone
If your hip pain has been stubborn, or if you’ve been quietly dealing with pelvic symptoms you assumed were normal, we’d love to help. Our approach pairs orthopedic and pelvic floor expertise so we can look at the whole picture, not just one piece of it.
To book an evaluation, contact us at 270-551-5248 or learn more by clicking here.
Rachel Atufunwa, PT, DPT
Owner, IdealFit Physical Therapy, Paducah, KY