Hip Pain and the Pelvic Floor: How One Can Drive the Other

Hip pain and pelvic floor problems can feed each other because the two areas share muscle. The clearest link is the obturator internus, which lines the inside of the pelvis and then wraps out to the hip. When the hip guards, the pelvic floor can tighten with it, and a tight pelvic floor can send a deep ache into the hip. That is why many people have both at once.

Where the hip and the pelvic floor meet

The obturator internus starts on the inner wall of the pelvis. Its tendon hooks around a notch at the back of the pelvis, then turns outward and attaches near the bony point at the side of your hip. Its main job is to turn the thigh outward.

Part of the levator ani, the main pelvic floor muscle, anchors to a thick band of tissue called the tendinous arch, which lies right over the inner surface of the obturator internus. In other words, the pelvic floor is partly anchored onto a hip muscle.

The other deep hip rotators and the gluteals sit close by and can be involved too.

How a hip problem can drive pelvic floor symptoms

When the hip joint is irritated, by a labral tear, impingement or arthritis, the muscles around it guard. The American Academy of Orthopaedic Surgeons notes that impingement pain often occurs in the groin, and that turning, twisting and squatting can bring on a sharp, stabbing pain.

The obturator internus is one of the muscles that guards. Because the pelvic floor anchors onto it, that tension does not always stay in the hip. Hip patterns that load the pelvis are one of the drivers I look for in pelvic floor dysfunction, which can show up as urinary urgency, frequency or leaking.

How a pelvic floor problem can drive hip pain

It works the other way, too. A pelvic floor that stays tight, after childbirth, surgery, a long stretch of pelvic pain or years of bracing, pulls steadily on its anchor. Trigger points in the obturator internus can then cause a deep, vague ache at the back or side of the hip or buttock.

When hip imaging does not explain the pain, the deep muscles are rarely examined, so this pattern is easy to miss. A useful clue is aching at the tailbone, sit bones or deep hip that tracks with pelvic symptoms.

Clues that both are involved

• A deep hip ache plus bladder, bowel or sexual symptoms.
• Hip pain that builds with sitting.
• Pelvic symptoms that flare with walking, stairs or long sits.
• Hip care that helped, but only part of the way.

Who should evaluate it first

See an orthopedist for the hip joint, since arthritis, labral tears, impingement and stress fractures need proper imaging and a physician's diagnosis. For bladder, bowel or sexual symptoms, see a gynecologist or urologist. My care works alongside theirs, not instead of it.

How the exam checks both

The first visit runs 60 to 75 minutes. I screen the hip joint to separate joint pain from muscle pain, examine the deep rotators, obturator internus and gluteals by hand, and watch you walk, climb stairs and squat. When pelvic symptoms are part of the picture, the pelvic floor muscles are examined from the outside, with no internal exam.

Dry needling reaches the deep rotators, obturator internus and gluteus minimus. When the pelvic floor needs treatment, deep needling goes in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum. Alongside dry needling, I use neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the nerves of the buttock and hip. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits that keep hip and pelvic pain going. Most patients are seen weekly or every other week during active care, and results vary from person to person.

If you are not sure what is causing your pain, try the My Symptoms tool.