Could Your Hip Pain Actually Be Coming From Your Pelvic Floor?

The Missing Piece Many People Never Hear About

Keywords: pelvic floor and hip pain, hip pain physical therapy, pelvic floor physical therapy Traverse City, chronic hip pain, pelvic health physical therapist, groin pain, SI joint pain, deep hip pain, women's health physical therapy

If you've been struggling with hip pain that just won't seem to go away, you've probably tried all the usual recommendations.

Maybe you've stretched your hip flexors every day.Maybe you've strengthened your glutes.Maybe you've had massages, chiropractic care, injections, or even completed weeks of traditional physical therapy.

And yet...

The pain keeps coming back.

If this sounds familiar, you aren't alone.

One of the most overlooked contributors to persistent hip pain is something many people never consider: your pelvic floor.

At Trailhead Physical Therapy & Wellness in Traverse City, Michigan, we frequently see clients who have spent months—or even years—treating the hip itself, only to discover the real issue was deeper.

Think of hip pain like an iceberg.

The pain is what you notice above the surface.

But underneath may be a completely different story.

Why Hip Pain Isn't Always a Hip Problem

Your body wasn't designed to function as separate pieces.

Your hips don't move independently from your pelvis.

Your pelvis doesn't work independently from your core.

Your core doesn't work independently from your diaphragm or pelvic floor.

They're one integrated system.

When one part isn't functioning well, the others begin compensating.

This is why treating only the painful area often provides temporary relief—but not lasting change.

Instead of asking,

"What's wrong with your hip?"

we ask,

"Why is your hip having to work so hard?"

That's often where the answers are found.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles that forms the bottom of your core.

These muscles support your:

• Bladder

• Bowel

• Reproductive organs

• Pelvis

• Spine

But they also play an important role in:

• Hip stability

• Balance

• Walking

• Running

• Lifting

• Squatting

• Rotating

• Breathing

• Pressure management

Because the pelvic floor shares attachments with your pelvis and works closely with many deep hip muscles, dysfunction in one area frequently affects the other.

How the Pelvic Floor and Hips Are Connected

There are several important anatomical connections that many people—and even healthcare providers—don't always consider.

1. Shared Muscle Attachments

Several deep hip muscles attach directly to the pelvis.

These include:

• Obturator internus

• Piriformis

• Deep rotators

• Gluteal muscles

One muscle deserves special attention.

The Obturator Internus

Many pelvic health specialists refer to the obturator internus as the "bridge" between the hip and the pelvic floor.

Why?

Because this muscle:

• Rotates the hip

• Stabilizes the pelvis

• Shares fascial connections with the pelvic floor

• Helps support pelvic organs

If this muscle becomes tight, weak, or overworked, it can contribute to:

• Deep buttock pain

• Groin pain

• Pain with sitting

• Pain during walking

• Pain with running

• Pelvic pain

Sometimes treating the hip alone isn't enough because the pelvic floor is contributing to the problem.

2. They Stabilize Together

Every time you:

• Walk

• Climb stairs

• Lift weights

• Pick up your child

• Get out of the car

Your hips and pelvic floor are working together.

If one system isn't doing its job efficiently, another system compensates.

Over time this compensation may create:

• Hip tightness

• Tendon irritation

• Muscle overuse

• SI joint discomfort

• Persistent pain

  
  

3. They Respond to Stress Together

This surprises many people.

Your pelvic floor isn't just affected by exercise.

It's affected by stress.

When we're under prolonged stress, our nervous system often keeps muscles in a protective state.

For some people, this means:

• Tight jaw

• Tight shoulders

• Holding the breath

For others...

It's the pelvic floor.

A constantly guarded pelvic floor changes how the hips move, absorb force, and stabilize the pelvis.

Signs Your Hip Pain May Actually Involve the Pelvic Floor

Not every hip problem is related to the pelvic floor.

However, there are certain clues that suggest it should at least be evaluated.

You may benefit from seeing a pelvic floor physical therapist if your hip pain is accompanied by:

• Urinary leakage

• Urinary urgency

• Frequent bathroom trips

• Constipation

• Painful intercourse

• Tailbone pain

• SI joint pain

• Groin pain

• Pain deep in the buttock

• Pain with prolonged sitting

• Pregnancy or postpartum changes

• Pelvic heaviness or prolapse symptoms

Even if these symptoms seem unrelated, they often share common underlying contributors.

Why Traditional Physical Therapy Sometimes Misses It

Traditional orthopedic physical therapy is excellent for many hip conditions.

But unless the therapist has specialized pelvic health training, they may not evaluate:

• Pelvic floor muscle coordination

• Internal muscle tension (when appropriate and with consent)

• Breathing mechanics

• Pressure management

• Pelvic organ support

• Scar tissue restrictions

• Pelvic floor muscle endurance

• Nervous system regulation

Without evaluating the pelvic floor, an important piece of the puzzle may remain hidden.

That doesn't mean previous treatment was "wrong."

It simply means another layer deserves attention.

Common Hip Diagnoses That May Have a Pelvic Floor Component

Although every diagnosis is unique, we frequently see pelvic floor involvement with:

Hip Impingement (FAI)

Persistent muscle guarding around the pelvis can change movement patterns and increase stress on the hip joint.

Gluteal Tendinopathy

If the pelvic floor isn't coordinating well with the core and hip stabilizers, the glute muscles may work overtime.

SI Joint Pain

The pelvis functions as one unit.

If pelvic floor muscles aren't contributing appropriately to stability, the SI joints often compensate.

Chronic Groin Pain

Sometimes groin pain isn't actually originating from the groin.

Deep pelvic muscles can refer pain into the groin, inner thigh, and hip.

Hip Pain During Pregnancy

As the body changes throughout pregnancy, the pelvic floor, abdominal wall, hips, and ligaments all adapt.

Addressing only the hip often overlooks the larger picture.

Postpartum Hip Pain

Many moms notice hip pain after having a baby.

Sometimes this is related to:

• Muscle weakness

• Pelvic floor dysfunction

• Scar tissue

• Pressure management

• Altered movement patterns

The good news?

These issues are often highly treatable.

What Happens During a Pelvic Floor Evaluation?

One of the biggest misconceptions is that pelvic floor physical therapy only involves internal treatment.

That's simply not true.

At Trailhead Physical Therapy & Wellness, your evaluation is individualized based on your history, symptoms, and comfort level.

Depending on your needs, your therapist may assess:

• Hip strength

• Hip mobility

• Walking mechanics

• Squat mechanics

• Breathing patterns

• Core coordination

• Balance

• Pelvic alignment

• Muscle tenderness

• Scar mobility

• Pressure management

An internal pelvic floor assessment is never required and is only performed with your informed consent when it would provide valuable information.

Many people make significant progress without internal treatment.

Our Root-Cause Approach

At Trailhead Physical Therapy & Wellness, we believe lasting results come from understanding why your pain developed—not simply treating where it hurts.

Our approach looks at the whole person.

That means considering:

• Hip strength

• Pelvic floor function

• Core coordination

• Breathing mechanics

• Nervous system regulation

• Movement habits

• Lifestyle demands

• Previous injuries

• Pregnancy and birth history

• Exercise goals

Because no two people experience hip pain for the same reason.

When Should You See a Pelvic Floor Physical Therapist?

You don't have to wait until you've exhausted every option.

In fact, many people wish they had been referred sooner.

Consider scheduling an evaluation if:

• You've had hip pain for more than three months.

• Traditional treatment hasn't fully resolved your symptoms.

• Your pain keeps returning.

• You also have bladder, bowel, or pelvic symptoms.

• Your hip pain began during pregnancy or postpartum.

• Your imaging doesn't fully explain your pain.

• You're tired of chasing symptoms instead of finding answers.

Frequently Asked Questions

Can pelvic floor dysfunction cause hip pain?

Yes. Because the pelvic floor works closely with the deep hip muscles and pelvis, dysfunction may contribute to hip, groin, buttock, and SI joint pain.

Can hip pain cause pelvic floor dysfunction?

Absolutely. The relationship works both ways. An injured hip may change movement patterns and increase tension or weakness within the pelvic floor.

Do I need an internal pelvic floor exam?

No. Internal examinations are always optional and performed only with your consent when clinically appropriate.

Is pelvic floor physical therapy only for women?

Not at all. Every person has a pelvic floor and can experience pelvic floor dysfunction contributing to hip pain, groin pain, and other symptoms.

The Bottom Line

Hip pain is rarely just about the hip.

Your pelvis, pelvic floor, core, breathing, nervous system, and hip muscles all work together every time you move.

If one part of that system isn't functioning well, the others often compensate.

That's why lasting relief sometimes requires looking beneath the surface.

If you've been living with persistent hip pain and haven't found the answers you're looking for, a specialized pelvic floor evaluation may uncover the missing piece.

Looking for Pelvic Floor Physical Therapy in Traverse City?

At Trailhead Physical Therapy & Wellness, we specialize in helping people uncover the root cause of persistent hip pain, pelvic pain, pregnancy and postpartum concerns, bladder and bowel dysfunction, and movement limitations.

We provide one-on-one, individualized care in a supportive environment where your symptoms are taken seriously and your goals matter.

Ready to find the "why" behind your hip pain?

Schedule an evaluation today and discover whether your pelvic floor could be part of the solution.