When Hip Pain Won’t Go Away: Could the Pelvic Floor Be the Missing Link?
You’ve stretched, foam rolled, strengthened, iced, and repeated all the traditional orthopedic physical therapy treatments — but your hip pain keeps coming back. You’ve been told it’s your glutes, your SI joint, your hip flexors — and while those might all play a role, there’s one area that’s often overlooked in persistent or recurring hip pain:
Your pelvic floor.
What Does the Pelvic Floor Have to Do with Hip Pain?
The pelvic floor is a group of muscles that sit at the base of your pelvis. These muscles are essential for core stability, bladder and bowel control, sexual function — and yes, they also directly affect the hips, pelvis, and spine.
Here’s why:
The pelvic floor is deeply connected to the hip musculature, sharing fascial connections with muscles like the obturator internus and piriformis.
It works in coordination with your deep core muscles (think: transverse abdominis and diaphragm) to stabilize your pelvis and spine with every step you take.
Dysfunction in the pelvic floor — whether it’s tightness, weakness, poor coordination, or inability to relax — can lead to compensations in the hips that create chronic pain patterns.
Signs Your Hip Pain Might Involve the Pelvic Floor
You’ve been through rounds of orthopedic PT with minimal or temporary relief
Hip pain feels deep or stubborn, and no amount of glute work seems to fix it
You also notice lower back discomfort, SI joint irritation, or tightness in your inner thighs or groin
You experience bladder frequency, pelvic heaviness, pain with sex, or difficulty fully relaxing your core
You have a history of pregnancy, delivery (vaginal or C-section), or pelvic/abdominal surgeries
Even if you don’t have classic signs of pelvic floor dysfunction like leakage or prolapse, your pelvic floor could still be contributing to dysfunctional movement patterns that are driving your hip pain.
What Happens When the Pelvic Floor Is Addressed?
Patients often say they’ve tried everything — but once the pelvic floor is assessed and integrated into their plan, things start to shift:
Hip mobility improves once overactive pelvic floor muscles are taught how to relax
Deeper core engagement returns, reducing strain on the hips during daily activity or exercise
Compensatory tension patterns unwind, allowing the glutes and hip stabilizers to function the way they were meant to
Pain finally stays away, rather than returning weeks after discharge from PT
Pelvic Floor PT Is More Than Kegels
It’s not just about squeezing muscles — in fact, sometimes the problem is too much tone, not too little. A skilled pelvic floor physical therapist evaluates not just the strength of these muscles, but also their ability to relax, coordinate with breathing, and support movement.
Treatment often includes:
Manual therapy to release pelvic floor and hip-related restrictions
Breath work to restore core-pelvic floor synergy
Targeted exercises that re-train your nervous system to use the right muscles at the right time
Movement retraining to address faulty patterns that have become second nature
The Takeaway
If you’ve been stuck in a cycle of chronic hip pain despite doing “all the right things,” it may be time to think outside the orthopedic box.
