Hip Injuries and the Pelvic Floor

Hip injuries and surgeries can be physically and emotionally challenging for anyone. Whether you’re an athlete recovering from a sports-related injury or a pregnant woman complaining of hip pain and/or muscle tightness, the road to recovery can be tough! While many people are familiar with traditional orthopedic rehabilitation for hip pain and injuries, one crucial aspect is often overlooked: pelvic floor physical therapy.

Although I may be a bit biased, pelvic floor physical therapy is like the hidden hero of hip rehabilitation and plays a vital role in the recovery process. Before diving deep into the need of pelvic floor physical therapy in hip rehabilitation, let’s first talk about the pelvic floor. The pelvic floor is a group of muscles, ligaments, and connective tissues that form a hammock-like structure at the base of the pelvis. Pelvic floor muscles play a crucial role in bodily functions: it supports organs, such as the bladder, rectum, and uterus (in females) to prevent conditions like pelvic organ prolapse; it has a sphincteric action to maintain urinary and fecal continence, it helps stabilize the spine to aide in maintaining posture and balance, it acts as a pump to help bring lymph and blood towards the heart, and last, but certainly not least, it is involved with sexual function to make sex satisfying!

You must be thinking, “How does that have anything to do with hip rehabilitation?” The hip connects to the pelvis and therefore the pelvic floor muscles are interconnected with the muscles and structures of the hip joint. Hip pain and injuries can disrupt the body’s natural body mechanics, which will lead to altered movement patterns and muscle imbalances. These changes can affect the pelvic floor, causing dysfunction and discomfort. Muscle imbalances will likely arise due to overusing certain muscles to compensate for hip weakness. When muscles are overused, it leads to weakness and tension. This may then cause other symptoms to arise such as painful intercourse or urinary incontinence/leaking with activity.

Let me tell you a story about one of my patients. For confidentiality reasons, let’s call her Jane. I am also going to leave out specific details to further protect her identity. During labor and delivery, Jane had torn her labrum in one of her hips. For several months, Jane went to a traditional physical therapy clinic for hip rehabilitation. She was going multiple times a week and reported slight improvement in hip pain and overall function, however she still felt tightness in her hips and she began experiencing new symptoms: difficulty initiating stream despite strong urge to urinate, painful intercourse, and decreased core strength. ((*Warning* I am not discrediting her previous physical therapist; Jane’s hip pain did decrease and she was able to return to working out through the guidance of her PT. However, unfortunately the pelvic floor was not addressed and therefore lead to new symptoms.))

When I evaluated Jane, she had hip range of motion deficits, hip and knee weakness on the involved side, core weakness, and significant tightness in her pelvic floor. Jane mentioned she was still doing her exercises from her previous physical therapist, which mainly included stretches. After her evaluation, I gave her a few pelvic floor relaxation exercises, including diaphragmatic breathing and specific pelvic floor stretches, hip strengthening exercises to address weakness in her internal rotators, glutes, and hamstrings, and core strengthening exercises. At her follow up appointment, Jane reported improvements in function due to decreased pain throughout the day. At her next session, Jane stated she was no longer experiencing urinary dysfunction symptoms and felt that she was able to feel a difference when relaxing her pelvic floor muscles. Furthermore, her hip range of motion improved, she wasn’t feeling as much tightness in her hips, and pain was almost completely gone! In just 3 sessions, we were able to work on relaxing the pelvic floor and improving strength in her hips and core. After 5 sessions, Jane felt almost at 100%! The hip and pelvic floor muscles must be addressed together in order to fully rehabilitate.