Is My Pelvic Floor Causing My Hip Pain?

Hip pain can sometimes be related to the pelvic floor, but it isn’t always the main cause. The hip joint, pelvic floor muscles and surrounding muscles all sit very close together and share several muscle and nerve connections. Because of this, irritation in one area can sometimes create pain that feels like it is coming from somewhere else. A physiotherapy assessment can help determine whether symptoms are coming from the hip joint, surrounding muscles, or the pelvic floor.

Hip pain can be surprisingly confusing.

Some women feel pain deep in the side of the hip when they walk.
Others notice discomfort when climbing stairs or getting out of the car.
And sometimes the pain sits in the groin or front of the hip and feels like something just isn’t moving comfortably.

A question we hear fairly often in clinic is:

“Could my pelvic floor be causing this?”

The short answer is: sometimes, yes – but not always.

The hip, pelvis and pelvic floor are closely connected. Because they share muscles, ligaments and nerves, irritation in one area can absolutely influence another.

Understanding how these structures work together can make hip pain a lot less mysterious.

At PhysioSista Pelvic Health in Bibra Lake, we often see women who are unsure whether their hip pain is coming from the hip joint itself or from surrounding muscles like the pelvic floor or pelvic girdle joints.

What Does the Pelvic Floor Actually Do?

The pelvic floor is a group of muscles that sit like a supportive hammock across the bottom of the pelvis.

These muscles:

• support the bladder, bowel and uterus

• assist with bladder and bowel control

• contribute to pressure control in the abdomen

• work with the deep abdominal and hip muscles to support the pelvis

The pelvic floor doesn’t work in isolation.

It’s part of a coordinated system involving:

•  the diaphragm (breathing muscle)

• the deep abdominal muscles

• the hip rotators and glute muscles

• connective tissues and ligaments around the pelvis

When this system works well, it helps manage pressure and stabilise the pelvis during everyday movement like walking, lifting, running or getting out of a chair.

How the Pelvic Floor and Hip Are Connected

A few key muscles create the link between the hip and pelvic floor.

The obturator internus is one of the most important.

This muscle sits deep inside the pelvis and attaches to the hip joint.

It helps rotate and stabilise the hip, but its inner surface also provides a supportive surface for part of the pelvic floor muscles to attach.

When the obturator internus or surrounding hip muscles become irritated or tight, the pelvic floor can sometimes respond by increasing tension as well.

And the opposite can also happen.

When pelvic floor muscles are holding more tension than usual, it can sometimes create discomfort that spreads toward the hip or buttock.

This is one reason pelvic health physiotherapists look at the entire system, not just one structure.

Why Hip Pain Can Feel Like Pelvic Pain

The pelvis is a crowded neighbourhood.

Several structures sit very close together:

• hip joint

• pelvic floor muscles

• sacroiliac joints

• deep glute muscles

• nerves supplying the pelvis and leg

When one of these tissues becomes irritated, the nervous system can sometimes interpret the signal as coming from a slightly different location.

This is called referred pain.

For example:

A tight deep hip rotator muscle might feel like pain in the buttock.

A pelvic floor muscle trigger point might feel like pain in the hip.

And hip joint irritation can sometimes feel like deep pelvic pain.

This is why assessment matters so much.
Symptoms alone rarely tell the full story.

When the Pelvic Floor Might Contribute to Hip Pain

There are a few situations where the pelvic floor can influence hip symptoms.

Increased pelvic floor tension

If the pelvic floor muscles stay switched on for long periods, they can sometimes irritate nearby tissues.

This may happen with:

•  stress or anxiety

• persistent bladder urgency

• painful bladder conditions

• chronic pelvic pain

When these muscles are holding more tension, nearby hip muscles may compensate or tighten as well.

After pregnancy or childbirth

During pregnancy, hormones increase ligament flexibility throughout the body so the pelvis can adapt during birth.

When ligaments become more flexible, muscles often need to provide a little more support.

If hip or pelvic muscles are still rebuilding strength after pregnancy, certain movements can irritate nearby joints or tissues.

This can sometimes feel like hip pain.

Changes in pelvic pressure management

The pelvic floor works together with the abdominal muscles to manage pressure when we lift, run or exercise.

If that pressure system isn’t coordinating well yet, some muscles may work harder than others.

Sometimes the hip muscles end up doing extra work.

Common Causes of Hip Pain (That Aren’t the Pelvic Floor)

While the pelvic floor can play a role, many cases of hip pain come from the hip joint or surrounding muscles themselves.

Common causes include:

• Gluteal tendon irritation

• Greater trochanteric pain syndrome (GTPS)

• Hip bursitis

• Hip joint cartilage irritation

• Labral tears or irritation in the hip joint

• Tight or weak hip flexor muscles

• Overload from running or strength training

• Reduced hip strength

• Lower back referral

Because these conditions can produce very similar symptoms, guessing based on location alone rarely works.

That’s why a good assessment looks at multiple structures.

What Physiotherapy Assessment Includes

When someone attends PhysioSista with hip or pelvic pain, the assessment usually includes several parts.

Movement history

We talk through: 

• when symptoms started

• what movements aggravate pain

• training history

• pregnancy or birth history

• bladder or bowel symptoms

This helps identify patterns in how the body is responding to load.

Movement assessment

We look at how the body moves during activities such as:

• Squatting

• Stepping

• single leg balance

• hip rotation movements

These tests often reveal whether the hip muscles are working efficiently.

Hip joint testing

Specific hip tests help identify whether symptoms are coming from the joint itself or surrounding muscles.

Pelvic floor assessment (if relevant)

If symptoms suggest the pelvic floor may be involved, assessment may include:

• pelvic floor muscle coordination

• ability to relax as well as contract pelvic floor muscles

• pelvic floor endurance

• pressure management strategies

Not everyone with hip pain requires a pelvic floor assessment, but it can provide useful information when symptoms overlap.

How Physiotherapy Treatment Can Help

Treatment always depends on the specific cause of symptoms.

But for many women, improvement comes from helping the whole system work together again.

Physiotherapy may include strengthening muscles that support the pelvis and hip, improving coordination between the pelvic floor and abdominal muscles, reducing excess muscle tension, and gradually returning to exercise and everyday activities.

Exercise Programs at PhysioSista

At PhysioSista we integrate physiotherapy assessment with exercise-based rehabilitation because strength and movement are powerful tools for recovery.

Options may include individual rehabilitation plans, structured return-to-gym programs such as Ready Set Gym, and clinical exercise and pilates classes that combine strength training, mobility work and pelvic floor support strategies.

The Takeaway

The pelvic floor and hip are closely connected.

Sometimes pelvic floor muscle tension or coordination changes can contribute to hip discomfort.

But many cases of hip pain originate from the hip joint or surrounding muscles.

The key is working out which tissues are actually responsible, rather than guessing based on symptoms alone.

If hip pain has been lingering, or if it overlaps with pelvic floor symptoms like bladder urgency or pelvic heaviness, a physiotherapy assessment can help figure out what’s happening. At PhysioSista in Bibra Lake, we assess both hip function and pelvic floor coordination to help identify the true source of symptoms.

Because when we understand the system, we can support it properly.

And that’s usually when things start to improve.

If you’re looking for an assessment, book an appointment here.

Written by Michelle Perks
Pelvic Health Physiotherapist
BSc Physiotherapy
Graduate Certificate Clinical Physiotherapy (Continence and Women’s Health)

Founder, PhysioSista Pelvic Health Centre – Bibra Lake, WA