(646) 355-8777

Strengthening hip muscles could improve pelvic floor strength: An Article Review

The following guest post comes to us from Angie Johnson, a physical therapist with Kaiser Permanente in Portland, OR.

Did you know that the pelvic floor muscles are actually quite thin? “Pelvic floor muscles are able to produce enough force to overcome changes in intra-abdominal pressure during less rigorous activities of daily living,“ but in activities such as coughing and jumping, “intra-abdominal pressure clearly exceeds the maximum force generated by pelvic floor muscles alone.”1 But we know that people are continent of urine during these activities, so it begs to question what structures help support the pelvic floor during high force events?

In our journey of pelvic rehabilitation and evidence-based medicine, researchers have determined that contributors to pelvic floor function include trunk stabilization2 and co-contraction of the abdominal wall (especially transverse abdominus)3,4. But this is only the beginning of the story. To add to this picture, new research, recently published in the Journal of Women’s Health Physical Therapy (January/April 2016) validates what we as practitioners already know; hip muscles play a crucial role in optimal pelvic floor functioning.

Knowledge of the anatomy of the pelvic floor and hip musculature helps to give us more understanding of the continence mechanism during high force activity. Obturator internus, which can be easily palpated through the vaginal wall “acts to externally rotate the hip. Interesting, this muscle actually shares a fascial attachment with the pelvic floor muscles.”

Researchers from a team at San Diego State University asked the very pertinent question: If you strengthen obturator internus do you strengthen the pelvic floor muscles too? To answer this question, they conducted a randomized control trial of 40 nulliparous women, aged 18-35, who were assigned to a hip exercise or control group. Both hip external rotator strength and pelvic floor muscle strength (via the Peritron™ perineometer) were measured in all of the women. The exercise group was then asked to perform clamshell exercises, isometric wall external rotation and “monster walks” as their specific hip exercises. The prescription of the exercises were 3 sets of 10 repetitions 3 days per week for 12 weeks. One session each week was supervised in the laboratory to ensure proper execution.

After the 12 weeks, the exercise group had an increase in hip external rotation strength, but also in pelvic floor muscle peak pressure. That was without any specific pelvic floor strengthening exercises at all. Strengthen the hips by doing these three exercises, and pelvic floor strength increases!! This is exciting and fantastic news for us as pelvic floor therapists and a good message to convey to our patients.

The results of this study are preliminary, but if you are treating pelvic floor weakness, hip external rotation strengthening exercises in addition to the traditional kegel strengthening exercises are a must. Go ahead – let’s all get hippie!


Tuttle LJ, DeLozier ER, Harter KA et al. The Role of the Obturator Internus Muscle in Pelvic Floor Function. Journal of Women’s Health Physical Therapy. 2016; 40, 1 pg 15-19
Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther 2004;9(1):31-42
Sapsford RR, Hodges PW, Ricahrdson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neruourol Urodyn 2001;20(1):3-12
Sapsord RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med REhabil. 2001;82(8):1081-1088

Jane Blair Johe is Our Featured Practitioner!
Visceral Mobilization and the Lumbar Spine

By accepting you will be accessing a service provided by a third-party external to https://www.hermanwallace.com/

Upcoming Continuing Education Courses

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Jun 19, 2021 - Jun 20, 2021
Location: Replacement Remote Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Jun 19, 2021 - Jun 20, 2021
Location: Replacement Remote Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Self-Hosted

Jun 25, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Medford, OR Satellite Lab Course

Jun 25, 2021 - Jun 27, 2021
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Gastrointestinal System - Chicago IL Satellite Location

Jun 25, 2021 - Jun 27, 2021
Location: Athletico Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Athens, GA Satellite Location

Jun 25, 2021 - Jun 27, 2021
Location: Thrive Integrated Medicine

Pelvic Floor Capstone - Satellite Lab Course

Jun 26, 2021 - Jun 27, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Self-Hosted

Jun 26, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Garden City, NY Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Capstone - Mequon, WI Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Capstone - Self-Hosted (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Torrance, CA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2A - Charlotte, NC Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Ivy Rehab Physical Therapy

Pregnancy Rehabilitation - Remote (SOLD OUT) Course

Jun 26, 2021 - Jun 27, 2021
Location: Replacement Remote Course

Pelvic Floor Capstone - Bozeman, MT Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 2A - Virginia Beach, VA Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Southeastern Physical Therapy

Pelvic Floor Capstone - Decatur,GA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Emory Healthcare

Pelvic Floor Capstone - Chamblee, GA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Revelle Physical Therapy Atlanta

Pelvic Floor Level 2A - Belle Chasse, LA Satellite Location (CANCELLED)

Jun 26, 2021 - Jun 27, 2021
Location: Rehab Access Belle Chasse

Pelvic Floor Level 2A - Hebron, NE Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Thayer County Health Services

Pelvic Floor Level 2A - Chicago, IL Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Advocate Condell Medical Center

Sacroiliac Joint Current Concepts - Remote Course (SOLD OUT)

Jun 26, 2021
Location: Short Form Remote Course

Coccydynia and Painful Sitting - Remote Course

Jun 27, 2021
Location: Short Form Remote Course