(646) 355-8777

Herman & Wallace Blog

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

Continue reading

Upcoming Continuing Education Courses

Oct 26, 2018 - Oct 28, 2018
Location: Kadlec Regional Medical Center

Oct 26, 2018 - Oct 28, 2018
Location: Advanced Physical Therapy of Little Rock

Oct 27, 2018 - Oct 28, 2018
Location: Nationwide Children's Hospital

Oct 27, 2018 - Oct 28, 2018
Location: Johns Hopkins Hospital

Nov 2, 2018 - Nov 4, 2018
Location: St. Joseph's Hospital - Phoenix

Nov 3, 2018 - Nov 4, 2018
Location: Pacific Medical Center

Nov 4, 2018 - Nov 6, 2018
Location: Touro College: Bayshore

Nov 9, 2018 - Nov 11, 2018
Location: Emory Healthcare

Nov 9, 2018 - Nov 11, 2018
Location: Johns Hopkins Hospital

Nov 10, 2018 - Nov 11, 2018
Location: Griffin Hospital

Nov 10, 2018 - Nov 11, 2018
Location: Houston Methodist

Nov 10, 2018 - Nov 11, 2018
Location: Carolinas HealthCare System

Nov 10, 2018 - Nov 11, 2018
Location: Comprehensive Therapy Services

Nov 10, 2018 - Nov 12, 2018
Location: Comprehensive Therapy Services

Nov 17, 2018 - Nov 18, 2018
Location: Florida Hospital - Wesley Chapel

Nov 30, 2018 - Dec 2, 2018
Location: FunctionSmart Physical Therapy

Nov 30, 2018 - Dec 2, 2018
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Dec 7, 2018 - Dec 9, 2018
Location: Good Shepherd Penn Partners

Dec 7, 2018 - Dec 9, 2018
Location: Tri-City Medical Center

Jan 11, 2019 - Jan 13, 2019
Location: Spooner Physical Therapy

Jan 11, 2019 - Jan 13, 2019
Location: Highline Physical Therapy

Jan 11, 2019 - Jan 13, 2019
Location: Tri-City Medical Center

Jan 18, 2019 - Jan 20, 2019
Location: Providence Healthcare

Feb 2, 2019 - Feb 3, 2019
Location: UCLA Rehabilitation Services

Feb 8, 2019 - Feb 10, 2019
Location: Florida Hospital - Wesley Chapel

Feb 22, 2019 - Feb 24, 2019
Location: Inova Physical Therapy Center

Feb 22, 2019 - Feb 24, 2019
Location: Rocky Mountain University of Health Professions

Feb 23, 2019 - Feb 24, 2019
Location: NorthBay HealthCare

Mar 1, 2019 - Mar 3, 2019
Location: Virginia Hospital Center

Mar 1, 2019 - Mar 3, 2019
Location: University of North Texas Health Science Center