(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

Aug 24, 2018 - Aug 26, 2018
Location: Loyola University Stritch School of Medicine

Aug 24, 2018 - Aug 26, 2018
Location: The Sage Colleges

Aug 24, 2018 - Aug 25, 2018
Location: Princeton Healthcare System

Aug 24, 2018 - Aug 26, 2018
Location: Princeton Healthcare System

Sep 7, 2018 - Sep 9, 2018
Location: Franciscan Health System

Sep 7, 2018 - Sep 9, 2018
Location: Viverant

Sep 8, 2018 - Sep 9, 2018
Location: Stanford Health Care- ValleyCare

Sep 8, 2018 - Sep 9, 2018
Location: St. Joseph Hospital Rehabilitative Services

Sep 14, 2018 - Sep 16, 2018
Location: Mercy Hospital

Sep 14, 2018 - Sep 16, 2018
Location: Memorial Hermann Health System

Sep 14, 2018 - Sep 16, 2018
Location: Mary Free Bed Rehabilitation Hospital

Sep 15, 2018 - Sep 16, 2018
Location: N2PT

Sep 21, 2018 - Sep 23, 2018
Location: Virginia Hospital Center

Sep 22, 2018 - Sep 23, 2018
Location: Beaumont Health - Royal Oak

Sep 22, 2018 - Sep 23, 2018
Location: The Everett Clinic

Sep 28, 2018 - Sep 30, 2018
Location: Veterans Administration - Salt Lake City

Sep 28, 2018 - Sep 30, 2018
Location: DeKalb Medical Atlanta Hospital and Medical Center

Sep 28, 2018 - Sep 30, 2018
Location: Kima - Center for Physiotherapy & Wellness

Sep 29, 2018 - Sep 30, 2018
Location: Sansum Clinic Physical Therapy

Oct 5, 2018 - Oct 7, 2018
Location: Embassy Suites Minneapolis - North

Oct 5, 2018 - Oct 7, 2018
Location: Physical Therapy Services of Lansing

Oct 6, 2018 - Oct 7, 2018
Location: Wesley Medical Center

Oct 12, 2018 - Oct 13, 2018
Location: The Carolton Chronic & Convalescent Hospital

Oct 12, 2018 - Oct 14, 2018
Location: Allina Health

Oct 12, 2018 - Oct 14, 2018
Location: Highline Medical Center

Oct 13, 2018 - Oct 14, 2018
Location: Anne Arundel Medical Center

Oct 13, 2018 - Oct 14, 2018
Location: Texas Children’s Hospital

Oct 19, 2018 - Oct 21, 2018
Location: Marathon Physical Therapy

Oct 19, 2018 - Oct 21, 2018
Location: FunctionSmart Physical Therapy

Oct 20, 2018 - Oct 21, 2018
Location: DeKalb Medical Atlanta Hospital and Medical Center