Hip Pain in Active Women: When the Pelvic Floor Might Be Part of the Picture
Hip pain is incredibly common in active women.
Maybe it shows up when you squat.
Maybe it bothers you after a run.
Maybe you feel it deep in the front of your hip, along the outside, or somewhere around the glute.
And if you've dealt with it for a while, you've probably tried some version of:
Stretch your hip flexors.
Strengthen your glutes.
Roll out your IT band.
Take some time off.
Sometimes those things help.
But sometimes the hip isn't the only piece of the picture.
The hip, pelvis, trunk, and pelvic floor don't function as completely separate systems.
That doesn't mean every woman with hip pain needs pelvic-floor treatment.
It does mean that when hip pain isn't improving—or when it exists alongside pelvic-floor symptoms—it may be worth looking beyond the painful spot.
Hip Pain Is a Symptom, Not a Diagnosis
“Hip pain” can mean a lot of different things.
Pain in the front of the hip isn't necessarily the same problem as pain on the outside of the hip. Pain that only occurs during a heavy squat may need a different approach than pain that starts 30 minutes into a run.
That's why a good orthopedic assessment shouldn't begin and end with:
Where does it hurt?
I also want to know:
What movements provoke it?
What movements feel good?
How much are you training?
Has your training recently changed?
How are you tolerating load?
What does your strength look like?
How does the hip move?
What is happening at the trunk, pelvis, knee, and foot?
What happens as you fatigue?
And for women, there may be another set of questions worth asking.
Are you leaking?
Do you experience pelvic pressure or heaviness?
Do you have pain with intercourse or tampon insertion?
Are there bowel or bladder symptoms?
Have you been pregnant or postpartum?
Those questions aren't separate from an orthopedic evaluation just because they're considered “pelvic health.”
They're part of understanding the whole person standing in front of me.
So What Does the Pelvic Floor Have to Do With the Hip?
More than most people realize.
The pelvic floor sits at the base of the pelvis and works as part of a larger system that includes the hips, abdominal wall, diaphragm, and muscles around the spine and pelvis.
There are also direct anatomical relationships in this region. For example, the obturator internus is a deep hip muscle, and connective tissue associated with it provides an attachment site for part of the pelvic floor.
That doesn't give us a simple equation like:
Hip pain = pelvic-floor dysfunction.
Bodies aren't that simple.
But it does help explain why separating “the hip” from “the pelvis” isn't always useful.
Your body doesn't know which provider traditionally treats which body part.
It just has to coordinate the entire system when you run, squat, jump, lift, rotate, change direction, or carry a kid through Target.
Sometimes the Hip Is the Main Problem
This part matters.
If you come to me with hip pain, I'm not automatically going looking for a pelvic-floor problem.
Sometimes you have hip pain because your hip needs orthopedic rehabilitation.
Maybe we need to improve strength.
Maybe your current training load exceeds what the area is ready to tolerate.
Maybe we need to modify an aggravating movement temporarily while building capacity.
Maybe there is a specific hip condition that needs to be considered.
Maybe we need to look at your lumbar spine or another nearby structure.
And sometimes the best treatment really is good, progressive orthopedic rehab.
Pelvic health shouldn't replace orthopedic care when orthopedic care is what you need.
But Sometimes We're Missing Part of the Story
Now imagine a different athlete.
She has hip pain when she squats and runs.
But she also leaks during double-unders.
She feels pelvic pressure after long runs.
Maybe penetration has become uncomfortable.
She's been working on hip strengthening for months, but something still doesn't feel right.
Now I have more information.
That doesn't prove the pelvic floor is causing her hip pain.
But it absolutely makes me interested in how the pelvic floor is functioning as part of the larger system.
Can it generate force when needed?
Can it relax and lengthen?
How does it coordinate with breathing and trunk strategy?
What happens under load?
What happens with impact?
And how does all of that relate to what she's actually trying to get back to?
That's the difference between chasing a painful body part and evaluating the person who owns it.
Your Glutes Probably Aren't “Off”
While we're here, can we retire this one?
Your glutes probably aren't asleep.
And they probably don't need to be “activated” for the next six months before you're allowed to do anything interesting.
Glute strength can absolutely matter in hip rehabilitation.
But active women need more than a collection of corrective exercises.
Eventually, rehabilitation has to prepare you for your actual life and sport.
If you want to run, we need to prepare you to run.
If you want to squat a barbell, we need to prepare you to squat.
If you want to jump, cut, tumble, hike, or chase your kids around the yard, your rehab should progressively build the capacity to do those things.
Clamshells can be a tool.
They aren't the destination.
This Is Where Orthopedic and Pelvic Health Care Should Meet
This is one of the biggest reasons I created FitPelvis.
I spent years practicing in orthopedics before specializing in pelvic health.
And the more I learned about pelvic health, the less sense it made to treat it as if it existed in its own little box.
The opposite is true too.
We shouldn't treat the hip, back, or core as though the pelvic floor doesn't exist.
Not every orthopedic patient needs pelvic-floor treatment.
Not every pelvic-health patient needs an extensive orthopedic workup.
But we should be able to recognize when the other system matters.
That's especially important for active women, because your goal usually isn't simply to make a symptom disappear while you're lying on a treatment table.
You want to do something.
Run.
Lift.
Compete.
Train.
Play with your kids.
Move through pregnancy and postpartum.
Stay strong as you get older.
The evaluation—and the rehab—should reflect that.
The Bottom Line
If you have hip pain, don't assume your pelvic floor is the problem.
But don't assume the rest of your body is irrelevant either.
Your hip is part of a system. Your pelvic floor is part of that system. And good rehabilitation should know how to look at both.
Sometimes the answer is pelvic-floor treatment.
Sometimes it's orthopedic rehab.
Sometimes it's a combination.
The goal isn't to find one muscle to blame.
It's to figure out what your body needs to get back to doing what you love.
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If pelvic floor symptoms, pain, or movement limitations are keeping you from doing the things you love, you don’t have to keep guessing. FitPelvis PT combines pelvic health, orthopedic care, and performance to look at the whole picture—not just one symptom.
