Your Hip Pain Might Not Be a Hip Problem—Here's Why Your Pelvic Floor Could Be the Missing Piece

Many people with chronic hip and groin pain have been through the medical maze: imaging, orthopedic exams, injections, and months of hip-focused physical therapy, only to hear that everything "looks normal." Yet the discomfort persists, sometimes sharp, sometimes deep and hard to pinpoint. The missing piece might not be in your hip at all—it could be your pelvic floor, a group of muscles that plays a much larger role in movement and pain than most people realize.

Why Does Hip Pain Sometimes Come From Somewhere Else?

The hip doesn't work in isolation. Every step, squat, lift, or rotation depends on how forces move through the pelvis, which acts as the foundation that transfers load between the spine and the legs. When that foundation is unstable, overworked, or poorly coordinated, surrounding tissues including the hip and groin absorb stress they were never meant to handle.

This explains why two people can have identical magnetic resonance imaging (MRI) findings, yet only one experiences persistent pain. Structure alone rarely tells the whole story—function matters just as much. Recent research published in the British Journal of Sports Medicine has reinforced what pelvic health clinicians have observed for years: pelvic floor dysfunction commonly coexists with hip and groin pain, particularly in active populations.

What Does Your Pelvic Floor Actually Do for Hip Health?

The pelvic floor is a group of muscles at the base of the pelvis. While it's often associated only with bladder, bowel, or sexual function, its role extends far beyond that. These muscles work closely with the diaphragm, deep abdominal muscles, and hip stabilizers in several critical ways:

• Pelvic Support: They support the pelvis during movement and help manage pressure during lifting, running, and impact activities
• Movement Coordination: They coordinate timing and stability as the legs move beneath the body, ensuring efficient force transfer
• Pressure Management: They work with other core muscles to manage internal pressure changes during physical activities

Pelvic floor dysfunction doesn't always mean weakness. In fact, many people with hip or groin pain have pelvic floor muscles that are overly tense or unable to relax when needed. This can lead to altered movement patterns, increased strain through the hip joint or groin tissues, and referred pain that feels deep, vague, or difficult to locate.

How Can You Tell if Your Pelvic Floor Is Involved?

Not everyone with pelvic floor involvement has obvious bladder or bowel symptoms. Common indicators that your pelvic floor might be contributing to your hip pain include deep groin pain or pain near the sit bones or tailbone, hip pain that changes with stress or fatigue, and symptoms that improve briefly but keep returning. You might also notice pain paired with constipation, irritable bowel syndrome (IBS), urinary urgency, or discomfort with intimacy.

"There's a growing understanding in sports medicine and rehabilitation that pain 'around the hip' isn't always coming from the hip joint itself," explains Katie Beckham, a pelvic floor physical therapist working with patients in the Memorial and Bellaire areas. "In many cases, the missing piece is the pelvic floor."

Athletes are particularly vulnerable to pelvic floor dysfunction due to repetitive load, high training volumes, breath-holding during exertion, and pressure management demands. When the pelvic floor isn't functioning optimally, power transfer becomes inefficient, stability decreases under fatigue, and re-injury risk increases.

Why Standard Hip Therapy Sometimes Falls Short

Traditional orthopedic rehabilitation often focuses on strengthening, stretching, and joint mobility. While these approaches are valuable, they don't always address how the body coordinates pressure, breath, and muscle timing during real-life movement. If the pelvic floor is overactive, poorly timed, or disconnected from the rest of the core system, strengthening the hips alone may reinforce compensation patterns rather than resolve them.

Pelvic floor physical therapy takes a different approach, looking beyond the site of pain to consider how the pelvis, hips, core, breathing patterns, and nervous system work together. Treatment may include manual therapy to address muscle tension, breathing and posture retraining to improve load management, and neuromuscular re-education to restore coordination and timing.

This comprehensive perspective is especially important for complex or chronic cases where standard approaches have fallen short. When the pelvic floor is properly assessed and treated, many patients finally experience the improvement that eluded them with hip-focused treatments alone.