Regarding the body's interconnected web of systems, one aspect that impacts the pelvic floor is the hips. The pelvic floor is a group of muscles, ligaments, and connective tissue that sits at the base of the pelvis and plays a vital role in supporting your pelvic organs, including your bladder, bowel, and reproductive functions, as well as your respiratory function. Since everything is connected and no one group of muscles works alone, how well your hips move can significantly impact the health of your pelvic floor. I will discuss this connection in this article, the importance of hip rotation (specifically internal rotation) for pelvic floor health, and exercises you can add to your current workouts.
A Brief Understanding Of The Pelvic Floor
Before we get into the hip connection, let us briefly understand the role of the pelvic floor. The pelvic floor acts as a hammock, supporting the internal organs, and their function, within the pelvis. The pelvic floor is also a diaphragm and plays a role in managing intra-abdominal pressure within the core “canister”. When you go to take a breath in, your lungs fill with air and your respiratory diaphragm flattens causing pressure to push your internal organs downward. Your pelvic floor immediately responds to this pressure by releasing and flattening. To exhale and decrease pressure in your body, the pelvic floor springs up like a trampoline, sending the organs upward, and the respiratory diaphragm responds by springing and doming up to release CO2 and achieve an exhalation. From the ground-up perspective, your pelvic floor holds a connection to your feet through the myofascial meridian line called The Deep Front Line (image below).
When you go to walk, run, or jump, your feet respond to the impact of ground force which trickles its way up through your pelvic floor and beyond to manage this impact. Pretty cool, huh.
The Hip-Pelvic Floor Connection
The relationship between the hips and the pelvic floor shares a biomechanical link. When you take a step forward, your hip joint moves through various ranges of motion at different points in the gait/walk cycle. One of these movements is internal rotation, which is often a range of motion that becomes limited due to several factors.
Many of us with a female pelvis tend to live in external rotation within the pelvis (think of an anterior pelvic tilt)- especially throughout pregnancy, postpartum, and beyond. It's also safe to say that most athletes will be more externally rotated due to this requirement within most sports. I should note here that there is nothing wrong with the pelvis being positioned this way. However many times a pelvis externally rotated (anterior pelvic tilt) can warrant femur heads (hips) getting shoved and stuck forward in their range of motion over time (see image below).
When the pelvis and femurs are stuck in this position, the inlet (or base) of the pelvis narrows causing the pelvic floor to become strained.
More specifically, the back of the pelvic floor becomes compressed and taut. Meanwhile, the front part of the pelvic floor becomes slack and can make it difficult to connect to the pelvic floor and let it do its thing- which is to be a reactive and springy sling of muscles.
One particular muscle that has a direct connection to the pelvic floor and hips is the obturator internus. It is a deep muscle that attaches to the hip joint and the lateral wall within the pelvis. Its action is to externally rotate the hip. Repetitive movements such as leaning and sinking into the hip joints when we stand for some time or when we are carrying a baby can lead to this muscle becoming chronically tight. Another repetitive habit that leads to this muscle and the pelvic floor becoming taut is butt gripping, especially when there is a lack of stability or hypermobility in the body. It serves not only as a protective mechanism to create tension or holding where it is lacking but is a subconscious response to stress and fear we struggle to manage.
Engaging in internal hip rotation can help to release not only this deep hip muscle but also its connected friend- the posterior pelvic floor. Internal rotation will also decompress the back of the pelvis, sacrum, and lumbar spine. This release allows one to make a connection to the front (or anterior) part of the pelvic floor. Having this balance is important for preventing a hypertonic pelvic floor (overly tense muscle) and pelvic floor-related symptoms such as incontinence and prolapse.
Overall, Accessing Hip Internal Rotation Can:
Restore pelvic floor function
Restore pelvic organ function
Improve alignment
Enable pelvic and hip stability and range of motion
This relationship between hip internal rotation and pelvic floor health only scratches the surface of so many different approaches in supporting the health of your pelvic floor. Below are a few exercises to strengthen this overall connection toward a balanced body and well-being.
Exercise: Staggered Hinge to Knee Drive
A great exercise to open the back of the pelvis and pelvic floor, and drive more internal rotation at the hip and pelvis. You can just focus on the hinge and omit the knee drive if this is a new pattern for you.
Exercise: Squat to Clean and Press (intermediate/advanced)
This exercise provides hip internal rotation and engages the lats, glutes, obliques, and adductors (the posterior and anterior oblique slings) to provide core and pelvic control. If you are familiar with and comfortable using kettlebells, this would be a great addition. You can also do this exercise bodyweight and focus on the movement.
Exercise: Forward Step Hinge to Cross Lunge and Reach
This is a dynamic exercise to drive femoral/hip rotation, get the pelvic floor to react and respond, and open up the lumbopelvic region.
Exercise: Squat, Pivot, and Halo
You can take this exercise slowly or quickly. The pivoting movement helps to drive hip internal rotation along with getting the feet to respond (remember the Deep Front Line connection). You also get a bonus shoulder opener with the halo.
Extra Resources:
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To find me in-person I offer personal training sessions at the Rochester Midtown Athletic Club.
This isn’t a source of medical advice. Please seek guidance from your healthcare provider or medical professional before starting any exercise or exercise program.
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