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Hips, Glorious Hips... and Your Pelvic Floor

Wouldn’t be an amazing thing to keep our body strong and agile right into the ripe old age. Happy joints, lean, strong muscles, flexible spine… oh, and a supportive, resilient pelvic floor with no “oopsie” momenents or pain.

Pretty good to aspire to this, right?

This does not happen automatically, and we need to put some degree of work into this to keep our body in best condition. To retain movement capability, we need to have good biomechanics, where our muscles, bones, tendons, and ligaments work well to move us.

And, we need to MOVE, and move often.

Today, I wanted to talk about hip movement and its connection into the pelvic floor, as they are directly linked.

A lot of women start having trouble with the pelvic floor around the time of the menopause. But that’s because the change in hormones, which does work against us reducing the strength of our ligaments, exposes some problems which were in existence well beforehand.

Happy hip movement allows us to turn the thigh bone outwards (called “external rotation”) and inwards (called “internal rotation”). However,we can have restrictions in movements, or lose the ability to do this movement “cleanly”, without compensations.

The loss of such clean movement potential will have a direct link to the health of our hip joints - potentially causing some wear and tear, increasing the risk of arthritis - AND it can be linked to pelvic floor dysfunction.

A good way to test your movement clarity is by lying on your back, with the knee bent and above the hip, then gently rotating your vertical thighbone as if it is a handle of a traditional manual coffee grinder. The knee should remain looking up at the ceiling throughout.

Does it feel the same or different on your left and on your right, and does one side feels easier to turn one way? Does it feel tight, uncomfortable, pinchy anywhere - and does your waist feel like it wants to hitch where movement is restricted?

If so, then there is something going on that warranties further investigation.

The loss of inward (internal) hip rotation is correlated with the risk of hip joint problems. Often, such movement feels like it comes to a hard stop, does not want to go any further, and can feel uncomfortable. The body tries to get round it by hitching the hip (think - a squeeze in the waistline on one side) to create an illusion of movement. That’s also not good, as it creates chronic side or lower back tension.

What’s more, there is an interplay between reduced internal hip rotation and how the pelvic floor muscles are. There is a predisposition to a weakened pelvic floor and less control over the pelvic floor muscles on that side of the pelvis.

So if a client comes to me with pelvic floor problems, I always assess their hip rotation.

I hardly ever prescribe Kegel squeezes, as that mainly targets the external layers of the pelvic floor. It is so much more beneficial to look at the connection of how all the core muscles integrate (or not!) in this - assessing how my client can do core engagement on the right and the left side separately, how they breathe, how well their spine moves in various directions, then look at how their hips move, and what is happening with the pelvic floor.

And for some people, Kegel squeezes of the pelvic floor can actually make their existing problems much worse. That goes against what we have been told for decades, but it is true. If we have excess tension in the pelvic floor, Kegels cause even more tension and even more symptoms.

The key for anyone who wants to improve their pelvic floor function, and their hip mobility, is to find out WHY their body is presenting the way it is, and work on the underlying reasons for that - not doing "standard" squeezes or stretches of something or other, just because this seems to be what "common wisdom" currently suggests. There is a lof of misinformation and misunderstanding out there.

The pelvic floor is a “slave” to the rest of the body, often being our last line of defence. It can be clenching for dear life, supporting our internal organs whilst we can be inadvertently putting constant downward pressure onto it through poor breathing, posture, and movement habits.

Our pelvic floor and hips' range of movement tell a story of how successful - or not - we have been in our movement strategies through our lifetime.

The good news is that a lot of it can be changed, especially if we start paying attention to it before we get any irreversible joint changes.

So look after your body, move well, notice tightness when it comes on, and seek advice and work to resolve this with your bodyworker before it gets to be your new norm.

Then, we can have longevity in our hips and a strong and happy pelvic floor for life.

To your health,



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