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Importance of Hip Mobility for Pelvic Health

Many people with pelvic floor dysfunction have decreased hip internal rotation mobility or lack hip internal rotation strength. When the hip internally rotates, the pelvic floor muscles become taut and ascend. Conversely, when the hip externally rotates, the pelvic floor muscles relax and descend.

Situations where hip internal rotation mobility is important:

▪️ During the pushing phase of labor, hip internal rotation helps open the pelvic outlet, facilitating the baby's passage.

▪️ For pelvic floor muscle laxity, exercises targeting loaded hip internal rotation with eccentric lengthening of the hip external rotators can be beneficial (see below).

▪️ When the hips are stuck in external rotation, this can contribute to gripping around the tailbone, posterior pelvic floor, and deep hip external rotators like the piriformis. Increasing internal rotation mobility can help decrease pelvic floor muscle tightness and alleviate constipation.

Hip Internal Rotation Control for Force Absorption

Controlled movement of the pelvis on the femur (thigh) is crucial for pelvic floor muscle function. When the pelvic floor muscles have laxity exercises targeting loaded hip internal rotation with eccentric lengthening of the hip external rotators can help! The hip external rotators on the standing leg eccentrically control internal rotation of the pelvis on the femur. This pelvis on femur hip internal rotation helps with force absorption during activities such as running and jumping by opening the pelvic outlet and therefore assisting in re-ascending the pelvic floor muscles. We want the pelvic floor muscles to ascend during impact to lift the pelvic organs and support the bladder to help prevent incontinence and pelvic pressure.

Inner Thigh Emphasis to Counteract Deep Hip External Rotator Tension

For those with increased hip external rotator tightness we can use the inner thighs to decrease external rotation and reduce gripping around the tailbone, posterior pelvic floor, and deep hip external rotators like the piriformis. 

Concentric adductors = eccentric obturator internus (sit bones widen)

This can help isolate the gluteus maximus (rather than the deep hip external rotators), decrease pelvic floor muscle tightness, and even help with constipation 💩

Also, eccentric adductor strength helps to decrease tone/tension in the deep hip external rotators like the obturator internus and piriformis as well as the posterior pelvic floor.

WARNING: If you have tension in your anterior pelvic floor or inner thighs this may make your symptoms worse - work with a pelvic floor PT for assessment and individualized treatment!

Tips to Decrease Pelvic Pressure and Leakage with Running

✨Improve thoracic (mid-back) rotation & arm swing

✨Don’t suck in your gut, tense your abdomen, or clench your pelvic floor

✨Keep your force forward (rather than excessive up/down motion)

✨Land your foot under your hip (rather than out in front of you)

✨Shorten your stride length and increase your cadence (faster feet)

✨Avoid rib flare and leading with chest - instead pretend like you’re running uphill (lean forward) and shift your gaze slightly down in front of you

Proper rib cage alignment ➡️ better inhale ➡️ better exhale ➡️ better support of organs

✨Work on your eccentric foot and hip control for better force absorption

Work with a pelvic floor PT for symptom free return to exercise! 

Strong & Mobile Feet are Crucial to Pelvic Floor Muscle Function

Limited toe, foot or ankle mobility may affect hip motion which is crucial to pelvic floor muscle function. 

If ankle dorsiflexion is limited, we can see excessive turning out of the foot and hip external rotation decreasing eccentric control and shock absorption. 

This hip external rotation closes the pelvic outlet and can prevent the pelvic floor muscles from ascending contributing to symptoms such as leaking and pelvic pressure upon impact.

Force absorption requires eccentric control through:

-Midfoot pronation (posterior tibialis)

-Ankle dorsiflexion (calves)

-Tibial internal rotation

-Hip IR (glutes/hip external rotators)

-Calcaneus eversion

Our feet naturally pronate (arches lower towards the floor) as we weight bear - such as when we lower into a split squat or heel strike when running - and supinate (arches lift up away from the floor) as we lift back up or push off during running. 

Promote Hip Flexion with Reduced Lumbar Involvement

Strengthening the hip muscles can help reinforce the proper lumbopelvic rhythm by reducing over-reliance on the lumbar spine and improving hip mobility.

In a typical lumbopelvic rhythm, during forward bending, the movement is initiated by the lumbar spine, followed by the pelvis, and finally the hip joint. However, sometimes the lumbar spine takes over, leading to decreased hip flexion and potentially causing issues.

Fascia Sling Systems

Sling systems are networks of muscles and fascia that work together to provide stability and generate force in the body. 

The posterior oblique sling system includes the latissimus dorsi muscle, the opposite side gluteus maximus muscle, and the thoracolumbar fascia that connects them. This sling system helps transfer force from the lower body to the upper body, and vice versa, and plays a key role in activities such as walking, running, and throwing. Dysfunction in the posterior oblique sling system can lead to inefficient movement patterns and increased risk of injury.

The anterior oblique sling system involves the external oblique, internal oblique, and the opposite side hip adductors (inner thigh). This system works in an integrated manner to transfer forces and provide stability during various movements. When you walk or perform activities that involve rotating your trunk while walking or running, the muscles and fascia of this sling work together to generate and transmit force while maintaining proper alignment of the pelvis and spine.

The longitudinal (deep) system is a group of muscles💪 and connective tissues that provide stability and support along the length of the spine and pelvis. These muscles work together to help you stand tall and move smoothly. Some of these muscles include the erector spinae, which are like vertical columns on your back, and the multifidus, which are small stabilizing muscles near your spine. They team up with other tissues and ligaments in your lower back and hips to support your spine and keep you balanced. When these muscles work well, they play a big role in preventing back pain and helping maintain good posture.

The lateral sling system involves the gluteus medius, gluteus minimus, tensor fasciae latae, IT band, and opposite side hip adductors (inner thighs). This group of muscles work together to provide stability and control to the lateral (outer) aspect of the hip and pelvis. These muscles work synergistically to provide stability and control during weight-bearing activities and contribute to maintaining proper alignment of the hips and pelvis. Dysfunction or weakness in any of these muscles can lead to issues such as poor hip stability, altered walking patterns, and increased risk of injuries.

Serratus Anterior Strengthening for Pelvic Health

The serratus anterior impacts the pelvic floor muscles as it has a role in positioning the ribcage🩻

▪️Elevates & expands ribcage

▪️Pulls ribcage posteriorly to scapula on inhale

▪️Stacks ribcage over pelvis

▪️Reduces rib flare - works in coordination with the external obliques to pull ribs down & in

Ribflare may cause decreased posterior ribcage expansion. It’s hard to exhale properly without a good inhale!

Proper ribcage positioning➡️proper inhale➡️proper exhale➡️improved pelvic floor muscle function

The pelvic floor muscles are not used functionally in isolation! Uncoordinated breathing can cause downward pressure on the pelvic floor contributing to symptoms such as incontinence and pelvic pressure.

A sign of weak serratus anterior muscles is scapular winging - people may have trouble getting air into the same side posterior ribcage. Think about expanding the ribs posteriorly on the inhale. 

Nerve Mobilization

Nerve flossing can help improve nerve mobility and function! Find nerve mobility exercises here.

Symptoms of peripheral neuralgia can include:

▪️Tingling and numbness


▪️Stabbing or shooting⚡️pain

▪️Muscle weakness

⚠️ If you are in a flare delay nerve glides until farther in your treatment plan to avoid further irritation (work with a physical therapist 😉). Hypertonic muscles and restricted connective tissue can tighten around nerves and cause issues. This tension and restriction should be addressed first.

The Feet and Genitals are Next to Each Other on the Homonculus

The homunculus is the motor and sensory distribution of the brain. You may notice you have plantar fasciitis and also have urinary leaking. The sacral nerve roots S 2-4 supply the pelvic floor muscles and S 2-3 supply the small muscles in our feet. If you have pelvic floor symptoms these foot exercises may be difficult because they share a similar originating home. If a nerve is restricted, compressed, compromised, then the muscles can become under or overactive.

Scapular Strengthening

Scapular strength and positioning is important in improving and preventing forward head/rounded shoulder posture as well as upper back, shoulder, and neck pain!

This is especially true postpartum and during lactation / breastfeeding - we tend to round the shoulders and head forward to look at baby (reclined feeding with your head supported is great to help avoid this). It’s always great to take breaks to do scapular and chin tuck exercises 😊

With these exercises try to engage from your mid-back (not the upper neck/shoulders). When the upper traps take over this can continue to pain and even headaches. Maintain the ribs down/stacked over the pelvis (try not to flare the ribs open).