Pelvic Therapy: The Missing Piece in Hip & Groin Pain Care

There’s a growing recognition in the orthopedic and sports medicine community that pain “around the hip” often involves more than just the hip joint. A newly published research article — “Hiding in Plain Sight: the pelvic floor in hip and groin pain” in British Journal of Sports Medicine — underscores a critical truth: the pelvic floor is frequently overlooked in cases of hip or groin pain, but may in fact be a major contributor. British Journal of Sports Medicine

Why This Matters

• The pelvic floor isn’t only about continence, bowel, or sexual health. It’s a neuromyofascial network integral to core stability, load transfer, and the coordination of muscles around the pelvis and hips. British Journal of Sports Medicine+2Johns Hopkins Medicine+2

• In athletes, dysfunction of the pelvic floor is common — for example, urinary or anal incontinence and pelvic pain are reported in a substantial fraction of weightlifters, endurance athletes, and cyclists. British Journal of Sports Medicine

• When the pelvic floor is tight, weak, or poorly coordinated, it can alter movement patterns, create compensations, and load the hips, groin, or surrounding soft tissues in ways that perpetuate pain. Rhode Island Pelvic Wellness+2Core Pelvic Floor Therapy+2

In short: if the pelvic floor isn’t functioning properly, standard hip-focused rehab may never fully resolve the problem.

What the New Research Adds

• The new BJSM article makes a compelling case that pelvic floor dysfunction (PFD) is common in athletes and regularly coexists with hip/groin pain — but is rarely considered in standard orthopedic or sports medicine assessments. British Journal of Sports Medicine

• The authors highlight how neglecting the pelvic floor can lead to misdiagnosis, incomplete treatment, or unnecessary imaging or even surgery when conservative, pelvic-informed rehab might suffice. British Journal of Sports Medicine+1

This aligns with clinical observations at pelvic-focused practices: patients with “hip pain” sometimes respond better when the pelvic floor and associated structures are addressed. Rhode Island Pelvic Wellness+2Core Pelvic Floor Therapy+2

Why Orthopedic and Sports Medicine Should Embrace Pelvic Rehab

1. Holistic Biomechanics — not just the hip joint: The pelvis is the foundation transferring load between trunk and lower limbs. Dysfunction here alters how forces travel — stressing the hip, adductors, groin, or back. Treating only the hip ignores this foundation. Wikipedia+2Rhode Island Pelvic Wellness+2

2. Identifying Hidden Contributors: Muscles like the obturator internus/externus — part of the deep hip stabilizers and closely linked to pelvic floor muscles — can refer pain to the groin or deep hip region. Core Pelvic Floor Therapy+1

3. Non-surgical, conservative first line: Given variable imaging findings (or even absence of pathology), incorporating pelvic floor assessment and rehab reduces risk of unnecessary surgery and can lead to lasting functional improvement. OUP Academic+2AAFP+2

4. Enhanced Outcomes, Especially for Athletes: Many athletes suffer from PFD — addressing pelvic floor dysfunction can improve not only hip/groin pain but also core stability, performance, and reduce risk of re-injury. British Journal of Sports Medicine+2Rhode Island Pelvic Wellness+2

Clinical & Patient-Centered Implications

For patients: if you’ve tried hip- or groin-focused therapy with limited improvement, persistent pain, or recurring symptoms — consider evaluation by a pelvic floor specialist. What might “look like” hip or labral pathology could instead (or also) be a pelvic floor or neuromyofascial issue.

For clinicians: incorporating pelvic floor screening (tone, coordination, myofascial trigger points, neuromuscular timing) into orthopedic, sports, or musculoskeletal assessments may uncover overlooked sources of pain. Collaboration between orthopedic/sports medicine providers and pelvic health therapists could enhance diagnostic accuracy and improve outcomes.

Why This Is a Paradigm Shift

Historically, pelvic floor dysfunction was siloed under urology, gynecology, or women’s health — often associated solely with incontinence or childbirth. But emerging data and clinical experience reveal a broader role: pelvic floor dysfunction can manifest as hip or groin pain, especially in active populations.

The new BJSM article isn’t just another “women’s health” study — it’s a wake-up call to the sports medicine and orthopedic community: the pelvic floor is not optional. It often plays a central role in hip and groin pain and deserves a seat at the assessment and rehabilitation table.