Why Hip Rotation Matters for Pelvic Floor Health
When most people think about pelvic floor exercises, they think about Kegels. But there is a critical group of muscles that plays an equally important role in pelvic floor health: the hip rotators. These deep muscles surround and support your pelvis, and their strength directly affects how well your pelvic floor functions day to day.
Your hip rotators are responsible for turning your thigh bone inward and outward within the hip socket. They stabilize your pelvis during walking, standing, sitting, and virtually every movement you make. When these muscles become weak or tight, the pelvic floor loses a key source of structural support, which can contribute to issues like incontinence, pelvic pain, and pelvic organ prolapse.
The hidden link: Research in pelvic rehabilitation has shown that women with pelvic floor dysfunction frequently have weakness in their hip rotators. Addressing both the pelvic floor and the hip rotators together leads to significantly better outcomes than training either muscle group alone.
The Obturator Internus Connection
The most important hip rotator for pelvic floor health is the obturator internus. This deep external rotator muscle is unique because it originates inside the pelvis, passes directly through the pelvic floor, and attaches to the top of the thigh bone (femur). It literally threads through your pelvic floor muscles on its way to the hip joint.
The obturator internus shares fascial connections with the levator ani, which is the primary muscle group of the pelvic floor. When the obturator internus contracts, it provides a lifting and supportive force to the pelvic floor from within. Think of it as an internal scaffolding system: when the obturator internus is strong and functioning properly, it helps hold the pelvic floor in its correct position and supports the organs above it.
Weakness or tightness in the obturator internus can pull the pelvic floor out of its optimal alignment, leading to dysfunction even when the pelvic floor muscles themselves are not the primary problem. This is why so many women do Kegels faithfully but still struggle with symptoms — they are missing this crucial piece of the puzzle.
Key Hip Rotation Exercises Demonstrated in the Video
In the video above, Sheree DiBiase demonstrates several targeted hip rotation exercises designed to strengthen the muscles that support your pelvic floor. Here are the key exercises covered and how they benefit your pelvic health:
1. Side-Lying Hip External Rotation (Clamshells)
Lie on your side with your knees bent and feet together. Keeping your feet touching, lift your top knee away from the bottom knee like a clamshell opening. This exercise directly targets the obturator internus and other deep external rotators. Focus on a slow, controlled movement and avoid rolling your pelvis backward. Aim for 2-3 sets of 12-15 repetitions on each side.
2. Seated Hip Rotation with Resistance
Sit on a chair with your feet flat on the floor. Place a resistance band around your thighs just above the knees. Press your knees outward against the band, hold for 3-5 seconds, then slowly return. This exercise strengthens both the external rotators and the gluteus medius, which work together to stabilize the pelvis. Perform 2-3 sets of 10-12 repetitions.
3. Supine Internal Rotation Slides
Lie on your back with your knees bent and feet flat. Slowly let one knee fall inward toward the midline while keeping your pelvis stable. This controlled internal rotation movement strengthens the internal rotators and teaches your pelvis to remain stable under rotational forces. Complete 2-3 sets of 10 repetitions per side.
4. Standing Hip Rotation with Pelvic Floor Engagement
Stand with your feet hip-width apart. Slowly rotate one leg outward from the hip, then bring it back to center. As you rotate, consciously engage your pelvic floor muscles. This exercise trains the hip rotators and pelvic floor to work as a coordinated unit, which is how they function during real-life activities. Perform 2 sets of 8-10 repetitions per side.
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How to Perform Hip Rotation Exercises Correctly
Proper form is essential for getting results from hip rotation exercises. The most common mistake is using the larger, superficial muscles (like the glutes or hip flexors) instead of engaging the deep rotators. Here are guidelines for correct technique:
- Start slowly and focus on control — the deep rotators respond best to slow, deliberate movements rather than fast, forceful ones
- Keep your pelvis stable — avoid rocking or tilting your pelvis during rotation movements; the rotation should come from the hip joint only
- Coordinate with your breath — exhale as you rotate and engage, inhale as you return to the starting position
- Engage your pelvic floor — as you perform each rotation, gently lift your pelvic floor muscles to train both systems simultaneously
- Avoid compensating with other muscles — if you feel your lower back or outer thighs doing most of the work, reduce the range of motion and refocus on the deep rotators
Tips for Better Results
- Warm up with gentle hip circles before starting your rotation exercises
- Use a mirror or place your hand on your pelvis to check for unwanted movement
- Progress gradually by adding resistance bands only after mastering bodyweight form
- Combine hip rotation exercises with pelvic floor contractions for the best outcomes
Benefits and Expected Results
When you consistently incorporate hip rotation exercises into your pelvic floor training routine, you can expect meaningful improvements over time:
- Weeks 1-3: Improved awareness of the deep hip rotator muscles and better mind-muscle connection with the pelvic floor
- Weeks 4-6: Noticeable improvements in pelvic stability during walking and daily activities, and reduced feelings of pelvic heaviness
- Weeks 6-12: Measurable strength gains in the hip rotators, reduced incontinence episodes, and improved support for pelvic organs
- Ongoing: Sustained pelvic health, better hip mobility, reduced risk of hip and lower back pain, and long-term pelvic floor resilience
The combination of hip rotator strengthening and pelvic floor training addresses the root cause of many pelvic floor issues rather than just treating symptoms. By building strength in the muscles that structurally support the pelvic floor, you create a foundation for lasting improvement.
Important Note
If you experience hip pain, groin pain, or significant pelvic floor symptoms such as prolapse or severe incontinence, please consult with a pelvic floor physical therapist before beginning these exercises. A qualified specialist can assess your specific needs and modify the exercises accordingly.
Frequently Asked Questions
How does hip rotation affect the pelvic floor?
The hip rotator muscles, particularly the obturator internus, pass directly through the pelvic floor. When you strengthen your hip rotators, you provide internal structural support to the pelvic floor from the inside. Weak or tight hip rotators can contribute to pelvic floor dysfunction, incontinence, and pelvic pain. Training hip rotation alongside pelvic floor exercises produces significantly better outcomes than either approach alone.
What is the obturator internus and why is it important?
The obturator internus is a deep hip rotator muscle that originates inside the pelvis and passes through the pelvic floor on its way to the hip joint. It shares fascial connections with the levator ani, the main pelvic floor muscle group. Strengthening the obturator internus directly supports pelvic floor function and stability, making it one of the most important muscles to target in a comprehensive pelvic health program.
How often should I do hip rotation exercises for pelvic floor health?
For best results, aim to perform hip rotation exercises 3-4 times per week. Start with 2-3 sets of 10 repetitions per exercise and gradually increase as your strength improves. Always allow rest days between sessions so the muscles can recover and rebuild. Consistency over weeks and months is far more important than intensity in any single session.
Can hip rotation exercises help with urinary incontinence?
Yes, hip rotation exercises can be an important part of managing urinary incontinence. Because the hip rotators directly support the pelvic floor, strengthening them improves the structural support around the bladder and urethra. Many women find that adding hip rotator work to their pelvic floor routine significantly reduces leakage episodes, especially stress incontinence triggered by coughing, sneezing, or exercise.
Are hip rotation exercises safe during pregnancy or postpartum?
Hip rotation exercises are generally safe and beneficial during pregnancy and postpartum, but modifications may be needed depending on your stage of pregnancy and recovery. During pregnancy, avoid deep external rotation positions that cause discomfort or strain. Postpartum, these exercises can help restore pelvic stability and support recovery. Always consult with your healthcare provider or a pelvic floor physical therapist before starting any exercise program during pregnancy or postpartum recovery.
Sheree DiBiase
Sheree DiBiase has been a physical therapist for over 40 years, specializing in pelvic floor rehabilitation. She is the founder of Lake City Physical Therapy and the creator of the Pelvic Floor Pro app. Sheree is a board-certified Pelvic Rehabilitation Practitioner (PRPC) and has helped thousands of women regain pelvic floor strength and confidence.