The hip and the pelvic floor share muscles and share load. Treating one and ignoring the other is why some hip pain lingers.
Also called: lateral hip pain · gluteal tendinopathy · hip impingement · groin pain
The hip joint sits directly alongside the pelvis, and several deep muscles attach to both. The deep rotators at the back of the hip run close enough to the pelvic floor that tension in one is regularly felt as pain in the other.
A few patterns come up repeatedly. Pain on the outside of the hip, often worst lying on that side at night, is usually the tendons where the glutes attach. Pinching at the front with deep bending or sitting is a different picture. And sometimes the hip is not the source at all — the pelvic floor is referring pain outward.
Pregnancy, postpartum and any prolonged period of altered walking will change the load through the hip, which is why this so often turns up alongside the rest of pelvic health.
Common presentations:
Assessment works out whether this is the hip joint, the tendons around it, the pelvic floor referring outward, or a combination — which it often is. That distinction determines everything that follows, because tendon problems and muscle tension want almost opposite things.
Tendon-related hip pain responds to graded loading rather than rest or stretching, and often to removing the positions that compress it — sitting cross-legged, standing hipped to one side, sleeping without a pillow between the knees.
Where the pelvic floor is contributing, manual work and downtraining are usually part of it. Either way, the end of the plan is the same: rebuilding tolerance for walking, stairs and whatever you want to get back to.
Often not, particularly for pain on the outside of the hip. The common stretches for that area compress the very tendons that hurt, which is why it feels better for a moment and worse overall. Loading tends to be more productive than stretching here.
Usually compression. Lying on the painful side squashes the tendons directly, and lying on the other side with the top leg dropping across does much the same thing. A pillow between the knees often makes a noticeable difference.
It can, and it is commonly missed. Muscles deep in the hip sit close to the pelvic floor and refer in both directions. If hip treatment has not worked, or if you have pelvic symptoms alongside it, that connection is worth assessing.
Usually not to begin. Most hip pain can be assessed clinically, and imaging findings frequently do not match symptoms. If your presentation suggests something needing investigation, I will say so and point you to a physician.