The Hip Connection to the Pelvic Floor
The obturator internus is a muscle that runs from each hip and attaches to the pelvic floor muscles (levator ani) through a tendon known as the ATLA (arcuate tendon levator ani). The obturator internus can be a contributor to symptoms of pelvic organ prolapse, pelvic pain, sit bone pain, hamstring pain, hip pain, bladder pain, tailbone pain, pelvic floor dysfunction and more. Its function is to rotate the hip laterally, or outward, and provides support through lifting the pelvic floor like a hammock.
Myofascial trigger points are hyperirritable muscle spasms that can refer pain to a remote location and are a major factor in muscle dysfunction. Myofascial trigger points create a shortening effect on muscles and cause muscle stiffness or loss of joint motion. Myofascial trigger points in the obturator internus are often overlooked in someone with hamstring and hip pain. The muscle can be found by palpating its attachment inside the sit bone (ischial tuberosity). Often myofascial trigger points are identified that reproduce the person's complaint of pain down the back of the leg. The pain can also radiate to the thigh, rectum, tailbone, bladder and hip, contributing to pelvic floor dysfunction.
The obturator internus is one of muscles that compensates for a weak core according to physician Vladimir Janda who coined the term, "crossed syndrome" in the 1950s. If the deep core muscles are not functioning properly, other muscles will compensate to help out. The obturator internus acts as a second string muscle; it is not designed to be in the entire game while the first string is sitting out. Other causes of dysfunction in this muscle can be direct trauma, vaginal birth, pudendal nerve entrapment and/or adhesions in the pelvic and abdominal region.
Trigger point release is one approach to addressing myofascial trigger points, along with dry needling, visceral mobilization and hip rotation exercises. The obturator internus can be palpated externally in a side lying position or internally via the vagina or rectum. Loss of hip range of motion can be resolved after addressing trigger points in this muscle. Another symptom of tension in this muscle is pelvic organ prolapse. The obturator internus acts as an anchor for the pelvic organs and can pull the organs and connective tissue around the organs downward. Pain with sitting or poor tolerance to sitting can be addressed by treating this muscle. This is common in people with professions that involve prolonged sitting or in avid cyclists who spend hours compressing the pudendal and obturator nerves that exit the pelvis at the sit bones.
In summary, myofascial trigger points in the obturator internus muscle should be addressed if you have hamstring pain, hip pain, pelvic pain, bladder pain, tailbone pain, testicular pain, urinary dysfunction, bowel dysfunction, pelvic floor dysfunction, sexual dysfunction, pelvic organ prolapse and/or poor sitting tolerance. Healthy Core therapists specialize in the treatment of the pelvis and can evaluate and treat myofascial trigger points in the obturator internus muscles. To make an appointment, visit our website or contact us at (330)528-0034. You don't have to live with pain and dysfunction.
written by Janine Laughlin - September 2022