Weak Glutes, Sprained Ankles? The Surprising Hip, Core & Pelvic Floor Connection

An ankle sprain may seem like a problem that starts and ends at the ankle, but the body does not work that way. Your muscles, joints, nerves, and connective tissues work together as a chain. When one part of that chain is weak or not working well, another part may have to work harder. This is especially true for the hips, glutes, knees, and ankles. Research has found a connection between decreased glute strength and a higher risk of ankle sprains. At the same time, an ankle sprain can change how the muscles higher up the leg work. This may create a cycle of weakness, poor balance, and repeated injury. Pelvic floor physical therapy may have a role in this bigger picture, especially when hip, core, and pelvic floor problems occur together. 

The gluteal muscles, often called the glutes, are the large muscles around the buttocks. They include the gluteus maximus, gluteus medius, and gluteus minimus. These muscles help move the hip and control the position of the pelvis and leg. The gluteus maximus helps with powerful movements such as standing, climbing stairs, and running. The gluteus medius and minimus help move the leg out to the side and keep the pelvis level when standing on one leg. Because so many activities require single-leg balance, strong and well-coordinated glute muscles are important for controlling the entire lower body. 

When the glutes are weak, the body may have a harder time controlling the leg during activities such as running, jumping, landing, and changing direction. This can affect what happens farther down the leg. For example, weakness of the hip muscles may reduce single-leg balance and change how the ankle moves when a person lands or changes direction. These changes may place more stress on the ankle and make it easier for the foot to roll inward, which is a common movement involved in a lateral ankle sprain. 

Research supports this connection. Studies of soccer players have found that lower hip abductor and hip extensor strength can be associated with a greater risk of lateral ankle sprains. One study found that male soccer players with lower hip abductor strength had a higher chance of experiencing a noncontact ankle sprain. Another study that followed young soccer players for several seasons found that reduced hip extension strength was an independent risk factor for ankle sprains. These findings do not mean that weak glutes will automatically cause an ankle sprain. Instead, they show that hip strength is one factor that may affect a person’s overall injury risk. 

The connection can also work in the opposite direction. An ankle sprain may change how the rest of the leg functions. After a significant ankle injury, people may unconsciously protect the injured side. They may put less weight on it, change the way they walk, or avoid certain movements. These changes can affect muscle activity higher up the leg. Research has found changes in glute muscle activation after severe ankle sprains, including delayed recruitment of the gluteus maximus. In people with chronic ankle instability, or CAI, researchers have also found changes in how the gluteal muscles work during balance and movement tasks. 

This can create a frustrating cycle. A person may have weak or poorly coordinated glute muscles, which can contribute to poor ankle control. The person then sprains the ankle. After the injury, the body changes how it uses the hip and ankle muscles. The ankle may remain unstable, and the person may become more likely to roll the ankle again. Over time, repeated sprains can lead to chronic ankle instability. This is one reason rehabilitation should look beyond the injured ankle and consider the entire lower-body movement system. 

Physical therapy for ankle instability often includes balance training, ankle strengthening, and exercises that improve coordination. Hip and glute strengthening can also be an important part of rehabilitation. Exercises may include bridges, side-lying leg lifts, resistance-band exercises, step-downs, squats, and single-leg activities. The goal is not simply to make a muscle stronger. The goal is to teach the hip, knee, ankle, and foot to work together during real-life movements. 

Pelvic floor physical therapy can add another part to this picture. The pelvic floor is a group of muscles located at the bottom of the pelvis. These muscles help support the pelvic organs and play a role in bladder and bowel control. They also work with the abdominal muscles, back muscles, diaphragm, and hip muscles to help control the trunk and pelvis. Because the pelvic floor is part of this larger core system, pelvic floor function can be considered when evaluating whole-body movement. 

The connection between the pelvic floor and ankle function is more indirect. The pelvic floor is one part of the lumbopelvic or “core” system. Research has shown that pelvic floor muscle activity can change with different ankle positions and that the pelvic floor works together with other deep muscles of the trunk. This suggests that the pelvis, core, and lower leg are connected through movement and muscle control.  

A physical therapist trained in pelvic health can evaluate how the pelvic floor, hips, pelvis, core, and lower extremities work together. For example, a person may have difficulty controlling a single-leg squat, weakness in the glute muscles, poor balance, and pelvic floor symptoms at the same time. A treatment plan can address each problem rather than treating the ankle in isolation. 

Pelvic floor therapy may include breathing exercises, pelvic floor strengthening or relaxation, core training, hip strengthening, mobility exercises, balance activities, and movement retraining. The treatment depends on whether the pelvic floor is weak, overly tight, poorly coordinated, or a combination of these problems. A person with a tight pelvic floor may need relaxation and breathing work rather than simply doing more strengthening exercises. 

A good rehabilitation program also considers other known risk factors for ankle sprains. A previous ankle sprain is one of the strongest risk factors for another sprain. Limited ankle dorsiflexion, poor balance, reduced proprioception, weakness of the muscles around the ankle, certain foot and ankle shapes, and other individual factors can also play a role. Addressing these issues can help improve confidence and reduce the chance of future injury. 

The biggest lesson is that the body works as a connected system. Strong glutes can help control the hip and leg, which may support better ankle control. An ankle injury can change how the hip and glute muscles work, which may contribute to ongoing movement problems. Pelvic floor physical therapy may be useful when pelvic floor and core issues are also present, but it should be viewed as part of a larger rehabilitation plan rather than a stand-alone treatment for ankle sprains. 

If you have repeated ankle sprains, chronic ankle instability, or difficulty trusting your ankle during exercise, a physical therapist can perform a full movement assessment. Looking at the ankle, foot, knee, hip, pelvis, and core together can reveal problems that may be missed when treatment focuses only on the injured joint. With the right combination of strength training, balance work, movement retraining, and individualized pelvic floor care when appropriate, rehabilitation can help you build a stronger and more coordinated foundation for movement. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.