Understanding the Obturator Internus Muscle in Persistent Pelvic Girdle Pain

While many people associate hip pain with joint-related issues such as osteoarthritis, labral tears, or bursitis, a lesser-known but highly significant cause of hip pain comes from the obturator internus (OI) muscle. This muscle, located deep within the pelvis, plays a crucial role in pelvic health and the movement of the hip joint. When the obturator internus becomes tight, inflamed, or injured, it can lead to both pelvic and hip pain.  

The obturator internus is a muscle located deep in the pelvis. It originates from the inner surface of the pelvis and attaches to the greater trochanter of the femur (the bony prominence of the hip). The primary function of the obturator internus is to externally rotate the hip joint, helping with activities like walking, running, and sitting. It is also involved in stabilizing the pelvis, especially during activities that require balance or standing on one leg or switch weight from side to side. 

This muscle is closely linked to the pelvic floor muscles, which support the pelvic organs, and the pudendal nerve, which provides sensation to the genital area. Due to the obturator internus’ location and role in stabilizing the pelvis, it is not uncommon for pain in this muscle to be confused with other pelvic conditions, such as pelvic floor dysfunction or issues related to the hip joint. 

There are several reasons why someone may experience pain in the obturator internus muscle. Common causes of OI pain include: 

1. Muscle Imbalance and Tightness: Like other muscles in the body, the obturator internus can become tight due to overuse, poor posture, or prolonged sitting. This muscle is often under a lot of strain, especially for people who engage in physical activities such as running or cycling. When the muscle becomes tight, it can lead to discomfort in the hip, pelvis, and groin area. 

2. Pelvic Floor Dysfunction: Because the obturator internus is part of the pelvic floor muscle group, dysfunction in the pelvic floor muscles can lead to pain in the OI. Pelvic floor dysfunction, which often involves muscle weakness or tightness, can exacerbate pain in the obturator internus, leading to referred pain in the hip and groin. 

3. Pudendal Nerve Irritation: The pudendal nerve, which supplies sensation to the pelvic floor, passes in close proximity to the obturator internus muscle. When the OI becomes tight or inflamed, it can compress the pudendal nerve, contributing to pudendal neuralgia, a condition characterized by pain, tingling, or numbness in the genital and perineal regions. 

4. Labral Tear: The hip labrum is a ring of cartilage that helps to stabilize the hip joint. A tear in the labrum, often caused by trauma or repetitive stress, can result in hip pain that may be aggravated by tightness or dysfunction in the obturator internus. A labral tear can lead to restricted range of motion and discomfort during movement, and the pain may radiate to the pelvis and groin. 

5. Injury or Trauma: Direct injury to the obturator internus, such as a fall or impact during physical activity, can lead to localized pain. This can result in muscle spasms, bruising, and inflammation that interfere with the normal movement of the hip joint. 

Obturator internus pain can present as a variety of symptoms, including: 

• Deep hip pain: Pain located deep in the groin, pelvis, or hip joint. 

• Pain with external rotation: Increased discomfort when the hip is externally rotated (e.g., during activities such as walking, running, or rotating the leg outward). 

• Referred pain: Pain that radiates to the lower back, groin, or pelvic region. 

• Reduced range of motion: Limited movement of the hip joint due to muscle tightness or pain. 

• Pain during sitting or standing: Discomfort while in a seated position or standing for prolonged periods. 

• Pelvic discomfort: Pain that may be felt in the pelvic floor region, especially when the OI muscle is tight or inflamed. 

The hip joint is a ball-and-socket joint that allows for a wide range of motion. The muscles surrounding the hip joint, including the obturator internus, are essential for stabilizing the joint during movement. When the OI muscle becomes tight or inflamed, it can affect the movement of the hip joint and lead to restricted range of motion, discomfort, and pain. The obturator internus also plays a role in external rotation of the hip, and tightness in this muscle can limit the ability to fully rotate the leg or move the hip freely. 

Additionally, the obturator internus is in close proximity to other important structures in the pelvis, including the pelvic floor muscles and the pudendal nerve. When the OI muscle is dysfunctional, it can lead to pelvic floor dysfunction and nerve irritation, contributing to pain in the pelvic and hip regions. 

Physical therapy is a highly effective treatment option for obturator internus pain. A skilled physical therapist will develop a treatment plan that addresses the specific needs of the patient, focusing on muscle relaxation, strengthening, and improving range of motion. Common treatments used in physical therapy for obturator internus pain include: 

1. Manual Therapy: A physical therapist may use hands-on techniques to complete soft tissue mobilization and stretching of the muscles of the pelvis and hip. Manual therapy can help release muscle tension, improve blood flow, and reduce inflammation in the obturator internus and surrounding tissues. 

2. Pelvic Floor Physical Therapy: For individuals with pelvic floor dysfunction, pelvic floor physical therapy can be particularly beneficial. The therapist will work to release tight pelvic floor muscles, strengthen weaker muscles, and restore balance to the pelvic region. This can help alleviate pain in the obturator internus and improve overall pelvic health. 

3. Stretching and Strengthening Exercises: Stretching and strengthening the muscles of the hip and pelvis are important components of the rehabilitation process. Specific exercises can help improve the flexibility and strength of the obturator internus and other muscles that support the hip joint. By addressing muscle imbalances, physical therapy can reduce the risk of future injury and alleviate pain. 

4. Nerve Mobilization: If the obturator internus is compressing the pudendal nerve or other nearby nerves, a physical therapist may use specific techniques to mobilize the nerves and reduce irritation. This can help relieve nerve-related pain and improve overall function. 

In many cases, conservative treatment options such as physical therapy can help alleviate obturator internus pain and improve hip function. However, if symptoms persist or worsen despite conservative treatment, it may be necessary to seek further medical attention. A healthcare provider may recommend diagnostic imaging (e.g., MRI or ultrasound) to assess for underlying issues such as a labral tear, hip impingement, or other structural problems that may require more intensive intervention. 

Obturator internus pain is a significant but often overlooked cause of hip and pelvic pain. This deep pelvic muscle plays an important role in hip function and pelvic health, and dysfunction in the OI can lead to a variety of symptoms, including hip pain, pelvic discomfort, and reduced range of motion. Physical therapy, including manual therapy, pelvic floor physical therapy, and targeted exercises, is a highly effective treatment option for alleviating pain, restoring function, and improving overall pelvic health. If you are experiencing persistent hip or pelvic pain, it’s essential to consult with a physical therapist  to develop an individualized treatment plan that addresses your unique needs. With proper care, you can find relief and return to a more active and pain-free lifestyle. 

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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.