Pelvic pain isn’t always just about the pelvic floor—sometimes the muscles around your hips and back are part of the story.
If you’ve been dealing with ongoing pelvic discomfort and wondering why it won’t go away, the answer might be outside the pelvis. Let’s unpack how these muscles matter and what you can do about it.
Why look beyond the pelvic floor for persistent pelvic pain?
When pelvic pain hangs around, it’s easy to assume the pelvic floor is the only culprit. But the truth is, your pelvis doesn’t work in isolation.
The muscles of your hips and lower back play a huge role in how your pelvis moves and supports your body. If these muscles are tight, weak, or overworked, they can feed into ongoing discomfort and make recovery harder.
Which external muscles can influence pelvic pain?
Your hips and lower back are home to powerful muscle groups that connect directly to the pelvis. These include:
Gluteal muscles (glute max, med, and min)
Deep hip muscles like piriformis, obturator internus, and gemelli
Lower back muscles such as multifidus, quadratus lumborum, and erector spinae
When these muscles aren’t functioning well, they can create tension, limit movement, and even irritate nerves—leading to pain that feels like it’s coming from the pelvis.
How do weak or tight gluteal muscles affect the pelvis?
Your glutes help stabilise the pelvis during walking and standing. If they’re weak or fatigued, smaller muscles deep in the hip joint often take over. This compensation can create tension through the buttock, hip, and even the pelvic floor itself. Over time, this imbalance can contribute to persistent pelvic pain.
What role does the piriformis play in pelvic pain?
The piriformis sits deep in the buttock and is a common troublemaker. When irritated or tight, it can compress nearby nerves and refer pain into the pelvis, groin, or even down the leg. This is why lower back pelvic pain often feels connected to hip or pelvic discomfort—it’s all linked.
Can lower back muscles contribute to pelvic discomfort?
Absolutely. Muscles like the multifidus, quadratus lumborum, and erector spinae connect closely with the pelvis. If they’re holding excessive tension—often due to posture, stress, or guarding after pain or injury—they can limit pelvic movement and create a sense of pulling or pressure around the sacrum and lower abdomen.
How can exercise and physiotherapy help manage persistent pelvic pain?
Addressing persistent pelvic pain often means looking beyond the pelvic floor. Releasing tension through stretching, gentle mobility work, and targeted strengthening of the hips and trunk can restore better balance and support.
Here’s how exercise helps:
Stretching and mobility reduce muscle tension and improve pelvic movement.
Strengthening glutes and core restores stability and prevents overcompensation by smaller muscles.
Postural training reduces strain on lower back muscles and improves alignment.
Because persistent pelvic pain is complex, an individualised plan from a pelvic health physiotherapist is often the best approach.
Other Blogs in the Pelvic Pain Series
Deep dive into education written by our pelvic physiotherapist, Claire, all about the pelvic pain – including symptoms, treatment & understanding the range of associated factors and conditions.
Menstrual Cycle: Understanding Your Cycle for Pelvic Pain Symptoms
Pelvic Pain & The Stress Response Cycle
Do you want to learn more about pelvic health, specialised to your symptoms?
