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Physiother Theory Pract. 2019 Feb 1:1-8. doi: 10.1080/09593985.2019.1571142. [Epub ahead of print]

Hip exercises improve intravaginal squeeze pressure in older women.

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a Doctor of Physical Therapy Program , San Diego State University , San Diego , CA , USA.



Pelvic Floor Muscle Training (PFMT), an accepted treatment for incontinence and pelvic floor dysfunction, has good evidence, though it is unknown if adjunct therapies can be useful. Strengthening the obturator internus (OI), along with other hip external rotator muscles, may help strengthen the pelvic floor muscles (PFM) through fascial attachment. We hypothesized that strengthening the hip external rotators will improve intravaginal squeeze pressure in older women.


A total of 25 women (with or without pelvic floor dysfunction) greater than 55 years of age participated in monitored and home exercise sessions three times a week for 12 weeks. The exercises included concentric, isometric, and eccentric training of hip external rotators, without instruction to include PFM contraction. A physical therapist performed the assessments of each participant: Pelvic Floor Distress Inventory-20 (PFDI-20), a manual pelvic assessment, hip strength testing using a hand-held dynamometer and maximum intravaginal squeeze pressure using the PeritronTM PFM manometer (correct PFM contraction was confirmed visually and with palpation). Comparison was made to data obtained in a previous study in young women. Data were analyzed using paired t-tests and mixed model ANOVA.


Average intravaginal squeeze pressure increased from 21.47 ± 2.55 to 29.1 ± 3.15 cm H2O p < 0.0001. Hip external rotation strength increased in the right hip from 12.75 ± 0.46 to 15.42 ± 0.63 lbs p = 0.0009 and the left hip from 11.43 ± 0.43 to 15.61 ± 0.69 lbs p < 0.0001. The PFDI-20 scores decreased from 56.88 ± 10.76 to 40.62 ± 10.63, p > 0.05. Compared to a previous study in young women, both hip external rotation strength and intravaginal squeeze pressure increased with no significant difference between groups.


Hip external rotation exercises may be effective as an indirect form of PFM exercise.


Women’s health; obturator internus; pelvic floor

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