Background: Pelvic floor muscle dysfunction is a frequently overlooked contributor to chronic posterior hip and thigh pain, particularly in active individuals whose symptoms persist despite standard orthopedic care. A systematic musculoskeletal and pelvic floor examination is critical for identifying nontraditional sources of pain. Case Description: A 59-year-old female distance runner presented to pelvic floor physical therapy with a 6-month history of right posterior hip and thigh pain, initially diagnosed as proximal hamstring tendinopathy. Despite extensive conservative treatment—including rest, modalities, injections, and orthopedic rehabilitation—symptoms persisted. Evaluation revealed minor orthopedic impairments; however, hypertonic pelvic floor musculature with associated myofascial restrictions was identified, reproducing her concordant symptoms of right posterior hip and thigh pain. Outcomes: A multimodal treatment plan included pelvic floor down-training, manual therapy, neuromuscular re-education, and progressive strengthening of the core and hips. Within 9 visits, the patient achieved full resolution of pain with sitting and running, normalization of pelvic floor coordination and strength, improved postural alignment, and reduction of her Pain Disability Index score from 21 to 8. Discussion: This case highlights the value of pelvic floor assessment in patients with chronic posterior hip and thigh pain unresponsive to traditional interventions. Interdisciplinary awareness and early screening for pelvic floor dysfunction may reduce delays in diagnosis and improve functional outcomes.
Goforth et al. (Thu,) studied this question.