Kinesiology THURSDAY – Obturator Internus v Gluteus Medius (Tug-o-War Series)

Ever pee when you cough, laugh or run? This is known as stress incontinence and one of the culprits of this unfortunate occurence is overactivity or a trigger point in one of the key muscles affecting the pelvic floor, the obturator internus (OI). Here’s a better picture of it:

Pelvic muscles: piriformis, quadratus femoris, obturator internus.

The obturator internus is actually a deep external rotator of the hip. But it’s significance to the pelvic floor lies in its proximity to the pudendal nerve. The pudendal nerve traverses through the obturator fascia. It controls the pelvic floor muscles and external urethral sphincter, playing a crucial role in bladder and bowel control. Compression of this nerve may lead to stress incontinence. If the obturator internus is tight, pelvic floor muscles may be weak.

Diagram of male pelvis nerves and structures.

What makes the obturator internus tight? Standing with your hips externally rotated (toes out) may cause chronic tightening of the OI. Weakness of the hip internal rotators may also cause chronic tightness: gluteus medius, gluteus minimus and tensor fascia lata.

How do I use this muscular tug-o-war to get rid of stress incontinence?

Strengthen gluteus medius with these exercises (see below)

Gluteus medius strengthening exercises demonstration.

Release obturator internus. Here is a link to a great stretch I found. The key thing here, which is not mentioned in the video is to lift the foot up off the floor during the contraction part of the exercise (she mentions pulling your knee into the floor). But lifting your foot up will activate the hip internal rotators (gluteus medius) while the obturator internus is in a shortened position of relaxation.

Here’s another useful technique for release of the obturator internus using a tennis or lacrosse ball.

Person sitting on yoga block in meditation

Why does this matter?

Pelvic floor weakness is a problem many have but few want to discuss. Kegel’s exercises after often prescribed but if they are not successful in strengthening the pelvic floor, it may be due to trigger points in the obturator internus which is affected by a weak gluteus medius. So wake up your side butt and sit on a ball. It just may help stop the leak.

Because nobody has time to be in pain (or wet their pants).

Until next time…