Does Hip Adduction Work the Pelvic Floor?

Hip adduction activates the pelvic floor muscles to some degree, but the relationship is far less straightforward than fitness content often suggests. Needle EMG studies confirm that squeezing the inner thighs produces a measurable co-contraction of the pelvic floor, yet multiple studies find that combining hip adduction with pelvic floor exercises does not actually increase pelvic floor muscle force and may even reduce how effectively those muscles contract. The real story involves competing findings, an important anatomical bridge muscle, and a distinction between “activating” a muscle and meaningfully training it.

There Is a Real Co-Activation Signal

The idea that hip adduction engages the pelvic floor is not invented. An EMG study using needle electrodes inserted into the striated urethral wall and pelvic floor muscles of healthy women found that hip adduction, gluteal squeezing, and abdominal contraction all produced synergistic pelvic floor muscle activity.¹ In other words, when you squeeze your thighs together against resistance, the pelvic floor contracts as well, even if you are not deliberately engaging it. This is a reflexive co-activation pattern, not a coincidence.

Part of the anatomical explanation involves the obturator internus, a deep hip muscle that shares fascial attachments with the levator ani, the main muscle group of the pelvic floor. The obturator internus sits along the inner wall of the pelvis and its connective tissue blends with the pelvic floor’s own fascia, creating a physical link between hip movement and pelvic floor tension. Animal research has even suggested the obturator internus could function as a pelvic floor substitute, based on its anatomical position and its ability to generate appropriate contractile force.² The pudendal nerve, which controls much of the pelvic floor, also has communicating branches with the sciatic nerve, providing a neural pathway through which hip muscle activation could spill over into pelvic floor recruitment.

So the co-activation is real and has clear anatomical reasons behind it. Where the story gets complicated is whether that co-activation translates into meaningful pelvic floor strengthening.

Adduction Does Not Appear to Strengthen the Pelvic Floor

Detecting muscle activation on an EMG is not the same as generating a training stimulus strong enough to build strength or endurance. Several studies have tested whether hip adduction actually improves pelvic floor force output, and the answer has consistently been no.

A controlled study of healthy women measured vaginal force during pelvic floor contractions performed alone versus pelvic floor contractions combined with isometric hip adduction at both 30% and 50% of maximum hip force. None of the measured variables differed between conditions: not peak force, not mean force, not the rate of force loss over time. The researchers concluded that “the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance.”³

A separate study went further and found that adding hip muscle co-contraction may actually interfere with pelvic floor performance. Researchers used ultrasound to measure bladder base elevation, a reliable indicator of how effectively the pelvic floor contracts upward and inward. Women performing pelvic floor exercises in a supine kneeling position showed significantly greater bladder base elevation than when they performed the same exercises in a standard supine position. But when hip adduction or hip abduction was added to the kneeling exercises, bladder base elevation dropped significantly, falling below the level achieved by kneeling alone.⁴ The implication is that engaging hip muscles during pelvic floor exercises can divert effort away from the pelvic floor itself, reducing the quality of the contraction rather than enhancing it.

A correlation study in women with stress urinary incontinence adds another dimension: hip adductor strength and pelvic floor muscle strength simply are not linked. The study found no significant correlation between pelvic floor muscle strength or endurance and the strength of the hip adductors, hip abductors, hip extensors, or gluteal squeeze.⁵ If squeezing your thighs were a reliable route to a stronger pelvic floor, you would expect strong adductors and strong pelvic floors to go hand in hand. They do not.

Conflicting Evidence on How Much Recruitment Actually Happens

The research on whether hip adduction recruits more or less pelvic floor activity than Kegel exercises alone is genuinely contradictory, and the reasons matter.

One study comparing various exercises found that adductor-focused trials actually produced higher pelvic floor muscle EMG activity than isolated Kegel exercises.⁶ This result suggests that for some people, particularly those who struggle to consciously engage their pelvic floor, hip adduction could serve as a gateway, creating pelvic floor activation through the co-contraction pathway that the person may not be able to produce intentionally.

But a study in postpartum women found the opposite: thigh adductions generated weaker pelvic floor contractions than Kegel exercises, even though ultrasound measurements of the levator hiatus were similar between the two.⁷ In this population, hip adduction was not just a weaker training tool compared to Kegels but actively inferior at recruiting the pelvic floor.

The discrepancy likely comes down to population differences and how the exercises were performed. The postpartum pelvic floor has often undergone significant stretch and possible injury, which can change both its baseline tone and its responsiveness to indirect activation through neighboring muscles. Measurement technique also matters. Surface EMG (which picks up electrical signals through skin or vaginal sensors) can accidentally register activity from nearby hip or gluteal muscles, potentially inflating the apparent pelvic floor signal during adduction exercises. Studies using intramuscular needle EMG or ultrasound tend to give a cleaner picture of what the pelvic floor itself is doing versus what is radiating from surrounding muscles.

Why Researchers Treat Adductor Activation as Contamination

One detail that says a lot about the clinical perspective on this question: in pelvic floor research, hip adductor activation during pelvic floor muscle testing is commonly treated as a source of error rather than a useful signal. Studies that measure pelvic floor strength routinely instruct participants to minimize abdominal, gluteal, and adductor muscle activity. Some protocols go further and exclude participants who cannot avoid excessive hip adductor co-contraction, on the grounds that it contaminates the pelvic floor measurement.

A prospective cohort study tracking pelvic floor EMG after vaginal delivery, for example, explicitly excluded women who displayed excessive activation of hip adductors during testing and educated participants before measurements on how to isolate the pelvic floor from the adductors, gluteals, and abdominals.⁸ This framing is telling: from a research standpoint, squeezing the adductors during a pelvic floor contraction is not seen as helpful, it is seen as something that clouds the results and potentially masks whether the pelvic floor is actually working on its own.

This does not mean co-contraction is harmful in everyday life. The pelvic floor, hip muscles, and abdominals work together constantly during functional movements like walking, lifting, and coughing. But in the context of targeted pelvic floor rehabilitation, the goal is usually to train the pelvic floor to activate independently and with adequate force. Relying on adductor squeezing as a substitute can create a false sense of progress if the pelvic floor itself is not doing the work.

When Combining Hip Exercises and Kegels Does Help

Here is where the practical picture gets more interesting. Even though hip adduction alone does not appear to strengthen the pelvic floor, clinical trials that combine hip muscle exercises with traditional Kegel exercises have shown better outcomes for urinary incontinence than Kegels alone.

A randomized trial of women with stress urinary incontinence found that the group performing pelvic floor exercises combined with hip synergist muscle strengthening reported less frequent daily urine leakage across the treatment sessions compared to the group doing pelvic floor exercises alone.⁹ That said, the combined group did not show superior improvements in pelvic floor muscle strength, perineometry readings, or quality of life scores, so the mechanism seems to involve something other than raw pelvic floor strengthening.

A separate randomized controlled trial in postmenopausal women with stress urinary incontinence found that eight weeks of hip muscle strengthening combined with Kegel exercises in various positions improved leakage frequency, pelvic floor muscle strength, symptom severity, and quality of life significantly more than Kegel exercises alone, with lasting effects.¹⁰

How do you reconcile these clinical improvements with the lab findings that hip adduction does not increase pelvic floor force? A few possible explanations:

Structural support: Stronger hip muscles may provide better bony and fascial support for the pelvis, improving the mechanical environment in which the pelvic floor operates without necessarily making the pelvic floor itself stronger in isolation.
Functional coordination: In real life, continence depends on multiple muscle groups firing in the right sequence during a cough or sneeze. Training the hip muscles alongside the pelvic floor may improve that coordination even if neither muscle group becomes dramatically stronger in isolation.
Adherence and engagement: Adding variety to a rehabilitation program can improve compliance. Pelvic floor exercises are difficult to feel and easy to skip. Having a broader exercise program may keep people more engaged over weeks of training.

What This Means if You Are Doing Hip Adductor Exercises

If you are using a hip adduction machine at the gym, squeezing a ball between your knees, or doing Copenhagen planks, your pelvic floor is getting some incidental activation. That co-contraction is automatic and well documented. But the level of pelvic floor engagement from these exercises is not enough to serve as a standalone pelvic floor training program. It is background noise, not a targeted signal.

If you are working on pelvic floor strength specifically, whether for incontinence, postpartum recovery, or pelvic organ prolapse symptoms, the evidence favors doing actual pelvic floor exercises (Kegels performed with correct technique) as the primary tool. You can add hip strengthening alongside that program and may see better functional outcomes, especially for stress incontinence. But substituting adductor squeezes for Kegels misses the point: the pelvic floor needs to learn to contract independently and with adequate force, and the research consistently shows that adding hip co-contraction does not improve (and may worsen) the quality of that isolated contraction.

A useful way to think about it: hip adduction is to the pelvic floor what push-ups are to the rotator cuff. There is some activation happening, the muscles are anatomically nearby and neurally connected, and strong surrounding muscles do contribute to joint health. But if you had a rotator cuff problem, nobody would tell you to just do push-ups. You would do targeted rotator cuff exercises and also keep doing push-ups for general shoulder strength. The pelvic floor works on a similar logic.

The “I Can’t Feel My Pelvic Floor” Problem

One scenario where hip adduction exercises may have a genuine clinical role is for people who cannot consciously activate their pelvic floor at all. This is surprisingly common. Estimates vary, but a meaningful percentage of women who are told to “do a Kegel” either bear down instead of lifting up, or simply cannot feel the contraction happening. For these individuals, starting with hip adduction or gluteal squeezing may provide a pathway into pelvic floor awareness through the co-activation reflex.

The logic is simple: if squeezing the adductors automatically triggers some pelvic floor contraction, and you can feel your adductors working, then adduction gives you an anchor sensation you can build from. A skilled pelvic floor physical therapist may use this strategy as a temporary scaffold, asking a patient to gently squeeze the inner thighs while also cueing the pelvic floor, then gradually reducing the adductor effort as awareness improves. The goal is never to rely on adductor co-contraction permanently but to use it as a teaching tool until the patient can voluntarily produce a pelvic floor contraction on its own.

This approach has theoretical support from the EMG data showing that adductor exercises can elicit higher pelvic floor EMG activity than isolated Kegels in certain populations.⁶ But the ultrasound data also shows that once a person can contract their pelvic floor voluntarily, adding hip co-contraction reduces the quality of that contraction.⁴ So the window of usefulness is narrow: it is a learning aid, not a training method.

Position Matters More Than You Might Think

An underappreciated finding from the research is that body position has a substantial effect on pelvic floor contraction quality, and this matters more than whether you add hip adduction or not. The study that measured bladder base elevation found that simply changing from a standard supine position to a supine kneeling position (knees bent, feet flat) produced significantly greater pelvic floor contraction without any hip co-contraction at all.⁴ In other words, bending your knees and putting your feet on the floor while lying on your back did more for pelvic floor recruitment than squeezing a ball between your knees did.

This finding suggests that the hip and leg position changes the resting length and tension of the pelvic floor through its fascial and bony attachments, putting it in a better mechanical position to contract forcefully. When hip adduction or abduction was layered on top of that kneeling position, the benefit disappeared, likely because the hip muscles competed for neuromuscular attention and disrupted the pelvic floor’s ability to contract cleanly. If you are looking for a simple, evidence-backed way to get more out of your pelvic floor exercises, adjusting your leg position is a better starting point than adding resistance to your inner thighs.

Men and the Pelvic Floor

Most of the research on hip adduction and the pelvic floor has been conducted in women, for the obvious reason that stress urinary incontinence and pelvic organ prolapse are far more common in women, especially after childbirth and menopause. But men have pelvic floors too, and pelvic floor dysfunction in men, particularly after prostate surgery, is a significant clinical problem.

The early EMG work demonstrating co-activation between hip adduction and the pelvic floor was done in women, and the anatomical links through the obturator internus and shared fascial layers exist in both sexes. There is no physiological reason to believe the co-activation pattern would be absent in men. However, the clinical trial evidence on whether combining hip exercises with pelvic floor training improves outcomes for male incontinence is much thinner. The trials on stress urinary incontinence that showed benefits from combined training were conducted exclusively in female populations. Translating those results to men recovering from prostatectomy, for instance, requires some extrapolation that the evidence does not fully support yet.

Men who are doing pelvic floor exercises for post-surgical incontinence or other reasons should not assume that hip adductor work on its own is addressing the pelvic floor in a meaningful way. The same principle applies: targeted pelvic floor training is the primary tool, and hip strengthening is a potentially useful addition to a broader program, not a replacement.