The primary goal of this research is to collect data on hip strength for active females and assess if there is a relationship between hip strength and pelvic floor dysfunction (PFD). The participants will fill out a REDCap questionnaire that includes informed consent, demographics, injury history, history of PFD and/or hip pain, characteristics of physical activity and/or sport(s), knowledge of pelvic floor musculature, and questions regarding the correlation between PFD and performance. Additionally, Patient Reported Outcomes Measurement Information System (PROMIS) surveys assessing anxiety and depression will be included. After completing the questionnaires, a one time hip strength assessment will be performed in four directions on each hip and the evaluator will be blinded to their results. Foster et al researched hip and pelvic floor strength in a different patient population (Urgency and Frequency prominent lower urinary tract symptoms) in 2021 with 18-60 year olds and did not have a classification for level of physical activity. This research group found that there was a reduction in hip external rotation and abduction strength compared to case controls. To this point, there has not been any research assessing the relationship between hip strength and relaxing versus nonrelaxing pelvic floor dysfunction and controls.

Women who participate in high-level physical activity are known to have increased rates of Urinary Incontinence (UI) with prevalence rates of 28-29.6% compared to non-athletes with rates of 9.8-13.4%. The current body of research for active females in pelvic health physical therapy has focused primarily on female athletes with Urinary Incontinence (UI), which is only one symptom under the greater umbrella of Pelvic Floor Dysfunction (PFD). Likewise, systematic reviews of females with PFD have been limited to the exploration of Female UI. Pelvic Floor Dysfunction can be separated into two broad categories: relaxing and nonrelaxing. Relaxing PFD conditions are more common and include diagnoses of UI and prolapse of pelvic structures. Nonrelaxing PFD can include a broad range of non-specific symptoms. These symptoms can include voiding, anorectal, and sexual dysfunction and pain. Specifically, the pain can be insertional or deep dyspareunia, low back pain that can radiate to the thighs or groin, and pelvic pain that may be unrelated to intercourse or may occur after intercourse. Voiding issues may include a sense of incomplete emptying, bladder pain, urinary frequency, urgency or dysuria.

Research related to nonrelaxing pelvic floor dysfunction has been mostly limited to a case example, a case study related to dry needling intervention and a continuing education formatted article from Mayo Clinic. Nonrelaxing PFD has been described as a disorder where "..the muscles of the pelvic floor remain in a contracted state causing increased pressure and pain." From these articles, nonrelaxing PFD can present with a wide range of nonspecific symptoms and can negatively affect quality of life.

An additional area of interest is the impact of anxiety and depression on pelvic floor dysfunction of active females. Anxiety and depression symptoms are common in individuals with PFD (30.9% and 20.3% respectively) and athletes. High performance athletes have depression rates ranging from 6.7% to 34.0% with risk factors including female gender and playing an individual sport. In a systematic review, Beisecker et al explored depression, anxiety and stress among student athletes and found specific themes related to these symptoms, including being a female student athlete, social support, connection and interaction and health components (diet and eating patterns, sleep and alcohol use).

Foster et al researched hip and pelvic floor strength in a different patient population (Urgency and Frequency prominent lower urinary tract symptoms) in 2021 with 18-60 year olds and did not have a classification for level of physical activity. This research group found that there was a reduction in hip external rotation and abduction strength compared to case controls. To this point, there has not been any research assessing the relationship between hip strength and relaxing versus nonrelaxing pelvic floor dysfunction.

I plan to make this work public through submission to the Journal of Women's Health Physical Therapy or the Journal of Orthopaedic & Sports Physical Therapy. Additionally, I will submit my findings to the American Physical Therapy Association Combined Section Meeting for platform presentation.

Inclusion Criteria:

• Age range 18-45 years
• Female gender
• Patients can either have no pelvic floor symptoms, current pelvic floor dysfunction (relaxing or nonrelaxing), or current musculoskeletal pain.
• Participants must be physically active as defined by the World Health Organization (WHO) as performing 150-300 minutes of moderate-intensity aerobic physical activity or at least 75-150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.

Exclusion Criteria:

• Pregnancy
• Gynecological or Obstetric Surgery within 6 months
• Active infection (including Sexually Transmitted Infection, Pelvic, Urinary Tract Infection (UTI), Yeast)
• Cancer
• Inflammatory Disease
• Connective Tissue Disease
• Or have been instructed by a Healthcare provider to not participate

18-45 year old females who are active as described by the WHO.