The Gist: What is hip pain during pregnancy?
Also known as: Stabbing pain in my hip bone, burning on the side of leg, "my butt cheek hurts"
Hip pain is typically caused one of three conditions:
- Piriformis syndrome, or a sharp, stabbing pinpoint pain in the glute that increases with prolonged sitting or moving
- IT band syndrome, or a sharp or burning pain on the side of the hips and down the side of the leg that increases with sitting and laying on your side
- Round ligament pain, or a sharp pain in the front of the hip that increases with standing up or sudden movements
The anatomy of Hip Pain
The hip is made up of the ball and socket joints between your pelvis and your femur, which is the long bone in your thigh, and the surrounding muscles including your glutes and hip flexors. Pain in the hips can be in the front, side, or back.
Unless there is another underlying condition, hip pain is typically caused by tightness or strain in the muscles, tendons, and ligaments that attach to the hip. When they become overused and tight, they can become inflamed causing pain, tightness, and irritation the area.
Who gets Hip Pain? When does it occur?
During pregnancy, the shape of the pelvis and uterus change. The pelvis expands and widens to prepare for childbirth, and the uterus expands as the baby grows. As the pelvis and belly change, the muscles and ligaments that attach to the pelvic girdle and pelvic cavity can move and stretch, causing pain and discomfort. Furthermore, when certain glute muscles are weak or not activating properly, other muscles will activate to compensate.
These muscles and ligaments include the tensor fasciae latae and iliotibial band (TFL and ITB, respectively), piriformis, and round ligament. The TFL is a small muscle that sits on the side of the hip, and the ITB is a long tendinous sheath that attaches the TFL to the side of the knee. The piriformis is a thin, cord-like muscle that runs from the big, bony bump on the side of the hip to the tailbone. The round ligament attaches the uterus to the mons pubis, which is the mound of tissue over the pubic bone. However, there are fascial attachments from the round ligament into the hip as well.
Hip pain can start at any point during pregnancy, but we typically see it arise in the middle of the second trimester once the hips widen and the belly pops a little. Pain on the side of your hips may arise even later as the load through your hips increases while sleeping. Round ligament pain is often transient, and will come about during growth spurts.
The Origin Way: Physical therapy for Hip Pain
More often than not, hip pain is caused by a certain movement or position that is putting too much strain or pressure on the muscles of the hip. Your Physical Therapist will assess your movements and positions and find the driver of your pain. Once identified, your Physical Therapist will treat your hip pain with a combination of manual therapy techniques to the hips, strengthening and mobility exercises to provide added stability to the hips and optimize range of motion, as well as make corrections to the way you move and position yourself.
Your Physical Therapist will ask you about your sleeping positions, work set up, preferred exercise, and even how you position your seat in your car. They may make modifications to one of all of those movements to address your symptoms.
How long will it take?
Typically, you will start feeling better in 1-3 weeks if you are consistent with your exercises. Improving hip strength and stability is key to addressing hip pain. Sometimes it takes a few visits to find the optimal positions for you, particularly for sleeping, but you and your Physical Therapist will work together through a series of trials and errors to find what works in your body.
What to expect in the future
If you keep up with your exercises (even postpartum) your hip pain will hopefully go away. However, if it starts to creep back up as you return to work or engage in a higher level activity like hiking, you will have the strategies and exercises to address it. If you return to a significantly higher level activity like running or crossfit in the future, it would be best to check in with your Physical Therapist so they can provide additional exercises and strategies appropriate for the added demand of that task.
Sources and additional reading
Sivrioglu, Ali Kemal, et al. "Piriformis Syndrome Occurring after Pregnancy." BMJ Case Reports, BMJ Publishing Group, 26 Mar. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3618849/
Battaglia, Patrick J, et al. "Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging." Journal of Chiropractic Medicine, Elsevier, Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5106442/?report=classic
Vallejo MC, Mariano DJ, Kaul B, et al. "Piriformis Syndrome in a Patient After Cesarean Section Under Spinal Anesthesia" Regional Anesthesia & Pain Medicine 2004;29:364-367.