Hip pain during pregnancy is common due to various reasons ranging from normal pregnancy changes to serious medical conditions. A study showed that 32.1% of women among 184 women who delivered at a tertiary hospital had hip pain during pregnancy (1).
Most pregnant women experience hip pain near the due date due to pressure from the growing baby and hormones preparing the body for labor. This usually feels as sudden or gradually increasing dull or sharp pain over the hip area. Read this post to learn about the causes and tips to relieve hip pain during pregnancy.
What Causes Hip Pain During Pregnancy?
The causes of hip pain during pregnancy may vary in each trimester. Although most women may experience hip pain near the due date, a few may have hip pain in the initial weeks of pregnancy or throughout the pregnancy. Common causes of pregnancy hip pain may include the following(1).
1. Sleeping position: The side-lying position is usually the most significant cause of hip pain in pregnancy. As the pregnancy progresses, mothers cannot sleep on their back or front and find it comfortable to sleep on their sides. However, it may increase the soreness in the hip area. Most women may experience hip pain at night since they lie down for a long time while sleeping.
2. Relaxin hormone: Pregnancy hormones, such as relaxin, can be the reason for hip pain and pelvic pain in some women. These hormones may soften and relax connective tissues, resulting in loose joints and ligaments between the pelvic bones. Although this process is needed to accommodate the growing uterus and delivery, it can be painful.
3. Round ligament pain: Sharp pain in the abdomen or groin during the second trimester can be due to round ligament pain. These ligaments support the uterus on each side. Rapid movement may cause contraction of the round ligament and pain in some women.
4. Sciatica: The pressure exerted by the uterus on the sciatic nerve may cause pain in the third trimester. This is often called sciatica and is usually associated with a tingling sensation on the hips, buttocks, and thighs.
5.Weight gain: Extra pounds you gained during pregnancy can increase the risk of hip pain. Weight-bearing joints of the body, such as ankles, knees, and hips, can be affected by increased body mass index. Knee and ankle pain are often seen with hip pain due to weight gain (2).
6. Poor posture: Pregnancy may alter the body alignment due to growing belly and loosened ligaments and joints. Some women may experience hip pain and lower back pain if they do not correct the natural poor posture during pregnancy.
In rare cases, specific disorders and trauma may cause hip pain in pregnancy. Doctors may order diagnostic tests to exclude these conditions while looking for the causes of hip pain in pregnancy. These conditions may include the following (3).
7. Transient osteoporosis of the hip (TOH): Transient osteoporosis of the hip is usually seen in the third trimester of pregnancy or the early postpartum period. In most cases, the exact cause of TOH is unknown. It is marked by gradual or sudden onset of intense hip pain, which worsens due to weight-bearing. MRI scans help to visualize the abnormality. TOH may result in femoral head fractures if left untreated or if unprotected weight-bearing continues for a long time.
8. Osteonecrosis of the femoral head: Osteonecrosis occurs due to disruption of blood flow to the head of the thigh bone (femur). Although the exact cause is unknown, several factors, such as advanced maternal age, maternal cortisol levels, high levels of progesterone and estrogen, and direct injury from the growing uterus, could contribute to this condition. This may often result in severe hip pain and is often seen in the third trimester or the early postpartum period. Both sides can be affected, but unilateral (one-sided) involvement affecting the left hip is common in pregnant women.
9. Inflammatory sacroiliitis: Sacroiliitis is an inflammation of one or both sacroiliac joints connecting the lower spine and pelvis. This can be due to increased stress on the joint due to pregnancy and often causes hip pain.
10. Sacral stress fractures: Sacral stress fractures may cause lower back pain and hip pain in pregnant women. Relaxin-induced hormonal changes in pregnancy may contribute to this, especially in women with vitamin D deficiency and reduced bone mass due to osteopenia (4).
11. Acetabular (hip) labral tears: Acetabular or hip labral tear involves tissue and cartilage damage of the hip. This may cause hip pain and often feel that the leg is clicking when you move it. Pregnant women may develop this condition due to changes in the joint due to pregnancy hormones.
12. Symphysis pubis dysfunction (SPD): SPD is the discomfort felt in the pelvic region due to stiffness and uneven movements of the pelvic joint called symphysis pubis. This may cause pelvic girdle pain and hip pain in some pregnant women.
13. Cauda equina syndrome: Cauda equina syndrome (CES) happens due to the compression and damage of nerve bundles called cauda equina. This may cause lower back pain, leg pain, and hip pain in some women, and it is a medical emergency since it can lead to bowel and urinary incontinence and paralysis. Compression due to pregnancy is seen in one in 10,000 cases, and it can be due to positional and mechanical stress on the lower back.
Although most causes of hip pain can be normal during pregnancy and resolve eventually, you may seek medical care to identify the exact cause.
How To Relieve Hip Pain During Pregnancy?
The following home remedies may help you alleviate hip pain during pregnancy (5).
1. Exercises and stretches
Exercises that strengthen back muscles and abdominal muscles may help to reduce hip pain during pregnancy. You may try antenatal yoga with the guidance of experts. Although these are simple exercises and stretches, seek your gynecologists’ advice before beginning them.
The following stretches and exercises may help to relieve hip pain during pregnancy (6).
i. Piriformis stretch
You may place your ankle on the opposite knee and lean forward till you feel the sides of your belly button being stretched. You may hold the stretch for 30 seconds and repeat on the other side. It can be done three times per day.
ii. Lumbar rotation or back stretch
You may lie down with knees up and feet flat on the bed with the arms outstretched to the sides. You may gently roll the knees to one side till you feel the stretch and hold for 30 seconds. You may repeat this for both sides and try three times per day.
iii. Iliotibial band or ITB stretch
You may stand near a wall supporting yourself on the wall with your hand and cross the painful leg behind the other leg. Lean away from the wall until the side of the painful leg stretches and hold for 30 seconds. You may repeat it three times daily.
iv. Standing hip abduction
You may stand with one hand on a firm and stable surface, such as on the back of a chair. Lift the painful leg out, hold it for five seconds, and bring it back to normal position. You may repeat this up to ten times and perform the exercise three times per day.
You may lie down with feet flat on the floor and knees up. Lift your bottom and hold for ten seconds and repeat ten times. Perform the exercise up to three times per day.
vi. Hip stability against the wall
You may stand with the good leg against the wall and lift it in 90 degrees and push against the wall. This could contract the hip muscles in the painful leg (leg away from the wall). Hold the position for 30 seconds. You may do five repetitions and perform the exercise thrice per day.
vii. Side leg raises
Lie down on your side and keep the legs straight. Raise the leg and hold it for five seconds. You may do it on both sides, ten times each. You may perform the exercise three times per day.
Lie down on your sides and keep the knees bent and ankles together. Try to raise your knee. Do this on both sides, ten times each side, and be careful to avoid back falls. You may do it three times per day.
ix. Wall squats
Lean against the wall, slowly bend your knees, and slide your back on the wall until you reach the squat position. Hold for ten seconds and repeat ten times. Perform the exercise up to three times per day.
You may also seek help from the midwife or physiotherapist if you cannot do the movements and stretches. Always ensure your safety while exercising.
2. Warm compresses or warm bath
A warm bath or warm compress over the sore area may relieve pain. Warmness helps to dilate blood vessels and increase the blood flow to the area. This may also reduce muscle spasms and stiffness of the joint.
You may do it with hot pads or a damp towel soaked in hot water for 10-15 minutes at a time. The use of magnesium sulfate (Epsom salt) in water may help relax the muscles further.
3. Pregnancy pillow
You may use a pregnancy pillow or blanket to support the back and lean against it if you have hip pain while sleeping on the sides. You may also use a pillow to support the abdomen and upper leg to increase comfort. Maternity pillows may help to reduce hip pain during pregnancy.
4. Change sleep positions
Sleeping on the side and keeping the knees bent near the due date may reduce hip pain in some women. If you lie down on the same side, it may increase the risk of pain in one area. You may change the sides if there is no pain on the other side.
Massages may help to ease the pain and soreness. Massages with gentle rotating and rocking movements over the painful area in the side-lying position may help to reduce pain. You may seek help from your partner or caregiver to do this at home.
6. OTC medications
Some women may require over-the-counter pain medication for hip pain during pregnancy. You may ask your doctor to know the type and doses of pain medication based on individual factors.
When To See A Doctor?
It is recommended to visit your doctor to identify the exact cause of hip pain during pregnancy. You may seek immediate medical care if you have hip pain with soreness or pressure in the pelvic area radiating towards the thighs before the 37th week of gestation. This could be a sign of preterm labor, which could also cause vaginal discharge and uterine contractions.
Hip pain during pregnancy could occur during specific periods or throughout the pregnancy. Inform your doctor and arrange a visit to know its exact cause. Exercises, such as lying on the back and elevating the hip above chest level for a couple of minutes, can be beneficial. Try to sleep with supporting pillows before the hip pain begins. You may try warm compresses and massage if the gynecologist does not recommend exercises and stretches.
2. Why weight gain matters when it comes to joint pain; Harvard Medical School
3. Pelvic Musculoskeletal Disorders Related to Pregnancy; Journal of the Belgian Society of Radiology
4. Two rare cases during pregnancy: pregnancy-associated inflammatory sacroiliitis and sacral stress fracture; Turkish Society of Physical Medicine and Rehabilitation
5. Pregnancy: Pelvic and Hip Pain; Michigan Medicine; University of Michigan
6. Hip pain in pregnancy: Greater trochanteric pain syndrome (GTPS); National Health Service