Hip Pain in Pregnancy - Is It Sciatica? Or Something Else?

Pregnancy is an incredible journey, but it can also bring about a variety of aches and pains, particularly in the hips and lower back. As your body adapts to accommodate a growing baby, structural changes, hormonal shifts, and increased stress on muscles and joints can lead to discomfort.

Two common culprits for hip pain during pregnancy are sciatica and pelvic misalignment, but other factors, such as hormonal changes and muscle strain, can also contribute. In this blog, we’ll explore the differences between these conditions and how they can affect pregnant moms, along with tips from a pelvic PT for pain relief!

Sciatica During Pregnancy: A Nerve-Related Cause of Hip Pain

What is Sciatica?
Sciatica occurs when the sciatic nerve, which runs from the lower back through the hips and down the legs, becomes compressed or irritated. Pregnancy can exacerbate or trigger sciatica due to physical and hormonal changes.

Why Sciatica Happens in Pregnancy
During pregnancy, the following factors can contribute to sciatica:

• Weight Gain: The growing baby and uterus place additional pressure on the spine and pelvic region, which may compress the sciatic nerve.

• Pelvic Shifts: As the pelvis widens and shifts to prepare for childbirth, changes in alignment can irritate the sciatic nerve.

• Hormonal Changes: Increased levels of relaxin, a hormone that loosens ligaments, can lead to joint instability, making the sciatic nerve more vulnerable to compression.

How Sciatica Feels During Pregnancy

• Location: Sciatic pain often starts in the lower back or buttocks and radiates down one leg.

• Character: Pain can be sharp, burning, or electric, sometimes accompanied by tingling, numbness, or weakness.

• Trigger Points: Prolonged sitting, standing, or certain movements may worsen symptoms.

How to Relieve Sciatica During Pregnancy

• Prenatal Physical Therapy: Exercises and stretches designed to alleviate nerve compression.

• Pelvic Support Belts: These can help stabilize the pelvis and reduce strain on the sciatic nerve.

• Postural Adjustments: Practicing good posture when sitting or standing to minimize pressure on the lower back.

• Rest and Positioning: Avoid prolonged sitting or standing and sleep on your side with a pregnancy pillow for support.

Hip Pain from Pelvic Misalignment During Pregnancy

What is Pelvic Misalignment?
Pelvic misalignment occurs when the pelvic bones shift out of their normal position. During pregnancy, this can happen due to the loosening effect of relaxin and the additional weight of the baby. Misalignment can lead to uneven stress on the hip joints and surrounding muscles, causing discomfort or pain.

How Pelvic Misalignment Happens in Pregnancy

• Relaxin’s Role: This hormone prepares the body for childbirth by relaxing ligaments, which can also make joints less stable.

• Postural Changes: As the belly grows, the body’s center of gravity shifts, often leading to changes in gait and alignment.

• Muscle Imbalances: Tight or weak muscles in the hips, back, or abdomen can pull the pelvis out of alignment.

How Pelvic Misalignment Causes Hip Pain During Pregnancy

• A feeling of imbalance or tightness in one or both hips.

• Pain in the groin, buttocks, or thigh, especially when walking, standing, or shifting weight.

• A clicking or popping sensation in the pelvis or hips.

Differentiating Pelvic Misalignment from Sciatica

• Location: Misalignment pain is often localized to the hip and groin, whereas sciatica radiates down the leg.

• Trigger points: Misalignment pain may feel dull, achy, or sharp as trigger point muscle pain, and can change with certain movements.

• Activities: Pain may worsen with activities like walking or prolonged standing but is less likely to involve tingling or numbness.

How to Address Pelvic Misalignment During Pregnancy

• Prenatal Physical Therapy: Focused on realignment exercises and strengthening weak muscles.

• Manual Therapy: Techniques like soft tissue massage or joint mobilization to release tension and improve alignment.

• Pelvic Stabilization: Using support belts or braces to reduce joint strain.

• Posture and Movement Training: Learning how to move safely and efficiently as your body changes.

Other Common Causes of Hip Pain During Pregnancy

While sciatica and pelvic misalignment are common sources of hip pain in pregnancy, other factors can also contribute:

1. Round Ligament Pain

What it Feels Like:

• A sharp, stabbing pain in the groin or lower abdomen.

• Pain that comes on suddenly with movement, such as rolling over or standing up.

Cause:
The round ligaments, which support the uterus, stretch as the uterus grows, leading to discomfort.

Relief Tips:
Gentle stretching, prenatal yoga, and avoiding sudden movements can help ease symptoms.

2. Hip Bursitis

What it Feels Like:

• A burning or aching pain on the outside of the hip.

• Pain that worsens with prolonged activity or lying on the affected side.

Cause:
Inflammation of the bursa (fluid-filled sacs cushioning the hip joints), often due to increased pressure from pregnancy weight.

Relief Tips:
Ice, rest, and sleeping with a cushion between your knees to reduce pressure on the hips.

3. Symphysis Pubis Dysfunction (SPD)

What it Feels Like:

• Pain or discomfort in the front of the pelvis, radiating to the hips, thighs, or lower back.

• A clicking sensation or feeling of instability in the pelvis.

Cause:
Loosened pelvic ligaments and joint instability caused by pregnancy hormones.

Relief Tips:
Physical therapy, pelvic support belts, and avoiding activities that strain the pelvis (like heavy lifting).

4. Muscle Strains and Tightness

What it Feels Like:

• Soreness, tightness, or spasms in the hip, buttock, or thigh muscles.

• Pain that worsens with activity or specific movements.

Cause:
The additional weight and altered posture during pregnancy can strain muscles, especially if they are already weak or tight.

Relief Tips:
Gentle stretching, foam rolling, and strengthening exercises tailored for pregnancy.

Getting the Right Diagnosis During Pregnancy

Since many causes of hip pain during pregnancy share similar symptoms, an accurate diagnosis is essential. If you’re dealing with persistent hip pain, consult a pelvic health physical therapist or your healthcare provider. They will:

1. Assess your posture, gait, and movement patterns.

2. Identify contributing factors, such as muscle imbalances or joint misalignments.

3. Recommend safe, pregnancy-appropriate exercises and treatments tailored to your specific needs.

Final Thoughts

Hip pain during pregnancy can stem from a variety of sources, including sciatica, pelvic misalignment, and other structural or hormonal changes. Understanding the root cause of your discomfort is key to finding relief. With the right support, including prenatal physical therapy and lifestyle adjustments, you can manage pain and feel more comfortable as your body supports the incredible work of growing a baby.

If hip pain is affecting your pregnancy journey, don’t hesitate to seek out a perinatal pelvic health physical therapist for professional guidance. The accurate diagnosis and treatment approach will help you move through pregnancy and into birth and postpartum with less discomfort and more confidence!

Are you at Risk for DRA?! Understanding the Risk Factors for Diastasis Recti Abs

What is DRA?

Diastasis recti abdominals (DRA), or the separation of the abdominal muscles, is a condition that primarily affects women during and after pregnancy. However, this issue can also affect men and non-pregnant individuals, making it a broader concern than many might realize. The abdominal muscles play a key role in holding up our posture, all movement, and supporting internal organs. When these muscles become separated and unable to work efficiently, it can lead to a range of symptoms, from cosmetic concerns to functional impairments like back pain or even pelvic floor issues.

While diastasis recti abdominals (DRA) is a common condition, affecting up to 60% of pregnant women by the third trimester, not everyone is equally at risk. There are several factors that can increase the likelihood of developing DR, from anatomical predispositions to lifestyle habits. Understanding these risk factors is key to both preventing and managing this condition.

Risk Factors Associated with DRA

1. Pregnancy

Pregnancy is the most significant risk factor for developing diastasis recti. As the uterus with baby inside grow, it pushes against the abdominal muscles, causing them to lengthen & stretch. The linea alba, a connective tissue running down the center of the abdomen, becomes thinner and weaker as the pressure increases. This separation of the rectus abdominis muscles (the “six-pack” muscles) is a natural part of pregnancy, but the degree of separation varies from woman to woman.

Multiple Pregnancies: Women who have been pregnant more than once are at an increased risk of developing diastasis recti. With each subsequent pregnancy, the abdominal muscles are repeatedly stretched, making them weaker and more prone to separation. This is particularly true if pregnancies occur close together, as the muscles may not have fully recovered from the previous pregnancy.

Multiple Births (Twins, Triplets, etc.): Carrying more than one baby further increases the likelihood of developing DR. A larger uterus means greater pressure on the abdominal wall, leading to more significant muscle separation.

Large Babies: If a baby is larger than average, it can place additional strain on the abdominal muscles, increasing the risk of diastasis recti. **This risk factor is one I see often in the PT clinic.**

2. Improper Exercise and Straining

Physical activity is essential for overall health, but improper exercise techniques or excessive straining can increase the risk of developing diastasis recti, when pregnant or not pregnant. Certain exercises that place undue pressure on the abdominal wall, particularly in the later stages of pregnancy or postpartum, can cause or worsen the separation of the muscles.

Heavy Lifting: Lifting heavy objects or engaging in high-intensity exercises without proper core engagement can put undue stress and strain on the weakened abdominal muscles. This risk is especially pronounced for individuals who lift weights without first addressing deep core muscle activation or pre-existing muscle separation.

Abdominal Exercises: Surprisingly, traditional abdominal exercises like crunches, sit-ups, and leg lifts can exacerbate diastasis recti if done incorrectly, especially in the postpartum period. These exercises increase intra-abdominal pressure, which can strain the rectus abdominals muscles more, causing more gapping.

For both pregnant and non-pregnant individuals, it’s important to focus on exercises that strengthen the deep core muscles, like the transverse abdominis, rather than exercises that place excessive pressure on the outer abdominal muscles. A pelvic floor physical therapist can guide safe and effective exercise techniques to prevent or reduce DR.

3. Age

Age can play a significant role in the development of diastasis recti. Older mothers, particularly those over the age of 35, are at a higher risk of developing DRA. This is because as we age, our connective tissues naturally lose elasticity and strength. The linea alba, in particular, may become less resilient, increasing the risk of separation under the strain of pregnancy or other abdominal pressure.

Older individuals who are not pregnant may also be at risk for DRA due to age-related weakening of the abdominal muscles and connective tissue. As the body’s natural collagen production decreases with age, the connective tissues become less able to withstand pressure and tension, leading to the possibility of separation in both men and women.

4. Excessive Weight Gain or Obesity

Excess weight, particularly around the abdominal region, can put significant pressure on the abdominal muscles, leading to separation over time. Both men and women who are obese are at a higher risk of developing diastasis recti due to the constant strain placed on the abdominal wall.

In women, excessive weight gain during pregnancy is another risk factor. A higher-than-average weight gain stretches the abdominal muscles even more than usual, exacerbating the risk of separation. While some weight gain is a natural and healthy part of pregnancy, significant gains beyond recommended guidelines can increase the risk of complications, including diastasis recti.

5. Genetics and Connective Tissue Weakness

Genetics plays a role in the likelihood of developing diastasis recti. Some individuals are born with a predisposition to weaker connective tissue, including the linea alba, making them more susceptible to abdominal muscle separation. This genetic predisposition can affect both men and women and may contribute to diastasis recti outside of pregnancy.

For example, conditions like Ehlers-Danlos syndrome, which affects connective tissue, may increase the risk of DR. In individuals with weak or overly elastic connective tissues, the abdominal muscles are less capable of withstanding pressure, leading to a higher likelihood of separation.

6. Chronic Cough or Respiratory Issues

Chronic coughing, whether due to asthma, smoking, or other respiratory issues, can create repeated pressure on the abdominal muscles. Each time you cough, the abdominal muscles contract, and over time, this repetitive motion can contribute to diastasis recti, especially if there is already weakness in the abdominal wall.

Individuals with chronic respiratory conditions or persistent coughing should learn now to properly contract their abdominal muscles and engage in core strengthening exercises to mitigate the impact on their core muscles with coughing.

7. Pelvic Floor Dysfunction

There is a strong connection between diastasis recti and pelvic floor dysfunction. The core and pelvic floor muscles work together to support the spine, organs, and overall core movement. Weakness or dysfunction in one area can lead to problems in the other. Women with pelvic floor issues, such as urinary incontinence or pelvic organ prolapse, are more likely to develop or have persistent DR, and vice versa.

Summary

Some risk factors are uncontrollable - a large baby, genetic risk factors, and having a respiratory condition. Other risk factors are controllable. No matter if the risk factor is controllable or uncontrollable, a holistic approach to strengthening and coordinating the core and pelvic floor muscles can significantly reduce the risk of both conditions. A pelvic floor physical therapist evaluates the state of your core and pelvic floor and prescribes tailored exercises to promote healing and prevent worsening symptoms. Piston breathing is a is a focused and productive core exercise to connect to your core and pelvic floor - give piston breathing a try!

Managing & Preventing DRA

Diastasis recti abdominals (DRA) is a multifactorial condition influenced by pregnancy, age, genetics, weight, and exercise form. Understanding these risk factors allows individuals to take proactive steps toward prevention and healing of your diastasis recti abdominals. Rehabilitation has to do with managing your intra-abdominal pressure to decrease pressure on the gap (or diastasis). To understand the specific questions about your body and diastasis recti, see a pelvic floor physical therapist who will take the time to perform a whole body evaluation of your movement, strength, breathing and symptoms.

Joint Hypermobility: How It Impacts Your Pelvic Health

Have you ever been able to bend your thumb back to touch your wrist? Or can you place your hands on the ground without bending your knees? Have you always been told that you’re flexible? 

You may have what’s known as joint hypermobility.  Most people live life without any impact from hypermobile joints. It might actually be something you show off to people. However, others may have significant symptoms from having hypermobile joints. 

What Is Hypermobility? 

A joint is where two bones come together. Ligaments are connective tissue that hold the bones together. Ligaments are normally tough fibrous tissue. Hypermobility in the joints means that you have more range of motion, or movement, in your joints than the average person. Having hypermobile joints can also mean that the tissues in your body are fragile and more prone to injury.  People with this condition may also have decreased proprioception, or knowing how your joints move in space without looking at your limbs. 

Hypermobility can be the result of a genetic mutation in the production of collagen in your body, the tissue that holds everything together. This condition is usually hereditary, but it can also spontaneously occur during development. Joint hypermobility can also be caused by: 

• The shape of the bones not fitting properly in the joints. 

• Decreased muscle tone 

Joint hypermobility can fall under Ehler ’s-Danlos Syndrome (EDS), a connective tissue disorder. There are 13 types of Ehler’s Danlos Syndromes with joint hypermobility being the most common form of this condition.  EDS is thought to affect 1 in 5,000 people and is more common in women than men.  It is mostly diagnosed in someone’s later 20s or early 30s. If EDS is suspected based on family history and symptoms, your doctor will run a genetic test for confirmation.

What Are The Signs of Hypermobility? 

Several symptoms indicate you may have joint hypermobility. They are: 

• Dislocation of joints, particularly at the shoulder 

• Pain and stiffness in the joints and muscles 

• Clicking joints 

• Fatigue 

• Back and neck pain 

• Recurrent sprains and soft tissue injuries 

Some symptoms aren’t related to the joints and muscles.  These can be: 

• Acid reflux

• Gastroparesis- slow digestion and emptying of the stomach causing bloating

• Constipation

• IBS

• POTS - Postural Orthostatic Tachycardia Syndrome.  

POTS occurs when abnormalities in the connective tissue around the nervous system are affected.  This impacts the body’s ability to regulate heart rate and blood pressure. As a result, sitting or standing for prolonged periods or changing positions can cause a drop in blood pressure, resulting in fainting. 

How is Joint Hypermobility Diagnosed? 

Diagnosing of this condition is done through 2 main tests. 

1. The Beighton Score.

The Beighton score looks at 5 criteria and gives a point for each positive result for 9 points. A score of 4 or more indicates a positive result. 

• placing your palms on the ground while standing with your legs straight 

• elbows that bend backward

• knees that bend backward

• thumbs that touch the forearm when bent backward

• little fingers that bend backward beyond 90 degrees

2. Brighton Criteria.  

This test requires a Beighton score, but also looks at other systems for identification. 

 A recent study looked at the diagnostic tests for joint hypermobility and found that there are limitations in their diagnostic criteria since they don’t take into account the systemic effects of connective tissue disorders. 

How Does Joint Hypermobility Impact Your Pelvic Health? 

Since hypermobility is a connective tissue disorder, it isn’t discriminatory and can affect every part of your body, including your pelvic floor. People who have hypermobility can have pelvic health symptoms such as: 

• Stress Incontinence

• Hernias

• Pelvic Organ prolapse

• Pelvic pain 

• Painful sex 

• Fecal incontinence

• Rectal prolapse

• Diastasis Recti 

Treating Pelvic Health Conditions in Women With Joint Hypermobility

Treating someone who has hypermobility and pelvic health symptoms requires a multidisciplinary approach.  Pelvic floor physical therapy can help to balance out the pelvis and strengthen the muscles around it.  This helps to stabilize the pelvis by improving the biomechanics of the pelvis. 

One study has shown that a 6-week generalized physical therapy program to improve strength and fitness improved pain scores and self-esteem in women with hypermobility and pelvic organ prolapse. 

Another study showed that patients with pelvic girdle pain improved with targeted physical therapy that included strength training, proprioceptive exercises, and gentle stretching. 

The bottom line is pelvic floor physical therapy is a great way to help improve your hypermobility symptoms. If you know you have joint hypermobility or EDS and are trying to conceive or are already pregnant, consult a pelvic floor PT early on.  We can help prepare your body and pelvic floor for pregnancy and delivery.