Exercises to reduce postpartum hip pain

Hip pain is something I treat often in my office in both pregnant and postpartum patients. In this blog post I explain why hip pain is common during pregnancy, why it may not start until postpartum, and what you should do about it. One of the recommendations I list is to work on mobility and strengthening exercises for your hips, which is what I am going to explain further in this blog post. Make sure to check the links for some exercise examples!

What is hip mobility and where should you start?

Hip mobility is the amount of range of motion you have available and can control. Your hip joint flexes, extends, abducts (moves your leg away from midline), adducts (moves your leg back to midline and crosses your leg), and rotates. The rotation movements of the hips are referred to as internal and external rotation. I encourage all of my patients to do exercises for both mobility and strength in all ranges of motion.

Where you start with mobility depends on where you feel most limited. Many of my patients are more limited in hip internal rotation than external rotation, especially if they have hip pain. It’s important to test your rotation in both directions to see if you are limited. Check out the video below and test your own hip internal and external rotation mobility. If you notice tension, try this as an exercise for a few weeks and see if you can improve your range of motion!

Hip flexion and extension may also be limited. Most often I see limited hip extension and hip flexors feeling “tight”. There are a lot of reasons hip flexors may feel tight, so if you consistently stretch them and they keep feeling tight, it’s important to get assessed to figure out why. In the meantime, stretching hip flexors can give some temporary relief and feel good, so as long as it isn’t increasing any symptoms like tightness or hip pain, go ahead and try the kneeling stretch below.

Last but not least is abduction and adduction. I often see limitations in abduction range of motion due to tight adductor muscles (inner thighs). These muscles can become tight if they are weak, if you experienced pubic symphysis pain during or after pregnancy, or if you have pelvic floor muscle tension. Check out my favorite hip adductor mobility exercise here.

What about strengthening exercises?

Hip strengthening can also play a key role in reducing hip pain, as well as improving pelvic floor function, reducing low back pain, and returning to higher level exercise postpartum. I recommend strengthening in all the directions discussed above. Here is a quick list of some hip strengthening exercise ideas.

1 - Hip flexor strengthening. Any exercises that resist hip flexion using a band or weight can work. Here is an example of a hip flexor strengthening exercise to try.

2 - Hip extensor strengthening. Strengthening hip extension can help build strong glutes postpartum, which is important both for your hips and pelvic floor. I like to encourage working your glutes throughout your range of motion and using both concentric (shortening) and eccentric (lengthening) exercises. An example of a concentric exercise would be bridges, check out a bridge variation to try here. One of my favorite eccentric exercises for hip extension is good mornings. You should feel these in your glutes and hamstrings, not your lower back!

Pro tip: make sure that you are using both your glutes and hamstrings, and not dominating these movements with your hamstrings only. If you’re only feeling your hamstrings working, you may need to work with a provider to help get more glute activation.

3 - Hip abduction strengthening. Focusing on single leg stabilization exercises (like bulgarian split squats) and exercises that require lifting the leg to the side or stepping to the side all work hip abductors. A few other exercises I like for hip abduction include lateral step ups and side steps with a band.

4 - Hip adduction strengthening. Hip adductors connect to your pelvis and play an important role in pelvic stability and pelvic floor function. I find that many of my patients feel tight in their hip adductors, but that these muscles are also pretty weak. Some exercises to strengthen your hip adductors include lateral lunges with adductor slides, sumo squats, and Copenhagen side planks (check out this modified version to start).

5. Hip rotation strengthening. Hip rotation often gets overlooked in most training programs, however deep hip rotators can play a major role in hip pain and pelvic floor function. This hip rotation exercise is one of my favorites to get patients started. When you’re ready, you can give this progression a try.

How do I know if an exercise is right for me?

I’m always honest in saying that the only way I can truly recommend the best exercises specifically for you is if I’ve done an assessment. I can give general guidelines, but if you want more personalized advice I definitely recommend scheduling an evaluation!

That being said, here are a few general postpartum exercise guidelines. If you notice any of these, I recommend modifying or trying a different exercise.

1 - If you notice any increase in your pain during or within an hour or two of an exercise. I’m not talking about muscle fatigue, but any sharp pain, numbness/tingling, or radiating pain.

2 - If you notice any pressure, heaviness, or bearing down on your pelvic floor.

3 - If you have any trouble controlling your bowels, bladder, or gas during an exercise.

For strengthening exercises, you should feel fatigued between 5-12 reps. If you can do more than 10-12 reps without feeling fatigued, you need to choose a more challenging exercise or add some weight/resistance to the exercise.

If you’re experiencing postpartum hip pain, hopefully you find some of these exercises are helpful for you! If you’re interested in learning more about working with me, you can set up your free 15 minute phone consult here. If you would like help building strength and returning to exercise postpartum, check out my self-paced postpartum rehab course Core Confidence here. (Core Confidence also includes troubleshooting for postpartum hip pain!).

Questions? You can reach me directly at alexis@absolutekineticspt.com.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS, PCES