Hip Mobility and Prolapse: Connection & Exercises to Mitigate Prolapse Symptoms

The hips and pelvic floor are intimately interconnected muscle systems. A clear understanding of how hip mobility affects the pelvic floor will help you work with clients with both hip pain and prolapse. And we’re offering some practical exercises to help mitigate the symptoms of pelvic organ prolapse and associated hip pain.

Hip Mobility and Why it Matters

Hip mobility is the ability of the muscles of the hips to move through a full range of motion under a variety of loads; hip flexibility refers to the passive range of motion of the hips. The muscles surrounding the hip joints are crucial for many movements, including most activities of daily living–walking, standing, finding comfortable seated positions, etc. The hips are responsible for stabilizing the pelvis as we move, and help facilitate single-leg movements and balances. Hip mobility and strength are also important to pelvic floor function. Hip mobility and hip strength go hand-in-hand: while many of your clients may come to you complaining for “tight hips,” they may actually need hip-strengthening work in addition to stretches.

Hip mobility and prolapse

Pelvic organ prolapse is an injury in which one or more of the pelvic organs “drop” from their normal position. Though bladder prolapse is the most common, any pelvic organ (bladder, uterus, rectum) can make the descent. This injury happens for a variety of reasons: birth injury, core and pelvic floor muscle imbalances, postural misalignments, and excess intra-abdominal pressure are all reasons one might sustain a prolapse. While the correspondence between hip mobility and pelvic organ prolapse has not been studied in great detail, the connection between hip strength and pelvic floor function in general has been studied, including in cases of urinary incontinence.

Exploring the Connection between Hip Mobility and Pelvic Organ Prolapse

What causes POP (pelvic organ prolapse)?

There is no single cause of pelvic organ prolapse; rather, it is a combination of conditions, often including laxity in some of the muscles of the pelvic floor, that allows for one or more of the organs nestled in the pelvic bowl to “slip” or “drop” down. Childbirth is frequently named as a cause of prolapse, but excessive intra-abdominal pressure caused by heavy lifting or athletic activities can also contribute to pelvic organ prolapse. This dropping can be responsible for a number of symptoms, ranging from occasional discomfort to constipation, to urine leakage and more. (For a more detailed breakdown of each type of prolapse, please refer to our article here). There are five major types of prolapse:

• • Bladder prolapse – Cystocele

• • Rectum prolapse – Rectocele

• • Uterine Prolapse

• • Vaginal Vault Prolapse

• • Small Intestine Prolapse – Enterocele

Each type differs in presentation and degree from person to person, but as you can imagine, feeling like one of your internal organs isn’t in the right place is incredibly disconcerting. Additional symptoms like hip pain can make it even more uncomfortable. The physical symptoms of prolapse are frequently quite difficult to manage, and the mental health effect of prolapse can be equally challenging for your clients. Everyday activities may feel difficult or impossible; for people who have previously been athletic, there is often a sense of loss of ability to take part in a favorite activity that can be devastating until a healing process begins to take place. POP does not have to mean completely giving up on all physical activities that bring your clients joy, however: there is hope, and many people find that a movement-based program often alleviates the symptoms of prolapse enough that they’re able to get back to doing more of the things they love.

Hip mobility and pelvic health

A pelvic prolapse rehab program needs to look at the whole body, and especially the muscles surrounding the pelvis and core. Just like the core is not only the visible abs, the pelvic floor is influenced by everything that attaches to the pelvis and the pelvic floor muscles. Instead of thinking of pelvic organ prolapse as a problem just of the organ involved, we need to look at the whole system that’s causing the organ to be moved out of place.

Hip mobility is an important factor in many aspects of everyday movement: it facilitates walking, bending, squatting, and sexual intercourse, among many, many other movements. Tying your shoes, or getting up and down from chairs or the toilet involves a squatting movement pattern. If getting up and down from the floor is difficult, working on acquiring more mobile hips can help. As your hips are helping you move through all of these things, they’re also having an influence on your pelvic floor. If your hips can’t make space for your body, your body will make space for itself in any way it can–including with excessive intra-abdominal pressure.

Intra-abdominal pressure and prolapse

One thing your clients may be struggling with is managing excessive intra-abdominal pressure. Imagine the whole core system (including the pelvic floor and diaphragm) as a balloon, and picture squeezing the top of the balloon. The bottom of the balloon pushes out and down. This is a very oversimplified version of how intra-abdominal pressure works. Intra-abdominal pressure isn’t inherently bad. It’s part of the breath system. But when we’re already holding tension in the core or pelvic floor, then excessive downward pressure can make a situation like prolapse worse. If the hips are freed up to do their job properly, so that movements require less strain overall, we can reduce the pressure that we’re putting on our clients’ abdomens.

The Role of Hip Mobility in Managing Pelvic Organ Prolapse and Hip Pain

Alleviating symptoms

Hip pain is often a symptom of both pelvic organ prolapse and other pelvic floor dysfunction. The muscles of the hip include the gluteal muscles, the abductors and adductors, and hip flexors including the psoas. Pain may present in different areas of the hip, but is often felt deep inside the hip joint. Doing exercises for hip mobility, rather than simply stretching the muscles of the hip, can alleviate hip pain by bringing more balanced strength and movement patterns to the hip.

Analysis of the relationship between prolapse and hip pain

Hip pain can be indicative of dysfunction in muscles of the pelvic floor, and increasing hip strength seems to decrease symptoms of stress incontinence, according to one study. Anecdotally, many of my clients have found relief from their prolapse symptoms when they add hip mobility work into their rehab exercises. Hip mobility also benefits folks with low back pain and pelvic pain. We know that the tissues of the body are continuous, not entirely separate entities with no connection to each other. And the protective compensation patterns that many people with POP develop may include inadvertently reducing their hip mobility (e.g., crossing their legs when sneezing to try to prevent urine leakage, or squeezing the hips tightly in response to the feeling of something falling out). Changing up those patterns gives the body space to learn new patterns that may improve the symptoms your clients are experiencing.

Exercises for Improving Hip Mobility

You can start your clients off with these six exercises for hip mobility to both assess and correct them. When practicing these exercises, remind your clients not to bear down as they move, and that their movements should be slow and controlled so that they can really feel where the limits are. Another easy modification is to cue your clients to bring their legs closer together in wide-leg positions such as a sumo squat.

Standing Exercises

Standing side bend:

• • Stand and cross one leg behind you

• • Reach up with the front arm and side bend

• • Hold for a few breaths to get length in the waist

• • Do both sides, noticing the difference between each side.

Pelvic list:

• • Step up on a block so that the heel is at the back of the block

• • Push down through the heel in order to elevate the floating leg

• • Hold with feet even, or make it more dynamic by moving up and down

• • Use a wall or chair for balance as needed.

Lunge with a hip shift to the side:

• • Come into a high lunge with the back foot on the floor (ok if the back foot turns out slightly)

• • Slide the front hip to the side without shifting the ribs

• • Then slide back to neutral

• • Repeat 4-5 times per side

• • Can also perform this next to a wall so that the wall becomes the target.

Seated/all fours exercises

Kneeling hip shifts:

• • Kneel with one leg stretched out to the side

• • Place hands on blocks or a chair or the floor (depends on what your body needs!)

• • Keep spine neutral and shift hips back toward the heel of the kneeling leg

• • Move forward and back 4-5 times per side.

Kneeling hip abduction:

• • Come into a kneeling side lunge with the torso upright.

• • Shift the hips toward the lunging leg

• • Repeat 4-5 times, then switch sides.

Sitting on a chair & shifting hips:

• • Sit on a chair with feet flat on the floor and sitbones under you.

• • Alternate sliding each knee forward and back, initiating the movement from the hips.

• • Keep the torso still.

Lifestyle Changes and Preventative Measures

Lifestyle changes can help improve hip mobility and prevent prolapse.

While your client is in the healing phase, they will need to avoid lifting loads that are heavier than their body can tolerate–which also means helping them develop a strategy for doing the lifting they inevitably will have to do. Our bodies crave novelty, so working with clients to find alternative working or sitting positions can be helpful for preventing further prolapse.

Integrating regular, shorter movement breaks into their day can be helpful for folks with prolapse. Sometimes a longer workout session will make the prolapse feel worse, especially if it involves a great deal of standing. So work with your client to find ways to move that support their healing.

Additional preventative measures to avoid exacerbating hip pain and prolapse symptoms.

Encourage your clients to focus on the quality of their movements, rather than upping the intensity too quickly. Help them develop a strong core engagement strategy since that will also support their healing from prolapse. Developing a good sense of what strategies help your clients find a level of exertion that is challenging, but not too intense can be helpful. Above all, remind your clients that healing isn’t linear, but that it is possible.

When to see a doctor or physical therapist?

Your clients should consult their doctor or a PT if they are experiencing a new feeling of “something falling out.” Severe pain when attempting exercises is also a cause for consulting a doctor. If your client has already been working with a medical professional, it can be helpful to find out what that person has recommended, so that you can support your client’s healing progress.

FAQ

1. What is hip mobility and why is it important for pelvic health? Hip pain is often a symptom of both pelvic organ prolapse and other pelvic floor dysfunction. The muscles of the hip connect to the muscles of the pelvic floor, and many people suffering from symptoms of pelvic floor dysfunction find that they benefit from hip mobility work. 2. Can a prolapsed uterus directly cause hip pain? There is no evidence that a prolapsed uterus alone can directly cause hip pain, but the conditions that caused the prolapse may also be the cause of hip pain.  3. How often should I perform hip mobility exercises for prolapse management? In general, 3-5 days a week while you’re in the healing phase is sufficient. 4. What lifestyle changes can aid in improving hip mobility and reducing prolapse symptoms? Give your body plenty of varied input, including rest and exercise. Change up the positions you sit and stand in throughout the day. 5. Are there any risks associated with hip mobility exercises for someone with pelvic prolapse? As with most exercises when pelvic organ prolapse is present, you’ll want to learn to listen to your body and not overdo things. Pay attention to when your body seems to tense up unnecessarily, or when you feel yourself straining too hard to perform an exercise. Back off, and try again another day. 6. How can I track my progress with hip mobility exercises in relation to prolapse symptom relief? Just like you would track any other progress: how do you feel? Are your symptoms getting better, worse, or staying the same? If you’ve just started adding a new move into your routine, don’t be surprised if your symptoms flare for a day or two–but DO back off the intensity and check your movement strategy.