What exercises can be done for a pregnant patient with iliopsoas bursitis?

Exercise Management for Pregnant Patients with Iliopsoas Bursitis

Pregnant women with iliopsoas bursitis should engage in a modified exercise program that includes hip rotation strengthening exercises, gentle stretching of the iliopsoas, and general pregnancy-appropriate aerobic and resistance activities while avoiding exercises that place the hip in 30-60° of flexion under load. 1, 2

Specific Exercise Recommendations

Hip-Specific Exercises for Iliopsoas Bursitis

• Hip rotation strengthening exercises are the cornerstone of treatment, as this approach has demonstrated a 77% success rate in improving pain and function in patients with iliopsoas syndrome 1
• Stretching of the iliopsoas muscle should be incorporated using post-isometric relaxation techniques, which have shown effectiveness in pregnant patients with iliopsoas-related conditions 3
• Avoid exercises that position the hip in 30-60° of flexion, as this range produces the highest iliopsoas activation (>60% MVIC) and may aggravate bursitis 4
• Specifically avoid active straight leg raises (ASLR) around 60° of hip flexion and supine leg lifts, as these generate maximal iliopsoas stress 4

General Pregnancy Exercise Guidelines

• Accumulate at least 150 minutes of moderate-intensity physical activity weekly over a minimum of 3 days, though daily activity is encouraged 2, 5
• Combine aerobic exercises with resistance training for optimal maternal and fetal outcomes, as this combination provides greater benefits than aerobic exercise alone 2, 5
• Include yoga and gentle stretching as these modalities are particularly beneficial for musculoskeletal issues during pregnancy 2, 5
• Perform daily pelvic floor muscle training (Kegel exercises) to reduce urinary incontinence risk, though proper technique instruction is essential 2, 6

Safe Exercise Modifications

Aerobic Activities

• Choose low-impact options like brisk walking, water aerobics, and stationary cycling, which maintain cardiovascular fitness without aggravating hip bursitis 6
• Water aerobics is particularly advantageous as buoyancy reduces joint loading while allowing movement 6

Resistance Training Adjustments

• Progress from closed kinetic chain to open kinetic chain exercises gradually, as closed chain exercises produce less iliopsoas activation 4
• Avoid exercises where the trunk moves on a fixed lower extremity in hip flexion, as these generate 40-60% MVIC iliopsoas activation 4
• Delay adding external loads until symptoms improve, as additional resistance increases iliopsoas demand 4

Position-Specific Precautions

• Modify or avoid supine exercises if experiencing lightheadedness, nausea, or feeling unwell, as supine positioning can compromise maternal hemodynamics 2, 6
• Avoid exercises in excessive heat or high humidity to prevent maternal hyperthermia 6, 7

Exercise Progression Algorithm

Initial Phase (Symptom Management)

• Begin with pelvic/low back mobility exercises as these address biomechanical stress without directly loading the inflamed bursa 3
• Incorporate gentle iliopsoas stretching using post-isometric relaxation techniques 3
• Start hip rotation strengthening in pain-free ranges, avoiding positions that reproduce symptoms 1
• Maintain activities of daily living even if vigorous exercise must be temporarily reduced 2, 5

Intermediate Phase (Functional Restoration)

• Progress hip rotation exercises as tolerated, as this specific intervention addresses the clinical deficiencies observed in iliopsoas syndrome 1
• Add low-impact aerobic activities to meet the 150-minute weekly target 2
• Include resistance training for major muscle groups while continuing to avoid high iliopsoas activation exercises 2

Maintenance Phase (Full Activity)

• Return to full pregnancy-appropriate exercise recommendations once pain resolves 2
• Continue hip rotation strengthening as prevention, as this maintains iliopsoas function without aggravating the bursa 1

Critical Safety Considerations

Warning Signs to Stop Exercise Immediately

• Cease activity and contact your obstetric provider if experiencing vaginal bleeding, regular painful uterine contractions, persistent excessive shortness of breath, severe chest pain, persistent dizziness, or amniotic fluid leakage 5, 6

Common Pitfalls to Avoid

• Do not become completely inactive due to hip pain, as inactivity increases adverse pregnancy outcomes including worsening musculoskeletal problems 5
• Do not assume all exercise is contraindicated, as only specific absolute contraindications warrant avoiding moderate-vigorous physical activity 2, 5
• Do not perform high-intensity hip flexion exercises (like leg raises or sit-ups from supine) as these maximally stress the iliopsoas 4
• Do not exercise in hot environments or use hot tubs for extended periods, limiting exposure to less than 10 minutes if used at all 7

Expected Outcomes

• Improvement in pain and function typically occurs within 3-6 months of initiating the hip rotation strengthening program, with most patients returning to full activity 1
• Exercise provides additional pregnancy benefits beyond bursitis management, including reduced risk of gestational diabetes, pre-eclampsia, gestational hypertension, cesarean section, and depression 2, 5
• Lumbopelvic pain severity decreases with regular physical activity, addressing the broader musculoskeletal challenges of pregnancy 2, 5

Multidisciplinary Consultation Indications

• Consider physical therapy referral for proper exercise technique instruction, particularly for hip rotation exercises and pelvic floor training 2, 1
• Consult maternal-fetal medicine if symptoms persist beyond 3 months or significantly limit daily activities 5
• Seek pain management specialist input for refractory cases that do not respond to conservative exercise-based treatment 5