Round Ligament Pain in Pregnancy: 4 Stretches for Immediate Relief

Just as you begin to make it out of the nauseating and exhausting haze of the first trimester, it’s common for pregnancy to throw another “fun” new symptom your way. You may experience a sharp pain down your lower belly after an unexpected sneeze, or a dull ache in your groin after getting up too quickly from the couch. Luckily the pain doesn’t stick around for too long, but what exactly is it? There's a solid chance that it's round ligament pain.

Round ligament pain is very common in pregnancy. In fact, it affects as many as 3 in 10 folks in their second trimester. Not typically tied to an injury, the pain often occurs as your uterus naturally grows up and out of your pelvis.

In this post, we'll dive into everything you need to know about round ligament pain in pregnancy, including flags that your pain may be linked to something more serious. But before we get into the facts, let's start with some quick tips and stretches that can bring you immediate relief.

Quick tips to ease round ligament pain in pregnancy

When you have round ligament pain in pregnancy, it can help to slow down and move carefully. Try these tips:

• Change positions slowly – don’t rush. This will help prevent excessive strain in your ligaments which can trigger painful contractions in the muscle.
• When moving from sit to stand, engage your deep core by gently hugging up-and-in around your baby with your stomach muscles. Move to standing from the front of your chair, and exhale as you stand to further engage your core.
• Lean forward when you are about to cough or sneeze and support under your bump with your hands.
• When rolling in bed, first bend your knees and roll onto your side while keeping your shoulders and hips aligned. To get out of bed, slide your feet over the side of the bed while using both hands to push yourself up from side-lying to seated.
• If cleared by your doctor, you can take an OTC pain medication. Ask which type of pain medication is best for you.
• When you have a pain flare-up, rest on your side with a pillow between your knees.

4 Gentle stretches for round ligament pain relief

Some gentle stretching of the muscles in your hips, lower abdomen, and inner thighs can ease muscle pain and round ligament irritation. Try these three stretches below, holding each for at least 30 seconds, and doing 2-3 sets if comfortable.

None of these stretches should cause pain or discomfort. If they do, discontinue to the stretch, and reach out to a pelvic PT for specific recommendations for your symptoms. 

1. Kneeling Hip Flexor Stretch

How to do a kneeling hip flexor stretch:

STEP 1: Start kneeling in "marriage proposal" position next to a chair or wall for support. The knee closest to the chair/wall should be in front, bent at a slightly greater than 90-degree angle (so that your foot is  out in front of your knee).

STEP 2: Tuck your tailbone and shift your weight onto the forward leg, brining your knee directly above your ankle. (Avoid pushing your knee past your toes.)

STEP 3: Hold for 30 seconds, then return to starting position.

STEP 4: Repeat facing the opposite direction, with your other leg out in front.

2. Seated Adductor Stretch

How to do a seated adductor stretch:

STEP 1: Start seated in a chair with feet flat on the ground and hip-distance apart. Stretch one leg out to the side, placing your heel firmly on the ground with toes pointed forward.

STEP 2: Step your other foot in the opposite direction, keeping your knee bent at 90-degrees. You should feel a gentle stretch in your groin.

STEP 3: Turn your upper body away from your extended leg to face the direction of your bent knee.

STEP 4: Keeping your back straight, place your hands on top of your bent knee and lean your trunk forward.

STEP 5: Hold for 30 seconds, then return to starting position. Repeat on the other side.

3. Pelvic Tilts on Exercise Ball

How to do pelvic tilts:

STEP 1: Sit on a large exercise ball with your hands on your knees and both feet planted firmly on the floor in a wide stance.

STEP 2: Tuck your tailbone, feeling your sacrum press into the ball and forming a "C" position with your lower spine.

STEP 3: Return to starting position.

STEP 4: Drop your belly forward, feeling your tailbone lift off of the ball as you arch your lower back.

STEP 5: Return to starting position. Repeat 5-10 times.

4. Tail Wag Stretch

How to do the tail wag stretch:

STEP 1: Start on all-fours with your hands under your shoulders and your knees under your hips.

STEP 2: Engage your core by pulling your belly button in toward your spine.

STEP 3: Keeping your core engaged, curve your torso as though trying to touch your shoulder and hip together on the same side.

STEP 4: Hold this pose for 30 seconds.

STEP 5: Return to starting position and repeat on the other side.

What is the round ligament?

The round ligament is a round, rope-like ligament that runs from the top sides of your uterus, forward and down into your pelvis through the broad ligaments, where it anchors in your labia majora. It’s a paired ligament, meaning you have one on each side of your uterus.

The round ligament is mostly fibrous — like you would expect a ligament to be — but it also contains some smooth muscle as it attaches to the uterus. The fibromuscular nature of the round ligament helps it perform its main function, which is to help maintain the position of the uterus. 

When not pregnant, the round ligament is strong and flexible, and it mostly functions totally unnoticed in your body.

When you're pregnant, the round ligaments stretch, widen, and lengthen as your uterus grows, helping to keep it in the normal anteverted position (when the uterus tips forward a tad, towards your belly). Hormones including relaxin and progesterone are thought to help relax the smooth muscle and soften the connective tissue, allowing the ligaments to adapt to pregnancy.

What causes round ligament pain in pregnancy

As your uterus grows in pregnancy, the top expands up and out of your pelvis around the start of your second trimester. As it grows, the round ligaments grow and lengthen along with it. 

Normally, the round ligaments stretch and contract slowly, allowing for small shifts in your pelvic organs, while helping to keep your uterus in place. But during pregnancy, these ligaments can become overstretched, and more easily strained. Quick movements or stressors (like can happen from a forceful cough, or quick shift of your body into standing) can further stretch the ligament, causing it to quickly contract, causing a sharp or cramping pain.

Because the symptoms occur as the ligaments are stretched, round ligament pain is most commonly experienced near the end of the first trimester or beginning of the second. It’s said to be more common in those who have had multiple children.

Although much less common, another cause of round ligament discomfort in pregnancy is round ligament varices (RLV). Although uncommon, RLV are swollen and dilated veins in the round ligaments that are often mistaken for an inguinal hernia because of the similar symptoms. Increased blood volume and hormone changes in pregnancy can cause swelling at the front of the hips (along the inguinal ligament) and a feeling of fullness.

Can I get round ligament pain even if I’m not pregnant?

Yes. While round ligament pain is most common in pregnancy, the round ligament is a common place for endometriosis lesions for those who have deep infiltrating endometriosis. This can lead to pelvic pain, pain during sex, painful periods, and infertility.

What does round ligament pain in pregnancy feel like?

Round ligament pain is most often felt as a sharp, cramping, or sudden stabbing sensation, in the lower abdomen (on one or both sides). Pain can radiate down the front of the hips and into the groin similar to where your underwear runs (along the path of the round ligament as it travels down to the labia). For some, it can present as a more general, dull ache in the lower belly during pregnancy. For some, it can present as a more general, dull ache in the lower belly during pregnancy.

Round ligament pain is most often provoke by quick movements, like:

• Moving from sitting to standing
• Coughing or sneezing
• Rolling over in bed

Round ligament symptoms can be painful, but usually they are pretty quick, lasting for only a few moments after aggravated.

Is round ligament pain in pregnancy dangerous?

Round ligament pain in pregnancy can be uncomfortable, and if you’ve never experienced it before, the pain can be alarming. The good news is that symptoms usually ease up by the third trimester and resolve completely after pregnancy, when your uterus shrinks back down to its pre-pregnancy size.

It is important to be able to distinguish round ligament pain from other types of abdominal pain in pregnancy. There are many causes of abdominal pain in pregnancy ranging from benign to serious conditions that need to be evaluated by a healthcare professional ASAP.

Common causes of abdominal pain in pregnancy:

• Gas pains
• Braxton Hicks contractions
• Constipation
• Abdominal strain
• Ectopic pregnancy
• Preterm labor
• Miscarriage
• Cyst rupture
• Abdominal, liver, or kidney problems
• Placental or uterine issues
• Preeclampsia

If you experience any new, changed, or persistent abdominal pain in pregnancy, it’s best to be evaluated by a healthcare provider, especially if you also have any of the following symptoms:

• Severe pain
• Vaginal spotting, bleeding, or new/different discharge
• Cramping pain that doesn’t improve with position changes or rest
• Low-grade fever, nausea, or vomiting
• Chills
• Painful urination

Pelvic floor physical therapy for round ligament pain in pregnancy

If these small adjustments don’t help (and even if they do), it's a good idea to schedule a visit with a pelvic floor physical therapist (PFPT). A specialized PFPT will listen to your symptoms, help rule out other complications, and do a complete assessment of your movement and strength (among other things) to help determine which exercises, body adjustments or stretches may reduce your symptoms.

A PT will also set you up for a more comfortable remainder of your pregnancy. While some discomfort can be expected as your body goes through extensive (and very impressive) amounts of change, you don’t have to "just deal with." There are many things we can do to minimize and even eliminate pain.

Pelvic physical therapy can play a key role in easing the discomfort of round ligament pain during pregnancy by improving posture, movement patterns, and core stability. Through gentle exercises, education, and hands-on techniques, physical therapists can support expectant mothers in navigating the physical challenges of pregnancy. 

Your physical therapy treatment for round ligament pain might include:

• Stretching: Stretching the muscles of the hips, legs, and shoulders might be recommended based on how you’re feeling. Gentle spinal mobility exercises and pelvic tilts may also help reduce pressure and discomfort on the lower abdominal area.
• Strengthening: Gentle core, upper back, and hip exercises could help with spinal alignment, improving comfort and endurance for daily activities.
• Body mechanics: As your body changes in pregnancy, it can help learn new and better ways to move to reduce strain on your body, while keeping your back, hips, and round ligaments happy.
• Tips on posture and positioning: Pregnancy changes or entire posture, from head to toes, which can place even more strain on your round ligaments. Correcting your posture can help to ease prolonged strain on your muscles, joints, and ligaments. 
• Support belts or Kinesio taping: Adding a bit of support is surprisingly helpful! Pregnancy support belts, belly bands, or Kinesio tape for extra support can help stabilize your pelvis and reduce strain on the round ligaments to provide relief during movement.
• Lifestyle modifications: Simple changes, such as avoiding sudden movements or adjusting sleeping positions, can lessen the frequency of round ligament pain. Physical therapists will help you identify and modify activities that might be aggravating the discomfort.
• Soft tissue massage: Gentle, targeted massage can help relax tight muscles surrounding the ligaments and relieve tension. This technique may also enhance circulation, aiding the body’s natural healing process and reducing inflammation in the affected area.

With pregnancy come many changes — some expected, and some unexpected. Whether you’re looking for relief from round ligament pain, want to learn proper pushing techniques or the best labor positions, or need guidance on postpartum recovery, we’re here to help. Our team offers both virtual and in-person evaluation and treatments, allowing you to receive expert care in the way that best suits your needs. 

Don’t let discomfort or pain limit your pregnancy experience. Take proactive steps towards a more comfortable pregnancy, and smoother postpartum recovery. Schedule an appointment with Origin Physical Therapy today and let us support you on your journey into parenthood.