Pregnancy-related Pelvic Girdle Pain: What's going on?

Pregnancy is a time of rapid and remarkable change. The body adapts to support a growing baby, prepare for delivery, and transition into postpartum and breastfeeding. For many people, these changes happen smoothly. For others, they can come with discomfort, including pelvic girdle pain during pregnancy. Pelvic girdle pain can feel confusing, unpredictable, and limiting. If you are experiencing it, you are not alone.

What is Pelvic Girdle Pain in Pregnancy?

Pregnancy-related pelvic girdle pain (PPGP) refers to pain around the pelvic ring. This can include:

• Sacroiliac joint pain in the back of the pelvis

• Pubic symphysis pain in the front of the pelvis

• Gluteal or lateral hip pain

• Low back pain

• Perineal or pelvic floor discomfort

Symptoms vary widely and are often not well localized, which can make diagnosis and treatment feel unclear. Research estimates that 3.9% to 89.9% of pregnant people experience pelvic girdle pain or low back pain, with an average of 45.3% (Wu).

Causes of Pelvic Girdle Pain During Pregnancy

Pelvic girdle pain has historically been attributed to posture changes and hormonal shifts during pregnancy. While these factors may contribute, research has not demonstrated a clear causal relationship (Franklin, Marnach, Bjorklund, Aldabe). Pelvic girdle pain is best understood as a multifactorial condition.

Known risk factors include:

• Previous low back pain

• Prior pelvic or back trauma

• Increased stress levels

• Lower job satisfaction (Albert)

The experience of pelvic pain is influenced by physical, emotional, and social factors.

A Whole-Body Approach to Pelvic Pain

During pregnancy, the body adapts in individualized ways. Common changes may include:

• The rib cage shifting backward while the pelvis moves forward

• Changes in breathing mechanics

• Altered coordination of the core and pelvic floor

• Increased joint mobility

The pelvis does not become unstable or unsupported. Muscles, fascia, and the nervous system adapt to maintain functional stability in most individuals. Pain is a complex signal from brain influenced by multiple systems, including movement, load, stress, and beliefs, prior experiences. This helps explain why symptoms vary widely between individuals.

Treatment for Pelvic Girdle Pain in Pregnancy

Education

Understanding pelvic girdle pain can reduce fear and improve confidence with movement.

A helpful patient resource is available through the Pelvic Obstetric and Gynecological Physiotherapy group.

Exercise and Movement

General exercise is helpful for overall health but may not fully address pelvic girdle pain. Research supports:

• Individualized stabilization exercises

• Supervised and tailored rehabilitation programs

  
  

Helpful exercise approaches that we use regularly in our Philadelphia clinic include:

• Stabilization exercises: Improve coordination between the diaphragm, pelvic floor, transverse abdominis, and multifidus muscles.

• Posterior chain exercises: Support the back of the pelvis through coordination of the gluteus maximus and latissimus dorsi.

• Anterior chain exercises: Support the front of the pelvis through coordination of the obliques and adductors.

• Glute strengthening: Helpful for gluteal tendinopathy and lateral hip pain.

• Aquatic exercise: Promotes movement and strength while reducing load.

• Pelvic floor exercises should be individualized. Both overactivity and underactivity can contribute to symptoms.

External Support

• Non-rigid pelvic support belts can reduce pain more than education alone (Liddle)

• Supportive pillows may improve sleep and reduce pain in later pregnancy (Young)

Acupuncture

Acupuncture may reduce pelvic girdle pain and can enhance the effects of exercise and education (Liddle, Elden).

Multimodal Physical Therapy

Multimodal care that includes manual therapy, exercise, and education is more effective than single interventions alone. Manual therapy has been shown to reduce pain more than no treatment (Liddle).

How Pelvic Floor Physical Therapy Helps

Pelvic health physical therapy can help you:

• Identify movement and lifestyle contributors to pain

• Modify daily activities to reduce strain

• Improve coordination and strength through targeted exercise

• Use manual therapy to reduce discomfort

• Explore and teach how to use supportive tools such as belts, pillows, or taping

• Address fear and uncertainty related to pain

This approach helps bring clarity and direction to recovery.

Final Thoughts

Pelvic girdle pain during pregnancy is common, but it is not something you have to simply tolerate. With the right support, many people experience meaningful improvements in pain, movement, and confidence during pregnancy and postpartum.

References

1. Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI, Östgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal. 2004 Nov;13(7):575-89.

2. Franklin ME, Conner-Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. Journal of Orthopaedic and Sports Physical Therapy. 1998 Sep;28(3):133-8.

3. Marnach ML, Ramin KD, Ramsey PS, Song SW, Stensland JJ, An KN. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol. 2003;101:331-5.

4. Bjorklund K, Bergstrom S, Nordstrom ML, Ulmsten U. Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79:269-75.

5. Aldabe D, Ribeiro DC, Milosavljevic S, Bussey MD. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European Spine Journal. 2012 Sep;21(9):1769-76.

6. Albert HB, Godskesen M, Korsholm L, Westergaard JG. Risk factors in developing pregnancy-related pelvic girdle pain. Acta Obstetricia et Gynecologica Scandinavica. 2006 May;85(5):539-44.

7. Moore K, Dumas GA, Reid JG. Postural changes associated with pregnancy and their relationship with low back pain. Clinical Biomechanics. 1990 Aug;5(3):169-74.

8. Biviá-Roig G, Lisón JF, Sánchez-Zuriaga D. Changes in trunk posture and muscle responses in standing during pregnancy and postpartum. PLoS One. 2018;13(3):e0194853.

9. Shiri R, Coggon D, Falah-Hassani K. Exercise for the prevention of low back and pelvic girdle pain in pregnancy: A meta-analysis of randomized controlled trials. European Journal of Pain. 2018 Jan;22(1):19-27.

10. Liddle SD, Pennick V. Interventions for preventing and treating low back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews. 2015(9).

11. Bogaert J, Stack M, Partington S, Marceca J, Tremback-Ball A. The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women. Annals of PRM. 2018;61:157-158.

12. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Practice. 2010;10(1):60-71.

13. Stuge B. Evidence of stabilizing exercises for low back and pelvic girdle pain. Brazilian Journal of Physical Therapy. 2019 Mar;23(2):181-6.

14. Young G, Jewell D. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2002;(1):CD001139.

15. Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain. BMJ. 2005;330:761.

Looking for Pelvic Floor Physical Therapy in Philadelphia?

If you are experiencing pelvic girdle pain during pregnancy or postpartum pelvic pain, individualized care can make a meaningful difference. At Hazel Physical Therapy, we provide pelvic floor physical therapy, prenatal physical therapy, and postpartum care in Philadelphia to help you move with less pain and more confidence. Schedule an evaluation to get started.

This post has been adapted from the original post written by Joanna Hess and published on April 2020 on the Beyond Basics Blog.