Pregnancy pelvic girdle pain (PGP) refers to discomfort and pain experienced around the pelvic region during pregnancy, involving the joints of the pelvis and lower back. It is one of the most common presentations to a physiotherapist in pregnancy.

Symptoms may include sharp, shooting pain or a dull ache that can radiate to the thighs or lower back, particularly with movement (sit to stand, rolling in bed) or weight-bearing activities (putting undies on, walking).

PGP in pregnancy and through the first postpartum year is common and combined with low back pain is estimated to occur in 56%–72% pregnant women. Early intervention in pregnancy and instilling the belief that it can improve will create a better long-term outcome.

Previously we believed PGP was caused by ligament laxity by the increase in the hormone relaxin. We now know that is not the case. If relaxin was to blame, every pregnant woman would experience PGP. The current belief is that PGP is caused my multiple factors including changes to posture through the pregnancy, previous pelvic trauma or low back pain, even work dissatisfaction has now been shown to be a risk factor. Hormones do play a role in PGP however it is more from the sense that relaxin may create more sensitivity to the tissues surrounding the pelvis including the muscles and joints. This combined with other factors can increase the experience of pain.

Some common misconceptions about PGP are:

Pelvic pain is a normal part of pregnancy.
The hormone relaxin makes the pelvis unstable.
Pelvic pain is caused by unstable pelvic ligaments and joints.
Birthing vaginally will worsen pelvic pain

Some important things to remember if your dealing with PGP are:

STABLE: Your pelvis is inherently stable. It’s resilient and adaptable to the changes in pregnancy and birth whilst remaining stable.
SAFE: The structural changes that occur to your pelvis are necessary, normal and safe. They are required to create space to hold and birth your baby.
MANAGEABLE: This condition is self manageable with advice regarding exercises, emotional wellbeing, sleep optimisation and external supports.

Some common tips when managing pelvic girdle pain:

Try rolling in bed one of two ways

Legs together like your wearing a mini skirt
Legs apart like your opening and closing a book

Try sitting down to get dressed if your getting pain when standing on one leg
Getting in and out of a car can be more comfortable when keeping the legs together like your wearing a mini skirt

The most common exercises I prescribe to my clients when they have PGP are:

Inner thigh, glute, hip flexor and hamstring stretches
Glute massage using a ball against the wall
Sit to stand
Open book stretch for the middle back
Cat and cow stretch

Check out this video for demonstrations on each exercise.

And finally, the products my clients have found help them the most are:

How to reduce pelvic girdle pain in pregnancy

The most important thing to remember is that early intervention for PGP is essential to help make sense of the pain experience, believe in the possibility of change and adopt positive lifestyle habits throughout your pregnancy for improved health and birth outcomes.

Reference:

Pulsifer J, Britnell S, Sim A, et al. Br J Sports Med: [Monday, January, 2025]. doi:10.1136/bjsports-2022-105724