Pelvic Girdle Pain in Pregnancy (PGP) is pain that comes from the joints, ligaments, and muscles around the pelvis during pregnancy. The pelvis is a ring made up of two hip bones (the ilium bones) and the sacrum (the triangular bone at the base of the spine). The joints at the back are the sacroiliac joints, and the joint at the front is the pubic symphysis. These joints are normally stable, supported by strong ligaments and coordinated muscle control.
During pregnancy, your body needs the pelvis to adapt. As your baby grows, the load through the pelvis increases and your posture changes. Hormonal shifts also affect connective tissue. Many people have heard of relaxin, a hormone that contributes to softening of ligaments during pregnancy. The result can be that the pelvic joints become more sensitive and feel less stable, especially with tasks that load the joints unevenly such as walking hills, climbing stairs, standing on one leg, or rolling in bed.
PGP is common. It can range from mild discomfort to pain that significantly affects mobility and day-to-day life. It may be felt at the front of the pelvis over the pubic bone, at the back near one or both sacroiliac joints, or in a combined pattern that can radiate into the hips, groin, buttocks, or thighs. Some people notice clicking or grinding in the pelvic area, and many find symptoms are worse later in the day or after being active.
Physiotherapy for pelvic girdle pain in pregnancy is one of the most helpful conservative treatments. A women’s health physiotherapist can assess which joints and movement patterns are provoking symptoms, then provide a tailored plan that usually includes specific exercises, activity modification, supportive taping or belts, manual therapy when appropriate, and practical advice for walking, sleeping, getting dressed, working, and planning for labour and birth. Earlier assessment usually makes it easier to settle symptoms and keep you active and comfortable as pregnancy progresses.
Key Facts
- Pelvic girdle pain is really common in pregnancy. In a large Australian study, about 44% of pregnant women were classified as having pregnancy-related PGP (nearly 1 in 2). 🔗
- It has a clear “where it hurts” pattern. It’s usually pain around the back of the pelvis (near the sacroiliac joints) and can spread into the back of the thigh; it may also be felt at the front pubic joint. It often makes standing, walking, or sitting harder. 🔗
- Physiotherapy can help manage pelvic girdle pain. Gentle, targeted exercises that focus on strength and stability can reduce pain and make daily activities easier. Exercise programs should be tailored to you, as pushing too hard can make symptoms worse. Some people also find that a pelvic support belt provides short-term pain relief. 🔗
Risk Factors
- Previous history of lower back or pelvic pain before pregnancy.
- Pelvic girdle pain in a previous pregnancy.
- Physically demanding work (prolonged standing, walking, lifting, or manual tasks) while pregnant.
- Higher body mass index (higher overall load through the pelvis).
- Low physical activity levels (reduced baseline strength and endurance can reduce load tolerance).
- Hypermobility (joints that naturally move more than average), in some people.
Symptoms
- Pain over the pubic bone at the front of the pelvis (pubic symphysis pain).
- Pain across one or both sides of the lower back or buttock region (sacroiliac joint area).
- Pain radiating into the hips, groin, buttocks, or thighs.
- Pain or discomfort when walking, especially longer distances or on uneven ground.
- Pain going up or down stairs, hills, or stepping into and out of the car.
- Pain standing on one leg, such as when getting dressed or putting on shoes.
- Pain when turning over in bed or changing positions after resting.
- Clicking, locking, or grinding sensations in the pelvic joints (not everyone experiences this).
Aggravating Factors
- Standing on one leg to get dressed, put on shoes, or step into pants.
- Walking for extended periods, fast walking, or walking on uneven surfaces.
- Climbing stairs or hills, especially if taking stairs two at a time.
- Rolling in bed or getting in and out of bed without keeping knees together.
- Getting in and out of the car, especially with knees wide apart.
- Deep squats or lunges that widen the pelvis or load one side more than the other.
- Standing or sitting for long periods without breaks, particularly on harder chairs.
- Carrying older children or heavy loads on one hip or on one side.
Causes
PGP in pregnancy is usually related to a combination of load, movement control, and tissue sensitivity around the pelvic joints.
Pregnancy-related changes in load and posture are a major driver. As your baby grows, your centre of mass shifts and the way you stand and walk often changes. This increases the demand on the pelvic joints, hip muscles, pelvic floor, and deep abdominal muscles that contribute to stability.
Hormonal changes can soften the ligaments that support the pelvis. The goal of this process is to allow the pelvis to adapt in preparation for birth. For some women, the combination of softer ligaments plus higher mechanical load can make the pelvic joints more sensitive, especially when the joints are loaded unevenly.
Uneven movement or ‘shearing’ forces through the pelvis can trigger pain. This is why activities such as stairs, lunging, getting out of a car, or standing on one leg often feel worse. These tasks can place more load through one side of the pelvis or create a twisting force through the pubic symphysis and sacroiliac joints.
Muscle coordination and endurance also matter. The pelvic girdle relies on hip muscles (including gluteals), pelvic floor muscles, and deep abdominal muscles to work together with breathing and posture. When these muscles fatigue, are weak, or are not coordinating well, the pelvis can feel less supported and symptoms can flare, particularly later in the day.
PGP does not mean your pelvis is “out” or that something is permanently damaged. It usually reflects a sensitive system that benefits from the right support, the right exercise, and smarter ways of moving. Physiotherapy for pelvic girdle pain in pregnancy is aimed at reducing joint irritation, improving how load is shared through the pelvis, and helping you keep moving confidently through pregnancy.
How Is It Diagnosed?
PGP is diagnosed primarily through a detailed history and physical examination. Your physiotherapist will ask where the pain is located (front, back, one side, both sides), what activities trigger it (stairs, walking, rolling, standing on one leg), how long it has been present, and how it is affecting your daily life, sleep, work, and exercise.
Physical examination usually focuses on observing how you move and load your pelvis rather than forcing painful tests. A pregnancy-trained physiotherapist may assess walking pattern, single-leg load tolerance, hip strength, pelvic floor coordination, deep abdominal control, and posture. They will also screen for other sources of pain, such as lumbar spine pain, hip joint pain, or nerve-related symptoms.
PGP is common, but not all pelvic pain in pregnancy is PGP. If your symptoms are severe, rapidly worsening, associated with neurological symptoms (numbness, weakness), fever, unusual vaginal bleeding, or pain that is not mechanically related, you should seek medical review promptly.
Early physiotherapy assessment can be particularly helpful because it allows you to learn strategies to reduce aggravation and build support before symptoms become more disabling.
Investigations & Imaging
- Imaging (usually not required)
- PGP is typically diagnosed clinically. Imaging is usually reserved for atypical symptoms, trauma, or when a different diagnosis is suspected.
- Ultrasound or MRI (medical referral if needed)
- May be used in selected cases to investigate other causes of pelvic pain when symptoms do not fit typical PGP patterns.
Grading / Classification
- Anterior PGP (pubic symphysis dominant)
- Pain is mainly at the front of the pelvis over the pubic bone, often worse with stairs, getting dressed, turning in bed, stepping in and out of the car, or widening the knees.
- Posterior PGP (sacroiliac joint dominant)
- Pain is mainly around the lower back/buttock area on one or both sides, often worse with walking, uneven ground, prolonged standing, or single-leg tasks.
- Combined PGP
- Pain is felt at both the pubic symphysis and one or both sacroiliac joints, commonly with more widespread radiation into hips, groin, or thighs.
Physiotherapy Management
Physiotherapy for pelvic girdle pain in pregnancy focuses on keeping you mobile and comfortable while reducing irritation of the pelvic joints. A women’s health physiotherapist will tailor strategies to your pain location (front, back, one side, both sides), your daily demands (work, caring for other children, commuting), and your stage of pregnancy.
Most physiotherapy plans combine: targeted exercise to improve pelvic support, practical activity modification to reduce flare-ups, manual therapy when appropriate, and supportive devices such as taping or a pelvic belt. You will also receive education on sleep positions, walking strategies, getting in and out of bed and the car, and labour and birth positioning options that keep you comfortable.
PGP is not something you should simply “push through”. The right balance is usually moving within your pain limits while avoiding repeated triggers that spike symptoms and reduce your ability to stay active.
Exercise
Exercise prescription for PGP aims to improve the stability and load-sharing of the pelvic ring. Rather than long, exhausting workouts, pregnancy PGP rehab often uses short, specific exercises that are repeated consistently.
Your physiotherapist may focus on gluteal and hip strength (especially the muscles that control the pelvis during walking and single-leg tasks), deep abdominal control, and pelvic floor coordination. These muscles work together to reduce strain through the sacroiliac joints and pubic symphysis.
Exercise is also about confidence and function. A good PGP program helps you tolerate walking, stairs, and rolling in bed with less pain. Many women do best when exercises are progressed gradually, staying below a flare threshold. If an exercise consistently increases pain during or after, your physiotherapist will modify it to keep rehab productive rather than aggravating.
Aquatic exercise may also be recommended because buoyancy reduces load through the pelvis while allowing you to maintain fitness and hip movement.
Activity Modification
Activity modification is one of the quickest ways to reduce PGP symptoms. The principle is to minimise uneven loading of the pelvis while keeping you active. Small changes can make a big difference.
Common physiotherapy strategies include: taking stairs one step at a time, shortening your walking distance and taking more breaks, avoiding wide steps or lunges, and keeping knees together when moving in and out of bed or the car. If standing on one leg is painful, your physiotherapist will show you alternatives for dressing, shoes, and stairs that keep the pelvis more symmetrical.
For work, modification might include changing task rotation, reducing prolonged standing, using a supportive chair with good back support, and taking micro-breaks to change positions. For home life, it can include avoiding carrying heavy loads on one hip and using practical aids (for example, placing items at bench height to reduce repeated bending and twisting).
Manual Therapy
Manual therapy can be helpful for some women with PGP, particularly when stiffness in the hips or lower back is contributing to poor load distribution. Physiotherapists may use gentle mobilisations of the hips, lumbar spine, or pelvic joints, and soft tissue techniques to reduce muscle guarding around the pelvis.
Manual therapy in pregnancy PGP should feel safe and controlled. It is not about forcefully “clicking the pelvis back in”. Instead, it is used to improve comfort and movement efficiency so that you can walk, roll, and perform daily tasks with less irritation.
Manual therapy is most effective when paired with exercise and practical movement changes, because the long-term improvement usually comes from better muscle support and better load management.
Postural Retraining
Postural retraining for PGP is about how you stand, walk, and transfer load through your pelvis, not about holding a rigid “perfect posture”. In pregnancy, your body naturally changes. The goal is to reduce sustained positions that increase pelvic strain and to improve how the trunk and hips share load.
Your physiotherapist may coach you to: take smaller steps, avoid swinging one leg far out to the side when walking, keep movements more symmetrical, and use your glutes effectively during gait. Simple cues for getting up from a chair, turning in bed, and lifting can reduce repeated pain spikes.
Breathing and trunk pressure strategies can also matter. Some women brace and hold their breath when standing up or lifting, which can increase strain through the pelvis. Physiotherapy often includes breath-coordinated movement to make tasks feel easier.
Bracing & Taping
Bracing and taping are commonly used for PGP in pregnancy. A non-rigid pelvic support belt or targeted taping can provide a feeling of support and reduce pain during walking, stairs, and daily tasks. Belts are often most helpful during more active periods of the day, rather than worn continuously without breaks.
Fit matters. A women’s health physiotherapist can help choose the right belt type, position it correctly (usually low around the pelvis rather than high on the belly), and advise when to wear it. Used well, a belt can reduce symptoms enough to allow you to keep moving and keep strengthening, which is vital for longer-term improvement.
Taping can be a useful alternative for women who prefer not to wear a belt all day, or who need targeted support over the pubic symphysis or posterior pelvis.
Heat & Ice
Heat and ice can be useful for settling pelvic girdle pain symptoms. Many women find ice helps after a flare-up, especially following walking or standing tasks. Use an ice pack for around 20–30 minutes, and always wrap it in a cloth or towel to protect your skin. Heat can also feel soothing for tight muscles around the hips and lower back, but it should be used sensibly and as a support to your overall rehab plan, not a replacement for it.
Education
Education is a major part of physiotherapy for PGP. Your physiotherapist will teach you practical strategies that apply immediately, including:
How to roll in bed with knees together, how to get in and out of the car with less pain, how to use stairs one step at a time, and how to modify walking (smaller steps, shorter distances, more breaks). You will also receive advice about supportive footwear (flat, comfortable, supportive shoes) and how to reduce pelvic strain during daily chores.
Labour and birth education is also important for many women with PGP. This may include discussing positions that avoid forced wide leg separation, and helping you communicate your PGP needs to your midwife or obstetric team so you feel confident and supported.
Other
Other physiotherapy options may include recommending aquatic exercise to offload joints while maintaining movement and fitness, pacing strategies for work and parenting demands, and advice on assistive devices (for example, a walking aid for short periods in severe cases). If symptoms are significantly limiting mobility, your physiotherapist can also liaise with your GP or maternity care team to coordinate broader support.
Other Treatments
Other treatments for PGP may include appropriate pain relief as advised by your GP, maternity care provider, or pharmacist (medication choices can differ during pregnancy). Some women explore acupuncture or other supportive therapies. If you do, it is important to choose a practitioner experienced with pregnancy and to keep your obstetric team informed.
For many women, the most effective approach is a combined plan: physiotherapy for pelvic girdle pain in pregnancy, supportive belt or taping, and practical daily modifications that reduce repeated flare triggers.
Prognosis & Return to Activity
The outlook for PGP is generally positive, especially with early diagnosis and a structured management plan. Symptoms can fluctuate as pregnancy progresses because the load through the pelvis increases, but many women improve with physiotherapy strategies that reduce joint irritation and build better support.
After birth, a large proportion of women experience gradual improvement over weeks to months, particularly when they continue appropriate strengthening and avoid early overload. If symptoms persist postpartum, physiotherapy remains very helpful, and a reassessment can identify ongoing drivers such as hip weakness, pelvic floor dysfunction, or movement patterns that keep the pelvis irritated.
The earlier you seek help, the easier it usually is to reduce pain spikes, stay active, and maintain quality of life through the remainder of pregnancy.
Complications
- Reduced mobility and decreased tolerance to walking, stairs, and daily activities, which can affect work and caring responsibilities.
- Sleep disruption due to pain when turning in bed or finding a comfortable position.
- Deconditioning and increased fear of movement if pain leads to avoiding activity for long periods.
- Ongoing pelvic pain postpartum in a smaller group, particularly if symptoms were severe and not managed early.
Preventing Recurrence
- Keep movements symmetrical: avoid repeated single-leg loading, take smaller steps, and avoid wide lunges to reduce shearing through the pubic symphysis and sacroiliac joints.
- Maintain hip and pelvic support strength with a pregnancy-safe program (guided by a physiotherapist) so muscles can share load as ligaments soften.
- Use supportive strategies early when symptoms appear (belt or taping, activity pacing) rather than waiting until pain becomes severe.
- Plan walking and chores: shorter distances, more breaks, and avoid carrying loads on one hip to reduce repeated joint irritation.
When to See a Physio
- If pelvic pain is affecting walking, stairs, sleep, or daily tasks like dressing and getting in and out of the car.
- If you are limping, avoiding movement, or feeling your mobility reduce week by week.
- If pain is worsening rather than settling with rest and simple changes, especially as pregnancy progresses.
- If you want a plan for labour and birth positions that take your pelvic pain into account.