You’re somewhere in the middle of your pregnancy when it starts. A deep ache in your lower back that feels different from the general heaviness you’ve come to expect. Pain through one or both sides of your pelvis when you roll over in bed at night. A sharp catch in your groin when you step out of the car. Walking up stairs has started to feel deliberate in a way it never did before, and getting dressed in the morning has quietly become something you think about and dread.
You mention it at your next prenatal appointment and are told it’s normal. That your body is preparing for birth. That it will resolve after the baby comes. You’re given a pamphlet about gentle stretching.
What you are not told is that what you are experiencing has a name, a well-understood mechanism, and a substantial body of research supporting specific physical therapy interventions that reduce pain, restore function, and allow women to move through the remainder of their pregnancy – and recover from it – far more comfortably than they would by simply waiting it out. You are not told that the passive advice to rest and accept it is not, in fact, what the evidence recommends.
Pelvic girdle pain during pregnancy affects somewhere between twenty and fifty percent of pregnant women, making it one of the most common musculoskeletal conditions in the entire perinatal period. For a significant proportion of those women it is severe enough to affect their ability to work, care for other children, sleep, and carry out the activities of daily life. It is not a minor inconvenience to be managed with reassurance. It is a clinical condition that responds to treatment.
What Pelvic Girdle Pain Actually Is
The Anatomy Involved
The pelvis is not a rigid structure. It is a ring made up of three joints: the two sacroiliac joints at the back, where the iliac bones of the pelvis meet the sacrum, and the pubic symphysis at the front, where the two halves of the pelvis meet in the midline. These joints are held together by some of the strongest ligaments in the body and are designed to transmit load between the spine and the lower limbs during every movement involving the trunk and legs – which is to say, virtually every movement you make.
Under normal circumstances these joints move very little. The sacroiliac joints have a few degrees of rotation and a small amount of glide. The pubic symphysis is essentially a cartilaginous joint with minimal mobility. The stability of the pelvic ring as a load-bearing structure depends on this controlled, limited motion and on the ligamentous and muscular systems that maintain it.
Pelvic girdle pain refers to pain arising from one or more of these three joints, experienced anywhere in the region bounded by the posterior iliac crest at the back and the gluteal fold below, and potentially radiating into the posterior thigh. Pain at the pubic symphysis – often called symphysis pubis dysfunction – is pelvic girdle pain localized to the front of the pelvis and frequently accompanies sacroiliac joint pain, though it can occur in isolation.
Why Pregnancy Creates the Conditions for It
Pregnancy produces a coordinated hormonal response that, among many other effects, changes the mechanical properties of the ligaments throughout the body. Relaxin, produced first by the corpus luteum and later by the placenta, acts on ligamentous tissue to increase its extensibility in preparation for labor and delivery. The pelvic ligaments – particularly those supporting the sacroiliac joints and pubic symphysis – are among the primary targets of this effect.
This is entirely appropriate and necessary for the birth process. The problem arises when the increased ligamentous laxity in the pelvis is not matched by adequate neuromuscular control of the pelvic joints. The bony and ligamentous stability of the pelvic ring is reduced. If the muscular system that compensates for this – the deep stabilizing muscles of the pelvis and lumbar spine, the pelvic floor, the hip stabilizers – does not adequately take up the stabilizing role that the ligaments can no longer fully perform, the pelvic joints are exposed to abnormal movement and stress under load.
The result is pain that is provoked by the activities that load the pelvis asymmetrically or in ways that require controlled, stable transfer of force across the pelvic ring: walking, climbing stairs, rolling over in bed, standing on one leg, getting in and out of a car, lifting. These are exactly the activities that characteristically provoke pelvic girdle pain, which is not a coincidence. They are the activities that most directly reveal the instability at the joint level.
The growing weight of the uterus shifts the center of gravity forward across the course of pregnancy, increasing the demand on posterior pelvic and lumbar structures and further loading already compromised joints. The expanding uterus also changes the length-tension relationships of the deep abdominal and pelvic stabilizing muscles, reducing their mechanical efficiency at exactly the point where their stabilizing function is most needed.
Sacroiliac Joint Pain Versus Symphysis Pubis Dysfunction
Both conditions are forms of pelvic girdle pain and frequently coexist, but their presentation and the activities that aggravate them can differ in ways that are clinically useful.
Sacroiliac joint pain is typically felt in the buttock and posterior pelvis, on one side more than the other in many cases, though bilateral pain is common. It is often provoked by weight-bearing activities, particularly those requiring prolonged standing, walking, or any activity involving a single-leg stance phase. It frequently disturbs sleep, as rolling over in bed loads the sacroiliac joints in ways that provoke pain.
Symphysis pubis dysfunction produces pain at the front of the pelvis, over the pubic bone, and sometimes into the inner thighs or groin. It is characteristically aggravated by activities that involve separating the legs – getting out of a car, stepping over objects, climbing stairs with a wide stance – because these movements create shear force across the symphysis. It can be acutely disabling, limiting stride length to the point that walking becomes a shuffle.
Understanding which joints are contributing to a woman’s pain helps direct treatment more precisely, which is one reason that proper clinical assessment by a physical therapist with training in pelvic health is so much more useful than generic advice to rest.
Why “It’s Just Normal Pregnancy” Is Not Good Enough
The Problem With Normalization
Pregnancy-related pelvic girdle pain has been normalized to a degree that causes real harm. When a condition affects up to half of pregnant women it can begin to seem like an inevitable biological experience rather than a clinical problem requiring management. Clinicians who see large volumes of obstetric patients can become accustomed to its presence and unconsciously lower their threshold for recommending treatment. Women who mention pain are reassured rather than referred.
The consequences of this normalization are not trivial. Studies following women with pelvic girdle pain during pregnancy have documented persistent symptoms at three months postpartum in a significant proportion of affected women, with some studies reporting ongoing pain at twelve months in women whose pain was severe during pregnancy and who did not receive adequate treatment. The assumption that delivery resolves everything is simply not supported by the data.
Beyond the postpartum timeline, the functional consequences during pregnancy itself are substantial. Women with moderate to severe pelvic girdle pain report higher rates of sick leave from work, greater difficulty with childcare for existing children, significant sleep disruption, and measurable impacts on psychological wellbeing. The experience of being dismissed with a pamphlet and told this is simply what pregnancy involves adds a layer of frustration and helplessness to what is already a physically challenging period.
What the Evidence Actually Recommends
Multiple clinical guidelines for the management of pregnancy-related pelvic girdle pain, including those from European obstetric and physiotherapy bodies that have been most active in this space, recommend specific exercise, manual therapy, and functional stabilization as the primary treatment approaches – not rest, not waiting, and not reassurance alone.
Targeted exercise programs addressing the deep stabilizing muscles of the lumbopelvic region have been shown in randomized controlled trials to reduce pain, improve function, and reduce sick leave in women with pregnancy-related pelvic girdle pain compared to standard obstetric care. A pelvic support belt used appropriately has evidence supporting pain reduction and functional improvement for sacroiliac joint pain specifically. Manual therapy techniques applied by a trained physiotherapist can reduce pain and improve mobility in affected joints. These are treatments that work. They are available. They are not being offered routinely to most pregnant women who need them.
What Physical Therapy Assessment and Treatment Looks Like
Assessment: Finding What Is Actually Going On
A physical therapy assessment for pelvic girdle pain during pregnancy begins with a detailed history that characterizes the pattern and provocation of the pain, the timeline of onset relative to gestational age, any previous episodes of pelvic girdle pain or low back pain, obstetric history, and the functional activities most significantly affected.
Physical assessment includes specific clinical tests for sacroiliac joint and symphysis pubis dysfunction – the posterior pelvic pain provocation test, the active straight leg raise test, the FABER test, and assessment of pubic symphysis tenderness – that allow the clinician to identify which joints are symptomatic and to gauge the degree of lumbopelvic instability. Assessment of hip mobility, lumbopelvic alignment, and movement quality during functional tasks provides additional information about contributing factors.
The active straight leg raise test deserves particular mention because it provides information that is directly actionable. The test asks a woman to lift one leg while lying on her back and assesses both the effort required and whether manual compression across the pelvis – simulating the effect of muscular or belt stabilization of the sacroiliac joints – reduces the perceived effort. A positive response to compression tells the clinician that the pain and movement difficulty are driven by insufficient force closure of the pelvic joints and that stabilization strategies are likely to be the most effective approach. This is exactly the kind of information that allows treatment to be targeted rather than generic.
Stabilization Exercise: The Foundation of Treatment
The cornerstone of physical therapy management for pelvic girdle pain is a progressive exercise program targeting the deep stabilizing musculature of the lumbopelvic region. The muscles most directly relevant are the deep fibers of the multifidus, the transversus abdominis, and the pelvic floor – the local stabilizing system of the lumbar spine and pelvis that, when functioning well, provides the active contribution to force closure of the sacroiliac joints that pregnancy-related ligamentous laxity reduces.
These exercises look nothing like a conventional gym workout and feel very different from the large-movement abdominal exercises many women associate with core training. They are subtle, controlled, and initially performed in positions that minimize the load demand on the pelvic joints while the neuromuscular control system is being reactivated and retrained. The goal is not strength in the conventional sense – it is the precise, coordinated activation of specific muscles at specific moments in the movement cycle that produces pelvic joint stability under load.
As control improves, exercise is progressed to more functional positions and eventually to the movements and activities that have been most limited by pain. A woman who has not been able to walk without pain for two weeks does not go directly from lying-down stabilization work to full walking rehabilitation. The progression is structured and guided by both symptom response and the demonstration of adequate control at each level before advancing.
Hip strengthening exercises – targeting the glute medius, deep hip external rotators, and hip extensors – complement the deep stabilization work by addressing the musculature that controls the position of the femur in the hip socket during single-leg activities, reducing the rotational demand on the sacroiliac joints during walking and stair climbing. These muscles are frequently underloaded in daily life and respond well to targeted exercise even in the third trimester when positions and loads must be modified for comfort and safety.
Pelvic Support Belts: How They Work and When They Help
Pelvic support belts – trochanteric belts worn around the pelvis at the level of the greater trochanters rather than maternity support belts worn higher across the abdomen – work by providing external compression across the sacroiliac joints, supplementing the force closure that the ligamentous and muscular systems are struggling to provide. For women with sacroiliac joint involvement, a properly fitted and positioned pelvic belt can meaningfully reduce pain during weight-bearing activities.
The critical word is properly. A belt worn in the wrong position, too loosely, or at the wrong level does not provide useful compression across the right structures and will not produce the intended benefit. Physical therapy assessment includes guidance on whether a belt is likely to help based on the active straight leg raise test finding, instruction in correct positioning and use, and practical guidance on when to wear it – typically during activities that provoke pain, not all day every day, which can reduce the muscular activation that is also needed.
A pelvic belt is a useful adjunct to treatment, not a substitute for the exercise program that addresses the underlying instability. Women who wear a belt but do not do the stabilization work may have some pain relief in the short term but are not building the neuromuscular capacity that reduces pain during the remainder of pregnancy and protects them in the postpartum period.
Manual Therapy and Movement Guidance
Hands-on treatment from a physiotherapist trained in pelvic health can address pain and movement restrictions contributing to the overall picture. Gentle mobilization techniques, soft tissue work addressing muscle guarding and tension patterns, and specific techniques for the sacroiliac joints and pubic symphysis can reduce pain and improve the quality of movement available for rehabilitation exercise.
Equally important is specific guidance on movement strategies for the activities most likely to aggravate pain. Getting in and out of bed, rising from a chair, climbing stairs, getting in and out of a car – these movements can all be modified in ways that reduce the asymmetrical loading and shear forces through the pelvic joints that provoke pain. Learning to keep the legs together during transitions, to reduce stride length during walking, to use hip hinge mechanics for loading tasks – these practical strategies can significantly reduce the daily pain burden while the exercise program is building the capacity to handle these tasks more robustly.
Postpartum: Why Treatment Does Not Automatically Stop at Delivery
The hormonal influences on ligamentous laxity do not resolve immediately at delivery. Relaxin levels remain elevated during breastfeeding, and the physical demands on the postpartum body – lifting, feeding, carrying, returning to activity – can continue to load a lumbopelvic system that has not yet fully restored its pre-pregnancy stability.
Women who experience significant pelvic girdle pain during pregnancy benefit from a postpartum physiotherapy assessment regardless of whether their symptoms have fully resolved, because the assessment can identify residual deficits in strength and control that, if not addressed, may contribute to persistent symptoms or to difficulty returning to exercise and sport. The window between delivery and the return to higher activity demands is a meaningful opportunity to complete the rehabilitation work that the pregnancy period initiated.
For women whose symptoms persist beyond six to eight weeks postpartum, physiotherapy assessment and treatment is clearly indicated and should not be delayed. Persistent pelvic girdle pain is not a normal postpartum experience and does not need to be accepted as one.
What You Can Do Right Now
Understanding Your Own Pattern
The most useful thing a pregnant woman experiencing pelvic girdle pain can do before a physiotherapy assessment is to develop a clear picture of her own pain pattern: which activities provoke it, which positions relieve it, whether it is predominantly at the back of the pelvis, the front, or both, and whether it is worse at particular times of day or following particular activities.
This information is genuinely useful to the assessing clinician and helps ensure the first appointment is as productive as possible. It also begins the process of relating symptoms to mechanical causes, which is an important foundation for understanding and engaging with the treatment.
Practical Modifications That Reduce Load
While waiting for assessment, a few practical principles can reduce daily pain load. Keeping the knees together during any movement that involves rotating the pelvis – rolling over in bed, getting in and out of a car, rising from low seating – reduces shear force across the symphysis pubis. Sitting to perform tasks that would otherwise require standing on one leg – such as getting dressed – reduces the single-leg stance demand on the sacroiliac joints. Sleeping with a pillow between the knees reduces hip adduction and the associated pelvic rotation during the night. Shortening stride length during walking reduces the range of sacroiliac joint motion with each step.
These are symptom management strategies, not treatment. They reduce the pain load of daily activity but do not address the underlying instability. They are useful in the interim, but they are not a substitute for the assessment and exercise program that actually builds the capacity to move without pain.
Asking for the Right Referral
If you are experiencing pelvic girdle pain and have been told to rest and wait, you have the right to ask for a physiotherapy referral. Specifically ask to be seen by a physiotherapist with experience in pregnancy-related pelvic girdle pain or pelvic health physiotherapy, because the assessment and treatment of this condition requires specific clinical training that not all physiotherapists have.
A physiotherapist working in this area will be able to tell you which joints are involved, what is driving the instability, what the appropriate exercise progression looks like for your specific presentation, whether a pelvic belt is likely to help you, and how to think about postpartum recovery. That is a very different outcome from a pamphlet.
Pain During Pregnancy Is Not a Cost of Entry
High school runners push through shin pain because they do not know where the line is between manageable discomfort and structural damage. Pregnant women live with pelvic girdle pain because they have been told it is simply what pregnancy involves. In both cases the underlying message is the same: your pain is normal, it will pass, and there is nothing meaningful to be done about it.
In both cases the message is wrong.
Pelvic girdle pain during pregnancy has real causes, real treatments, and a real evidence base supporting those treatments. It is not an inevitable feature of pregnancy to be endured. It is a clinical condition that responds to skilled assessment and appropriately targeted physical therapy, that affects quality of life significantly when left unmanaged, and that carries forward into the postpartum period in a proportion of women who never received adequate treatment.
You deserve more than reassurance. You deserve to understand what is happening in your body, to have the contributing factors identified, and to receive a treatment plan built around your specific presentation that gives you the tools to move through your pregnancy and early postpartum period with as much comfort and function as possible.
The women’s health physiotherapy team at DeRosa Physical Therapy in provides specialist assessment and treatment for pelvic girdle pain throughout pregnancy and the postpartum period. We work with you to identify the mechanical drivers of your pain, design a progressive stabilization program appropriate to your stage of pregnancy and current capacity, provide guidance on movement strategies and pelvic belt use, and support your recovery through the postpartum transition.
You do not have to wait for delivery and hope for the best. Call us today at (609) 601-6140 to schedule a pelvic girdle pain assessment and get a clear, evidence-based picture of what is causing your pain and what will actually help.
