Episode 14 | Ask the Expert | Guest: Diedre – Pelvic Health Physiotherapist
Pelvic girdle pain (PGP) is one of the most common musculoskeletal complaints in pregnancy – affecting approximately 20% of pregnant women – and one of the most under-treated. Many women are told to simply manage with crutches and a support belt for the remainder of their pregnancy. That, says pelvic health physiotherapist Diedre, is rarely the right answer.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Diedre for a third time – following earlier episodes on pelvic health and men’s pelvic health – to explore PGP specifically. This is the practical guide to understanding and managing pelvic girdle pain that most pregnant women never receive.
What is pelvic girdle pain?
Pelvic girdle pain is an umbrella term for pain experienced in and around the pelvis during pregnancy. It has previously been called Symphysis Pubis Dysfunction (SPD) – a name that is still widely used – but PGP is the preferred term because it captures the fact that pain can occur across a wider area than just the pubic symphysis at the front.
The pain can occur in multiple locations:
- Front of the pelvis – around the pubic symphysis
- Lower back and sacroiliac joints (SIJ)
- Top of the hip bones (iliac crest)
- Underneath the pelvis and into the buttocks
- Down the back of the leg
The most commonly affected areas are the lower back, the sacroiliac joints, and the pubic symphysis at the front. All three can occur simultaneously.
Why does it happen?
The causes of PGP are not fully understood, but several contributing factors are well established.
The most significant risk factors are:
- Previous back or pelvic pain: the strongest predictor. An area that has been sensitised by previous injury is more likely to become painful again when the demands of pregnancy increase
- Smoking: associated with heightened pain sensitisation
- Hormonal changes: pregnancy hormones reduce the stiffness of ligaments and connective tissue, which is necessary for childbirth but also means less structural support around the pelvis – increasing load through the joints
- Postural factors and muscle imbalance: pre-existing weakness or imbalance in the muscles around the pelvis
Notably, baby size and number of previous pregnancies have not been shown to be significant risk factors. The assumption that a large baby is the primary cause of pelvic pain is a common misconception.
One telling observation: PGP can begin as early as eight to ten weeks into pregnancy – when there is virtually no bump yet. This points firmly to hormonal and sensitisation factors rather than mechanical pressure from the growing baby.
When should you seek help – and from whom?
Not all pelvic pain in pregnancy signals PGP, and it is important to distinguish between different types. The key distinction is between pain that has clear mechanical triggers (worse when turning in bed, standing for long periods, getting in and out of the car) and pain that is unpredictable, random, or accompanied by bleeding or sharp internal sensations.
Diedre’s guidance:
- Sharp pelvic pain or any bleeding: contact your midwife or fetal medicine unit promptly
- Aching, mechanical pelvic or back pain with clear triggers: a physiotherapist specialising in pelvic health is likely the most appropriate first step
- Unsure which applies: your midwife is always a safe first point of contact
PGP can begin at any stage of pregnancy and there is no point at which it is too early or too late to seek physiotherapy input. Diedre has seen women present with PGP at eight weeks and others at one week before their due date. Both can benefit from treatment.
Treatment: what actually works
The historical approach of issuing crutches and a pelvic support belt and sending women home for the remainder of their pregnancy is, as Diedre puts it, not good for long-term recovery. While some women do need this level of support – particularly those with severe pain – it should not be the only option offered.
Effective physiotherapy for PGP combines two elements that work best together:
- Strengthening: targeted exercises for the muscles around the pelvis to provide better support and counteract the ligament laxity caused by hormonal changes
- Manual therapy: hands-on treatment to release tight muscles, mobilise stiff joints, and address any specific restrictions contributing to pain
Treatment is always individualised. What one woman needs will differ from another depending on where her pain is, what is driving it, and how far into pregnancy she is.
Does PGP resolve after birth?
For the majority of women, yes. Most find that pelvic pain resolves within the first one to two weeks after delivery as hormone levels normalise. A slightly smaller group find resolution takes a few more weeks. Around 5% of women experience pain that persists beyond the postnatal period – and this group should seek physiotherapy input if they have not already.
Even for women whose pain resolves quickly after birth, a postnatal physiotherapy assessment is worthwhile – particularly if PGP was significant during pregnancy. Rebuilding pelvic floor and core function after pregnancy reduces the risk of longer-term problems.
Diedre’s top tips for managing PGP day to day
- Turning in bed: keep your knees and feet together as you roll rather than letting the legs separate, which overloads the pubic symphysis
- Getting in and out of a car: sit down first, then swivel both legs in together rather than stepping in one leg at a time
- Putting on underwear or socks: sit down to do this rather than standing on one leg, which places unequal load through the pelvis
- Walking: take shorter stride lengths rather than striding out, which reduces the rotational forces through the pelvis
These adjustments are simple but consistently effective at reducing pain during the activities that most commonly aggravate PGP.
The bottom line
Pelvic girdle pain in pregnancy is common, but it is not inevitable and it is not something women simply have to endure. With the right physiotherapy input – ideally combining targeted strengthening with manual therapy – the majority of women can significantly reduce their pain and maintain function through pregnancy and beyond.
For more on pelvic health during and after pregnancy, including bladder, bowel, and postnatal pelvic floor care, see the earlier episodes in Diedre’s series: an introduction to pelvic health (episode 8).
Diedre is a specialist pelvic health physiotherapist with over ten years of experience treating men and women across a wide range of pelvic floor, bladder, bowel, and pain conditions, including pregnancy-related pelvic girdle pain.
To book an appointment with the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
