PGP is common, often dismissed, and frequently misunderstood. Here's plain-English education about what it is, why it happens, and what the research says about managing it.
Pelvic girdle pain is one of the most common musculoskeletal experiences of pregnancy, and one of the most frequently dismissed.
Women describe it in various ways: a deep ache through the front of the pelvis, sharp pain in the pubic area, pain through the sacroiliac joints at the back, difficulty walking, rolling over in bed, or managing stairs. For some it's a background discomfort. For others it's genuinely limiting.
It's almost always met with some version of: this is normal in pregnancy, it should settle after the baby comes. Sometimes that's true. Sometimes it isn't, and the women who didn't get useful support during pregnancy are still dealing with it months postpartum.
The pelvis is a ring of bones connected at three joints: the two sacroiliac joints at the back, and the pubic symphysis at the front. These joints are normally stable and move very little. During pregnancy, the hormone relaxin increases ligament laxity throughout the body, including at these joints. This is necessary for birth, but it changes the mechanical environment of the pelvic ring significantly.
When the joints of the pelvis are moving more than usual, the surrounding muscles have to work harder to compensate for reduced ligamentous stability. If those muscles are asymmetrical in their activation, or if the load through the pelvis is uneven, the joint surfaces can start moving in ways that create pain. This is the core mechanism behind most pelvic girdle pain.
It typically presents somewhere on a spectrum between mild discomfort that's manageable with modification, and significant pain that affects walking, sleep and daily function. The pubic symphysis variant, symphysis pubis dysfunction, tends to produce sharp pain at the front of the pelvis and groin, and is often associated with difficulty with leg-separating movements.
Pelvic girdle pain affects an estimated one in five pregnant women to some degree, though estimates vary depending on the definition used and how the question is asked. It tends to worsen as pregnancy progresses and load through the pelvis increases.
The evidence for management is reasonably clear that activity modification, targeted exercise, and manual therapy approaches are more effective than rest alone. A Cochrane review of interventions for pelvic girdle pain in pregnancy found that individualised, stabilising exercise was associated with reduced sick leave and improved function compared to standard antenatal care.
That evidence applies to stabilising exercise specifically, often delivered by physiotherapists with women's health training. It does not represent a claim about any specific type of manual therapy, and any practitioner working with pelvic girdle pain during pregnancy should be working within their scope and in conjunction with the woman's broader care team.
If you're experiencing pelvic girdle pain during pregnancy, a few things are worth knowing.
It doesn't mean something is seriously wrong. It means the pelvic ring is under load it's not managing symmetrically, and that's a mechanical problem that can often be addressed.
Symmetrical movement helps. Keeping your knees together when rolling over in bed, sitting down to put on shoes and socks, avoiding activities that require standing on one leg, and reducing asymmetrical loading through the pelvis can all reduce aggravation.
It's worth getting assessed. Whether by a women's health physiotherapist, a chiropractor with pregnancy experience, or both, understanding what's driving your specific presentation is more useful than general advice. Not all pelvic girdle pain is the same, and what helps one person may not help another.
Tell your midwife or obstetrician. Pelvic girdle pain should be on your antenatal care record. It can affect decisions around birth positioning and immediate postpartum care, and your primary care team should know you're dealing with it.
It usually improves after birth, but it doesn't always resolve immediately or automatically. If you're still experiencing symptoms weeks or months postpartum, that's worth following up rather than assuming it will eventually go away on its own.
Wild Chiropractic is a nervous system-led chiropractic practice in Shenton Park, Perth.
