Pelvic Pain During and After Pregnancy

Steps You Can Take To Improve

Pregnant woman with pelvic girdle pain

You’ve probably read all the books about what to expect when during and after pregnancy. You knew in advance the changes your body would go through – the morning sickness, and the labor process. It’s likely you were even made aware of the potential for lower back pain during this 9-month journey. But no one warned you about the pelvic girdle pain you’re having.

What can you do for pelvic girdle pain? Is it safe to treat during pregnancy or soon afterward? When will it go away?

Let’s address these questions, starting with some good news: there are things you can do to help.

What is Pelvic Girdle Pain?

Symptoms of pelvic girdle pain are usually felt in the region of the Sacroiliac joint, in the buttock, the back of the thigh, or in the groin1.

Pelvic girdle pain can occur from a sudden trauma, such as a fall, or over time from arthritis.

There are also associations of pelvic girdle pain with2,3,4,5,6,7,8:

  • An increased BMI
  • Glute and pelvic floor muscle dysfunction
  • Joint hypermobility (excessive joint mobility)
  • Periods of amenorrhea
  • A history of low back pain (especially in a previous pregnancy)
  • Work dissatisfaction
  • A lack of belief in your ability to improve

However, more than any other population, pelvic girdle pain most often occurs in relation to pregnancy9.

Pelvic Girdle Pain in Pregnancy

Pelvic girdle pain occurs in 56% to 72% of the pregnant population – most severe during 20 to 30 weeks gestation10,11,12,13. It can even continue after your pregnancy is over – occurring in 7% to 25% of women.

Why is this such a prominent problem?

Here’s what common sense tells us:

  1. Your belly gets bigger with pregnancy
  2. This causes an increased lumbar lordosis (curve in your lower back)
  3. This tilts your pelvis more forward
  4. This shift in pelvic position puts more stress on the pelvic girdle, thus leading to pain

Well, this time, common sense is wrong. No link has been found in the development or intensity of pelvic girdle pain in the pregnant population in relation to postural changes during pregnancy14.

I was shocked, too.

What about hormones? During pregnancy, your body releases the hormone Relaxin that helps the ligaments in your pelvis to “relax”, preparing your body for delivery. It has long been thought that Relaxin was at least partially to blame for pelvic pain during pregnancy.

Wrong again. Current studies show no correlation between Relaxin and pelvic girdle pain15,16.

However, changes that occur in your ability to manage loads due to pregnancy-related joint laxity may be a factor in the development of pelvic girdle pain.

Stabilization of your pelvis is achieved by 2 mechanisms17,18:

  1. Form closure: your sacrum fitting tightly between your pelvic bones
  2. Force closure: the muscles, fascia, and ligaments surrounding your bones and joints that provide them stability

We do know, based on research, that there is an increase in motion in the pelvic joints in pregnant females with pelvic girdle pain compared to pregnant females without pelvic girdle pain 19.

We also know that pelvic floor muscle dysfunction is a risk factor for pelvic girdle pain 20, and is also associated with Diastasis Rectus Abdominis21 – when 2 sides of the abdominal muscle separate – which occurs in 66% of pregnant women and continues in 39% after pregnancy22,23.

Therefore, increasing stability in the pelvis should be a priority.

Increasing Pelvic Stability

Can’t you just wear a stability belt? You can… but there are mixed reviews based on the research24.

A better recommendation would be to strengthen the muscles that assist in Force Closure of the pelvis to increase stability25,26,27,28,29.

To see if it is safe for you to participate in exercise during pregnancy, the ACOG and Canadian CPG have guidelines.

If you’ve got the green light, give these exercises a try:

1. Sacroiliac Stability: hip abduction/adduction strengthening

2. Bent Knee Fallouts

 

Question: What have you found to help relieve Pelvic Girdle Pain? You can leave a comment by clicking here.


  1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment ofpelvic girdle pain. Eur Spine J. 2008;17(6):794–819.  ↩
  2. Bewyer KJ, Bewyer DC, Messenger D, et al Pilot data: association between gluteus medius weakness and low backpain during pregnancy. Iowa Orthop J. 2009;29:97–99.  ↩
  3. Gutke A, Ostgaard HC, Oberg B. Association between muscle function and low back pain in relation to pregnancy. JRehabil Med. 2008;40(4):304–311.  ↩
  4. Mens JMA, Pool­Goudzwaard A, Stem HJ. Mobility of the pelvic joint in pregnancy­related lumbopelvic pain: asystematic review. Obstet Gynecol Survey. 2009;64:200–208.  ↩
  5. Gutke A, Ostgaard HC, Oberg B. Predicting persistent pregnancy­related low back pain. Spine. 2008;33:E386–E393.  ↩
  6. Vøllestad NK, Stuge B. Prognostic factors for recovery from postpartum pelvic girdle pain. Eur Spine J.2009;18(5):718–726.  ↩
  7. Stomp­van den Berg SGM, Hendriksen IJM, Bruinvels DJ, Twisk JWR, van Mechelen W, van Poppel MNM.Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study. Pain.2012;153(12):2370–2379.  ↩
  8. Olsson C, Nilsson­Wikmar L. Health­related quality of life and physical ability among pregnant women with andwithout back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004;83:351–357.  ↩
  9. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment ofpelvic girdle pain. Eur Spine J. 2008;17(6):794–819.  ↩
  10. Albert HB, Godskesen M, Westergaard JG. Incidence of four syndromes of pregnancy­related pelvic joint pain.Spine. 2002;27:2831–2834.  ↩
  11. Fast A, Sharpo D, Ducommun EJ, et al Low back pain in pregnancy. Spine. 1987;12:368–371.  ↩
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  13. Mogren IM. Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scand JPublic Health. 2005;33:300–306.  ↩
  14. Franklin ME, Conner­Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. JOrthop Sports Phys Ther. 1998;28:133–138.  ↩
  15. Bjorklund K, Bergström S, Nordström ML, Ulmsten U. Symphyseal distention in relation to serum relaxin levels andpelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79(4):269–275.  ↩
  16. Petersen LK, Hvidman L, Uldbjerg N. Normal serum relaxin in women with disabling pelvic pain during pregnancy.Gynecol Obstet Invest. 1994;38(1):21–23.  ↩
  17. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment ofpelvic girdle pain. Eur Spine J. 2008;17(6):794–819.  ↩
  18. Vleeming A, Stoechart R, Volkers ACW, et al Relationship between form and function in the sacroiliac joint, part 1:clinical anatomical aspects. Spine. 1990;15:130–132.  ↩
  19. Mens JMA, Pool­Goudzwaard A, Stem HJ. Mobility of the pelvic joint in pregnancy­related lumbopelvic pain: asystematic review. Obstet Gynecol Survey. 2009;64:200–208.  ↩
  20. Gutke A, Ostgaard HC, Oberg B. Predicting persistent pregnancy­related low back pain. Spine. 2008;33:E386–E393.  ↩
  21. Spitznagle TM, Leong FC, van Dillen LR. Prevalence of diastasis recti abdominis in a urogynogecological population.Int Urogyencol J. 1997;18(3):321–328.  ↩
  22. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominus during the childbearing year. Phys Ther.1988;68(7):1082–1086  ↩
  23. Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S Dakota J Med. 1990;43(10):5–8.  ↩
  24. Clinton, SC, et al. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women’s Health and the Orthopaedic Section of the American Physical Therapy Association. Journal of Women’s Health Physical Therapy. 2017;41(2):102–125. doi: 10.1097/JWH.0000000000000081Clinical Practice Guidelines  ↩
  25. Depledge J, McNair PJ, Keal­Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancyusing exercise and pelvic support belts. Phys Ther. 2005;85:1290–1300.  ↩
  26. Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilizing exercises as adjunctto standard treatment in pregnant women with pelvic girdle pain: randomized single blind controlled trial. BMJ.2005;330(7494):761.  ↩
  27. Garshasbi A, Faghih Zadeh S. The effect of exercise on the intensity of low back pain in pregnant women. Int JGynaecol Obstet. 2005;88(3):271–275.  ↩
  28. Morkved S, Salvesen KA, Schei B, Lydersen S, Bo K. Does group training during pregnancy prevent lumbopelvicpain? A randomized clinical trial. Acta Obstet Gynecol Scand. 2007;86(3):276–282.  ↩
  29. Clinton, SC, et al. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women’s Health and the Orthopaedic Section of the American Physical Therapy Association. Journal of Women’s Health Physical Therapy. 2017;41(2):102–125. doi: 10.1097/JWH.0000000000000081Clinical Practice Guidelines  ↩
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