Pelvic Girdle Pain During Pregnancy: Why It Happens and How Physiotherapy Helps

Understanding Pelvic Girdle Pain

Pelvic girdle pain (PGP) - previously called symphysis pubis dysfunction (SPD) - is pain felt in the joints of the pelvis: the pubic symphysis at the front, the sacroiliac joints at the back, or both. It affects approximately 20% of pregnant women and ranges from mild discomfort to severe pain that limits walking, climbing stairs, turning in bed, and standing on one leg.

In Melaka, many pregnant women dismiss PGP as normal pregnancy discomfort and endure it unnecessarily. While some pelvic discomfort is common in late pregnancy, significant pain that limits daily activities is treatable and should not be ignored.

Why Pregnancy Causes Pelvic Pain

During pregnancy, the hormone relaxin loosens the ligaments that hold the pelvic joints together, allowing the pelvis to expand for childbirth. In some women, this increased laxity causes the joints to move unevenly or excessively, producing pain.

Contributing factors include uneven pelvic alignment (one side moving more than the other), muscle weakness in the gluteals and deep stabilisers that normally control pelvic movement, a history of lower back or pelvic problems before pregnancy, physically demanding work or lifting older children, and rapid weight gain. PGP typically starts in the second or third trimester but can begin earlier, especially in second or subsequent pregnancies.

Physiotherapy Assessment and Treatment

Your physiotherapist assesses pelvic joint mobility, muscle strength, and movement patterns to identify the specific cause. Treatment includes pelvic joint mobilisation or muscle energy techniques to restore alignment, pelvic girdle stabilisation exercises targeting the deep gluteals, transversus abdominis, and pelvic floor - these muscles act as a natural pelvic support belt, manual therapy to release tight muscles that are compensating for pelvic instability, activity modification advice to reduce joint stress, and if needed, a pelvic support belt recommendation to provide external stability.

Treatment is gentle and safe during pregnancy - techniques are adapted to your stage and comfort level.

Daily Management Strategies

Simple strategies make a significant difference. Keep knees together when turning in bed - use a satin sheet to reduce friction.

Sit down to dress - avoid standing on one leg. Take smaller steps when walking and avoid walking on uneven ground.

Carry equal weight in both hands rather than one-sided. Use a pillow between your knees when sleeping on your side.

Avoid breaststroke when swimming (the leg movement aggravates the pubic symphysis) - backstroke and freestyle are fine. Climb stairs one step at a time, leading with the less painful leg going up and the more painful leg going down.

These modifications, combined with physiotherapy, allow most women to remain active throughout pregnancy.

Recovery After Delivery

The good news: PGP usually resolves within weeks to months after delivery as hormones normalise and ligaments tighten. However, approximately 10% of women continue to have symptoms beyond 3 months postpartum.

Postnatal physiotherapy accelerates recovery through progressive pelvic and core strengthening. If your PGP was severe during pregnancy or persists after delivery, request a postnatal physiotherapy referral rather than waiting for it to resolve on its own.

Your physiotherapist in Melaka can begin gentle rehabilitation as early as a few days after vaginal delivery or 6 weeks after caesarean section, depending on your recovery.

Struggling with pelvic pain during pregnancy in Melaka? WhatsApp PhysioMelaka to describe your symptoms - we will connect you with a women's health physiotherapist who specialises in pregnancy-related pelvic pain.

What a Pregnancy Pelvic Pain Assessment Includes

A pelvic girdle pain or pubic symphysis pain assessment during pregnancy runs 45–60 minutes and is specifically trauma-informed for pregnant patients. It covers: pregnancy history (gestation, previous pregnancies, previous pelvic pain episodes), specific pain pattern (front pubic, sacroiliac, tailbone, radiating into thighs), aggravating activities (turning in bed, getting in and out of the car, walking, climbing stairs, single-leg activities), bladder and bowel symptoms, external assessment of pelvic alignment and movement patterns, gentle provocation testing to localise the pain generators, and assessment of the hip, lumbar spine, and thoracic spine.

Internal pelvic floor assessment is offered when appropriate and with full consent, and is often deferred in pregnancy unless symptoms specifically indicate it. The assessment ends with a working diagnosis, treatment plan, pregnancy-appropriate exercises, and pacing guidance.

Contraindications and Pregnancy-Specific Cautions

Pregnancy changes what is safe and appropriate. After the first trimester, avoid exercises in supine (lying on back) for prolonged periods - the weight of the uterus compresses the vena cava.

Do not perform exercises that create asymmetrical hip loading if pubic symphysis pain is severe (single-leg loading, wide-legged positions, long strides). High-impact exercise and running are usually deferred if pelvic pain is significant.

Heavy resistance training with Valsalva holds is inappropriate. Deep hip flexion movements are often painful and can be modified.

Manual therapy avoids certain points during pregnancy, and acupuncture or dry needling is only done by practitioners specifically trained in pregnancy applications. Any new bleeding, reduced fetal movements, or signs of preterm labour means stopping all activity and contacting obstetrics immediately.

Red Flags Beyond Typical Pregnancy Pelvic Pain

Contact Hospital Melaka obstetrics, Pantai Hospital Melaka, or your obstetrician urgently for: vaginal bleeding, reduced fetal movements after 24 weeks, regular contractions before 37 weeks, fluid leaking vaginally (possible waters breaking), severe one-sided pain (possible pathology), fever with pelvic pain, calf pain and swelling (DVT risk is elevated in pregnancy), severe headache with visual changes (possible pre-eclampsia - emergency), inability to bear weight suddenly (possible pubic symphysis rupture - rare but serious), or signs of urinary tract or kidney infection. Pregnancy pelvic pain is common and usually musculoskeletal, but these features need obstetric, not physiotherapy, assessment.

Managing Pelvic Pain Through the Remaining Pregnancy

Physiotherapy for pregnancy pelvic pain is pragmatic and centred on symptom modification. Practical strategies: sleeping with a pillow between the knees to keep the pelvis aligned, sitting to put on trousers and socks, avoiding wide-legged getting-in-and-out of cars (swing both legs together as one unit), keeping knees together when turning in bed, a supportive pregnancy belt when walking longer distances, pool-based exercise (Kolam Renang MBMB or Stadium Hang Jebat) which offloads the pelvis while maintaining fitness, and paced activity - break long tasks into shorter segments.

Labour positioning advice - upright positions, side-lying, hands and knees - often reduces pelvic pain during delivery. Book a postnatal physiotherapy review in the first six weeks after birth; pelvic pain usually improves rapidly postpartum but a specific programme speeds return to function and reduces recurrence in subsequent pregnancies.