Propel Physiotherapy

Physiotherapy management for pelvic girdle pain

by | Oct 1, 2025 | Blogs

Physiotherapy management for pelvic girdle pain

Managing pelvic girdle pain during pregnancy

What is pelvic girdle pain (PGP)?

PGP is defined as pain between the posterior iliac crest and the gluteal fold, particularly inthe vicinity of the sacroiliac joint (SIJ), which may radiate to the thighs and hips. PGP canoccur in conjunction with or separately to pain in the groin (pubic symphysis). During pregnancy, the relaxin hormones is released to prepare your pelvis for the birth of your baby, and it can cause your pelvic bones to become more mobile. PGP can either by just a mild discomfort, or it could be rather severe, making it painful and difficult to participate in daily activities. Pelvic girdle pain usually dissipates after giving birth, though symptoms would
likely return in future pregnancies.

The most common symptoms of PGP are:

  • Clicking, locking or grinding in the pelvic joints.
  • Pain in the front or the back of the pelvis, buttocks, groin and/or radiating into the thighs.
  • Pain and difficulty with single leg stance activities: eg: walking, going up/down stairs
  • Pain, difficulty and stiffness with rolling in bed and getting out of bed

Who gets pelvic pain in pregnancy (Clinton et al., 2017)?

  • Women with previous pelvic, hip or lower back pain
  • Previous history of trauma to the back, hip of pelvis
  • Genetic predisposition: hypermobility
  • More than one pregnancy
  • Physically demanding work
  • Emotional stress
  • Increased body mass index
  • Smoking

Activities that may aggravate your pelvic girdle pain (PGP)

  • Prolonged, fast or excessive walking
  • Standing on one leg (e.g. dressing – putting on pants)
  • High impact exercise (e.g. running and jumping activities)
  • Splitting legs apart (eg: getting in/out of the car)

Diagnosis of PGP

It is important to note that pelvic girdle pain can often be misdiagnosed by health professionals. The most common misdiagnosis is discal-related lower back pain or sciatica. However, the treatment pain and activity modifications for low back pain is very different from pelvic girdle pain. Thus, it is important to see a health professional who is experienced and
knows all the correct tests and differential diagnosis for the pelvis and the low back, especially in the antenatal population.

Physiotherapy management of pelvic girdle pain (PGP)

Due to the nature of the activities that aggravate PGP, it is important that physiotherapists consider the psychosocial implications for you and your family. Based on current research, physiotherapy management is safe and effective to maintain and improve pelvic girdle pain during pregnancy (Almousa et al., 2018).

Activity modification (Vleeming et al.,2008)

Physiotherapists would normally discuss the relevant activity modification and ways to modify certain activities throughout the day. The activity modifications are important to avoid placing uneven stress on the sacroiliac joint, which then decreases pain on the pelvis.
Important things to modify:
– Getting out of the car with legs together
– Keeping stride steps a little bit smaller
– Log rolling to roll in bed at night
– Keeping legs together whilst getting out of bed
– Minimise crossing legs whilst sitting
– Minimise sitting on low chairs/couch
– Reducing non-essential weight bearing activities (eg: climbing stairs,
standing/walking for long periods of time)

Wearing supportive pelvic girdle belt and supportive garments:

Pelvic girdle belts may assist in further supporting the pelvis especially during weight bearing tasks, such as walking or ascending/descending stairs. We also recommend wearing supportive garments for to support the abdomen as abdominal separation is common in pregnant women, and the lack of support through the abdomen can further contribute to pelvic girdle pain as well (Vleeming et al., 2008).

Doing specific and tailored pelvic stabilization exercises:

Based on the most recent systematic reviews, specific stabilization exercises prescribed by physiotherapists is safe and very effective to decrease pain and improve quality of life in both the antenatal and postnatal population with PGP (Almousa et al., 2018). Due to the pelvic ligaments being more relaxed and softer, doing targeted and tailored specific stabilization exercises to further stabilize the lower back and pelvis, thus reducing pain and quality of life. It is important to note that the exercises need to be tailored to the pregnant client to minimize further aggravation of PGP, and exercise progression is important to improve your quality of life in the long term.

Massaging glutes and other adjustments to the pelvis:

The glutes (buttock) muscles can spasm up due to the pelvic girdle pain. Sometimes, massaging the glutes can aid with PGP, and some specific adjustments to the pelvis can help as well, but the physiotherapist would need to check the patterning of the lower back and pelvis to determine the correct form of treatment for you (Fogarty et al., 2023).
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How do I know if I have it?

An abdominal separation can by rather tricky to assess, as it is one of the most common misdiagnosed postpartum condition by health professionals. If you do a curl-up or a crunch, you can sometimes see an abdominal bulge or abdominal doming.

Please note that we would prefer to check and diagnose face to face to calculate the inter-recti distance (the distance between the two 6 pack muscle heads).

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What can I do about it?

Based on the latest systematic review, there is very strong evidence that exercise therapy that includes abdominal strengthening and deep trunk stabilizer exercises can effectively reduce abdominal separation and improve abdominal separation dysfunctions postpartum. There is a huge emphasis on the goals being to improve abdominal muscle strength and functional ability as full abdominal separation recovery may not always occur. The review has emphasized proper intra-abdominal pressure management and that patients should be taught to engage their deep trunk muscles during exercise and daily activities (Skoura et al., 2024).

Activating deep transversus abdominus properly

It is very common to have poor transversus abominus activation and technique, especially in the postpartum population. Thus, it is very important that the trasnversus abdominus is activating well when cued, and that it is able to co-contract well with the other abdominal muscles, especially during functional activities (Skoura et al., 2024).

Doing targeted core home exercise programs

Once you are able to contract the deep transversus abdominals well, we would encourage you to layer other core exercises properly with the program. We recommend doing the tailored core exercise program daily to encourage further healing of the abdominal separation (Skoura et al., 2024).

Doing pelvic floor exercises

The pelvic floor muscles which help to support continence, and supports the bladder, uterus and bowels. These muscles are weakened during pregnancy and/or childbirth. Pelvic floor dysfunction occurs in 83% of women with abdominal separation (Fei et al., 2021). Thus, pelvic floor muscles have to contract and work together with the deep core to further reduce abdominal separation (Thompson et al., 2006).

Wearing tight compressions support garments or abdominal binding

Abdominal binding coupled together with exercise therapy has shown to create good results for abdominal separations (Thabet et al., 2019). We normally recommend wearing SRC leggings. We have found very good results with this product. Wearing these garments may help to improve the abdominal separation, and support the core and protect your lower back and pelvis as well.

Doing clinical pilates

To further compliment the home exercise program, it is best to start participating in clinical pilates. Clinical pilates allows for a targeted and a tailored exercise program, which aids to further improve the abdominal separation (Skoura et al., 2024).

The Propel Physiotherapy difference

Here at Propel Physiotherapy, having firsthand experience of having two pregnancies with pelvic girdle pain, Aileen personally understands and empathizes with the clients who have PGP and really understands the implications and all the relevant treatment and management
for pelvic girdle pain.

At your initial consultation, our most important goal is to complete various tests to differentially diagnose the source of the pain, and provide you with very clear and concise advice and activity modifications in your career and at home to improve your symptoms. Then, we will provide you with specific stabilization exercises, completely targeted to your condition, your strength and endurance of your muscles, especially for your core and your glutes. Where time permits and in subsequent appointments, we also aim to treat the affected muscles and joints which can provide further relief to your symptoms.

We look forward to meeting you and working with you to create a memorable and pleasant pregnancy journey for you and your family!

Citations:

Citations:
1. Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population. US: Women’s Health American Physical Therapy Association, 2017; p. 102–24.
2. Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008;17(6):794–819.
3. Almousa S, Lamprianidou E, Kitsoulis G. The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review. Physiother Res Int. 2018 Jan;23(1).
4. Fogarty S, McInerney C, Chalmers J, Veale K, Hay P. The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study. Int J Ther Massage Bodywork. 2023 Dec 1;16(4):5-19.
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