How to Relieve Pelvic Girdle Pain (PGP) During Pregnancy

What Is Pelvic Girdle Pain?

Pelvic girdle pain (PGP) is an umbrella term for pain in the pelvic joints during pregnancy. It includes:

• Symphysis pubis dysfunction (SPD), pain at the front of the pelvis where the two pubic bones meet
• Sacroiliac (SI) joint pain, pain at the back of the pelvis where the spine meets the pelvis
• Combined PGP, pain in both areas

PGP affects an estimated 15–25% of pregnant women to some degree, making it one of the most common pregnancy complaints. Yet it's frequently dismissed as "just part of pregnancy," which is both unhelpful and inaccurate. PGP has clear biomechanical causes and responds well to targeted interventions.

The Biomechanics of PGP: Why It Happens

Understanding why PGP occurs is the first step toward addressing it effectively.

Relaxin and Joint Laxity

During pregnancy, the hormone relaxin increases significantly, causing ligaments throughout the body to become more flexible. This is necessary, as it allows the pelvis to widen during childbirth. But it also means the joints that normally provide stable support for your pelvis become more mobile and less stable.

The pelvic girdle is a ring of bones (two hip bones, the sacrum, and the coccyx) held together by ligaments. When those ligaments loosen, the ring becomes less rigid. Under the load of a growing uterus and the altered gait of pregnancy, this instability can cause pain.

Load Distribution Changes

As your center of gravity shifts forward with a growing belly, your body compensates by:

• Increasing lumbar lordosis (the inward curve of the lower back)
• Shifting weight-bearing patterns in the hips and pelvis
• Altering gait mechanics

These compensations can create uneven loading across the SI joints and symphysis pubis, leading to inflammation and pain.

Muscle Imbalances

Pregnancy often creates predictable muscle imbalances:

• Hip flexors become tight (from prolonged sitting and postural changes)
• Glutes and hip abductors become weak (from altered movement patterns)
• Core muscles are stretched and less effective at stabilizing the pelvis

These imbalances reduce the muscular support that normally helps stabilize the pelvic joints, increasing the load on ligaments and joints.

Practical Logic Moves: What Actually Helps

1. Pelvic Tilts

Pelvic tilts are one of the most effective and accessible exercises for PGP. They gently activate the deep core muscles that support the pelvis without loading the SI joints.

How to do them:

• Lie on your back with knees bent and feet flat (or stand with your back against a wall)
• Gently flatten your lower back against the floor/wall by tightening your abdominals and tilting your pelvis slightly
• Hold for 5–10 seconds, then release
• Repeat 10–15 times

Why it works: Pelvic tilts activate the transverse abdominis, the deep core muscle that acts like a natural corset around the pelvis. Strengthening this muscle improves pelvic stability without stressing the joints.

2. Clamshells

Clamshells target the hip abductors (gluteus medius), which are critical for pelvic stability during walking.

How to do them:

• Lie on your side with knees bent at 45 degrees, feet together
• Keeping your feet together, rotate your top knee upward like a clamshell opening
• Hold briefly, then lower slowly
• Repeat 15–20 times per side

Why it works: Strong hip abductors reduce the lateral pelvic drop that occurs with each step, decreasing stress on the SI joints.

3. SI Belt / Pelvic Support Belt

A sacroiliac (SI) belt or pelvic support belt provides external compression to the pelvic ring, essentially doing the job that the loosened ligaments can no longer do as effectively.

How to use it:

• Wear it low across the hips, below the belly
• It should feel supportive but not restrictive
• Wear during activities that aggravate symptoms (walking, standing, climbing stairs)
• Remove when lying down

Evidence: Multiple studies have shown that pelvic support belts reduce PGP pain and improve function. They're particularly helpful for women with SI joint pain.

4. Symmetrical Movement

One of the most important, and often overlooked, principles for managing PGP is keeping your pelvis symmetrical during movement.

Avoid:

• Wide-legged movements (getting in/out of cars with legs apart)
• Carrying weight on one side
• Standing on one leg
• Asymmetrical exercises (lunges, single-leg movements)

Instead:

• Keep knees together when getting in/out of bed or a car
• Sit to put on pants and shoes
• Carry bags in front of your body or use a backpack
• Take smaller steps when walking

5. Sleep Positioning

Sleep is often when PGP is most disruptive. Strategies that help:

• Sleep on your side with a pillow between your knees (keeps the pelvis aligned)
• A full-length pregnancy pillow can support both the belly and the knees simultaneously
• Avoid sleeping on your back (increases SI joint stress and compresses the vena cava)
• When turning over in bed, keep your knees together and roll as a unit

Daily Life Improvements

Sitting

• Choose chairs with good lumbar support
• Avoid sitting cross-legged or with legs wide apart
• Use a small cushion or rolled towel for lumbar support
• Take regular breaks from sitting, stand and move every 30–45 minutes

Stairs

• Lead with your stronger leg going up, weaker leg going down
• Use the handrail for support
• Take one step at a time if bilateral movement is painful

Getting In and Out of a Car

This is one of the most common PGP aggravators. The solution:

1. Back up to the seat and sit down first

2. Swing both legs in together, keeping knees together

3. Reverse the process when getting out

Exercise Modifications

Swimming and water aerobics are often well-tolerated because water reduces the gravitational load on the pelvis. Walking may be fine in small amounts but can aggravate symptoms if overdone. Avoid:

• Running and high-impact activities
• Wide-stance exercises
• Deep squats
• Any exercise that causes or worsens pain

When to Seek Professional Help

PGP that significantly limits daily function warrants professional assessment. A physiotherapist or physical therapist specializing in pelvic health can:

• Assess the specific joints and muscles involved
• Provide manual therapy to reduce joint irritation
• Design a personalized exercise program
• Advise on appropriate supports and modifications

Don't wait until you can barely walk. Early intervention produces better outcomes.

Will PGP Resolve After Pregnancy?

For most women, yes. PGP typically improves significantly within weeks of delivery as relaxin levels drop and the pelvis stabilizes. However, some women experience persistent pelvic pain postpartum, which is why addressing it during pregnancy, rather than just enduring it, is worthwhile.

*This content is for educational purposes only and does not constitute medical advice. If you're experiencing pelvic pain during pregnancy, consult your healthcare provider or a pelvic health physiotherapist.*