Pelvic Pain in Pregnancy

Advice and Exercises

What is pelvic girdle pain (PGP)?
Pelvic girdle pain describes pain in and around the joints and tissues that
make up your pelvic girdle. The pelvic girdle includes the symphysis pubis
joint at the front of the pelvis and the sacro iliac joints (one each side) at the
back of the pelvis plus many ligaments and muscles. It is a very strong
structure.

The discomfort of PGP can often be felt over these joints but can also be
below your tummy, between your upper thighs or at the sides of your pelvis.
It can affect one side of your pelvis or both sides. The symptoms and
severity vary between women and between pregnancies in the same
woman.
PGP is common with as many as 1 in 5 pregnant women reporting
symptoms. Although common it is not a normal part of pregnancy and there
is a lot of advice and treatment available that can help.

A small number of women may find symptoms persist after pregnancy and
you can arrange further physiotherapy input to help.

Causes of PGP are thought to be due to a variety of factors relating to

normal pregnancy changes but sometimes there are no obvious
explanations.

As pregnancy progresses your body changes shape (front loading – bump,

baby, breasts) and your weight increases. Pregnancy hormones are
released. These hormones affect the pelvis with the ligaments becoming
stretchier, preparing it to carry a baby and for the birth itself.

All these changes alter the demands on the muscles, tissues and joints
around the tummy, pelvis, hips and pelvic floor. Some support muscles are
then not able to work so effectively, whilst others may overwork to help
compensate.

This can result in an alteration of how your body moves with irritation and
increased sensitivity of the joints and tissues around the pelvis. Equally
influential to PGP are other factors such as poor sleep, stress and anxiety,
previous history of back pain and constipation.

The symptoms of PGP may cause difficulty and/or pain with:

• Walking
• Standing on one leg – stairs, dressing, getting in/out of bath
• Moving legs apart – getting in/out of car
• Clicking grinding in pelvic area – you may hear or feel this
• Hip movements – turning in bed
• Some lying positions – side or back
• Some normal everyday activities
• Sexual intercourse
 Top Tips for
Pelvic Girdle Pain

SLEEP

• Try a pillow between your knees or under your

bump if lying on your side
• Support/hold your bump when moving in bed
• Rather than turning over, turn under on all fours
• Turn onto your side to get in/out of bed

EVERYDAY ACTIVITIES

• Sit down to get dressed rather than standing on

one leg
• Use a rucksack over both shoulders rather than
carrying shopping bags in one hand
• Carry your baby/small child in front of you, rather
than on one hip
• Take stairs one at a time
• Keep your knees together getting in/out of a car
• Try not to sit/stand for long periods – regularly
change positions

STRESS

• Accept help, especially with other children

• Rest when you can
• Speak to a health professional if you feel you need to
 SITTING

• Raise height of your chair with cushions

• Sit with legs symmetrical (not crossed or tucked under
you)
• Set an alarm for 15 minutes so you regularly get up
• Try not to slump back in the chair

Try these ideas for getting up:

• Have one foot in front of the other getting up
• Breathe out as you get up and think about squeezing
your bottom muscles rather than pushing through your
arms
• You could try altering your foot position to get up, for
example slightly turning your feet in or out to change
the muscles you are working

PAIN RELIEF

• Try ice (frozen peas wrapped in a damp tea towel) over pubic
bone for 10-20 minutes, up to three times per day
• For buttock pain, try a hot water bottle/wheat bag over the area
• Consider trying an elasticated tubular support/pelvic support belt
during activity
• Seek advice from your GP/pharmacist as needed

BOWEL

• Eat and drink adequate fibre and fluids to help avoid

constipation
• When emptying your bowel keep your knees apart,
consider placing your feet on a small stool and keep your
tummy and breathing relaxed
Exercise therapy
The majority of women will respond well to physiotherapy exercises and
lifestyle modifications. The purpose of the exercises below is to improve the
support and muscle function around your pelvis to help ease symptoms.
All of the exercises within this leaflet are safe to complete throughout your
pregnancy, however as your bump gets larger you may need to adapt some
of the exercise positions. It is advised that you complete the exercises in a
propped up lying or side lying position to reduce potential dizziness, which
can be associated with lying flat in the later stages of pregnancy. Think
about using a pillow or rolled up towel to help with positioning.
Complete the following exercises in a comfortable position – for example
lying, sitting or standing.
• Aim for up to 10 repeats of each exercise but you may need to start
with fewer and gradually build up.
• Repeat 2-3 times a day if possible.
• You should aim to practice these exercises regularly.

These exercises should not be painful but may cause some discomfort,
which should settle within approximately 30 minutes. If any of the exercises
cause a sharp pain or make you feel worse, stop doing that exercise for a
few days and then try again. Please contact our physiotherapy service if
you have any questions regarding this information.
If your symptoms are continuing despite trying the self-help advice and
exercises in this leaflet, please contact our physiotherapy service. If you are
having difficulty managing to complete daily tasks such as washing and
dressing or going to work please consider contacting your GP to discuss
pain relief.

Pelvic floor muscles

In a lying or seated position contract your pelvic floor by

drawing up your front and back passages. Imagine you
are trying to stop wind and at the same time trying to
prevent your flow of urine. The feeling is one of ‘squeeze
and lift’. It is recommended that you complete two types
of pelvic floor exercises – long and short holds.
• Long hold: Aim to hold this squeeze for 3 breaths in and out and
build up to 10 repeats.
You could also think about gently drawing in the lower part of your
stomach, drawing your ‘bump’ upwards at the same time as
contracting your pelvic floor muscles.

• Short hold: Aim to hold this squeeze for 1-2 seconds then relax. Aim
to repeat this up to 10 times.

Pelvic tilting

In a sitting position encourage the lower part

of your spine to move freely by gently arching
and rounding your lower back by rocking your
pelvis.

Pelvic tilting in a kneeling position

On all fours encourage the lower part of your spine to move freely by gently
arching and rounding your lower back by rocking your pelvis.
Child’s pose

On all fours with your knees apart to

accommodate your tummy, let your
arms slide along the floor/bed as far as
possible. Push your bottom back and
down and the chest towards the floor.
Breathe out while doing the exercise.

Sit to stands

Place your arms across your chest. Stand up and then sit down slowly on a
chair. (This can be made easier or more difficult by changing the height of
the chair). Place your hands on your thighs or hips for support if required.
Squats

Stand tall with your feet slightly wider than hip-width apart. Point your toes
forwards or outwards by a few degrees. Keep your chest up and your spine
and neck in a neutral position.
Squat down by sitting back and bring your arms forward. Push back up
through the heels, chest up, and straighten your hips.
Note:
- Keep your hips, knees and toes aligned and don't let your lower back
round.
- Keep your weight evenly on your whole foot.
Squats with band

Stand with your feet hip-width apart and an exercise band placed around
your legs just above or under your knees with the slack taken off the band.
Squat down by moving your pelvis backwards and bending your knees.
Actively push your knees against the band to keep your hips, knees and
toes aligned.

Calf raises

Stand tall with your feet hip-width apart and your weight evenly on both feet.
Keep your toes and knees pointing forwards. Rise up onto your toes. In a
controlled manner then lower your heels back down again to return to the
starting position. Note: Avoid shifting the weight towards the outer side of
your forefoot during the heel raise.
Self-help information

https://thepogp.co.uk/patient_information/
pregnancy_and_early_postnatal.aspx

https://assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/829894/5-physical-activity-for-pregnant-
women.pdf - UK Chief Medical Officers’ Physical Activity Guidelines, 2019,
infographics.

To refer yourself to a physiotherapist for additional advice and treatment,

and your GP surgery is in Cambridgeshire or Huntingdonshire, please visit
www.eoemskservice.nhs.net and click on the ‘physiotherapy self-referral’
tab.

If your GP surgery is in any other area, you can ask your GP to refer you to
a physiotherapist local to your home.
City Care Centre, Thorpe Road, Peterborough, PE3 6DB

0128 - Nov 2022

Aug 2020
Nov 2024