Pelvic Girdle Pain in Pregnancy: What Physiotherapy Offers

Pelvic girdle pain is pain arising from the joints and ligaments of the bony pelvis in pregnancy or after birth, most often at the back of the pelvis or over the pubic joint, and it is a different problem from pelvic floor dysfunction even though both get called pelvic. The two can occur together, which is the practical reason this article exists: being assessed for one does not mean the other has been looked at.

I did not have pelvic girdle pain in either pregnancy, so this is not written from experience of the condition. What I do have experience of is the confusion it causes on the other side, because when I first tried to describe leaking to a clinician I used the phrase “pelvic problem” and the conversation went straight to backache. Two different structures, one adjective. Read red flags and when to stop and get checked first, because a small number of symptoms need urgent assessment rather than a physiotherapy referral.

What it is, anatomically

A load transfer problem in a ring of bone.

The bony pelvis is a ring: two halves joined at the back to the sacrum and at the front at the pubic joint. Every step you take transfers load from one leg, through that ring, to the trunk. Pelvic girdle pain is pain arising from those joints and the ligaments around them, felt most commonly at the back of the pelvis on one or both sides, over the pubic joint at the front, or in both places at once.

The provoking movements follow from the mechanics. Walking, stairs, standing on one leg to dress, turning in bed, and getting in and out of a car are the classic ones, because each loads one side of the ring at a time. Pain that is worse at the end of a day of walking and easier after a period of unloading fits the same pattern.

Why it keeps getting confused with a pelvic floor problem

Because of one adjective, and because they genuinely overlap.

The pelvic floor is the muscular sheet slung across the base of that bony ring, and its jobs are closure, support and release: see what is the pelvic floor. Its failures produce leaking, heaviness, urgency, difficulty emptying and pain with sex. Pelvic girdle pain produces none of those directly. They are different structures with different failures.

The overlap is real, though, and it runs in both directions. Persistent pain anywhere in the region can produce guarding, and a guarded pelvic floor is an overactive one, with its own symptom list: see hypertonic pelvic floor and downtraining. Meanwhile a pregnancy that produces one of these problems frequently produces the other, for the same reasons of load and tissue change.

So the useful practical rule is to raise both explicitly. An appointment about walking and stairs will not automatically cover leaking, and an appointment about leaking will not automatically cover the pubic joint.

The numbers that are not on this page

No prevalence figure for pelvic girdle pain in pregnancy, and no effect size for physiotherapy in it, appears in the sourced evidence base behind this site, so neither is published here.

That is a real gap and naming it is more useful than filling it. Prevalence estimates for this condition vary widely in the literature depending on whether the definition rests on self-reported pain, on a clinical examination, or on a set of provocation tests, and on whether mild transient pain is counted. When you meet a confident percentage, the three questions worth asking are the ones this site applies to every figure: what population, what definition, what comparison.

There is a second reason for the gap that is worth being open about. This site’s central entity is pelvic health physiotherapy, meaning treatment of the pelvic floor and the structures around it, and its verified evidence base is built around continence, prolapse and pelvic pain rather than around musculoskeletal pregnancy conditions. Writing beyond that base would mean importing numbers this site has not checked, which is exactly what its house rule forbids.

What the pregnancy evidence on this site does cover

Continence, and it is worth stating clearly so that nobody reads it as applying to joint pain.

In the Cochrane review of pelvic floor muscle training in antenatal and postnatal women, continent women who began antenatal training were about 29% less likely to report urinary incontinence at 3 to 6 months postpartum than those receiving usual care, 251 per 1,000 against 179 per 1,000, a risk ratio of 0.71 with a 95% confidence interval of 0.54 to 0.95, from 5 trials and 673 women, graded high certainty¹. In late pregnancy the same comparison gave a risk ratio of 0.38, 421 per 1,000 against 160 per 1,000, from 6 trials and 624 women, moderate certainty.

For scale, a systematic review of postpartum urinary incontinence found a pooled prevalence in the first 3 months after birth of 33% for any incontinence, 12% weekly and 3% daily, with 31% after vaginal delivery against 15% after caesarean section².

Those figures are about bladders, not joints. Antenatal pelvic floor training sets them out in full, including the narrow NICE trigger for a supervised antenatal programme.

What physiotherapy actually offers for the joint pain

Assessment, load management and a plan for the movements that hurt.

An assessment establishes where the pain is coming from, which movements provoke it, and how load is currently being transferred. From there a programme is typically built around modifying the provoking activities rather than stopping everything, working on strength and control around the pelvis and hips, and staging what you do through a day so that the total load is manageable rather than concentrated.

Advice about ordinary life is a bigger component here than in most pelvic health work, because the provoking movements are ordinary: how you get out of a car, how you turn in bed, whether you carry a toddler on one hip, how long you stand still. Those are unglamorous and they are frequently where the change comes from.

NHS information notes that physiotherapy is available free at the point of use in the UK, with the caveat that there may be a long waiting list, and that in many areas community musculoskeletal services can be accessed without a GP referral³. That route is often the fastest one for this presentation specifically, which is worth knowing because pelvic health self-referral is much more restricted.

Belts and crutches, described rather than recommended

Both are tools for managing load, not treatments, and neither is chosen from a webpage.

A support belt applies external compression around the pelvis with the intention of reducing the load the joints have to manage during activity. Whether it helps depends on the presentation, and how it is positioned, how tightly it is worn and for how long all matter enough that it should be fitted and then reviewed rather than bought on a description and used indefinitely.

Crutches reduce the load passing through a painful side. That is useful and it is not free: prolonged use changes how everything else is loaded and can create its own problems, which is precisely why they come with a review rather than as a purchase. This site does not recommend or supply any device, and it does not name products.

Where the pelvic floor question still belongs

In its own conversation, deliberately raised.

If leaking, heaviness, urgency or difficulty emptying is also happening, that is a separate assessment with its own guideline. NICE NG210 covers urinary incontinence, bladder emptying disorders, faecal incontinence, bowel emptying disorders, prolapse, sexual dysfunction and chronic pelvic pain for women aged 12 and over, and specifies that programmes should be supervised by a physiotherapist or other healthcare professional with the appropriate expertise, with at least one review during a programme and one at the end⁴.

If pain is the dominant feature and the pelvic floor is involved, the direction of treatment may be release rather than strengthening, which is why pelvic pain and vaginismus sits next to this article. And if you are heading for an assessment of any kind, questions to ask at your first appointment covers how to get both questions onto the agenda rather than one.

Finding someone, and the title problem

The word specialist is doing no regulatory work.

“Physiotherapist” is a title controlled by a statutory register in several of the systems this site covers, while “pelvic health specialist” is protected nowhere, so a clinic website cannot tell you whether somebody has years of postgraduate training or a weekend course. The Chartered Society of Physiotherapy is the UK professional body, with voluntary membership separate from the statutory register⁵, and its specialist network for this area, Pelvic, Obstetric and Gynaecological Physiotherapy, publishes a route to finding physiotherapists working in it⁶. Finding a registered pelvic health physiotherapist sets out how to check a register in each of the five systems this site covers.

What is published about access, and what is not

Very little, and the honest version is worth having.

NHS England runs a perinatal pelvic health services programme, and the one defensible coverage fact this site holds is that 20 of 42 integrated care boards had a service in operation as at 16 May 2024, two months after the March 2024 universal coverage deadline⁷. No access or waiting-time data is published for those services at all. This site does not substitute a general musculoskeletal waiting figure for a pelvic health one, because a reader on a pelvic health list is not in the musculoskeletal queue.

The policy case for better antenatal provision is on the record. The Independent Medicines and Medical Devices Safety Review recommended that pelvic floor education be encouraged in schools and certainly in antenatal classes, and that the NHS adopt the French model for universal postnatal pelvic floor rehabilitation, while recording that specialist pelvic floor physiotherapy cannot match the demand⁸. Getting referred to pelvic health physiotherapy covers the routes that do exist, postnatal pelvic floor recovery covers the first year, and pelvic floor physiotherapy sets out the treatment this site is actually about.