Pelvic Girdle and Low Back Pain in Pregnancy

Dr Victoria Chambers (Osteopath)

Pregnancy presents many challenges to a woman’s body, but without a doubt, one of the most challenging, and often painful, is pelvic girdle pain! This pain can present either as low, deep pain at the front of the pelvis around the pubic bone, or pain in the low back, which can radiate down into the buttocks or thighs. It can also be a combination of both regions.

Pelvic girdle pain can present at any stage during pregnancy, although commonly begins in the 18th week, peaking during the 24th & 36th week[1]. It can range from mild pain to debilitating and is often described as anything from a heavy deep ache, to sharp discomfort when performing aggravating activities. It often worsens as pregnancy progresses and a woman’s body changes as her belly gets bigger.

Unfortunately, pelvic girdle pain can interfere with and be aggravated by many basic everyday activities such as walking up stairs, getting in and out of the car, rolling over in bed, prolonged sitting, lifting and carrying[2]. An inability to perform or having major pain with such activities can prove to make life incredibly difficult for anyone, let alone a pregnant woman who may have other children to lift and carry.

What causes pelvic girdle pain? Its development tends to be multifactorial and is related to biomechanics, history and hormonal factors[3][4]. A major factor is the increasing biomechanical stresses applied to a woman’s low back and pelvis during the pregnancy. This generally causes a compensatory increased arch in the low back which can place extra pressure on the joints in the area.

Another factor is that a growing belly will stretch out abdominal muscles, which means they are not as effective in maintaining strong core support. This means that the body needs to rely on other muscles to step up and help provide the support which was previously coming from your abdominal muscles. This is where any weakness or poor muscle firing around the pelvic girdle can really let us down in pregnancy, because when we ask these muscles to step up, if they’re already doing a poor job, it can lead to that extra pregnancy load being transferred to joints and ligaments, which can contribute to pain.

A previous history of low back pain also appears to be a predisposing factor for this type of pain in pregnancy[5]. There is also suspected involvement of the hormone relaxin, which is often associated with joint laxity in pregnancy, however there is not enough solid research to clearly identify this as a cause of pelvic girdle pain in pregnancy[6].

So, there is all the bad news, but what are we going to do about it? The good news is that there is there are tangible steps you can take to aid in preventing the likelihood of this pain coming on, or deal with it once you have it.

An important preventative factor for this type of low back and pelvic girdle pain is your fitness and pelvic stability before you become pregnant. Especially if you have pre-existing back pain, improving your overall strength & stability through your core, pelvic girdle and legs seems to have a protective effect from low back pain in pregnancy and can help to decrease the intensity of pelvic girdle pain[7].

A targeted exercise program prescribed by an exercise physiologist or by your osteopath, which targets those muscles supporting your low back and pelvic girdle, can help to stabilize your pelvis and prevent some of the impact of your changing biomechanics on your low back and pelvis.

If you’re already pregnant and experiencing pain, it’s not too late! You can begin some gentle targeted exercises prescribed by your health professional to help strengthen pelvic muscles such as the glutes and hamstrings while you’re pregnant.

Another great tool is the use of a pregnancy belt, compression stockings or shorts during pregnancy. This compression appears to provide stabilization to the pelvic girdle which can not only provide relief, but also help you get through your day more easily. They can be expensive, so if you’re beginning to experience pain, ask your friends with kids if they have one which you can borrow to see if it will be an effective tool for you!

Heat or ice can also be really helpful for pain relief. Try both (not in immediate succession) and see which one is best for you.

Relative rest and a few ergonomics changes can also be great ways to manage your pregnancy related pain. As your belly grows, the load on your pelvic girdle and low back increases, so relative rest is an important tool in managing your pain. Rest alone is not the answer, but short periods of rest throughout the day can be an important way to give yourself little bursts of relief from the pain.

There are also a few little ergonomic changes you can try to make which will help reduce some of the acute pain, such as:

  • Keeping your knees together as you roll over in bed, or getting in and out of the car
  • Learning to engage your glutes and hamstrings to help with the discomfort of things like standing from sitting, or walking up stairs
  • Mobilising your mid-back, to help gain some extra movement up higher to take the load off from down below
  • Avoiding high heels
  • Sleeping with a body pillow which supports both your belly and can also sit between your legs

Finally, manual therapy may be effective in managing your pelvic girdle pain, not only in terms of hands of relief of tight muscles, or joint articulation, but also in prescribing rehabilitation exercises and providing advice which is specific to your condition.

In terms of the pain postpartum, the spectrum for resolution is varied. For some women, their pain spontaneously resolves postpartum, while for others it can continue on after their baby is born. Preparing your body for pregnancy and for your baby is an important way of avoiding ongoing pain, but as a general rule, much of the above advice will apply once your baby is born.

Trying to think ahead about how you’ll set yourself up for breastfeeding, the type of cot you have for your baby etc. will do wonders for aiding in preventing aggravating positions for your pain once you have your baby. This type of preparation before the baby comes will prove invaluable once you’re wrapped up in life with a newborn.

As always, reach out to and ask for help from your health professional. They will always have suggestions or options which may help prevent or reduce any pain related to pregnancy and help you MOVE THROUGH LIFE during and after pregnancy!

[1] Bergstrom et al., Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation, BMC Pregnancy and Childbirth 201414:48, DOI: 10.1186/1471-2393-14-48
[2] Obstet et al., Pelvic girdle pain in pregnancy: the impact on function, Acta Obstet Gynecol Scand. 2006; 85(2):160-4
[3] Homer C, Oats J. Clinical practice guidelines: Pregnancy care. Canberra: Australian Government Department of Health, 2018; p. 355–57
[4] Bhardwaj A, Nagandla K. Musculoskeletal symptoms and orthopaedic complications in pregnancy: Pathophysiology, diagnostic approaches and modern management. Postgrad Med J 2014;90(1066):450–60. doi: 10.1136/postgradmedj-2013-132377
[5] Walters et al., Pelvic Girdle Pain in Pregnancy, AJGP-01-18-4467
[6] Aldabe, D., Ribeiro, D.C., Milosavljevic, S. et al. Eur Spine J (2012) 21: 1769.
[7] Shiri, R. , Coggon, D. and Falah?Hassani, K. (2018), Exercise for the prevention of low back and pelvic girdle pain in pregnancy: A meta?analysis of randomized controlled trials. Eur J Pain, 22: 19-27. doi:10.1002/ejp.1096

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