Pelvic Girdle Pain and Symphysis Pubis Dysfunction in Pregnancy.
What is pelvic girdle pain in pregnancy?
Pelvic girdle pain refers to discomfort or pain experienced in the pelvic region, particularly around the symphysis pubis joint, sacroiliac joints, or surrounding muscles and ligaments. Symphysis pubis dysfunction specifically involves instability or dysfunction of the symphysis pubis joint, which can lead to pain, stiffness, and difficulty with weight-bearing activities.
Pelvic girdle pain (PGP) is one of the most common musculoskeletal complaints of pregnancy, affecting up to one in five pregnant women to some degree. It encompasses several distinct pain patterns — pubic symphysis pain, sacroiliac joint pain, and posterior pelvic pain — that frequently coexist and are often collectively called PGP in clinical practice. Symphysis pubis dysfunction (SPD) specifically refers to pain at the front of the pelvis, at the pubic symphysis joint where the two halves of the pelvis meet.
The condition can begin as early as the first trimester but most commonly emerges in the second or third trimester, and symptoms can persist into the postnatal period if not adequately managed.
What causes PGP in pregnancy?
During pregnancy, hormonal changes, increased joint laxity, and the shifting of weight and posture can contribute to PGP. The hormone relaxin — which increases during pregnancy to allow the pelvis to accommodate the growing uterus and prepare for delivery — increases the laxity of the pelvic ligaments. This laxity, combined with the altered centre of gravity and load distribution from the growing abdomen, can produce pain when the pelvic joints are unable to move in a well-coordinated, stable way.
It is important to understand that increased joint laxity is a normal and necessary feature of pregnancy, not a pathology. PGP develops when this laxity is not adequately supported by the active muscular stabilisers of the pelvis — particularly the deep core muscles, pelvic floor and hip muscles — leading to abnormal pelvic mechanics and pain. This understanding drives the physiotherapy approach: building active muscular support rather than trying to prevent normal joint movement.
What are the symptoms?
PGP can cause pain and tenderness in the pubic bone or symphysis pubis at the front of the pelvis, and difficulty with weight-bearing activities such as walking, climbing stairs, standing, or turning in bed. Clicking or grinding sensations in the pelvic region may also be experienced.
The pain pattern varies depending on which joints are primarily affected. Symphysis pubis pain is felt at the front of the pelvis — central, around the pubic bone — and is typically sharper with weight transfer and single-leg activities like walking and climbing stairs. Sacroiliac joint pain is felt posteriorly — in the buttocks and lower back, sometimes referring into the thigh — and is provoked by rolling in bed, prolonged standing and asymmetric loading. Many women experience both simultaneously.
Severity ranges from mild discomfort that requires only activity modification to severe pain that significantly limits mobility and daily function. The condition does not indicate any risk to the baby.
How is it diagnosed?
Diagnosing pelvic girdle pain typically involves a thorough assessment by a physiotherapist, including detailed medical and obstetric history, physical examination, functional tests such as gait analysis, and provocative manoeuvres to reproduce symptoms and assess movement patterns.
The posterior pelvic pain provocation test (P4 test / thigh thrust), FABER test, and active straight leg raise test are the primary clinical assessment tools. Imaging is generally not required during pregnancy for the management of PGP.
How can physiotherapy help?
Women's health physiotherapy offers evidence-based interventions to address pelvic girdle pain and improve pelvic stability and function, focusing on gentle manual therapy techniques such as mobilisations to improve joint alignment and mobility, soft tissue techniques including massage and myofascial release to alleviate muscle tension and reduce pain, targeted exercises to strengthen the deep core muscles including the transverse abdominis and pelvic floor to provide support and stability to the pelvis, and functional exercises to improve coordination and control of the pelvis during movement and weight-bearing activities.
Sacroiliac joint belts and supportive garments — worn around the pelvis at the level of the greater trochanters — provide external compression that reduces SIJ movement and offers meaningful pain relief during activity, particularly for women with significant posterior pelvic pain. Pregnancy-specific exercises with physiotherapy advice and using a support garment such as a sacroiliac joint belt, flexible tubigrip, or medical compression pants may also provide relief.
Activity modification advice is a practical and important component — teaching women how to move, sit, stand and transfer in ways that minimise asymmetric pelvic loading. Getting in and out of a car, rolling over in bed, dressing and navigating stairs all have specific techniques that significantly reduce pain provocation. Avoiding single-leg activities and keeping movements symmetrical are key principles.
Ergonomic advice for activities such as sitting, standing, lifting, and sleeping minimises discomfort and optimises pelvic alignment.
For postnatal PGP — which can persist or even begin after delivery — the approach is similar but includes attention to the demands of infant care, breastfeeding positioning, pram use and return to exercise. Diastasis recti frequently coexists with postnatal PGP and should be assessed and addressed alongside it. Our Mums and Bubs Postnatal Pilates program is appropriate for women recovering from PGP in the postnatal period.
Clinical Pilates can be a valuable adjunct — strengthening the deep core muscles and stabilising muscles of the pelvis, enhancing body awareness and movement control, and promoting relaxation that alleviates muscle tension. Pilates exercises are carefully modified for the pregnant or postnatal body and avoid positions that load the pelvis asymmetrically.
Our physiotherapist, Emma Cameron has experience in women's health physiotherapy and pelvic girdle pain, and is a member of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Pelvic girdle pain refers to discomfort or pain experienced in the pelvic region, particularly around the symphysis pubis joint, sacroiliac joints, or surrounding muscles and ligaments. Symphysis pubis dysfunction specifically involves instability or dysfunction of the symphysis pubis joint, which can lead to pain, stiffness, and difficulty with weight-bearing activities.
Pelvic girdle pain (PGP) is one of the most common musculoskeletal complaints of pregnancy, affecting up to one in five pregnant women to some degree. It encompasses several distinct pain patterns — pubic symphysis pain, sacroiliac joint pain, and posterior pelvic pain — that frequently coexist and are often collectively called PGP in clinical practice. Symphysis pubis dysfunction (SPD) specifically refers to pain at the front of the pelvis, at the pubic symphysis joint where the two halves of the pelvis meet.
The condition can begin as early as the first trimester but most commonly emerges in the second or third trimester, and symptoms can persist into the postnatal period if not adequately managed.
What causes PGP in pregnancy?
During pregnancy, hormonal changes, increased joint laxity, and the shifting of weight and posture can contribute to PGP. The hormone relaxin — which increases during pregnancy to allow the pelvis to accommodate the growing uterus and prepare for delivery — increases the laxity of the pelvic ligaments. This laxity, combined with the altered centre of gravity and load distribution from the growing abdomen, can produce pain when the pelvic joints are unable to move in a well-coordinated, stable way.
It is important to understand that increased joint laxity is a normal and necessary feature of pregnancy, not a pathology. PGP develops when this laxity is not adequately supported by the active muscular stabilisers of the pelvis — particularly the deep core muscles, pelvic floor and hip muscles — leading to abnormal pelvic mechanics and pain. This understanding drives the physiotherapy approach: building active muscular support rather than trying to prevent normal joint movement.
What are the symptoms?
PGP can cause pain and tenderness in the pubic bone or symphysis pubis at the front of the pelvis, and difficulty with weight-bearing activities such as walking, climbing stairs, standing, or turning in bed. Clicking or grinding sensations in the pelvic region may also be experienced.
The pain pattern varies depending on which joints are primarily affected. Symphysis pubis pain is felt at the front of the pelvis — central, around the pubic bone — and is typically sharper with weight transfer and single-leg activities like walking and climbing stairs. Sacroiliac joint pain is felt posteriorly — in the buttocks and lower back, sometimes referring into the thigh — and is provoked by rolling in bed, prolonged standing and asymmetric loading. Many women experience both simultaneously.
Severity ranges from mild discomfort that requires only activity modification to severe pain that significantly limits mobility and daily function. The condition does not indicate any risk to the baby.
How is it diagnosed?
Diagnosing pelvic girdle pain typically involves a thorough assessment by a physiotherapist, including detailed medical and obstetric history, physical examination, functional tests such as gait analysis, and provocative manoeuvres to reproduce symptoms and assess movement patterns.
The posterior pelvic pain provocation test (P4 test / thigh thrust), FABER test, and active straight leg raise test are the primary clinical assessment tools. Imaging is generally not required during pregnancy for the management of PGP.
How can physiotherapy help?
Women's health physiotherapy offers evidence-based interventions to address pelvic girdle pain and improve pelvic stability and function, focusing on gentle manual therapy techniques such as mobilisations to improve joint alignment and mobility, soft tissue techniques including massage and myofascial release to alleviate muscle tension and reduce pain, targeted exercises to strengthen the deep core muscles including the transverse abdominis and pelvic floor to provide support and stability to the pelvis, and functional exercises to improve coordination and control of the pelvis during movement and weight-bearing activities.
Sacroiliac joint belts and supportive garments — worn around the pelvis at the level of the greater trochanters — provide external compression that reduces SIJ movement and offers meaningful pain relief during activity, particularly for women with significant posterior pelvic pain. Pregnancy-specific exercises with physiotherapy advice and using a support garment such as a sacroiliac joint belt, flexible tubigrip, or medical compression pants may also provide relief.
Activity modification advice is a practical and important component — teaching women how to move, sit, stand and transfer in ways that minimise asymmetric pelvic loading. Getting in and out of a car, rolling over in bed, dressing and navigating stairs all have specific techniques that significantly reduce pain provocation. Avoiding single-leg activities and keeping movements symmetrical are key principles.
Ergonomic advice for activities such as sitting, standing, lifting, and sleeping minimises discomfort and optimises pelvic alignment.
For postnatal PGP — which can persist or even begin after delivery — the approach is similar but includes attention to the demands of infant care, breastfeeding positioning, pram use and return to exercise. Diastasis recti frequently coexists with postnatal PGP and should be assessed and addressed alongside it. Our Mums and Bubs Postnatal Pilates program is appropriate for women recovering from PGP in the postnatal period.
Clinical Pilates can be a valuable adjunct — strengthening the deep core muscles and stabilising muscles of the pelvis, enhancing body awareness and movement control, and promoting relaxation that alleviates muscle tension. Pilates exercises are carefully modified for the pregnant or postnatal body and avoid positions that load the pelvis asymmetrically.
Our physiotherapist, Emma Cameron has experience in women's health physiotherapy and pelvic girdle pain, and is a member of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
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If you are unsure about which appointment type is right for you, please don't hesitate to get in touch with our friendly reception staff by calling 07 3706 3407 or emailing [email protected].