Pelvic Girdle Pain
What is pelvic girdle pain?
Pelvic girdle pain (PGP) is an umbrella term for pain originating from the joints, ligaments and muscles of the pelvis — specifically the sacroiliac joints (SIJ) at the back of the pelvis, the pubic symphysis at the front, and the surrounding soft tissue structures. It can occur in the low back, buttocks, groin, inner thighs, hips and tailbone, and is often provoked or worsened by activities that load the pelvis asymmetrically — walking, climbing stairs, rolling over in bed, getting in and out of a car, or standing on one leg.
PGP is most commonly associated with pregnancy, where hormonal changes — particularly the hormone relaxin — increase ligamentous laxity throughout the body including the pelvic joints, and where the growing uterus shifts the centre of gravity and alters load distribution through the pelvis. Up to one in five pregnant women experience clinically significant PGP, making it one of the most common musculoskeletal complaints of pregnancy. However, PGP also occurs outside of pregnancy — in men, in non-pregnant women, and as a long-term condition following pregnancy that persists into the postnatal period and beyond. For pregnancy-specific PGP and symphysis pubis dysfunction, our dedicated pregnancy pelvic girdle pain page covers these presentations in more detail.
What causes pelvic girdle pain?
The pelvis functions as a ring — load passes through it from the spine above and the lower limbs below, and it needs to be stiff enough to transfer force efficiently while allowing the small degree of movement that normal walking and breathing require. When the joints of the pelvic ring lose their normal stiffness — whether from hormonal ligament laxity, trauma, degeneration, or muscle imbalance — the result is excessive or aberrant movement that irritates the joints and surrounding tissues.
The most common form is sacroiliac joint dysfunction, where one or both SIJ become symptomatic from abnormal load transfer. Sacroiliitis — inflammation of the sacroiliac joint — produces similar symptoms and may have inflammatory rather than mechanical origins.
Beyond pregnancy, PGP occurs in athletes — particularly those in asymmetric sports like running, football and dancing — where repetitive one-sided loading creates cumulative stress at the SIJ. It also occurs as a result of falls on the coccyx, hip fractures, sacroiliac joint fusion surgery complications, and inflammatory conditions such as ankylosing spondylitis and psoriatic arthritis.
What does PGP feel like?
The pain is typically felt deep in the buttock, around the posterior iliac crest, or across the low back just above the sacrum. Many people describe a specific point of maximum tenderness just below the dimple at the base of the spine — this corresponds to the posterior sacroiliac ligament, which is often the primary pain generator. Pain may refer into the groin, inner thigh, or down the back of the leg, which can be confused with sciatica or hip pathology.
A characteristic feature of SIJ-related PGP is that it is provoked by activities that load the joint asymmetrically — particularly stepping up, standing on one leg, or rolling over in bed — while activities that load the pelvis symmetrically (like sitting, swimming, or squatting with equal weight through both legs) may be more comfortable. This pattern is one of the clinical clues that distinguishes SIJ pain from lumbar spine pathology.
How is pelvic girdle pain diagnosed?
A physiotherapist will assess PGP through a combination of history, provocation tests and movement analysis. The Active Straight Leg Raise test and posterior pelvic pain provocation test (P4 test) are well-validated clinical tools for identifying SIJ-related PGP. Assessment also includes evaluation of lumbar spine function, hip mobility, and the strength and coordination of the deep stabilising muscles — the transversus abdominis, pelvic floor, multifidus and diaphragm — which form the primary active stabilising system for the pelvis.
Imaging is not routinely required for PGP management but may be used to rule out other pathology, assess joint degeneration, or confirm inflammatory joint disease in appropriate patients.
How can physiotherapy help?
Physiotherapy is the first-line treatment for pelvic girdle pain and has strong evidence supporting its effectiveness. The approach varies depending on the underlying cause and the patient's presentation, but broadly involves a combination of load management, targeted exercise, manual therapy and education.
Load management is often the first and most impactful intervention — identifying and modifying the specific activities that are provoking symptoms, and advising on movement strategies that reduce asymmetric loading through the pelvis. This might include advice on how to get in and out of bed, how to manage stairs, and how to modify exercise during recovery.
Deep stabilising muscle rehabilitation is central to most PGP programs. The transversus abdominis, pelvic floor, and multifidus form a cylinder of support around the lumbar spine and pelvis — when these muscles are not coordinating effectively, the passive structures (ligaments and joints) are exposed to higher loads. Real time ultrasound is a valuable tool for assessing and retraining these muscles, providing visual feedback that significantly accelerates the learning process.
Progressive hip, gluteal and abdominal strengthening addresses the broader muscle imbalances that contribute to SIJ instability. Pelvic belts can provide useful short-term support, by compressing the SIJ and improving force closure of the pelvic ring.
Clinical Pilates and our Prenatal Pilates and Mums and Bubs programs are excellent complements to physiotherapy management for women with postnatal PGP. The controlled, low-impact environment of Pilates allows meaningful strengthening work in positions that don't provoke symptoms, and the group setting provides connection with other women navigating similar experiences.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in women's health and pelvic girdle pain management. Both are members 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 (PGP) is an umbrella term for pain originating from the joints, ligaments and muscles of the pelvis — specifically the sacroiliac joints (SIJ) at the back of the pelvis, the pubic symphysis at the front, and the surrounding soft tissue structures. It can occur in the low back, buttocks, groin, inner thighs, hips and tailbone, and is often provoked or worsened by activities that load the pelvis asymmetrically — walking, climbing stairs, rolling over in bed, getting in and out of a car, or standing on one leg.
PGP is most commonly associated with pregnancy, where hormonal changes — particularly the hormone relaxin — increase ligamentous laxity throughout the body including the pelvic joints, and where the growing uterus shifts the centre of gravity and alters load distribution through the pelvis. Up to one in five pregnant women experience clinically significant PGP, making it one of the most common musculoskeletal complaints of pregnancy. However, PGP also occurs outside of pregnancy — in men, in non-pregnant women, and as a long-term condition following pregnancy that persists into the postnatal period and beyond. For pregnancy-specific PGP and symphysis pubis dysfunction, our dedicated pregnancy pelvic girdle pain page covers these presentations in more detail.
What causes pelvic girdle pain?
The pelvis functions as a ring — load passes through it from the spine above and the lower limbs below, and it needs to be stiff enough to transfer force efficiently while allowing the small degree of movement that normal walking and breathing require. When the joints of the pelvic ring lose their normal stiffness — whether from hormonal ligament laxity, trauma, degeneration, or muscle imbalance — the result is excessive or aberrant movement that irritates the joints and surrounding tissues.
The most common form is sacroiliac joint dysfunction, where one or both SIJ become symptomatic from abnormal load transfer. Sacroiliitis — inflammation of the sacroiliac joint — produces similar symptoms and may have inflammatory rather than mechanical origins.
Beyond pregnancy, PGP occurs in athletes — particularly those in asymmetric sports like running, football and dancing — where repetitive one-sided loading creates cumulative stress at the SIJ. It also occurs as a result of falls on the coccyx, hip fractures, sacroiliac joint fusion surgery complications, and inflammatory conditions such as ankylosing spondylitis and psoriatic arthritis.
What does PGP feel like?
The pain is typically felt deep in the buttock, around the posterior iliac crest, or across the low back just above the sacrum. Many people describe a specific point of maximum tenderness just below the dimple at the base of the spine — this corresponds to the posterior sacroiliac ligament, which is often the primary pain generator. Pain may refer into the groin, inner thigh, or down the back of the leg, which can be confused with sciatica or hip pathology.
A characteristic feature of SIJ-related PGP is that it is provoked by activities that load the joint asymmetrically — particularly stepping up, standing on one leg, or rolling over in bed — while activities that load the pelvis symmetrically (like sitting, swimming, or squatting with equal weight through both legs) may be more comfortable. This pattern is one of the clinical clues that distinguishes SIJ pain from lumbar spine pathology.
How is pelvic girdle pain diagnosed?
A physiotherapist will assess PGP through a combination of history, provocation tests and movement analysis. The Active Straight Leg Raise test and posterior pelvic pain provocation test (P4 test) are well-validated clinical tools for identifying SIJ-related PGP. Assessment also includes evaluation of lumbar spine function, hip mobility, and the strength and coordination of the deep stabilising muscles — the transversus abdominis, pelvic floor, multifidus and diaphragm — which form the primary active stabilising system for the pelvis.
Imaging is not routinely required for PGP management but may be used to rule out other pathology, assess joint degeneration, or confirm inflammatory joint disease in appropriate patients.
How can physiotherapy help?
Physiotherapy is the first-line treatment for pelvic girdle pain and has strong evidence supporting its effectiveness. The approach varies depending on the underlying cause and the patient's presentation, but broadly involves a combination of load management, targeted exercise, manual therapy and education.
Load management is often the first and most impactful intervention — identifying and modifying the specific activities that are provoking symptoms, and advising on movement strategies that reduce asymmetric loading through the pelvis. This might include advice on how to get in and out of bed, how to manage stairs, and how to modify exercise during recovery.
Deep stabilising muscle rehabilitation is central to most PGP programs. The transversus abdominis, pelvic floor, and multifidus form a cylinder of support around the lumbar spine and pelvis — when these muscles are not coordinating effectively, the passive structures (ligaments and joints) are exposed to higher loads. Real time ultrasound is a valuable tool for assessing and retraining these muscles, providing visual feedback that significantly accelerates the learning process.
Progressive hip, gluteal and abdominal strengthening addresses the broader muscle imbalances that contribute to SIJ instability. Pelvic belts can provide useful short-term support, by compressing the SIJ and improving force closure of the pelvic ring.
Clinical Pilates and our Prenatal Pilates and Mums and Bubs programs are excellent complements to physiotherapy management for women with postnatal PGP. The controlled, low-impact environment of Pilates allows meaningful strengthening work in positions that don't provoke symptoms, and the group setting provides connection with other women navigating similar experiences.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in women's health and pelvic girdle pain management. Both are members 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.
Who to book with:
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].