Pelvic girdle pain (PGP) is pain at the front and/or back of the pelvis, most commonly experienced during pregnancy. It affects roughly one in four pregnant women, though estimates range widely depending on the study, with some reporting prevalence as high as 60 to 70% in late pregnancy. The pain centers on the joints of the pelvic ring: the two sacroiliac joints at the back (where the spine meets the pelvis) and the pubic symphysis joint at the front.
Where the Pain Shows Up
The pelvis is a ring of bones at the base of your spine, held together by ligaments, muscles, and connective tissue. PGP can affect the front of that ring, the back, or both. While the joint pain itself is localized, it often radiates into surrounding areas. You might feel it in your pubic bone, lower back, hips, groin, inner thighs, or even your knees.
The hallmark of PGP is that specific movements trigger or worsen it. Walking on uneven ground, climbing stairs, getting in and out of a car, rolling over in bed, standing on one leg (to get dressed, for example), and separating your knees all tend to flare symptoms. Some people also notice a clicking or grinding sensation in the pelvic area. The pain can range from a mild ache to severe enough to interfere with sleep, daily tasks, and mobility.
What Causes Pelvic Instability
The sacroiliac joints are relatively flat, which means they depend heavily on surrounding muscles, ligaments, and connective tissue for stability. When that support system fails or is overwhelmed, the joints move more than they should during everyday activities like walking or shifting weight from one leg to the other. This excessive movement is what researchers call pelvic instability, and it’s the primary driver of PGP.
During pregnancy, the body’s center of gravity shifts forward, the load on pelvic joints increases, and ligaments soften to prepare for delivery. The combination of mechanical stress and ligament changes can overload the pelvic ring. Interestingly, the hormone relaxin, long assumed to be the main culprit, has not been shown to play a significant role. Multiple studies have found more evidence against relaxin being a cause than for it. The real issue appears to be a breakdown in how muscles and the nervous system coordinate to keep the pelvis stable under load.
Who Is Most at Risk
A history of low back pain or pelvic pain in a previous pregnancy is one of the strongest risk factors. Previous back trauma nearly triples the odds in some studies. Having already had a child, being younger, and having a lower educational level are also associated with higher risk.
Physically demanding work increases susceptibility. Lifting heavy loads, carrying heavy objects, bending forward repeatedly, twisting at work, and working in uncomfortable positions all raise the likelihood of developing PGP. Women who did not exercise before pregnancy also appear to be at greater risk. The relationship between body weight and PGP is less clear: some studies show a modest association, particularly for pubic symphysis pain, while others find no significant link. Stress, depression, and anxiety are additional contributing factors.
How PGP Differs From Sciatica
PGP and sciatica can both occur during pregnancy, but they feel different and respond to different triggers. PGP is joint pain. It centers around the pubic bone, hips, groin, or lower back and flares with weight-bearing movements: walking, rolling in bed, climbing stairs, standing on one leg. Sciatica is nerve pain. It produces a sharp, shooting, or burning sensation that radiates down the back of one leg, sometimes with tingling or numbness. Sciatica tends to flare when you sit for long periods, bend forward, or lift something. If your pain stays around your pelvis and worsens with movement, PGP is the more likely explanation. If it shoots down your leg with a burning or electric quality, that points toward sciatica.
Getting a Diagnosis
PGP is diagnosed through physical examination rather than imaging. A clinician will use a combination of tests because no single test captures every type of PGP. The most widely used is the active straight leg raise (ASLR) test, considered the gold standard for assessing how well the pelvis transfers load. You lie on your back and lift one leg slightly off the table. If the pelvis can’t stabilize properly, the test reproduces your symptoms. The ASLR has high specificity (88%), meaning it rarely flags a problem that isn’t there, but moderate sensitivity (54%), so it can miss some cases. Combining it with a second test that applies direct pressure to the sacroiliac joint bumps sensitivity up to about 68%. Multiple tests together help rule out other causes and pinpoint whether the sacroiliac joints, the pubic symphysis, or both are involved.
Daily Modifications That Help
Small changes in how you move throughout the day can make a meaningful difference. The core principle is to keep the pelvis symmetrical and avoid movements that force one side to bear load alone.
- Getting in and out of a car: Keep your knees together and swing both legs in or out as a unit, rather than stepping one leg at a time.
- Rolling over in bed: Bend your knees, press them together, and turn your whole body as one piece. A nest-shaped pillow that supports your abdomen while lying on your side can reduce pain and improve sleep in later pregnancy.
- Getting dressed: Sit down to put on pants, socks, and shoes instead of standing on one leg.
- Walking: Stick to even surfaces and shorter distances. Avoid rough or uneven terrain.
- Lifting: Avoid twisting while lifting. Keep the load close to your body.
- Standing and sitting: Maintain a straight posture and take regular breaks. A lumbar roll behind the lower back or a sacroiliac belt can provide additional pelvic support.
Bouncing, jarring movements, and uneven weight distribution on the legs should be avoided as much as possible. These aren’t permanent restrictions. They’re strategies to reduce the load on irritated joints while the body heals or adapts.
Exercise and Physical Therapy
Stabilizing exercises that target the muscles supporting the pelvic ring are the primary treatment for PGP. A physiotherapist can assess whether your pelvis has reduced force closure (too little muscular support) or excessive force closure (muscles gripping too tightly), since the two patterns require different approaches. General core and pelvic floor strengthening is helpful for most people, but the specific exercise program should match your pattern of instability.
Sacroiliac belts and abdominal supports can complement exercise by providing external stability to the pelvic ring. They work best as a short-term tool alongside an active rehab program rather than as a standalone solution. Some women also benefit from manual therapy or hands-on treatment to address joint stiffness or muscle tightness contributing to the pain.
Recovery After Pregnancy
For most women, PGP improves significantly in the weeks and months following delivery. The pelvic floor muscles and surrounding connective tissue are thought to reach their maximum recovery by four to six months postpartum, though many women feel substantially better well before that point. Return to higher-impact activity like running is generally recommended no sooner than eight weeks after delivery, and only if you can walk for 30 minutes without symptoms and perform basic strength tasks (step-ups, single-leg squats, wall sits, planks) pain-free.
A subset of women, however, continue to experience pelvic pain well beyond the postpartum period. Persistent symptoms at three months postpartum are a signal that targeted rehabilitation is warranted, as unresolved pelvic dysfunction at that stage is less likely to resolve on its own. Women with more severe pain during pregnancy, pain in multiple pelvic joints, or a history of previous episodes are at higher risk for longer recovery. Early treatment during pregnancy, rather than waiting it out, is associated with better outcomes.