PGP, or pelvic girdle pain, is pain at the front and/or back of your pelvis during pregnancy. It affects roughly 1 in 4 pregnant women and ranges from mild discomfort to pain severe enough to interfere with walking, sleeping, and daily routines. The good news: for most women, it resolves within months of delivery, and there are effective ways to manage it during pregnancy.
Where the Pain Shows Up
Your pelvic girdle is the ring of bones at the base of your spine. Three joints hold it together: two sacroiliac joints at the back (where your spine meets the pelvis) and the symphysis pubis joint at the front. PGP can affect any combination of these joints, which is why the pain can feel like it’s in several places at once.
Common pain locations include the pubic area, lower back, hips, groin, inner thighs, and sometimes the knees. Many women also notice a clicking or grinding sensation in the pelvic area. The hallmark of PGP is that movement makes it worse, particularly:
- Walking on uneven ground or for long distances
- Climbing stairs or standing on one leg (getting dressed, stepping into a bath)
- Separating the knees, like getting in and out of a car
- Rolling over in bed
Why Pregnancy Causes Pelvic Pain
During pregnancy, your body produces a hormone called relaxin. Its job is to loosen the muscles, ligaments, and joints around your pelvis so your body can eventually accommodate delivery. That loosening is necessary, but it also reduces the stability of the pelvic joints. When those joints move more than they should, even ordinary activities can cause pain.
Relaxin doesn’t just affect the pelvis. It loosens tissues across the back and abdomen too, which is part of why many pregnant women feel generally unsteady. Add the shifting center of gravity from a growing belly, and the pelvic joints end up absorbing forces they weren’t designed to handle in their loosened state. The result is inflammation, muscle tension, and pain that can range from a dull ache to sharp, stabbing discomfort.
Who’s More Likely to Get PGP
A large scoping review of risk factors found several patterns. Women who had low back pain or pelvic pain before pregnancy are at higher risk, as are those who’ve had a previous pregnancy. Being overweight or obese, being younger in age, and having a history of back injury or spinal problems all increase the odds. Lifestyle factors matter too: women who didn’t exercise before pregnancy and those with physically demanding jobs are more susceptible. Psychological stress, depression, and anxiety have also been linked to higher rates of PGP, likely because stress increases muscle tension and lowers pain thresholds.
How PGP Is Diagnosed
There’s no blood test or scan that confirms PGP. Diagnosis is clinical, meaning a physiotherapist or midwife will assess your symptoms and perform hands-on tests. Two tests are especially common. The posterior pelvic pain provocation test (P4) involves applying pressure through the pelvis while you lie on your back to see if it reproduces the deep, familiar pain in the buttock area. The active straight leg raise test checks whether you can lift your leg against gravity without your pelvis shifting, which reveals how well your pelvic joints are transferring load.
These tests help distinguish PGP from general lower back pain, which has different causes and responds to different treatments. The key difference is location: PGP pain centers around the pelvic joints themselves, not the lumbar spine.
Managing PGP During Pregnancy
Treatment focuses on reducing pain and keeping you as mobile as possible. Physiotherapy is the first-line approach, combining education, targeted exercises, and practical advice for modifying daily activities. A controlled trial found that stabilizing exercises (focused on the muscles that support the pelvis) significantly reduced pain compared to standard care alone, with improvements in both morning and evening pain scores.
Acupuncture has shown even stronger results in some studies. In the same trial, women who received acupuncture reported greater pain reduction than those doing stabilizing exercises, particularly for evening pain. This may partly reflect the one-on-one attention from an acupuncturist compared to group physiotherapy sessions, but the pain relief was measurable and consistent. Water-based exercise, such as aqua aerobics classes for pregnant women, has also been found beneficial, likely because the buoyancy takes weight off the pelvis while still allowing strengthening movements.
Pelvic Support Belts
A pelvic support belt wraps snugly around the hips to compress and stabilize the pelvic joints. Studies show belts are effective at reducing pain intensity at both the symphysis pubis and sacroiliac joints. There are two main types: rigid belts with firm reinforcement, and flexible, nonrigid belts. In a comparison study, 82% of participants preferred the nonrigid belt, finding it more comfortable and more effective. The rigid version tended to ride up, shift out of position when sitting, and dig into the skin. If you try a belt, a soft, adjustable one is generally the better starting point.
Practical Tips for Daily Life
Small changes to how you move can make a significant difference. The general principle is to keep your knees together and avoid any position that forces your legs apart.
When getting in or out of a car, sit first, then swing both legs in together rather than stepping one leg in at a time. When climbing stairs, take them one step at a time rather than alternating feet, and use the handrail. When getting dressed, sit down instead of balancing on one leg. Avoid carrying loads on one hip, and distribute weight evenly between both sides of your body whenever possible.
Rolling over in bed is one of the most commonly painful movements. The technique that helps most is bending your knees and pressing them together before you turn, so your pelvis moves as a single unit rather than twisting. A pillow between your knees keeps the hips aligned and prevents the top leg from pulling the pelvis out of position.
Sleep Positions That Help
Side sleeping with a pillow between your legs is the most recommended position for pelvic pain. Drawing your legs up slightly toward your chest and placing a firm pillow (or a full-length body pillow) between your knees aligns the spine, pelvis, and hips so the joints aren’t under strain. This position takes pressure off the sacroiliac joints and prevents the upper leg from dropping forward, which would twist the pelvis.
If you sleep on your back earlier in pregnancy, placing a pillow under your knees helps maintain the natural curve of the lower back and relaxes the muscles around the pelvis. A small rolled towel under the waist can add extra support. Sleeping on your stomach is generally not recommended with PGP (and becomes impractical as pregnancy progresses), since it increases strain on the lower back and pelvis.
Recovery After Delivery
For most women, PGP improves steadily after birth once relaxin levels drop and the pelvic joints tighten back up. In one study of women treated with physiotherapy and activity modification, 12 out of 13 experienced significant or complete resolution of symptoms within a year, with the average recovery time being about four months postpartum. Some women feel better within weeks, while others take closer to a year.
A small percentage of women do experience persistent pain beyond 12 months. This is more common in women who had severe symptoms during pregnancy or who had pelvic pain before becoming pregnant. Continued physiotherapy focusing on core and pelvic floor strengthening is the standard approach for lingering symptoms, and the vast majority of cases resolve without any surgical intervention.