Pelvic girdle pain (PGP), including symphysis pubis dysfunction (SPD), is one of the most common musculoskeletal challenges during pregnancy. While often dismissed as a “normal” part of pregnancy, it is treatable, manageable, and should be taken seriously, particularly when it begins to interfere with daily life.
This article provides an evidence-based overview of PGP/SPD, including why it happens and how physiotherapy-led care can support you through pregnancy.
What is Pelvic Girdle Pain (PGP) and SPD? away
Pelvic girdle pain is an umbrella term describing pain around the pelvic joints, including the sacroiliac joints (back of the pelvis) and the symphysis pubis joint at the front. [bmj.com], [rcog.org.uk]
Historically, the term symphysis pubis dysfunction (SPD) was used. It is now generally considered part of the broader PGP spectrum. [bmj.com]
Women with PGP/SPD typically experience:
- Pain in the front (pubic bone), lower back, hips or groin
- Difficulty walking, climbing stairs, or turning in bed
- Pain with single-leg activities (e.g. dressing or getting into a car)
How common is it?
PGP is very common in pregnancy:
- Around 20% (1 in 5) pregnant women experience it [rcog.org.uk]
- Some estimates suggest up to one-third to two-thirds of women have pelvic or lower back pain during pregnancy [bmj.com]
- SPD-specific symptoms may affect around 25% of pregnant women [knee-pain-…lained.com]
Despite how common it is, it can significantly affect mobility, sleep, and overall quality of life if left untreated. [bmj.com]
What causes pelvic girdle pain in pregnancy?
The exact cause is multifactorial, meaning several factors contribute at once rather than a single issue. [bmj.com]
1. Hormonal Changes
Hormones such as relaxin increase ligament flexibility to prepare the body for birth.
- This can lead to reduced joint stability in the pelvis [my.clevela…clinic.org]
2. Biomechanical Changes
As your baby grows:
- Your centre of gravity shifts
- Load through the pelvis increases
- Movement patterns change [thewomens.org.au]
These changes can place additional strain on the pelvic joints.
3. Altered Muscle Function
Reduced strength or coordination in:
- Deep abdominal muscles
- Pelvic floor
- Gluteal muscles
…can impair how load is transferred through the pelvis, contributing to pain. [bmj.com]
4. Joint Irritation or Instability
SPD occurs when the pubic symphysis joint becomes overly mobile or irritated, leading to pain and instability. [physio-pedia.com]
5. Additional Risk Factors
- Previous back or pelvic injury
- Hypermobility
- Previous pregnancy with PGP
- Physically demanding activity or deconditioning [rcog.org.uk], [bmj.com]
Is pelvic girdle pain harmful to your baby?
No—PGP/SPD does not harm your baby. However, it can greatly affect your comfort, sleep, and emotional wellbeing, so early support is important. [rcog.org.uk]
Physiotherapy-led management: what does the evidence support?
Physiotherapy plays a central role in managing PGP/SPD, focusing on reducing pain, improving stability, and enabling safe movement.
Clinical guidance recommends referral to physiotherapy when symptoms persist or impact function. [bmj.com]
1. Education and Activity Modification
Understanding how to move safely can significantly reduce symptoms.
Common strategies include:
- Keeping knees together when getting in/out of bed or cars
- Avoiding asymmetrical loading (e.g. standing on one leg)
- Breaking activities into smaller tasks
These approaches help minimise stress on the pelvic joints. [thewomens.org.au]
2. Individualised Exercise Therapy
Exercise is a cornerstone of physiotherapy management and may include:
- Pelvic floor training
- Deep abdominal (core) strengthening
- Gluteal strengthening
- Gentle mobility and control exercises
Exercise helps improve force transfer and stability across the pelvis, reducing pain and improving function. [ubiehealth.com]
3. Movement Retraining
A physiotherapist can guide:
- Walking patterns
- Sit-to-stand strategies
- Bed mobility techniques
This helps prevent aggravation and supports more efficient biomechanics.
4. Manual Therapy
Hands-on techniques may be used to:
- Reduce muscle tension
- Improve joint movement
- Relieve pain
Often combined with exercise for best outcomes.
5. Pelvic Support Belts
Support belts can provide external stability:
- May reduce pain by improving load transfer
- Some studies show improved pain outcomes, though functional benefits are mixed [doaj.org]
They are typically used alongside, not instead of, exercise therapy.
6. Pain Management & Practical Support
- Heat/ice application
- Sleep positioning (e.g. pillow between knees)
- Activity pacing
These strategies help manage symptoms day-to-day.
When should you seek help?
Consider seeing a women’s health physiotherapist if you experience:
- Pain affecting walking, sleep, or daily tasks
- Clicking or grinding in the pelvis
- Difficulty with stairs, dressing, or turning in bed
Early intervention is associated with better outcomes and faster recovery. [rcog.org.uk]
Takeaway: You don’t have to “push through” pelvic pain
Pelvic girdle pain and SPD are common during pregnancy—but they are not something you need to simply endure. With the right support, many women can significantly reduce symptoms, stay active, and feel more confident in their bodies throughout pregnancy.
Early assessment and targeted treatment can make a meaningful difference to both your comfort now and your recovery after birth.
Need help managing pelvic pain during pregnancy?
Our women’s health physiotherapists provide personalised assessment and evidence-based treatment for pelvic girdle pain and symphysis pubis dysfunction.
We support you with:
- Tailored exercise programs to improve strength and stability
- Hands-on physiotherapy to reduce pain
- Practical movement strategies for daily activities
- Guidance throughout each stage of pregnancy
Whether your symptoms are mild or more limiting, we’re here to help you move with greater comfort and confidence.
👉 Book an appointment or speak with our team today to get started.
References
- BMJ. Identifying and managing pregnancy-related pelvic girdle pain (2026). [bmj.com]
- Royal College of Obstetricians & Gynaecologists (RCOG). Pelvic girdle pain and pregnancy. [rcog.org.uk]
- Cleveland Clinic. Symphysis Pubis Dysfunction. [my.clevela…clinic.org]
- Royal Women’s Hospital. Pregnancy-related pelvic girdle pain factsheet. [thewomens.org.au]
- Physiopedia. Pubic Symphysis Dysfunction. [physio-pedia.com]
- NHS Physiotherapy Leaflet. Pregnancy-related symphysis pubis dysfunction. [royalberks…ire.nhs.uk]
- Bidari et al. (2024). Systematic review of pelvic belts. [doaj.org]
- Ubie Doctor’s Note (summary of clinical evidence). [ubiehealth.com]