Pelvic Girdle Pain in Pregnancy (SPD) Physiotherapy

What pelvic girdle pain feels like

Pain sits over the pubic bone at the front, over one or both sacroiliac joints at the back, or in the groin and inner thigh. Some women feel or hear a click. The pattern is what gives it away: it's worst when the legs move independently or apart. Standing on one leg to put on trousers, getting in and out of a car, climbing stairs, turning over in bed and walking any distance are the classic triggers.

You may have heard it called SPD, short for symphysis pubis dysfunction. Pelvic girdle pain is the broader term, because the back of the pelvis is often involved as well. By most estimates it affects around one in five pregnant women, and it can start as early as the first trimester.

Why it happens

The pelvis is a ring of three bones joined at the pubic symphysis in front and the two sacroiliac joints behind. It stays stable through two things working together: the shape of the joint surfaces, and compression from the muscles and connective tissue around them. In pregnancy the ligaments soften, the load increases and the abdominal muscles that normally help compress the ring are stretched. If the muscles don't take up the slack evenly, one side ends up moving more than the other and the joints get sore.

Two things worth knowing. The pelvis is not "out of place" and a click isn't a dislocation. And pelvic girdle pain doesn't harm your baby.

Hip pain in pregnancy

Pain on the outside of the hip, worse when lying on that side, is usually irritated tissue over the bony point of the hip, similar to trochanteric bursitis. A pillow between the knees and a softer mattress topper often make a real difference. Front-of-hip and groin pain overlaps with pelvic girdle pain and is assessed the same way.

One rare exception: severe hip pain in the third trimester with a limp that keeps getting worse needs a doctor's opinion and sometimes imaging, because a condition called transient osteoporosis of the hip can occur in pregnancy. We look for this and refer when it fits.

How we treat it

Assessment

Specific tests for the pubic and sacroiliac joints, hip movement, muscle strength and the activities that provoke your pain.

Manual therapy

Gentle techniques to the pelvic joints and the muscles around them, often using your own muscle contractions to even out the pelvis. Most women walk out easier than they walked in.

Stability work

Glute, deep abdominal and inner thigh activation, built into movements you actually do, like getting up from a chair or onto the bed.

Support

Fitting advice for a pelvic support belt worn low around the pelvis, and occasionally crutches for a short spell if walking is very limited.

Day-to-day changes that take the pressure off

• Keep your knees together when getting in and out of a car, bed or auto: sit first, then swing both legs together.
• Sit down to put on trousers, socks and underwear.
• Take stairs one at a time, leading up with the less painful leg and down with the more painful one.
• Turn in bed with your knees together, and keep a pillow between them when you sleep.
• Take shorter steps and walk in shorter bouts rather than one long walk.
• Avoid wide-legged squats, breaststroke kick and carrying a toddler on one hip.

Planning for labour

Pelvic girdle pain rarely changes how you give birth, but it's worth telling your birth team about it. Before labour, lie on your back or side and have someone measure how far apart your knees can comfortably go without pain. Put that distance in your birth plan. If you have an epidural and can't feel pain, it stops your legs being opened wider than your pelvis tolerates. Many positions for labour, such as side-lying or kneeling on all fours, are kinder to a sore pelvis than lying on your back.

After the baby arrives

For most women the pain settles within weeks to a few months after birth. When it lingers, it's usually because the muscles around the pelvis never regained full strength. That's picked up in our postpartum rehabilitation program. Pelvic girdle pain tends to come back earlier in a later pregnancy, so starting physiotherapy early the second time pays off. There's more on this in our article on pregnancy-related hip and pelvic pain.

Frequently asked questions