PGP stands for pelvic girdle pain, a condition that causes pain in the joints of your pelvis during pregnancy. It affects a surprisingly large number of pregnant women, with one large Australian study finding a prevalence of 44%. The pain can range from mildly annoying to severely debilitating, and it centers on the joints that hold your pelvis together: the pubic symphysis at the front and the sacroiliac joints at the back.
Where the Pain Comes From
Your pelvis isn’t one solid bone. It’s a ring of bones connected by joints and held together by ligaments. The joint at the very front, where your left and right pubic bones meet, is called the pubic symphysis. The two joints at the back, where your pelvis connects to your spine, are the sacroiliac joints. PGP can affect any or all of these joints.
During pregnancy, your body produces a hormone called relaxin that loosens the muscles and ligaments around your pelvis, back, and abdomen. This loosening is intentional: it helps your body prepare for birth. But it can also make these joints less stable, which leads to pain when they move in ways they normally wouldn’t. Add in the shifting center of gravity from a growing belly, changes in posture, and extra weight bearing down on already-loosened joints, and the conditions are set for PGP.
Women who have pain in both the front (symphysis) and both sides of the back (bilateral posterior pain) tend to experience the most disability. Pain deep in the buttock on one side is a hallmark sign that the sacroiliac joints are involved.
What PGP Feels Like
PGP is distinct from ordinary lower back pain, though the two can overlap and sometimes coexist. The key difference is location. PGP pain is felt in the pelvic area itself: across the front of the pubic bone, deep in the buttocks, in the groin, or radiating down the inner thighs. It often gets worse with activities that involve shifting weight onto one leg, like climbing stairs, getting out of a car, or rolling over in bed.
Some women feel a clicking or grinding sensation in the pelvis. Others describe it as a deep ache that flares with certain movements and eases with rest. Walking, standing on one leg (even briefly, like when putting on pants), and separating the knees can all trigger it.
How PGP Is Diagnosed
There’s no scan or blood test for PGP. Diagnosis is based on where you feel pain and how your body responds to specific physical tests. A physiotherapist or midwife will typically use two key assessments. The first is a posterior pelvic pain provocation test, where pressure is applied to your bent knee while you lie on your back to see if it reproduces a familiar deep pain in the buttock. The second is an active straight leg raise, where you lift one leg while lying flat. If this feels disproportionately difficult or heavy, it suggests your pelvis isn’t transferring load effectively between your spine and legs.
Pain drawings, where you mark exactly where you feel pain on a diagram, also help clinicians distinguish PGP from lower back pain and identify which pelvic joints are involved.
Managing Pain Day to Day
The most effective strategies for PGP are practical changes to how you move through your day. These small adjustments protect your pelvic joints from the asymmetric forces that trigger pain:
- Getting in and out of bed: Keep your knees together and roll under (toward the mattress) rather than over. Swing your legs off the side of the bed as a unit rather than one at a time.
- Sleeping: Lie on your side with a pillow between your knees to keep your pelvis aligned.
- Walking: Take smaller steps and shorter distances. Don’t push through pain.
- Housework and lifting: Reduce heavy lifting and pushing or pulling activities like vacuuming. Break large tasks into smaller chunks with rest in between.
- Posture: Stand tall and sit with back support. Relaxin loosens the structures that normally help maintain your posture, so conscious effort matters more than usual.
The overarching principle is to avoid anything that forces your legs apart or puts your weight unevenly on one side. Stairs, stepping over things, and getting out of cars with one leg at a time are common culprits.
Physiotherapy and Exercise
Physiotherapy is the cornerstone of PGP treatment. A targeted exercise program reduces the severity of flare-ups and addresses the underlying mechanical problems that develop as your body compensates for pelvic instability. The focus is on strengthening the gluteal muscles (the muscles in your buttocks) and the inner thigh muscles, while reducing overactivity in the lower back muscles that often tighten up to compensate.
A physiotherapist can also teach you specific strategies for daily activities that aggravate your symptoms. This kind of practical, individualized coaching often makes more difference than generic exercises alone.
Support Belts and Other Options
Pelvic support garments can reduce pain by physically stabilizing the pelvic ring. One study comparing a modified pregnancy support belt to a standard belt found measurable reductions in pain scores with both, though the modified belt performed better. These belts work best when fitted correctly and used for short periods rather than worn all day.
Acupuncture has some evidence behind it as well. Women who received acupuncture alongside standard care reported less morning and evening pain and better functional outcomes, though the evidence is limited. For acute flare-ups, paracetamol (acetaminophen) is the first-line option for pain relief. Stronger pain medications are used cautiously during pregnancy due to side effects. Surgery is extremely rare and only considered after all other options have been exhausted in cases of persistent, debilitating symptoms.
PGP During Labor and Birth
PGP doesn’t prevent you from having a vaginal birth, but it does influence which positions feel manageable. Many women with PGP find it uncomfortable to give birth lying on their backs. Positions that tend to work better include kneeling on all fours, standing, leaning forward against the raised back of the bed, or lying on your side with pillows or a peanut ball supporting the less painful leg. Side-lying is especially useful if you have an epidural and can’t easily change positions.
It helps to discuss your PGP with your birth team beforehand so they know to avoid positions that strain your pelvis and can help you find alternatives during labor.
Recovery After Birth
For most women, PGP resolves on its own within three months of delivery. The hormone levels that caused ligament loosening return to normal, and the joints gradually restabilize. However, recovery isn’t universal. Research tracking women from late pregnancy through the first year found that about 30% still reported pelvic girdle pain at 12 months postpartum, and that number stayed roughly the same between 12 weeks and one year, suggesting that if symptoms persist past the early postpartum period, they may not resolve without targeted treatment.
A smaller long-term study found that 8.5% of women who had PGP in late pregnancy still reported it two years after giving birth. If your pain lingers beyond the first few months postpartum, physiotherapy focused on pelvic stability and strengthening is the most effective path forward.