Anatomy & Body Systems
Bony Structures The pelvic girdle consists of several bones that work together to form a stable but flexible structure:
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Two Illic Bones (Hip Bones) : Large, paired bones forming the sides of the pelvis. Each ilium consists of a body and a wing, and articulates with the sacrum posteriorly and the pubis anteriorly.
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The Sacrum : A triangular bone formed by five fused vertebrae, located at the base of the spine and connecting the spine to the pelvis. It articulates with the iliac bones on each side at the sacroiliac joints.
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The Coccyx (Tailbone) : A small bone at the very base of the spine, formed by three to five fused vertebrae. It provides attachment points for pelvic floor muscles and ligaments.
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The Pubis : The anterior portion of the hip bone, consisting of a body and two branches. The two pubic bones meet at the pubic symphysis.
Joints of the Pelvis The pelvis contains several joints that allow for movement while maintaining stability:
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Sacroiliac Joints (Posterior) : These joints connect the sacrum to the iliac bones. They are designed for stability with limited movement, but during pregnancy they become more mobile due to ligament relaxation.
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Pubic Symphysis (Anterior) : This joint connects the two pubic bones. It is a cartilaginous joint with a fibrocartilaginous disc. During pregnancy, this joint relaxes and can widen significantly (up to 2-3mm or more) to allow for childbirth.
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Sacrococcygeal Joint : The joint between the sacrum and coccyx, allowing for some movement of the tailbone.
Ligaments Strong ligaments connect the pelvic bones and provide stability:
- Anterior Sacroiliac Ligaments : Connect the anterior surface of the sacrum to the ilium
- Posterior Sacroiliac Ligaments : Strong ligaments connecting the posterior sacrum to the ilium; these are the main restraints against excessive sacroiliac movement
- Pubic Ligaments : Connect the pubic bones at the symphysis; include superior and inferior pubic ligaments
- Sacrospinous Ligaments : Connect the sacrum to the ischial spine
- Iliolumbar Ligaments : Connect the lumbar vertebrae to the iliac crest
Muscles Several muscle groups support the pelvis and can be affected by or contribute to PGP:
- Pelvic Floor Muscles : A group of muscles forming the floor of the pelvis, supporting the pelvic organs and contributing to stability
- Abdominal Muscles : Including the rectus abdominis, obliques, and transversus abdominis; provide anterior pelvic support
- Gluteal Muscles : Including gluteus maximus, medius, and minimus; hip extensors and stabilizers
- Hip Muscles : Including hip flexors, adductors, and abductors
- Piriformis : A deep hip muscle that can affect sacroiliac function
- Erector Spinae : Muscles running along the spine that can refer pain to the pelvis
Hormonal Changes Pregnancy involves significant hormonal changes that affect the musculoskeletal system:
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Relaxin : A hormone produced by the ovaries and placenta that increases ligamentous laxity throughout the body. It peaks during the first trimester and remains elevated throughout pregnancy, allowing the pelvis to expand for childbirth.
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Progesterone : Causes relaxation of smooth muscle throughout the body, including pelvic ligaments.
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Estrogen : Works synergistically with relaxin to increase ligamentous laxity.
These hormonal changes are essential for childbirth but can lead to instability and pain in the pelvic joints when the joints become too mobile.
Mechanical Changes The growing uterus creates mechanical challenges:
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Shifted Center of Gravity : As the uterus expands, the center of gravity moves forward, changing posture and load distribution on the pelvis.
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Altered Gait Pattern : The changing shape of the body and the loosened pelvis lead to a characteristic "waddle" gait during pregnancy.
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Increased Load on Pelvis : The growing baby and uterus increase the weight-bearing load on the pelvic joints.
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Changed Posture : Lumbar lordosis (curvature) increases to accommodate the growing uterus, putting additional stress on the sacroiliac joints.
Types & Classifications
Classification by Location
PGP can be classified according to the location of pain:
Anterior PGP (Symphysis Pubis Dysfunction)
- Pain localized to the pubic symphysis
- May radiate to the lower abdomen or groin
- Often worsens with weight-bearing activities
- Commonly causes pain when walking, climbing stairs, or getting in/out of bed
- May cause a sensation of the pelvis "giving way"
Posterior PGP
- Pain in the sacroiliac joints
- Pain may radiate to the buttocks or posterior thigh
- Often worse with standing, walking, or climbing stairs
- May be one-sided or bilateral
- Can be confused with sciatica
Combined or Mixed PGP
- Pain in both anterior and posterior pelvic structures
- The most common presentation
- Symptoms may vary in location and intensity
Classification by Severity
Mild PGP
- Discomfort with certain movements or activities
- Minimal impact on daily activities
- Pain typically resolves with rest
- Easily managed with self-care measures
- May not require formal treatment
Moderate PGP
- Noticeable pain with routine activities
- Some modification of daily activities required
- May benefit from professional treatment
- Can affect sleep and work activities
Severe PGP
- Significant pain affecting most activities
- Marked limitations in mobility
- May require assistive devices (crutches, wheelchair in extreme cases)
- Significantly impacts quality of life
- Requires comprehensive treatment
Classification by Onset
Early Pregnancy Onset
- Begins in first or second trimester
- Often related to early hormonal changes
- May indicate more severe or persistent PGP
- Often persists throughout pregnancy
Late Pregnancy Onset
- Begins in third trimester
- More commonly related to mechanical factors
- May be less severe than early-onset cases
- Often improves more quickly postpartum
Causes & Root Factors
Hormonal Factors The primary cause of pregnancy-related PGP is hormonal:
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Relaxin : This hormone, produced by the corpus luteum and placenta, increases dramatically during pregnancy. It causes collagen remodeling in ligaments throughout the body, making them more extensible and allowing the pelvic bones to separate during childbirth.
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Progesterone : Elevated progesterone levels cause relaxation of smooth muscle and connective tissue throughout the body.
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Estrogen : Works synergistically with relaxin to enhance ligamentous laxity.
The degree of hormonal-induced laxity varies significantly between individuals, which explains why some women develop severe PGP while others experience minimal symptoms.
Mechanical Factors Physical changes during pregnancy contribute to PGP:
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Increased Weight : The growing fetus, uterus, placenta, and increased blood volume add significant weight to the anterior pelvis.
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Shifted Center of Gravity : The expanding uterus moves the body's center of gravity forward, altering posture and increasing stress on the sacroiliac joints.
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Altered Biomechanics : Changes in gait, posture, and movement patterns to accommodate the growing belly.
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Pelvic Torsion : Asymmetric loading can cause twisting of the pelvis.
Previous Medical History
- Prior pelvic trauma or injury
- Previous pregnancy with PGP
- History of low back pain or sacroiliac dysfunction
- Previous pelvic surgery
- History of joint hypermobility or connective tissue disorders
Physical Factors
- Weak core muscles
- Poor postural habits
- Occupational factors (prolonged standing, heavy lifting)
- High-impact physical activities
- Previous injuries to hips, knees, or ankles affecting gait
Risk Factors
Pregnancy-Related Factors
- Multiple Pregnancy : Twins, triplets, or more put additional mechanical stress on the pelvis
- Large Baby : Macrosomia (large fetal size) increases mechanical load
- Polyhydramnios : Excess amniotic fluid increases uterine size
- First Pregnancy : First-time mothers may be more susceptible due to unprepared pelvic tissues
- Young Maternal Age : Younger women may have less developed pelvic support
Historical Factors
- Previous PGP : The strongest predictor of PGP in a subsequent pregnancy is PGP in a previous pregnancy
- Previous Pelvic Injury : Trauma to the pelvis or lower back
- History of Low Back Pain : Pre-existing back problems increase risk
- Joint Hypermobility : Conditions like Ehlers-Danlos syndrome
- Previous Pelvic Surgery : Including cesarean sections
Physical and Lifestyle Factors
- Physically demanding occupation or activities
- High-activity lifestyle before pregnancy
- Weak abdominal or pelvic floor muscles
- Poor posture
- Smoking (associated with more severe symptoms)
Other Factors
- Stress and psychological factors may influence pain perception
- Lack of social support may affect coping
Signs & Characteristics
Location PGP pain typically occurs in one or more of these locations:
- Lower back (often one-sided, near the sacroiliac joints)
- Buttocks (one or both sides)
- Groin (anterior pelvis)
- Pubic area (at the symphysis)
- Thigh (sometimes, particularly posterior thigh)
- Hip joints
Quality Pain descriptions commonly include:
- Aching or dull pain
- Sharp or stabbing sensations
- Burning or throbbing
- Grinding or clicking sensation
- Feeling of instability or "giving way"
Aggravating Factors Activities and movements that typically worsen PGP:
- Walking, especially for prolonged periods
- Standing for extended periods
- Climbing stairs
- Getting in and out of a car
- Rolling over in bed
- Lifting anything heavy
- Long periods of sitting
- Standing on one leg (to dress)
- Getting in and out of bed
Relieving Factors Activities and interventions that may help:
- Rest and reducing activity
- Lying down, especially in a comfortable position
- Applying heat (warm compresses, baths)
- Using supportive devices (maternity belt, pillows)
- Modifying movement patterns
- Gentle movement and stretching
Daily Activities Significantly Affected
- Walking, especially distance walking
- Climbing stairs
- Getting dressed (putting on pants, underwear)
- Getting in and out of bed
- Getting in and out of a car
- Standing for long periods
- Housework and childcare
- Work activities
Sleep Disturbances
- Difficulty finding comfortable position
- Pain when rolling over in bed
- Waking due to pain
- Difficulty getting in and out of bed
Associated Symptoms
Related Pregnancy Pains PGP often coexists with other pregnancy-related discomforts:
- Round Ligament Pain : Sharp pains in the lower abdomen or groin due to stretching of the round ligaments
- Low Back Pain : Non-specific back pain in pregnancy
- Sciatica : Pain radiating down the leg due to nerve compression
- Hip Pain : Pain in the hip joints
- Pubic Pain : Specifically at the pubic symphysis
Other Associated Symptoms
- Audible Sounds : Clicking, grinding, or popping in the pelvis
- Sensation of Instability : Feeling that the pelvis is "giving way" or unstable
- Urinary Symptoms : Sometimes increased urinary frequency or urgency
- Bowel Symptoms : Occasional constipation or discomfort
Postpartum PGP
- Can persist after delivery in some women
- May improve gradually or suddenly after birth
- Some women experience worsening initially before improvement
- May require continued treatment postpartum
- Usually resolves within 3-6 months
- A small percentage may have persistent symptoms
Clinical Assessment
Your comprehensive PGP evaluation at Healers Clinic includes several components:
1. Detailed Symptom History
- Location and radiation of pain
- Onset and duration
- Character and severity
- What aggravates and relieves symptoms
- Impact on daily activities, work, and sleep
- Previous treatments tried
- Previous pregnancies and any PGP history
- Medical history including injuries
2. Physical Examination Your examination may include:
- Posture assessment standing and walking
- Observation of movement patterns
- Palpation of pelvic joints
- Range of motion testing
- Muscle strength assessment
- Special tests for sacroiliac joint and pubic symphysis
- Neurological assessment if indicated
3. Functional Assessment
- Gait analysis
- Activity limitations
- Quality of life impact
- Self-management abilities
Diagnostics
Clinical Diagnosis
PGP is primarily diagnosed clinically:
- Based on typical symptoms
- Physical examination findings
- Exclusion of other conditions
- No specific diagnostic test exists
Diagnostic Tests
Imaging Studies
- Ultrasound : May be used to assess pubic symphysis separation
- X-ray : Generally avoided in pregnancy; may be used postpartum
- MRI : Used only if severe or unusual symptoms suggest other pathology
Laboratory Tests
- Blood tests to rule out other conditions
- Urine tests to rule out urinary tract infection
At Healers Clinic, we use validated assessment tools:
- Pelvic Girdle Questionnaire
- Visual Analog Scale for pain
- Functional assessment scales
- Quality of life measures
Differential Diagnosis
Other Pregnancy-Related Pains
- Round Ligament Pain : Typically sharper, more localized to the groin
- Low Back Pain : Non-specific back pain without clear pelvic involvement
- Sciatica : Radiating pain down the leg, often with numbness/tingling
- Hip Pathology : Conditions like hip osteoarthritis or bursitis
More Serious Conditions These require prompt evaluation:
- Placental Abruption : Severe abdominal pain with bleeding
- Kidney Stones : Severe flank pain with urinary symptoms
- Urinary Tract Infection : Burning with urination, fever
- Pelvic Inflammatory Disease : Fever, pelvic pain
- Appendicitis : Right lower quadrant pain with fever
- Ovarian Cyst : Sudden severe pelvic pain
- Preterm Labor : Regular painful contractions
Conventional Treatments
Medications
- Acetaminophen (Paracetamol) : Generally considered safe for pregnancy
- Always consult your healthcare provider before taking any medication
- Avoid NSAIDs (ibuprofen, aspirin) in pregnancy unless specifically recommended
- Self-medication should be avoided during pregnancy
Physical Support Devices
- Maternity Support Belts : Provide external support to the pelvis
- Crutches : For severe cases to reduce weight-bearing load
- Pelvic Support Garments : Specialized clothing for support
Lifestyle Adjustments
- Avoid activities that worsen pain
- Use proper body mechanics (bending at knees, not waist)
- Rest when needed
- Pace activities throughout the day
- Ask for help with heavy tasks
- Use assistive devices when available
Integrative Treatments
Specialized pregnancy physiotherapy is the most effective treatment for PGP:
Manual Therapy Techniques
- Joint mobilization of sacroiliac joints and pubic symphysis
- Soft tissue release of tight muscles
- Myofascial techniques
- Muscle energy techniques
- Counterstrain techniques
Exercise Programming
- Pelvic floor exercises (Kegels)
- Core stabilization exercises
- Gentle strengthening for glutes and core
- Stretching routines for tight muscles
- Movement re-education
- Stabilization exercises
Modalities
- Heat therapy for muscle relaxation
- Ice therapy for acute inflammation
- TENS (Transcutaneous Electrical Nerve Stimulation)
- Biofeedback for muscle re-education
- Ultrasound therapy
Education and Self-Management
- Body mechanics training
- Activity modification strategies
- Safe exercise guidance
- Use of support devices
Gentle homeopathic support is safe during pregnancy:
Common Remedies for PGP
Rhus Toxicodendron
- Stiffness that improves with movement
- Pain worse in cold, damp weather
- Restlessness
- Aching in bones
Bryonia
- Pain worse with slightest movement
- Irritability
- Wants to be left alone
- Worse from heat
Arnica Montana
- Bruised, sore feeling
- Fear of being touched
- bed feels too hard
- Restless, wants to change position
Bellis Perennis
- Deep aching bruise sensation
- Worse from cold applications
- Soreness in pelvic region
- Old injuries flare up
Cimicifuga Racemosa
- Cramping, shooting pains
- Feeling of depression
- Shooting pains across pelvis
- Fidgety, cannot stay still
Ruta Graveolens
- Bruised feeling in bones
- Restlessness
- Pain from overexertion
- Hip and pelvis pain
Treatment Approach
- Individualized prescription based on complete symptom picture
- Safe for use during pregnancy
- Addresses underlying susceptibility
Traditional Chinese medicine offers valuable support:
Benefits
- Pain relief
- Reduced inflammation
- Hormone regulation
- Relaxation and stress reduction
- Improved sleep
Common Points
- Based on pattern diagnosis in TCM
- Points on back, abdomen, and limbs
- Safe during pregnancy when administered by qualified practitioner
Ayurvedic approaches support overall pregnancy health:
Dietary Recommendations
- Vata-pacifying diet
- Warm, nourishing foods
- Proper hydration
- Anti-inflammatory foods
- Avoid cold foods and drinks
Lifestyle Practices
- Gentle exercise (walking, prenatal yoga)
- Adequate rest
- Stress reduction techniques
- Abhyanga (daily self-massage with warm sesame oil)
Herbal Support Under qualified guidance:
- Safe anti-inflammatory herbs
- Joint-supporting formulations
- Herbs that support soft tissue health
Gentle movement practices support PGP management:
Benefits
- Gentle stretching
- Strength building
- Relaxation techniques
- Community and support
- Mind-body connection
Recommended Practices
- Prenatal yoga classes
- Swimming (supportive, non-weight-bearing)
- Walking at comfortable pace
- Gentle stretching
- Breathing exercises
Self Care
Walking
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Take shorter steps
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Avoid walking uphill
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Use supportive, comfortable shoes a comfortable pace
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Walk at- Rest frequently on long walks
Getting In/Out of Car
- Sit down on the seat first
- Keep knees together when pivoting
- Use arms for support when standing
- Back up to the seat before sitting
Getting Out of Bed
- Roll to your side first
- Push up with your arms
- Swing legs over the edge of the bed
- Sit up slowly
Getting Dressed
- Sit down to put on underwear and pants
- Avoid standing on one leg
- Use a dressing stick if needed
Maternity Belts
- Provide external pelvic support
- Reduce joint movement and instability
- Help with pain when walking or standing
- Various styles available
Pillows
- Support between knees when sleeping
- Support the belly when lying on side
- Use for positioning in bed
Heat Therapy
- Warm compresses on painful areas
- Warm baths
- Heating pads (on low setting)
- Warm showers
Cold Therapy
- Ice packs (15-20 minutes)
- Cold compresses
- Always wrap ice in a towel
- Rest when needed
- Avoid overexertion
- Break up prolonged sitting or standing
- Ask for help with difficult tasks
- Prioritize important activities
- Accept help from family and friends
Prevention
Physical Preparation
- Core strengthening exercises
- Pelvic floor exercises (Kegels)
- General fitness and flexibility
- Posture awareness
- Balanced nutrition
Health Optimization
- Maintain healthy weight
- Address any existing musculoskeletal issues
- Ensure adequate calcium and vitamin D
Early Intervention
- Start gentle exercises early in pregnancy
- Pay attention to body mechanics from the beginning
- Don't ignore early symptoms
- Seek treatment promptly if symptoms develop
Lifestyle Maintenance
- Maintain reasonable activity level
- Use support devices when needed
- Rest adequately
- Avoid overexertion
- Sleep in comfortable positions
Movement and Posture
- Avoid standing for long periods
- Sit with good posture
- Use pillows for support
- Wear supportive shoes
When to Seek Help
Seek professional help if:
- Pain is severe or worsening
- Pain is significantly affecting daily activities
- You're having difficulty walking
- Pain is accompanied by other concerning symptoms
- You need help with pain management
- Self-care measures aren't helping
Emergency Signs
Seek Immediate Medical Attention For:
- Severe pelvic pain
- Vaginal bleeding
- Fluid leakage (possible membrane rupture)
- Regular painful contractions (possible preterm labor)
- Fever
- Severe headache
- Vision changes
- Sudden swelling
Prognosis
Typical Course
- PGP often begins in second or third trimester
- Symptoms typically increase as pregnancy progresses
- Usually improves with treatment
- Most commonly resolves after delivery
With Treatment
- Physiotherapy : Most effective treatment; significant improvement common
- Homeopathy : Can reduce pain and improve function
- Acupuncture : Effective for pain relief
- Combined Approach : Best outcomes with multiple modalities
Recovery
- Most women improve significantly after delivery
- 80-90% resolve within 3-6 months postpartum
- Some may have persistent symptoms requiring continued treatment
- Treatment can continue safely postpartum
Long-Term Outlook
- Excellent prognosis with appropriate care
- Most women return to full function
- Future pregnancies may have recurrence risk
- Prevention strategies help with subsequent pregnancies
FAQ
Q: What causes pelvic girdle pain in pregnancy? A: PGP is caused by hormonal changes (particularly relaxin) that relax pelvic ligaments, combined with mechanical changes from the growing uterus. These changes cause instability in the pelvic joints, leading to pain. The degree of laxity varies between women, explaining why some experience more severe symptoms.
Q: How long does pelvic girdle pain last? A: PGP typically begins in the second or third trimester and usually improves after delivery. Most women experience significant improvement within days to weeks postpartum. Some women (5-10%) may have persistent symptoms requiring continued treatment, which usually resolves within 3-6 months.
Q: Is pelvic girdle pain dangerous to my baby? A: PGP itself is not dangerous to you or your baby. It's a discomforting but benign condition related to normal pregnancy changes. However, severe pain should be evaluated to rule out other more serious conditions.
Q: What helps pelvic girdle pain the most? A: Specialized physiotherapy is the most effective treatment, including specific exercises, manual therapy, and supportive devices. Heat, rest, and activity modification also help. Most women improve significantly with a comprehensive treatment approach.
Q: Can I exercise with pelvic girdle pain? A: Yes, but you should modify your exercise routine. Avoid high-impact activities and movements that worsen pain. Swimming, walking, and prenatal yoga are usually well-tolerated. Working with a physiotherapist can help develop a safe exercise program.
Q: Will pelvic girdle pain go away after pregnancy? A: Most women experience significant improvement or complete resolution after delivery. Continued physiotherapy and self-care can help with recovery. A small percentage may have persistent symptoms requiring ongoing treatment.
Q: How is PGP different from SPD? A: SPD (Symphysis Pubis Dysfunction) is a type of PGP that specifically affects the pubic symphysis. PGP is a broader term encompassing pain in all pelvic joints (sacroiliac, pubic symphysis, and surrounding structures).
Q: Does homeopathy help pelvic girdle pain? A: Many women find homeopathy helpful for PGP. Individualized remedies based on complete symptom presentation can provide relief and are safe during pregnancy. Best results typically occur when combined with physiotherapy.
Q: Can I prevent pelvic girdle pain? A: While not entirely preventable, you can reduce your risk through pre-pregnancy core strengthening, maintaining healthy weight, and starting pregnancy in good physical condition. Early intervention when symptoms begin can prevent worsening.
Q: Will PGP affect my labor and delivery? A: PGP does not typically affect labor and delivery. Most women with PGP can have normal vaginal deliveries. In some cases with severe pubic symphysis dysfunction, discussions about delivery positions may be helpful.
Q: When should I see a doctor about pelvic girdle pain? A: See your provider if pain is severe, affecting your daily activities, getting worse, or if you're having trouble walking. Also seek care if you have other concerning symptoms like bleeding or fever.
This content is for educational purposes only. Consult your healthcare provider for diagnosis and treatment. For appointments at Healers Clinic Dubai, call +971 56 274 1787 or visit https://healers.clinic/booking/
Last Updated: March 2026
Healers Clinic - Transformative Integrative Healthcare Serving patients in Dubai, UAE and the GCC region since 2016 Phone: +971 56 274 1787 Website: https://healers.clinic/