Why Does My Pelvis Hurt During Pregnancy?
Getting out of the car has become a production. Rolling over in bed wakes you up. Walking up the stairs sends a sharp, unstable feeling right through the front of your pelvis, like something in there isn't quite connected the way it should be. Someone probably told you this is just "part of pregnancy." It's common, yes. But that doesn't mean it's something you're stuck with for the next several months.
What you're likely dealing with has a name — pelvic girdle pain, sometimes still called symphysis pubis dysfunction — and it affects roughly one in five pregnant women to some degree.[^1] It's not rare, it's not something you caused, and importantly, it responds well to the right kind of treatment.
Pelvic girdle pain during pregnancy results from hormonal changes (particularly relaxin) increasing ligament laxity throughout the pelvis, combined with the postural and load changes of a growing pregnancy. This creates instability at the pubic symphysis joint in front, the sacroiliac joints in back, or both. It typically produces sharp or aching pain in the pubic area, groin, hips, or lower back that worsens with walking, stair climbing, turning over in bed, or getting in and out of a car. Physical therapy is considered one of the most effective treatments available.
Here's what's actually happening in your pelvis, why it's not something to just push through, and what treatment realistically looks like.
Why Does My Pelvis Hurt During Pregnancy?:
What's Actually Going On Mechanically
Your body produces a hormone called relaxin during pregnancy, and its job is exactly what it sounds like — loosening the ligaments throughout your pelvis to allow the flexibility needed for delivery. This is a completely normal, necessary process.
The problem is that this increased laxity doesn't always translate into stability. The pubic symphysis — the joint at the very front of your pelvis where the two pubic bones meet — along with the sacroiliac joints in the back, can end up moving more than they're used to, and somewhat unevenly. When those joints move asymmetrically or excessively, the surrounding muscles, ligaments, and connective tissue end up compensating, and that's typically where the pain actually comes from.
Add to this the very real biomechanical shift of a growing pregnancy — your center of gravity moving forward, your posture adapting, your core and pelvic floor working differently than before — and you've got multiple factors converging on the same joints at once.
Researchers and clinicians don't fully understand why some pregnant women develop significant pelvic girdle pain while others with similar hormone levels don't, but there is at least some evidence connecting risk factors like previous pelvic trauma, multiple pregnancies, and prior episodes of pelvic girdle pain to increased likelihood of developing it again.[^2]
What This Actually Feels Like
Pelvic girdle pain shows up differently for different people, but there's a fairly recognizable cluster of symptoms.
Pain right at the pubic bone, sometimes described as sharp or stabbing, particularly with movements that involve separating the legs — getting out of a car, turning over in bed, going up stairs one leg at a time. Aching or throbbing that can radiate to the groin, hips, buttocks, or upper thighs. A sense of instability, like the front of your pelvis is grinding, clicking, or shifting when you move. Pain that's often worse by the end of the day, or after a day involving a lot of walking or standing.
For a lot of women, this creates real functional difficulty — walking becomes uncomfortable, certain positions in bed become impossible, and everyday movement patterns require modification just to manage the pain.
Why Waiting It Out Isn't the Best Strategy
There's a common assumption that pelvic girdle pain is just something to endure until delivery, at which point it resolves on its own. For many women, symptoms do improve substantially in the weeks or months after birth once relaxin levels drop and the ligaments tighten back up. But research indicates that roughly one in ten women continue to have symptoms well beyond that point.[^1]
More importantly, clinical guidance increasingly emphasizes that early intervention is associated with better outcomes and faster recovery, both during pregnancy and afterward.[^3] Waiting it out isn't just uncomfortable in the meantime — it may also mean a longer road to full resolution.
What Assessment Actually Looks Like During Pregnancy
Evaluation focuses heavily on movement and function, since imaging generally isn't recommended during pregnancy except in unusual circumstances.
We look at how your pelvis moves and whether one side moves differently than the other. We assess strength throughout your hips, core, and pelvic floor, since these muscles play a major role in providing the stability your ligaments currently aren't providing well on their own. We look at your posture and how your walking pattern has changed as pregnancy has progressed. We also talk through which specific movements consistently provoke pain, since that tells us a lot about which structures are most involved.
Physical therapy is widely considered one of the most effective treatment approaches available for pregnancy-related pelvic girdle pain, and it's built around a few core pieces.
Targeted strengthening of the muscles that support pelvic stability — deep core muscles, glutes, and pelvic floor — gives your pelvis the muscular support it needs while the ligaments themselves are more mobile than usual.
Manual therapy and soft tissue work can reduce the muscle tension and compensation patterns that build up around an unstable joint, providing meaningful symptom relief and making the rest of treatment more effective.
Movement modification education — practical guidance on how to get in and out of a car, how to turn over in bed, how to navigate stairs — reduces the number of times per day you're provoking pain unnecessarily.
Breathing and pelvic floor coordination work. Diaphragmatic breathing specifically helps the pelvic floor relax appropriately, which reduces overall tension and can meaningfully ease pain.[^4]
A support belt, when appropriate, can add external stability by compressing and supporting the pelvic girdle, particularly during activity. It's a helpful tool alongside treatment, not a replacement for it.
Most women notice meaningful symptom relief within a few weeks of starting appropriately targeted treatment, and many continue that improvement throughout the remainder of pregnancy with ongoing care adjusted as things progress.
When It's Worth Getting Evaluated
Worth scheduling an evaluation if: you're experiencing pubic, groin, hip, or lower back pain that's affecting how you move through your day, you've been told this is "just normal" but it's significantly limiting your activity, walking or turning over in bed has become genuinely difficult, or you simply want proactive support rather than waiting to see how bad it gets.
Common Questions About Pelvic Girdle Pain in Pregnancy
Is this the same thing as symphysis pubis dysfunction?
Yes — SPD is the older term for what's now more broadly called pelvic girdle pain, which includes the sacroiliac joints as well as the pubic symphysis.
Will this definitely go away after I deliver?
For most women, yes, symptoms improve substantially within a few months postpartum as hormone levels normalize. A smaller percentage continue to have symptoms longer, which is part of why early treatment matters.
Is it safe to exercise or stay active with this?
Generally yes, with appropriate modification. Complete rest isn't usually the answer — targeted strengthening and movement modification tend to produce better outcomes than avoiding activity altogether.
Can this happen even in a first pregnancy, or is it only with multiple pregnancies?
It can happen in a first pregnancy. Multiple pregnancies and prior episodes of pelvic girdle pain do increase risk, but plenty of first-time pregnant women experience this too.
Do I need my doctor's referral before seeing a physical therapist for this?
Not typically — physical therapists can evaluate and treat pregnancy-related pelvic girdle pain directly, though coordinating with your OB is always reasonable if you have specific concerns.
Is a pelvic support belt something I should just get on my own?
It can be a helpful tool, but getting guidance on proper fit and use as part of a broader treatment plan tends to produce better results than using one in isolation.
Will treatment involve internal pelvic floor assessment?
Not necessarily, though it can be relevant depending on your specific symptoms. Treatment approach is tailored to what's actually needed in your case.
Could this be something more serious than typical pelvic girdle pain?
Occasionally other issues can contribute to pelvic pain during pregnancy, which is part of why a proper evaluation matters rather than assuming it's automatically standard pelvic girdle pain.
Why Does My Pelvis Hurt During Pregnancy?: Bottom Line
Pelvic pain during pregnancy is common, but common doesn't mean you have to just push through it for months. It's driven by a specific combination of hormonal ligament laxity and mechanical load changes, and it responds well to targeted physical therapy — strengthening, manual therapy, movement modification, and breathing-pelvic floor coordination work. Earlier treatment tends to mean better and faster outcomes, both now and after delivery.
Dealing with pelvic pain that's making pregnancy harder than it needs to be?
Schedule a Pelvic Floor Evaluation at Nashville Physical Therapy & Performance. You'll get completely 1:1 care with your therapist for the entire visit — no aides, no split attention. We'll assess what's contributing to your pelvic pain and build a pregnancy-safe treatment plan to help you move through the rest of your pregnancy more comfortably. Available at South Nashville, East Nashville, and The Nations/West Nashville. Call 615-428-9213 or book online at nashvillept.com.
References
[^1]: Tommy's. Pelvic Pain (SPD or PGP) in Pregnancy. 2025.
[^2]: Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study. PMC. 2022.
[^3]: Alana Healthcare. Pelvic Girdle Pain & Symphysis Pubis Dysfunction in Pregnancy. 2026.
[^4]: Hodges PW, et al. Coordination of the human respiratory and continence mechanisms. Journal of Applied Physiology. 2007;103(6):1930-1940.
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