Back and Pelvic Pain in Pregnancy: What's Normal and What Helps
Back and Pelvic Pain in Pregnancy: What's Normal and What Helps
Quick summary
- Low back and pelvic girdle pain are very common in pregnancy, affecting around 45% of pregnant women (Wu et al., 2004).
- Pelvic girdle pain is felt at the back of the pelvis (sacroiliac joints) and/or the front (pubic symphysis). It is typically worse with walking, stairs, standing on one leg and rolling in bed (Vleeming et al., 2008).
- Some symptoms need your midwife or doctor first: bleeding, fluid loss, regular tightenings or contractions, fever, severe or one-sided pain with feeling unwell, or headache with visual changes.
- A Cochrane review found low-quality evidence that exercise, and some other approaches including manual therapy, may help pregnancy-related back and pelvic pain (Liddle & Pennick, 2015).
Back and pelvic pain are among the most common discomforts of pregnancy. They can make walking, sleeping and getting out of the car surprisingly hard. Common does not mean you have to just put up with it. Here is what is happening, which signs need your maternity team, and what tends to help.
How common is it?
A systematic review estimated that around 45% of pregnant women experience pregnancy-related low back and/or pelvic girdle pain (Wu et al., 2004). It often starts in the second trimester, but it can begin earlier. For most women it settles after the birth, although a smaller group has ongoing symptoms.
Back pain or pelvic girdle pain?
These often overlap, but the difference matters for management.
- Pregnancy-related low back pain is felt above the pelvis, in the lower back, and is often worse with prolonged sitting or standing and bending.
- Pelvic girdle pain (PGP) is felt between the top of the pelvis and the buttock crease, around the sacroiliac joints, and/or at the front over the pubic bone (sometimes called symphysis pubis dysfunction). The European guidelines describe it as typically aggravated by walking, climbing stairs, standing on one leg, turning in bed and getting in and out of a car (Vleeming et al., 2008).
Pregnancy hormones, the growing baby, changes in posture and centre of gravity, and changes in how the pelvic muscles share load all contribute.
When to contact your midwife or doctor first
Contact your maternity team or seek urgent care if back or pelvic pain comes with:
- vaginal bleeding or a gush or leak of fluid;
- regular tightenings, cramping or contractions, especially before 37 weeks;
- fever, burning when passing urine, or pain in the side or loin;
- severe headache, visual changes, or swelling of the face and hands;
- reduced baby movements;
- severe pain, numbness in the saddle area, or changes in bladder or bowel control.
We check for these at every visit and work alongside your midwife, obstetrician or GP.
What helps
Stay active, within comfort
Exercise in pregnancy is safe and recommended for most women with uncomplicated pregnancies. A Cochrane review found low-quality evidence that land-based exercise, alone or with education, may reduce pregnancy-related low back pain, and that water-based exercise may reduce sick leave (Liddle & Pennick, 2015). Walking, swimming, pregnancy pilates and strengthening exercises are good options.
Everyday strategies for pelvic girdle pain
- Keep your knees together when getting in and out of the car or bed, and roll in bed with a pillow between your knees.
- Take smaller steps, and go up stairs one step at a time if needed.
- Avoid standing on one leg to dress. Sit down to put on pants and shoes.
- Spread out lifting and carrying, and avoid wide-legged positions that are painful.
- A pelvic support belt helps some women.
Hands-on care
The same Cochrane review reported low-quality evidence that some manual therapies may help pregnancy-related back and pelvic pain (Liddle & Pennick, 2015). At Spirit Chiropractic we use gentle, pregnancy-adapted techniques and positioning with supportive pillows, so you can lie comfortably on your side. We combine this with exercise and practical advice, and we keep your maternity team informed if needed.
Pregnant and struggling with back or pelvic pain?
We use gentle, pregnancy-adapted care and practical strategies, and work alongside your midwife or obstetrician.
Frequently Asked Questions
Is back pain in pregnancy normal?
It is very common. Around 45% of pregnant women experience pregnancy-related low back or pelvic girdle pain. Common does not mean you have to put up with it, and some symptoms, such as bleeding, contractions, fever or severe pain, need your maternity team first.
What is pelvic girdle pain?
Pelvic girdle pain is pain at the back of the pelvis around the sacroiliac joints and/or at the front over the pubic bone. It is typically worse with walking, stairs, standing on one leg, rolling in bed and getting in and out of a car.
Is chiropractic care safe in pregnancy?
Gentle, pregnancy-adapted care is generally well tolerated. A Cochrane review reported low-quality evidence that some manual therapies may help pregnancy-related back and pelvic pain. Care should include screening for warning signs and work alongside your midwife or doctor.
What exercises help pelvic pain in pregnancy?
Walking, swimming, pregnancy pilates and gentle strengthening are good options for most women. Avoid positions that are painful, such as wide-legged movements or standing on one leg, and adjust as your pregnancy progresses.
References
- Wu, W.H., Meijer, O.G., Uegaki, K., et al. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575–589. https://doi.org/10.1007/s00586-003-0615-y
- Vleeming, A., Albert, H.B., Östgaard, H.C., Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794–819. https://doi.org/10.1007/s00586-008-0602-4
- Liddle, S.D., & Pennick, V. (2015). Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews, 2015(9), CD001139. https://doi.org/10.1002/14651858.CD001139.pub4
This article is general information, not a diagnosis or a substitute for individual advice from your health professional.
