Pelvic pain can be a real pain in the a$$. But you don’t have to just “wait it out”.
Let’s talk about how to relieve pelvic pain during pregnancy.
◾️What is Pelvic Pain?
◾️What is Pelvic Girdle Pain?
◾️Sacroiliac Joint Pain During Pregnancy
◾️Symphysis Pubis Dysfunction During pregnancy
◾️Does Relaxin Cause Pelvic Pain?
◾️What causes pelvic pain?
◾️What Activities Aggravate Pelvic Pain During Pregnancy?
◾️How Can You Relive Pelvic Pain During Daily Activities?
◾️How Can You Relieve Pelvic Pain During Exercise?
◾️What exercises relieve pelvic girdle pain?
◾️Exercises for SIJ
◾️Exercises for SPD
◾️How Does Pelvic Pain Impact Labor?
◾️Understand Scope of Practice
What Is Pelvic Pain?
Pelvic pain during pregnancy is a wide umbrella covering all kinds of discomfort in the pelvic region.
It can refer to pain and discomfort related to the pelvic floor. It can also include sciatica, round ligament pain, low back pain and pain associated with the bony pelvis.
Here, I’m going to spotlight bony pain.
Pelvic pain can occur near the pubic bone (symphysis pubis dysfunction or SPD), around the tailbone (sacroiliac joint dysfunction or SIJ) or it can feel diffuse and non-specific.
Often, we talk about all of these types of pain under the umbrella term pelvic girdle pain (PGP) because the causes and solutions are similar.
Here’s another thing about PGP:
Whatever your flavor, there’s probably a lot you can do to feel better.
Common advice includes:
- “Just wait it out. It’ll go away after you have the baby”
- “Just keep your legs together”
- “Rest more”
But if you’re the one experiencing pelvic pain, this advice is likely aggravating AF.
Here’s the deal:
You don’t have to just wait it out.
Actual solutions to manage pelvic pain include:
- Addressing full-body movement or strength deficiencies
- Improving lumbo-pelvic stability
- Moving more
A lot of folks experience pelvic pain in pregnancy. Exact numbers are hard to measure because there is so much symptom overlap between various sources of pelvic pain. And really, the exact numbers aren’t so import.
The important thing is this: If you’re experiencing pelvic pain, you’re not alone. You’re also not fragile.
You have a lot of tools at your disposal to manage your pain and stay active for the duration of your pregnancy.
What Is Pelvic Girdle Pain?
PGP is pain in the hips or pelvis that gets worse with single leg, split stance or pivoting movements. The pain itself can range from mild to debilitating.
Most commonly, PGP is concentrated in the front of the pelvis (Symphysis Pubis Dysfunction) or the back of the pelvis (Sacroiliac Joint Dysfunction).
Sacroiliac Joint Pain During Pregnancy
Sacroiliac joint pain (SIJ) originates in the back of the pelvis, where the sacrum and iliac bones join. It might feel like:
- a nagging pain in your tailbone or in one side of your butt
- local discomfort, not a radiating pain
SIJ is related to, but often independent of it’s cousin, Symphysis Pubis Dysfunction.
Symphysis Pubis Dysfunction During Pregnancy
Symphysis Pubis Dysfunction (SPD) originates in the front of the pelvis where the pubic bones come together at the pubic symphysis. It can show up as a spectrum of symptoms that include:
- sharp, shooting or stabbing pain in the front of the pelvis
- achey or throbbing pain in the inner thighs or groin
- “clicking” sounds in the pelvis
- pain getting into or out of bed
- pain when transferring weight from one leg to the other (as in walking)
While SIJ and SPD have somewhat different presentation, they have some stuff in common when it comes to their “why”.
Does Relaxin Cause Pelvic Pain?
This is where relaxin often gets thrown under the bus. Everyone thinks that pelvic girdle pain is caused by relaxin, but in truth, that’s not the case.
Increased levels of the hormones relaxin and progesterone do cause an increase in tissue laxity during pregnancy. These hormones are super important because they allow the pelvic joints to shift to accomodate your baby and for it’s exit. This does increase mobility in the pelvis and may reduce stability to a degree.
However, there is no data linking relaxin (or any other hormone) to pelvic pain during pregnancy.
I know. This is probably a surprise (it was a surprise to me!).
Fact is, relaxin levels peak during the first trimester while pelvic pain tends to increase as pregnancy progresses, peaking during the third trimester.
To boot, relaxin levels are much higher during twin pregnancies but twin pregnancies are not associated with greater pain than singleton pregnancies.
So Then, What Causes Pelvic Pain?
There are so many possible causes of pelvic pain and the root of your pain is likely very complex.
Discomfort can stem from:
- pelvic floor tension
- biomechanical changes in response to the growing uterus and increased body weight as pregnancy progresses
- changes in your connective tissues as a result of shifting hormone levels (but, it’s unlikely to be the whole story)
Pelvic pain also has a significant biopsychosocial component.
Your worries, your expectations, your pain history (and more!) can greatly influence the way your brain interprets and responds to the changing loads, altered postural alignment and compensatory movement patterns it experiences during pregnancy.
Pelvic pain is difficult to treat because there are so many factors that can contribute.
What Activities Aggravate Pelvic Pain During Pregnancy?
Here are some activities that might aggravate pelvic pain:
- Sitting cross-legged
- Getting into or out of the car
- Getting into bed or rolling over in bed
- Climbing the stairs
- Walking or running
- Lunging or split stance movements
- Deep hip stretching
Identify the specific activities that trigger YOUR pain, then see if you can find ways to adjust those activities to make them more tolerable.
How Can You Relieve Pelvic Pain During Daily Activities?
Think of the following ideas as “bandaids” rather than long-term solutions to pelvic pain. These will minimize symptoms but may not address the root cause of your pain.
Getting in and out of the car
- Bring your legs together
- Rotate into or out of the carseat with legs together.
- When getting out of the car, make sure both feet are planted on the ground before standing up
Getting into bed
Place a stool or a step next to the bed and use it to take smaller movements as you get into bed.
Rolling over in bed
Place a pillow between your knees. Squeeze the pillow as you roll over.
A common aggravator of SIJ pain is standing with a hip jutted out to one side.
Check in with yourself a few times during the day and try and rebalance your weight evenly between both feet.
A word on support belts
Pelvic support belts and belly bands can be really useful tools to support of the pelvis and minimize discomfort during activities of daily living.
Keep in mind, they fall under the category of “bandaid”.
If you need to use them, it behooves you to address the source of the problem as well. I encourage you to reach out to a pelvic floor therapist for assistance.
How Can You Relieve Pelvic Pain During Exercise?
Often, you’ll need to address the symptoms of pelvic pain WHILE improving strength and coordination.
One of the simplest strategies to reducing pelvic pain is to bring your legs closer together
For a hinge or a squat-based exercise, this might mean bringing your legs closer together. For example, you could take a narrower stance in your squat. Or, you could hold a yoga block between your knees as you perform a Romanian Deadlift.
If you’re performing a split stance exercise, reduce the distance between your front and back foot.
In some cases, you might need to forgo split stance work (split squats, lunges) until you get your pelvic pain under your control.
As you get stronger, you may be able to increase the distance between your legs or ditch the props.
What Exercises Relieve Pelvic Girdle Pain?
Contrary to popular advice, PGP is a symptom of instability and stretching is not the most appropriate way to relieve symptoms.
Deep hip stretches, like the pigeon pose or figure 4 stretch, can exacerbate your mobile joints and make symptoms worse.
PGP likely benefits from improved strength and stability.
I wish I could tell you that there are a couple magic exercises to cure your SPD or SIJ. Unfortunately, that’s not the case. In fact, there’s no data to support specific exercises as a corrective for SIJ and SPD.
That said, there are countless people who have found relief for their pelvic pain by making changes to their alignment, body mechanics and overall strength.
The following exercises specifically support the muscles of the lumbopelvic hip complex (fancy word for the area where SIJ and SPD symptoms are felt). Try them out.
Exercise is a low risk, high reward activity that is always worth trying as a first line of intervention.
4 Exercises for SPD
Exercises selection for SPD aims to:
- Strengthen the muscles that cross at the pubic bone (think abdominal muscles and adductors).
- Increase stability of the lumbopelvic hip complex (low back, pelvis and hip musculature)
- Reduce tension in the muscles attached to the pelvis (e.g. pelvic muscles, adductors)
Give these four exercises a try:
1) Connection breath, hands and knees
Set up in a hands and knees position. Inhale into your ribcage, relax and release your belly and pelvic floor. On exhale, contract your pelvic floor and feel your abdominal muscles engage.
For step-by-step guidance, I breakdown the Connection Breath in the No B.S. Guide to a Stronger, Drier Pregnancy and Postpartum (it’s FREE!).
2) Seated Ball Squeeze
Setup on a stability ball or a firm seat. Place a squishy ball or yoga block between your knees.
Sit nice and tall. Slowly squeeze the ball to a count of 3 or 4, slowly release the ball to a count of 3.
Exhale to squeeze, inhale to release.
3) Pallof press with ball squeeze
The Pallof press is such a rockstar it gets an entire post of it’s own. I’ll give you the Cliffs Notes here, but I encourage you to invest a few minutes in going to learn more about this one.
Briefly, anchor a resistance band at chest height. Place a yoga block or squishy ball between your knees.
Keep tension on the ball or block throughout the exercise.
On exhale (with a gentle pelvic floor contraction), press the band in front of you. On inhale, draw it back in. Adjust your distance from the anchor point so that you feel like you are resisting rotation towards the anchor point, but you’re not fighting.
4) Adductor Rockback
After all the adductor activation, give them a little love.
With one leg extending, inhale into your ribcage as you sit back towards your heel. Exhale to come forward.
On your inhale, focus on relaxing your pelvic floor. Take this exercise slowly (more slowly than my video!) and enjoy the stretch. Adjust your rockback to avoid aggravating your pelvic pain.
4 Exercises for SIJ
Exercises selection for SIJ is similar to that of SPD. Only the first aim differs:
- Strengthen the muscles and tissues that cross at the sacroiliac joint (think lats and glutes)
- Increase stability of the lumbopelvic hip complex
- Reduce tension in the pelvic floor and associated musculature
Give these exercises a try:
1) Connection breath, hands and knees
See the instructions above!
2) Squat with row
Inhale to lower into your squat, exhale and engage your pelvic floor and glutes to stand. As you stand, perform a resistance-banded row. Drive elbows to rib cage and feel the muscles of your back activate to do the work.
To adjust for pelvic pain, consider:
Limit your range of motion by squatting to a chair or a box
Keep your stance narrower and perform a hip hinge instead of a squat
3) Elevated Clamshell
The clamshell exercise is a classic. Elevating the clamshell takes it up a notch.
Set up in a side plank on your knees. Exhale as you rotate your upper leg open, like a book. Inhale as you lower. In this exercise, you are using your glute medius- these are your “side glutes” located at the outer edge of where you’d find the back pocket of a pair of jeans.
To make it harder, add a miniband about 2 inches above your knees.
4) Quadruped Rockback
Set up on your hands and knees. Slowly rock your hips towards your heels. Inhale as your rock back and tune into the sensation of your sit bones spreading apart and your pelvic floor lengthening. Exhale as you come forward.
Take this exercise slowly and even take a pause when you’re in the rock back position.
How Does Pelvic Pain Impact Labor?
You might be concerned about how your pelvic pain will impact your labor and delivery experience. Fair concern!
Here’s the great news:
You have so many options beyond delivering your baby on your back, knees wide.
In fact, positions that draw the knees together and allow the ankles to go wide actually do a better job of opening up the pelvic outlet (the exit chute).
Below are two examples of laboring positions, appropriate for the pushing phase of labor, that do not require your legs to be spread wide apart:
A Word On Scope Of Practice
Please note, as you go down your pelvic pain journey- physical therapists and doctors are the only professionals who can diagnose and treat pain.
As a movement professional, I can not treat your pain. My goal in offering this advice and these exercises is to expand your movement options and address common strength deficiencies that are associated with some of the conditions we’ve discussed.
Before you go!
Are you or have you experienced pain during pregnancy? Tell me about it in the comments below- Please also share how you’ve managed it! Exercise? Pelvic support bands? Physical therapy?
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Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I also offer personal training services and consultations to folks locally (Seattle, Bellevue, Redmond, Kirkland) and online.