Pregnancy back and pelvic pain

What it is

Two related problems sit under this heading. Low back pain in pregnancy behaves much like ordinary back pain. Pelvic girdle pain is different: pain at the sacroiliac joints or the pubic joint at the front, worse on single-leg activities, rolling over in bed and climbing stairs.

Both are driven by the same combination. Relaxin and progesterone increase ligament laxity, so the joints rely more on muscle; the abdominal wall lengthens and loses its ability to support the pelvis; the centre of mass moves forward and upward; and all of this happens over months rather than years, faster than the muscles can adapt.

What it feels like

• Aching or sharp pain low in the back, or at the back of the pelvis on one or both sides
• Pain at the pubic joint at the front, sometimes described as a grinding
• Much worse turning over in bed, climbing stairs and standing on one leg to dress
• Worse as the day goes on and after standing or walking
• Sometimes a clicking or a feeling of the pelvis being unstable

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Ligament laxity from relaxin and progesterone

Hormonal changes increase the elasticity of ligaments throughout the body to allow the pelvis to accommodate birth. The joints therefore rely far more on muscular control than they did.

A rapidly shifting centre of mass

The growing uterus moves the centre of mass forward and up over a few months, increasing the lumbar arch and changing how load crosses the pelvis on every step.

A lengthened abdominal wall

The abdominal muscles stretch considerably and lose their ability to generate tension. They are one of the main supports for the pelvis and the lumbar spine, and that support fades exactly as it is most needed.

Glute and deep trunk weakness

The muscles that compress and stabilise the pelvis have more to do and less capacity. Where they were already weak before pregnancy, the deficit shows up early.

Weight gain over a short period

Ten to fifteen kilograms gained over months is a large change in load for tissue with no time to adapt to it.

A previous episode

Pelvic girdle pain in a previous pregnancy is one of the strongest predictors of it happening again, and it often starts earlier the second time.

Pre-existing back pain or hypermobility

Both raise the risk substantially. Hypermobile women start with less passive stability and lose more of it.

Asymmetric daily habits

Carrying a toddler on one hip, standing hung on one side, sleeping in one position. These matter more when the passive stability is reduced.

Being told it is just part of pregnancy

Not a physical cause, but the reason many women receive no treatment. Pelvic girdle pain responds well to physiotherapy and is not something to simply endure.

Who tends to get it

• Anyone who is pregnant - low back or pelvic pain affects a large majority
• Women who had it in a previous pregnancy
• Anyone with pre-existing back pain or generalised hypermobility
• Women who were inactive before pregnancy
• Anyone whose work involves prolonged standing or heavy lifting

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routinePregnancy & Postpartum Recovery

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Bleeding, leaking fluid, reduced fetal movement, severe headache or visual change - urgent obstetric review

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Most pregnancy-related back and pelvic pain improves substantially in the weeks after delivery, and a majority of women are symptom-free within three to six months. Exercise during pregnancy reduces both the incidence and the severity, which makes it worth starting early rather than in response to pain. Persistent pelvic girdle pain beyond a few months postpartum responds well to targeted physiotherapy and should not be left. Severe pubic pain that limits walking deserves prompt referral rather than endurance.

Prevalence basis: Obstetric cohort studies

Others the same routine covers

These share the Pregnancy & Postpartum Recovery routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.