Navigating pregnancy with physiotherapy: managing pain and preparing for birth
Written by Hollie, Osteopath (pre and postnatal exercise qualification, GOsC registered) · Medically reviewed by Tommaso Luccarini, Osteopath and Physiotherapist (GOsC, Institute of Osteopathy, HCPC, CSP) Published: 25 September 2026 · Last reviewed: 25 September 2026
Physiotherapy in pregnancy is a hands-on and exercise-based approach to pelvic girdle pain, lower back pain and birth preparation, and it works by addressing the mechanical cause of pain, not just softening pregnancy hormones as many patients are told. Around one in five pregnant women develop pelvic girdle pain, and roughly half develop some form of lumbopelvic pain, so if you are experiencing it, you are not managing something unusual or something you caused.
Pregnancy hormones, mainly relaxin, loosen the ligaments around the pelvic joints to prepare the body for birth, but hormones alone rarely explain persistent pain. The more common driver is uneven movement between the two sides of the pelvis and the lower back, combined with postural changes as the baby grows and the supporting muscles working harder than usual, which a physiotherapist can assess and treat directly.
If pain is affecting how you walk, sleep, or get in and out of the car, the next step is a physiotherapy assessment rather than waiting to see if it settles, since manual therapy and a tailored exercise plan help most women manage pelvic girdle pain safely at any stage of pregnancy. The stage-by-stage table below shows what tends to come up at each point in pregnancy and where physiotherapy typically focuses.
This article covers why pelvic girdle pain and back pain happen in pregnancy, what physiotherapy involves at each stage, what the evidence says about exercise and manual therapy, and how physiotherapy input can shape your birth plan rather than only manage pain before it.
Why pelvic girdle pain and back pain happen in pregnancy
Pelvic girdle pain is rarely explained by loose ligaments alone. The pelvis is made up of three joints, two sacroiliac joints at the back and the pubic symphysis at the front, that need to move evenly together as you walk, climb stairs or roll over in bed. When one side moves more than the other, often because posture and muscle activation shift as the uterus grows and the centre of gravity moves forward, the joints and surrounding muscles become irritated and pain follows, typically in the pubic area, lower back, groin, hips or thighs.
This is why pelvic girdle pain often worsens with specific movements rather than staying constant: standing on one leg to dress, getting out of a low car seat, or turning over in bed all load the pelvis asymmetrically. It also explains why rest alone rarely resolves it and can make it worse, since the surrounding muscles lose the conditioning needed to support the joints as pregnancy progresses. Physiotherapy addresses this mechanically, through manual therapy to restore even joint movement and a graded exercise programme to rebuild the muscle support the pelvis needs as your body changes week by week.
Physiotherapy through pregnancy: what tends to come up at each stage
Every pregnancy is different, but this gives a realistic sense of what physiotherapy usually addresses as pregnancy progresses, and it is a guide rather than a fixed schedule.
| Stage of pregnancy | What commonly comes up | What physiotherapy typically focuses on |
|---|---|---|
| First trimester | Fatigue, early postural changes, pre-existing back or hip issues flaring | Baseline assessment, movement advice, addressing any pre-existing pattern early |
| Second trimester | Pelvic girdle pain or lower back pain often begins as the bump grows and posture shifts | Manual therapy for joint movement, core and pelvic floor activation, activity pacing advice |
| Third trimester | Pain with walking, turning in bed, stairs or getting in and out of the car; sciatic-type leg pain in some women | Continued manual therapy, positions and aids for daily tasks, birth preparation and positioning discussion |
| From around 36 weeks | Questions about labour positions, breathing, and how PGP affects delivery choices | Practical birth-position guidance and liaison points to raise with your midwife or obstetric team |
What the evidence actually says
A 2019 Cochrane review of 32 studies involving over 52,000 pregnant women found that exercise during pregnancy did not reduce the odds of developing low back or pelvic girdle pain, but it did reduce how severe that pain was when it occurred. This is a more honest claim than "exercise prevents pregnancy pain", and it means the goal of an exercise programme is symptom management and function, not prevention.
The POGP patient guidance states that pregnancy-related pelvic girdle pain and low back pain typically stem from uneven movement of the pelvic and lower back joints and weakening of supporting muscles, rather than hormonal factors alone, and recommends referral to a specialist pelvic health physiotherapist when symptoms persist or affect sleep and daily function.
The Pelvic Partnership, a UK charity focused on pelvic girdle pain, states that PGP can be safely and effectively treated with tailored, hands-on treatment including manual therapy at any stage of pregnancy, and notes that exercises and pain-relieving measures alone manage symptoms without addressing the underlying joint-movement cause. NCT guidance adds that around 90 percent of women see PGP resolve after birth, and that induction or caesarean birth are not treatments for PGP itself.
When to get medical attention rather than book physiotherapy
Pelvic girdle pain and pregnancy back pain are common and not usually a sign of anything serious, but certain symptoms need same-day medical attention rather than a physiotherapy appointment.
Contact your midwife, maternity unit or NHS 111 the same day for: reduced or absent baby movements, vaginal bleeding, a severe headache with visual disturbance or swelling (possible signs of pre-eclampsia), or a fever. Seek immediate medical attention for bilateral leg pain or numbness, new numbness in the saddle area, or loss of bladder or bowel control, since these can indicate a more serious neurological cause rather than straightforward pelvic girdle pain, and a physiotherapist who identifies any of these will refer you back to your midwife or GP rather than proceed with treatment that day.
How physiotherapy input shapes your birth plan, not just your pain
Pelvic girdle pain does not mean you cannot have a vaginal birth, and physiotherapy input is most useful earlier than most women realise, not only once labour is close. Positions that keep the knees roughly hip-width apart and avoid extremes of hip abduction, such as side-lying or all-fours rather than lithotomy, tend to be more comfortable for women with PGP, and a birth pool can ease movement and reduce joint strain during labour for some women. Induction or a planned caesarean are not treatments for pelvic girdle pain itself, so a birth plan built around comfortable positioning, discussed with your midwife or obstetric team ahead of time, is generally more useful than assuming PGP rules out particular delivery choices.
At Complement, we build this into ongoing appointments through pregnancy rather than treating it as a single late-pregnancy conversation, so positioning strategies are practised and refined as your body changes rather than introduced for the first time in the final weeks. Where appropriate, we also link physiotherapy with our private Pilates service for pregnancy-safe core and pelvic floor conditioning, and with our women's health physiotherapy service if pelvic floor symptoms sit alongside the pelvic girdle pain, so the plan addresses everything relevant rather than only the loudest symptom.
Common questions
Is it safe to have physiotherapy or manual therapy while pregnant?
Yes. Manual therapy and pregnancy-adapted exercise are considered safe throughout pregnancy when delivered by a physiotherapist or osteopath experienced in treating pregnant patients, who will adapt positioning and technique as pregnancy progresses. Tell your physiotherapist about any pregnancy complications so the plan can be adjusted accordingly.
Will pelvic girdle pain go away after birth?
For most women, yes. Around 90 percent of women see pelvic girdle pain resolve after birth, though recovery can take some weeks and future pregnancies carry a higher risk of it recurring. Postnatal physiotherapy can support recovery if symptoms persist beyond the first few weeks after delivery.
Can exercise make pelvic girdle pain worse?
The wrong exercise at the wrong time can aggravate symptoms, particularly movements that load the pelvis asymmetrically, such as single-leg exercises done too early. This is why a physiotherapy assessment before starting or continuing an exercise programme matters more in pregnancy than a generic prenatal fitness plan.
Do I need a GP or midwife referral to see a physiotherapist during pregnancy?
No, you can book a physiotherapy appointment directly at Complement without a referral. If your midwife or GP has flagged a specific concern, mentioning this at booking helps us tailor the first assessment.
Can physiotherapy help me plan for labour if I have pelvic girdle pain?
Yes. Physiotherapy input can guide comfortable labour positions and practical strategies to discuss with your midwife or obstetric team, and pelvic girdle pain does not rule out a vaginal birth. This is most useful when discussed across several appointments rather than left until the final weeks.
What is the difference between pelvic girdle pain and normal pregnancy aches?
Pelvic girdle pain tends to be specific to certain movements, such as turning in bed, climbing stairs or standing on one leg, rather than a general ache, and it often affects the pubic area, groin, hips or lower back together. General pregnancy discomfort tends to be more diffuse and less affected by particular movements. A physiotherapy assessment can clarify which pattern you have.
About the author
Hollie is an osteopath at Complement with a specialist qualification in pre and postnatal exercise, working within the clinic's integrated osteopathy, physiotherapy and Pilates model in Islington to support women through pregnancy and the postnatal period. Meet the team.
Book a pregnancy physiotherapy assessment
If pelvic girdle pain or back pain is affecting your day-to-day life or you want support preparing for birth, book an assessment with our physiotherapy service. We also offer specialist women's health physiotherapy and pregnancy-safe Pilates as part of our integrated approach at our clinic in Islington, with packages and insurance support available. Book Your Session.
