Pelvic Pain During Pregnancy: Causes and Natural Relief Options

By Dr. Andrew Biggs, DC | Principled Chiropractic | Royal Palm Beach, FL

If you are pregnant and experiencing pelvic pain, you are not alone and you are not simply expected to endure it until your baby arrives.

Pelvic pain during pregnancy is one of the most common complaints we hear from expectant mothers in our Royal Palm Beach office. Research published in peer-reviewed medical literature estimates that pelvic girdle pain affects nearly half of all pregnant women, making it one of the most prevalent discomforts of pregnancy and yet one of the least discussed. Many women are told it is normal, that it will resolve after delivery, and that there is not much to be done about it in the meantime.

That is not accurate. For the women who experience significant pelvic pain, pain that makes walking difficult, disrupts sleep, makes turning over in bed an ordeal, and limits their ability to function in daily life, it is also not an acceptable answer.

Pelvic pain during pregnancy has identifiable causes. It has well-established structural components. It responds remarkably well to the kind of gentle, specific care that NeuroStructural chiropractic provides, care that is safe for both mother and baby throughout pregnancy.

Here is what you need to know.

Understanding Pelvic Girdle Pain

The term most commonly used in medical literature for pregnancy-related pelvic pain is pelvic girdle pain (PGP). It refers to pain in the sacroiliac joints (the joints where the sacrum meets the iliac bones of the pelvis on each side), the pubic symphysis (the joint at the front of the pelvis where the two pubic bones meet), the lumbosacral region, or any combination of these structures.

Pelvic girdle pain can occur as early as the first trimester, though it most commonly develops during the second and third trimesters as the baby grows and the structural demands on the pelvis increase. It can range from a mild, intermittent ache to a severe, debilitating pain that radiates into the hips, buttocks, groin, and down the legs.

Common descriptions include:

• A deep, aching pain in the back of the pelvis, hips, or buttocks

• A sharp, stabbing pain at the front of the pelvis, near the pubic bone

• Pain that worsens with walking, climbing stairs, rolling over in bed, or standing on one leg

• A clicking or grinding sensation in the pelvis with movement

• Pain that radiates down one or both legs, sometimes resembling sciatica

• Difficulty with activities that require separating the legs, such as getting in and out of a car, dressing, or getting up from a chair

Around 8 to 10 percent of women with pelvic girdle pain during pregnancy continue to have pain for one to two years postpartum, a fact that underscores the importance of addressing the structural causes during pregnancy rather than waiting and hoping it resolves on its own.

What Causes Pelvic Pain During Pregnancy?

Pelvic pain during pregnancy is not caused by a single factor. It arises from the interaction of hormonal changes, biomechanical shifts, structural vulnerability, and the cumulative physical demands of a growing pregnancy. Understanding each of these components helps explain why chiropractic care is so effective in addressing it.

The Role of Relaxin

The hormone most commonly associated with pregnancy-related pelvic pain is relaxin, a hormone produced in increasing amounts during pregnancy whose primary purpose is to prepare the body for childbirth by loosening ligaments, cartilage, and other soft tissue structures of the pelvis.

Relaxin is a necessary and beneficial hormone. Without it, the pelvis could not accommodate the passage of a baby through the birth canal, but its effects are not limited to the pelvis as relaxin increases ligament laxity throughout the entire body. In the pelvis specifically, the loosening of the sacroiliac joints and the pubic symphysis can create a state of hypermobility, increased joint motion that the surrounding muscles and ligaments struggle to stabilize.

During pregnancy, the hormone relaxin allows the ligaments stabilizing the pubic symphysis joint to relax, allowing the joint to move and separate. There is normally a 4 to 5 millimeter gap between the bones of the pubic symphysis which has a intervertebral disc-like cushion. That space can increase during pregnancy, often causing pelvic pain, lower back pain, and sacroiliac pain simultaneously.

What is important to understand, and what many patients are surprised to learn, is that research does not show a direct correlation between the level of relaxin in the bloodstream and the degree of pain a woman experiences. This means relaxin sets the stage for pelvic pain, but it does not independently cause it. The structural integrity of the pelvis and the mechanical function of the sacroiliac joints and lumbar spine are equally important, and they are exactly what chiropractic care is designed to address.

Biomechanical Shifts and Postural Changes

As pregnancy progresses, the body undergoes significant biomechanical changes that place escalating demands on the pelvis and lumbar spine.

Research has shown that as pregnant women move into their second and third trimesters, their center of mass shifts forward, causing an increase in lumbar lordosis, the forward curve of the lower back. This in turn causes overactivity of the low back and pelvic muscles and increased mechanical stress on the thoracic and lumbar joints.

This, coupled with the expanding pelvis, leads to increased activity in the paraspinal musculature as well as the rectus femoris, external oblique, psoas major, and adductor longus muscles. The root cause of much pelvic pain during pregnancy may be mechanical, stemming from the low back or sacral joints, rather than purely hormonal.

This is significant because it means the structural component of pelvic pain is addressable. A chiropractor experienced in treating pregnant patients can identify the specific mechanical dysfunctions contributing to pelvic pain and apply targeted corrective care.

Sacroiliac Joint Dysfunction

The sacroiliac joints are among the primary sources of pelvic pain in pregnancy. These are the joints on either side of the sacrum, the triangular bone at the base of the spine often called the tailbone, where it connects to the iliac bones of the pelvis. Under normal circumstances, the sacroiliac joints are relatively stable, designed primarily for weight-bearing rather than significant movement.

During pregnancy, increased ligament laxity from relaxin, combined with the postural changes and weight redistribution described above, dramatically increases the mobility of the sacroiliac joints. Ligament laxity caused by hormonal changes allows these traditionally stable, weight-bearing joints to move and shift in ways they are not designed for. This increased mobility puts stress on the surrounding ligaments and muscles, which produces the deep, aching pelvic and hip pain that many pregnant women experience.

Sacroiliac pain is one of the most common sources of pain for pregnant women, often affecting the back of the pelvis and hips and sometimes traveling down the legs. Many women incorrectly describe their discomfort as hip pain, because the sacroiliac joint is located in the same region.

When a NeuroStructural Shift is present in the lumbar spine or sacrum, as is frequently the case in women who had pre-existing structural dysfunction before pregnancy, the additional mobility demands of pregnancy can push a structurally compromised pelvis into significant pain very rapidly.

Symphysis Pubis Dysfunction

Symphysis pubis dysfunction (SPD) is a specific form of pelvic girdle pain that involves the joint at the front of the pelvis. The pubic symphysis is a cartilaginous joint that, under the influence of relaxin, can become hypermobile and painful during pregnancy. The pain is typically felt at the front of the pelvis, in the groin, and sometimes radiating into the inner thighs.

Women with SPD often describe a sharp pain or burning sensation at the front of the pelvis, particularly with activities that involve separating the legs, such as climbing stairs, getting in and out of a car, putting on pants, or walking with a wide stride.

SPD and sacroiliac dysfunction frequently occur together, creating a pattern of pelvic instability that affects both the front and back of the pelvic girdle simultaneously.

Pre-Existing Structural Dysfunction

One of the most important, and most overlooked, contributors to pregnancy-related pelvic pain is structural dysfunction that existed before pregnancy began.

Women who have had previous injuries to the pelvis, lower back, or sacroiliac joints, or who have lived with unaddressed NeuroStructural Shifts in the lumbar spine or pelvis, often find that pregnancy dramatically amplifies symptoms that were previously manageable or even unnoticeable. The hormonal and biomechanical demands of pregnancy essentially stress-test the structural integrity of the pelvis, and pre-existing weaknesses become painfully apparent.

This is one of the strongest arguments for proactive chiropractic evaluation before or early in pregnancy, rather than waiting until pain becomes significant. A pelvis that is structurally sound and properly aligned at the beginning of pregnancy is far better equipped to accommodate the demands of the next nine months than one carrying pre-existing structural dysfunction into that journey.

Why Conventional Approaches Often Fall Short

The standard medical advice for pelvic pain during pregnancy typically includes rest, heat or ice application, a pelvic support belt, and referral to physical therapy for strengthening exercises.

These approaches can be valuable. A pelvic support belt can provide meaningful symptomatic relief by reducing the mechanical load on the sacroiliac joints, though become difficult and uncomfortable to use as pregnancy advances. Specific strengthening exercises can help the muscles around the pelvis compensate for ligament laxity. Rest reduces acute inflammation.

Perinatal-specific physical therapy is often helpful at creating better balance and ease within the soft-tissue structures of this area. In fact, we routinely refer patients with this problem to (and are referred patients from) perinatal PT's as it is a helpful partnership in creating optimal results.

Many of these approaches are symptomatic. They address the discomfort without correcting the underlying structural problem. The sacroiliac joints remain dysfunctional. The lumbar spine remains shifted. The pelvic architecture remains unbalanced. Because the structural cause has not been addressed, the pain returns, often progressively, as the pregnancy advances and the physical demands on the pelvis increase.

For many women, the result is a pregnancy dominated by escalating pain that is managed but never resolved, followed by a postpartum period in which the expected resolution doesn't come as quickly or completely as hoped.

The Chiropractic Approach: Structural Care for a Structural Problem

At Principled Chiropractic, we approach pregnancy-related pelvic pain as a structural problem that requires a structural solution; one that is safe, gentle, and specifically adapted for the unique demands and vulnerabilities of the pregnant body.

The Webster Technique

The cornerstone of our approach to prenatal care, including pelvic pain, is the Webster Technique, a specific chiropractic analysis and adjustment developed by Dr. Larry Webster.

The Webster Technique is designed to restore proper sacral alignment and pelvic balance by addressing the specific sacroiliac dysfunction and associated soft tissue tension that develops during pregnancy. It involves a gentle analysis of the sacrum, the sacroiliac joints, and the round ligaments, the ligaments that support the uterus, followed by a specific, gentle adjustment tailored to the needs of a pregnant body.

Dr. Biggs is certified in the Webster Technique through the ICPA. It is recognized by the ICPA as a safe and effective approach to improving pelvic function during pregnancy, and it is the most widely used and most thoroughly studied chiropractic technique for prenatal care.

Women under Webster Technique care during pregnancy consistently report:

• Significant reduction in pelvic and lower back pain

• Improved ability to walk, sleep, and perform daily activities

• Reduced hip pain and sacroiliac dysfunction

• Greater overall comfort throughout pregnancy

• Easier labor and delivery, reported by many patients and supported by emerging research

Addressing the Full Structural Picture

The Webster Technique is central to our prenatal care, but our approach does not stop there. Because pelvic pain during pregnancy often reflects a broader pattern of structural dysfunction, including NeuroStructural Shifts in the lumbar spine, thoracic spine, and cervical spine, we assess and address the full structural picture.

The specific muscles that need to be released to decrease mechanical pelvic pain can be identified by a licensed chiropractor experienced in treating pregnant patients. We use this comprehensive approach to identify all structural contributors to a patient's pelvic pain, not just the most obvious one, because treating one component while leaving others unaddressed produces incomplete results.

Safety During Pregnancy

One of the most common questions we receive from pregnant patients is whether chiropractic care is safe during pregnancy.

The answer, well-supported by research and by the clinical experience of the ICPA, is yes, when provided by a chiropractor with training and experience in prenatal care.

We use specialized adjusting techniques and positioning protocols designed specifically for pregnant patients. Pregnant women are never placed face-down on a standard adjustment table. Instead, we use positioning that supports the abdomen comfortably and keeps the mother and baby safe throughout the adjustment. The forces used are gentle and specific, far from the dramatic manipulations that some people imagine.

Chiropractic care is considered safe throughout all trimesters of pregnancy, including the third trimester. Many of our prenatal patients begin care in their first or second trimester and continue through the final weeks of pregnancy.

Things You Can Do at Home

While professional structural care is the most effective approach to pregnancy-related pelvic pain, there are several strategies that can provide additional support between visits.

Sleep positioning. Sleeping on your side with a pillow between your knees reduces rotational stress on the sacroiliac joints and helps maintain pelvic alignment during sleep. A full-length body pillow can provide additional support for the abdomen and lower back.

Mindful movement. Keep your movements symmetrical when possible. When getting in and out of a car, move both legs together rather than stepping in one leg at a time. When getting dressed, sit down to put on pants rather than standing on one leg. Avoid carrying heavy objects (especially young children) on one side.

Avoid aggravating activities. Prolonged standing, climbing stairs frequently, and activities that require separating the legs widely should be minimized during periods of significant pelvic pain. This is not a permanent restriction but a short-term accommodation while structural care addresses the underlying dysfunction.

Gentle movement. Complete rest is not recommended for pelvic girdle pain, as deconditioning can worsen the problem. Gentle, supported walking and swimming are generally well-tolerated and help maintain circulation and muscle tone without aggravating pelvic dysfunction.

Pelvic support belt. A properly fitted maternity support belt or SI joint belt can provide additional mechanical support for the pelvis between chiropractic visits. Ask us about proper fitting and usage, as an improperly fitted belt can sometimes worsen symptoms.

Avoid prolonged postures. Sitting or standing in the same position for extended periods allows pelvic muscles to tighten and joints to stiffen. Taking regular movement breaks, even brief ones, helps prevent the accumulation of mechanical stress.

When to Seek Care

If you are experiencing any of the following during pregnancy, we encourage you to schedule an evaluation as soon as possible:

• Pelvic, hip, or lower back pain that is interfering with sleep, walking, or daily activities

• Pain at the front of the pelvis or groin

• A clicking or grinding sensation in the pelvis with movement

• Pain that radiates into the buttocks or down one or both legs

• Significant discomfort when turning over in bed, climbing stairs, or getting in and out of a car

• Any pelvic or lower back pain that began during a previous pregnancy and did not fully resolve

You do not need to wait until the pain is severe to seek care. Early intervention consistently produces better outcomes, both in terms of pain relief during pregnancy and in preventing the postpartum persistence of pelvic dysfunction that affects a significant percentage of women.

A Note on Postpartum Recovery

Pelvic pain that begins during pregnancy does not always resolve immediately after delivery. The structural dysfunction that drove the pain during pregnancy, the sacroiliac joint dysfunction, the lumbar NeuroStructural Shifts, the pelvic imbalance, does not automatically correct itself simply because the pregnancy has ended.

For women who experience significant pelvic pain during pregnancy, postpartum structural evaluation and continued chiropractic care during the recovery period is strongly recommended. The ligament laxity produced by relaxin persists for several months after delivery in breastfeeding mothers, meaning the pelvis remains vulnerable to structural dysfunction during this period and benefits from the same supportive structural care that helped during pregnancy.

We offer postpartum care for all of our prenatal patients, and we encourage new mothers not to wait until pain becomes significant before scheduling their postpartum evaluation.

You Don't Have to Just Endure It

Pregnancy is one of the most physically demanding experiences a woman's body undergoes. The structural changes, hormonal shifts, and mechanical demands of growing and delivering a new life are extraordinary. Pain during this time is common, but it is not inevitable, and it does not have to be something you simply endure.

At Principled Chiropractic, we have helped many expectant mothers in Royal Palm Beach, Wellington, West Palm Beach, Loxahatchee, and Lake Worth find meaningful, lasting relief from pelvic pain; safely, gently, and without medication.

We invite you to schedule a complimentary consultation and find out whether NeuroStructural chiropractic care, including the Webster Technique, is the right fit for you and your baby.