Pelvic Girdle Pain in the Third Trimester: What Physiotherapy Can Do

Pelvic girdle pain is the most common musculoskeletal complaint of pregnancy, and it is most common in the third trimester when the load is highest and the connective tissue most relaxed. Most people are told it is normal and to wait it out until delivery. They are right that this pain is a normal part of pregnancy, but there are treatment options beyond just waiting it out.

If you are in your final weeks and the pain is starting to limit what you can do, this article explains what pelvic girdle pain is, why it tends to peak late in pregnancy, and what physiotherapy can do about it.

What pelvic girdle pain is

Pelvic girdle pain (PGP) is a term that covers pain in and around the joints of the pelvis during or after pregnancy. The pelvis has three joints: the two sacroiliac joints at the back, where the pelvis meets the sacrum, and the symphysis pubis at the front. PGP can involve one or all three, in different combinations.

Symphysis pubis dysfunction (SPD) is the name for pain at the front of the pelvis: sharp or aching pain at the pubic bone, typically worse with stairs, rolling over in bed, dressing, or any activity that requires one leg to bear weight while the other lifts. Sacroiliac joint pain presents at the back of the pelvis, one or both sides, sometimes travelling into the buttock or upper thigh.

Both are PGP. The assessment sorts out which pattern you have and what your treatment should focus on.

Based on population studies, the prevalence of PGP during pregnancy ranges from 45 to 86 percent, depending on how strictly the condition is defined. A systematic review in the European Spine Journal found that one in five pregnant people (20 percent) develop activity-limiting PGP. It is common, and it can get in the way of daily life.

Why it gets worse in the third trimester

Three things in the third trimester increase the likelihood and severity of pelvic girdle pain.

First, the weight distribution shifts. The uterus and baby are heaviest in the final eight to ten weeks, and all of that sits directly over the pelvic joints. More load means more force through joints that are already under stress.

Second, relaxin continues to peak. Relaxin is the hormone that loosens pelvic ligaments to allow the pelvis to expand for delivery. It does not target only the pelvis: it circulates systemically and affects all the connective tissue in the body. Looser ligaments mean the joints rely more heavily on muscle control for stability. When those muscles are fatigued or weak, the joints become symptomatic.

Third, the gait changes. A wider stance, a waddling walk, more single-leg loading as balance shifts: all of these place asymmetrical demands on pelvic joints that are already working harder than usual.

The result is that you may have been managing fine at 24 weeks, then find yourself limited at 30 and struggling at 35.

What the assessment looks for

The physiotherapy assessment for third-trimester PGP has a specific structure. The physiotherapist asks where the pain is, when it happens, and what sets it off. Tasks that load one leg at a time, walking up stairs, standing from a chair, getting in and out of a car, are particularly informative because they reveal whether the sacroiliac joints or the symphysis pubis are driving the picture.

The posterior pelvic pain provocation test (P4 test) is a reliable clinical test for sacroiliac joint involvement. The active straight leg raise test identifies how well the pelvis is loaded through the abdominal and pelvic muscles. Neither test requires the pregnant person to lie face down.

The assessment also includes a brief movement screen and a look at what daily activities are currently most affected. This shapes the management priorities for the session.

What physiotherapy does

Treatment for third-trimester PGP is active. The goal is to change what is driving your pain.

Load management comes first. This means identifying which specific tasks are most provocative and adjusting how they are done. Sitting to stand from a lower chair, sitting to dress rather than standing, reducing stair trips, and using a support surface for single-leg tasks: these changes reduce the daily load on symptomatic joints without requiring you to stop living your life.

Targeted strengthening addresses the muscle control problem. The hip abductors and external rotators, the deep hip flexors, and the pelvic floor all contribute to how well the pelvis is stabilised during single-leg tasks. Weakness in any of these groups is common in the third trimester, partly from reduced activity and partly from the changed movement patterns that pain creates. The exercise program is specifically designed for the trimester, the symptom pattern, and what you can currently do.

Manual therapy has a role when the joints are mechanically restricted or when soft tissue tension is a significant driver. Sacroiliac joint mobilisation and soft tissue work to the gluteal and hip external rotator muscles can provide meaningful pain relief in specific presentations. The manual therapy used during pregnancy is adapted to avoid sustained positions that create pressure on the vena cava, the large vein that returns blood to the heart.

Support belts are useful in a subset of presentations, particularly when pain is severe during walking or weight-bearing. A belt worn across the sacroiliac joints or the symphysis pubis region can offload the joints during peak load periods. The physiotherapist can fit and trial the belt at the session, assess whether it helps, and advise on how and when to use it. Not every case needs one. Trialling the belt in clinic tells you whether it helps before you spend weeks wearing it.

Pelvic floor coordination becomes part of the picture when the pelvic floor is contributing to the load pattern. The pelvic floor works alongside the deep abdominal and hip muscles to stabilise the pelvis. Where there is PGP, there is often a disruption in how those muscles coordinate. Pelvic floor training in this context focuses on the timing and control of the contraction.

What physiotherapy cannot change

Relaxin is a hormone, so physiotherapy cannot reduce relaxin levels or make the ligaments tighter. What it can do is build the muscle support around joints that are currently under-stabilised. Think of it as strengthening the muscles around a loose joint so they take on more of the work of holding it steady.

Similarly, the weight of the baby and uterus cannot be reduced. Load management strategies change how that weight is transferred through the joints, but the load itself is not going anywhere until delivery.

Pain that is completely provoked by hormonal changes and has no mechanical component may improve less with physiotherapy than presentations that have a meaningful muscular or loading driver.

Does this resolve after delivery?

For most people, pelvic girdle pain improves in the weeks after delivery, as relaxin levels fall and the load reduces. For some it persists into the postpartum period, particularly if the delivery involved prolonged pushing, an instrumental delivery, or if the muscle control gaps were not addressed before delivery.

The risk factor for PGP that continues after birth is activity-limiting pain before delivery combined with no rehabilitation during pregnancy. Starting rehabilitation before delivery makes the third trimester easier, and the strength and control you build carry over into your recovery after birth.

When to book

A reasonable time to book is when PGP begins to affect your day. You do not have to wait until delivery. Physio for PGP can start at any point in pregnancy, including the third trimester.

If you have already had PGP in a previous pregnancy, an early assessment in the current pregnancy allows a programme to be established before the third-trimester peak. If this is a first pregnancy and symptoms started recently, start now.

Pelvic health physiotherapy is available at three of our Metro Vancouver studios: Lougheed, Coquitlam, and North Burnaby.

Frequently asked questions

Is pelvic girdle pain the same as sciatica?

No. Sciatica refers to pain from irritation of the sciatic nerve, usually involving the lower back and travelling down the leg to the foot. PGP is joint and muscle pain in and around the pelvis, not nerve pain. They can coexist, and the assessment differentiates them.

Will a support belt fix pelvic girdle pain?

A support belt can reduce pain during weight-bearing activities for some people. It does not address the muscle control gaps that are contributing to the problem, so it works better as a short-term aid alongside physiotherapy than as a standalone solution. A physiotherapist can fit the belt, check whether it actually helps your specific pattern, and advise on how long to wear it during the day.

Can I keep exercising with pelvic girdle pain?

Often yes, with modifications. The principle is to avoid single-leg loading when it is significantly provocative. Pool walking, seated cycling, and specific strengthening exercises are often well-tolerated. A physiotherapist can advise on which activities to continue and which to modify for your specific presentation, and can build a targeted strengthening program around the hip and pelvic muscles that supports the joints rather than aggravating them.

Is PGP worse in subsequent pregnancies?

Research does suggest that a history of PGP in a previous pregnancy is a risk factor for it occurring earlier or more severely in the next one. This makes early assessment and prevention work useful if you are in a second or later pregnancy, since a program can be established well before the third-trimester peak rather than starting once symptoms are already limiting your day.

What is the difference between PGP and normal pregnancy discomfort?

Normal discomfort is general, dull, and not specifically provoked by single-leg loading tasks. PGP tends to be sharp, has a specific location, and is clearly provoked by particular movements such as stairs, rolling in bed, or getting in and out of a car. The distinction is worth establishing with a physiotherapist, because the management is different and depends on which pattern, front or back, is driving the pain.

What tests does a physiotherapist use to diagnose pelvic girdle pain?

The posterior pelvic pain provocation test (P4 test) is a reliable clinical test for sacroiliac joint involvement, and the active straight leg raise test identifies how well the pelvis is loaded through the abdominal and pelvic muscles. Neither test requires the pregnant person to lie face down. Combined with a history of what triggers the pain, these tests help sort out whether the front joint, the back joints, or both are driving the presentation.

Can manual therapy be done safely during pregnancy for pelvic girdle pain?

Yes, with adaptations. Sacroiliac joint mobilisation and soft tissue work to the gluteal and hip external rotator muscles can provide meaningful pain relief in specific presentations. The manual therapy used during pregnancy is adapted to avoid sustained positions that create pressure on the vena cava, the large vein that returns blood to the heart.

Does pelvic girdle pain mean I cannot have a vaginal delivery?

Physiotherapy for PGP does not determine delivery method on its own. That decision is made with your obstetric or midwifery care provider based on the full clinical picture. Building muscle control and managing load during pregnancy is about comfort and function leading into delivery and through the postpartum weeks, not a factor that by itself rules out any delivery option.

This article is general information, not personal medical advice. A physiotherapist can assess whether the patterns described apply to your specific situation.

Sources

• European Spine Journal: Pelvic Girdle Pain and Low Back Pain in Pregnancy
• CHCPBC: College of Health and Care Professionals of BC
• Birth-prep physiotherapy in BC: what happens in a third-trimester pelvic floor session
• Prenatal physiotherapy: what it is and when to start