Pelvic health physiotherapy · Exercise programme
Where to find the exercises, and the one thing worth knowing if you also live with rheumatoid arthritis, lupus, axial spondyloarthritis, psoriatic arthritis, or myositis: new pelvic, back, or hip pain in pregnancy is not automatically "just pregnancy". For what pelvic health physiotherapy is and what the evidence shows, start with the pelvic health physiotherapy guide.
Pelvic girdle pain, the mechanical pain of pregnancy felt around the sacroiliac joints, the pubic bone, or the buttock, is common and usually settles with the right activity and support. The clinical practice guideline for pelvic girdle pain lists what else can cause pain in the same area, and inflammatory arthritis is on that list by name: ankylosing spondylitis (axial spondyloarthritis), psoriatic arthritis, rheumatoid arthritis, and lupus. The same guideline notes that pain of a systemic origin can present very much like pain of a musculoskeletal origin, which is exactly why it is worth mentioning rather than assuming.
This is not a reason to worry about every ache. Most pelvic pain in pregnancy is mechanical, and most of it responds to exercise and pacing. It is a reason to describe your pain to the team who knows your disease, especially if it wakes you in the second half of the night, if there is prolonged morning stiffness, or if it feels like your usual inflammatory pain rather than a new mechanical strain. For axial spondyloarthritis in particular, distinguishing inflammatory back pain from pregnancy-related pelvic girdle pain matters, and the axSpA guide sets out what inflammatory back pain feels like.
The pelvic floor is a sling of muscle running from the pubic bone at the front to the tailbone at the back. It supports the bladder, bowel, and uterus, helps you control wind and urine, works with the deep tummy and back muscles to steady the pelvis, and has a role in sex. Pregnancy loads it, and birth, however it happens, changes it for a while. Most people notice it recovers with time and some deliberate attention.
Finding the muscles is the first step: the contraction is a gentle squeeze and lift, as though you were stopping yourself passing wind and urine at the same time, without holding your breath, without squeezing your buttocks, and without pulling your tummy in hard. Just as important, and more often missed, is letting go fully afterwards. A pelvic floor that never relaxes can cause its own problems, including pain, and for some people the answer is learning to release rather than to squeeze. That is one of several reasons the amount you should do is best set with a pelvic health physiotherapist rather than guessed.
Starting these exercises early, before any leaking begins, is the part with the strongest evidence behind it. The pelvic health physiotherapy guide sets out what the Cochrane review found and how large the effect is.
Pelvic girdle pain is felt around the back of the pelvis, the pubic bone, or both, and is often worst on the things that load one leg at a time: turning in bed, stairs, getting out of a car, walking far. It is common in and after pregnancy and it is treatable.
On exercise, the clinical practice guideline is unusually clear. It reports strong evidence, its highest grade, that exercise improves the performance of the pelvic floor, the back flexors, the back extensors, and the hip extensors, and it says physiotherapists should prescribe exercise for those muscle performance problems. It is also candid about the limit of that evidence: how much this changes pain and day-to-day disability in postpartum pelvic girdle pain is not well understood. Exercise that hurts should be modified rather than pushed through, and the guideline notes that education, a pelvic belt, a walking aid, functional training, and hands-on therapy can all be used alongside while tolerance builds.
The practical version: keep moving, but spread the load. Shorter, more frequent walks. Keep the knees together turning in bed. Sit down to dress. Take stairs one at a time if that helps. Pace the day rather than doing everything in the good hour.
Ask for a referral to a pelvic health physiotherapist if you are not sure you have found the right muscles, if leaking urine or wind is affecting you, if there is a feeling of heaviness or dragging, if sex is painful, or if pelvic pain is limiting walking, sleep, or work. None of these are things to put up with because you are pregnant or newly postpartum, and all of them are treatable.
Tell your rheumatology team about new pelvic, hip, or low back pain, particularly if it behaves like inflammatory pain, and tell your maternity team about anything that changes suddenly. Seek prompt medical attention for new numbness or weakness in the legs, loss of bladder or bowel control that is new and different, fever with pelvic pain, or a fall or injury.
This page draws on the principles used in the booklets published by Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), a professional network of the Chartered Society of Physiotherapy in the UK. Their patient booklets are free, illustrated, written by pelvic health physiotherapists, and reviewed against the evidence every three years. They are the pelvic health equivalent of the NASS programme we point to for axial spondyloarthritis.
Exercise and advice for staying well through pregnancy, including the pelvic floor and the deep tummy muscles.
Advice and exercises after birth: pelvic floor, tummy muscles, and getting back to activity at a sensible pace.
Includes pelvic floor exercises, pregnancy-related pelvic girdle pain, prolapse, bladder and bowel, and returning to exercise.
Plain-language explanation of what a pelvic health physiotherapist does and what an appointment involves.
In Ontario, pelvic health physiotherapy is available privately and through some hospital and community clinics. Ask your rheumatology or maternity team, or your family doctor, for a local referral.