Postpartum Pelvic Girdle Pain: Causes, Exercises, and When to Seek Care

If you are weeks or months past delivery but your pelvis still throbs when you roll in bed, lift your baby, or climb stairs, you are not alone. Pelvic girdle pain after pregnancy affects a large share of new parents, sometimes starting during the third trimester and lingering into the post-partum months. The ache is usually felt across the back of the pelvis near the dimples above your buttocks, deep in one groin, or at the pubic bone. It can feel sharp with certain movements and dull the rest of the day. The good news: with a smart plan that targets the sacroiliac joints and the surrounding muscles, most people improve quickly—often without strong medications.

This guide translates current best practice into a step-by-step plan. You will learn what is happening in your pelvis, which movements to dial down temporarily, which exercises actually help, what is safe while breastfeeding, and how to know when imaging or injections are worth considering.

Your pelvis is a ring made from the two hip bones and the sacrum (the base of the spine). Three joints knit that ring together:

1. Sacroiliac joints—one on each side where the sacrum meets the iliac bones.
2. Pubic symphysis—the joint at the front where left and right pubic bones meet.

These joints are stabilized by a web of ligaments plus the gluteal muscles, deep hip rotators, pelvic floor muscles, and the transversus abdominis (a deep corset-like abdominal muscle). In pregnancy, hormonal softening, altered posture, and growing-bump mechanics place new demands on this system. After birth, the tissues do not snap back overnight; they need targeted help to regain tension and timing.

• Ligament laxity and timing lag: Hormone shifts (relaxin, estrogen, progesterone) increase ligament stretch so the pelvis can widen for birth. After delivery those ligaments gradually retighten, but the muscles must temporarily carry more of the stability load—often before they are ready.
• Core and pelvic floor deconditioning: Pregnancy stretches the abdominal wall and pelvic floor. Without retraining, the sacroiliac joints can feel “loose” during everyday tasks.
• Movement asymmetry: Caring for a newborn is repetitive: always carrying the baby on one hip, feeding from the same side, or rocking while weight-bearing on one leg. Small asymmetries add up and irritate the sacroiliac joints.
• Cesarean section or vaginal delivery recovery: Either route changes how you brace the trunk and move. After a cesarean section, people often guard the abdomen; after a vaginal birth, the pelvic floor may be sore or weak. Both patterns can shift load into the sacroiliac joints.
• Pre-existing hip or low-back issues: Old injuries, hypermobility, or scoliosis can make the system slower to recalibrate.

• Pain over one or both sacroiliac joints (dimples above the buttocks), in the groin, or at the pubic bone
• Pain that spikes when you stand on one leg, get out of a car, roll in bed, climb stairs, or carry a car seat
• A feeling of “giving way” or clicking at the front of the pelvis
• Aching after long walks or prolonged sitting with legs crossed
• Relief when you squeeze a pillow between your knees or wear a supportive belt

If you also notice numbness or weakness down a leg, fever, loss of bladder or bowel control, or severe night pain, seek urgent medical review. These are not typical for simple pelvic girdle pain.

1) Optimize Daily Movements to Calm The Joints

• Keep movements symmetrical. When lifting baby or stroller, square your hips and use both hands. Switch the hip you carry on.
• Log-roll in bed. Bend both knees, roll as one unit, and push up with your arms to sit—no twisting through the pelvis.
• Shorten your stride. Long steps shear the pubic symphysis; take smaller steps and keep feet under hips.
• Sit with support. A small cushion behind the lower back and feet flat on the floor reduces pelvic strain during feeds.

2) Use Targeted Support

• Pelvic belt. A properly fitted sacroiliac belt, worn snugly around the pelvis (not the waist), can help for short periods when symptoms spike—on walks, during errands, or while carrying baby.
• Heat or cold. Warmth helps tight hip muscles; a brief cold pack reduces an acute ache over the sacroiliac joint.
• Footwear. Cushioned, supportive shoes matter more than ever when your stabilizers are recovering.

3) Breastfeeding-safe pain relief (ask your clinician)

• Paracetamol (acetaminophen) is widely considered compatible with breastfeeding.
• Non-steroidal anti-inflammatory drugs such as ibuprofen are commonly used postpartum and while nursing; confirm with your obstetric or primary-care clinician, especially if you have stomach, kidney, or blood-pressure issues.
• Topical anti-inflammatory gels can be useful for localized tenderness away from the nipple area.
• Strong opioid medications are rarely needed for pelvic girdle pain and can worsen fatigue and constipation; reserve them for short-term post-operative contexts if advised.

Key principle: stability returns when local muscles learn to share the load again. Focus first on low-load control, then add strength, then endurance.

• Diaphragmatic breathing with pelvic floor “lift”: Inhale through the nose, letting ribs expand. On a long exhale, gently lift the pelvic floor as if stopping gas and urine, while lightly drawing the lower abdomen inward (no belly suck). Five slow breaths, three to four times a day.
• Transversus abdominis setting: Lying on your side or back with knees bent, imagine zipping up a low-rise pair of jeans. Hold 5–8 seconds while breathing; repeat ten times.
• Isometric hip adduction: Squeeze a small pillow between the knees for five seconds, relax for five; repeat ten times. This taps the adductors that assist pubic symphysis stability.
• Gluteal sets: Gently tighten buttock muscles for five seconds, ten times.

These drills reduce the “loose” feeling and settle pain so you can move more.

• Bridge progressions: With feet hip-width apart, brace the lower abdomen, squeeze glutes, and lift pelvis to a straight line from knees to shoulders. Start with both legs, then progress to marching bridges (lift one foot a few centimetres without tilting).
• Clamshells with light band: Keep pelvis stacked; open the top knee without rolling back. This awakens gluteus medius, the side-hip muscle that protects sacroiliac joints when you stand on one leg.
• Hip hinge practice: With hands on a countertop, push hips back while keeping the back neutral, then stand tall by squeezing glutes. This is the blueprint for lifting baby and car seat safely.
• Sit-to-stand without hands: Feet slightly staggered if needed. Stand up by driving through both heels; avoid twisting.

Aim for three sessions per week, two to three sets of eight to twelve controlled repetitions.

• Loaded hinges (light dumbbells or kettlebell): Train hip-dominant lifting with perfect form.
• Step-downs: Stand on a low step and tap the opposite heel to the floor, keeping pelvis level. This bullet-proofs the side-hip for stairs and hills.
• Carry drills: Farmer’s carry with a weight in both hands, then a single-arm carry while keeping the pelvis level—great preparation for carrying baby on one side without overload.
• Gentle cardio: Start with walking intervals or a recumbent bike; progress to brisk walks or low-impact classes.

Progress by increasing control first, then load. If pain spikes above a mild level or lingers more than 24 hours after a session, scale back and rebuild.

• Side-lying with pillow between knees and ankles: This keeps the pelvis stacked and calms the pubic symphysis.
• Back-lying with a small pillow under knees: If snoring or reflux worsens back-lying, incline the torso slightly.
• Avoid twisted positions (half-prone with the top leg thrown forward): If you must feed in bed, stack pillows so the trunk stays level.

• Car seat strategy: Bring the seat close to your body before lifting; hinge at the hips and use both hands. Avoid reaching with a rotated pelvis.
• Babywearing: Choose a carrier with wide hip belt and lumbar support; center the load rather than perching baby on one hip.
• Stroller loading: Step close to the trunk and hinge; do not lever heavy items with outstretched arms.
• Laundry and floor pickups: Try the “golfer’s lift”: one leg back, hinge at the hips, and use the opposite hand to reach.

Small changes compound into fewer flares.

• Pelvic health physiotherapist: Best first call for assessment, exercise progression, manual therapy, and belt fitting.
• Obstetric or primary-care clinician: Review pain control options compatible with breastfeeding, assess for anemia, thyroid issues, or mood concerns that can amplify pain.
• Sports or spine specialist: If symptoms persist despite six to eight weeks of guided rehab or you have significant pubic symphysis separation, radiating leg pain, or suspected nerve involvement.

Imaging (ultrasound, X-ray, or magnetic resonance imaging) is rarely needed early. It can help when pain does not improve, when significant pubic symphysis separation is suspected, or when other conditions must be ruled out.

Pelvic belts can be game-changing during symptom spikes, long walks, or grocery runs. Worn snugly around the pelvis (just above the greater trochanters), they provide passive compression while your muscles relearn their role. Kinesiology taping across the sacroiliac joints or pubic symphysis can cue posture and reduce apprehension. Use supports as helpers, not crutches: the aim is to wean as strength and control return.

• Manual therapy—mobilization of the sacroiliac joints, soft-tissue release of hip flexors and piriformis, and gentle pubic symphysis techniques—often complements exercise by reducing short-term pain and improving movement tolerance.
• Acupuncture or dry needling can quiet reactive muscles and ease pain for some people; choose a practitioner experienced with postpartum clients.
• Image-guided injections (local anesthetic and anti-inflammatory) may be considered when pain is severe and blocks rehab progress, especially for pubic symphysis inflammation. Injections should be part of a wider plan that includes strengthening and movement coaching.

1. Prerequisites: no pain with brisk thirty-minute walks, symmetrical single-leg squat to a chair, and twenty-five consecutive calf raises without pelvic tilt.
2. Walk-jog intervals: start with one minute jog / two minutes walk for fifteen to twenty minutes on flat ground every other day.
3. Progress rules: add one minute total jogging each session if there is no next-day pelvic tenderness.
4. Hills and trails: add once you can jog comfortably for thirty minutes on flat.
5. Stop signs: pubic or sacroiliac ache during or after running, limping, or clunking sensations—dial back and reinforce strength first.

Sleep disruption, feeding challenges, and life changes can sensitize the nervous system. Evidence shows that education, graded exposure to movement, and simple breathing practices help reduce pain amplification. If low mood, anxiety, or birth trauma memories surface, enlist support early. Pelvic pain eases more quickly when the whole person is cared for.

• How long does postpartum pelvic girdle pain last?
  Most people improve markedly within six to twelve weeks of targeted rehab. A smaller group needs several months, especially if pain started early in pregnancy or there is significant pubic symphysis involvement.
• Can I fix sacroiliac joint pain after pregnancy without strong medications?
  Yes. Movement modifications, a short-term pelvic belt, and a progressive strengthening plan are the core of recovery. Over-the-counter options like paracetamol or ibuprofen (if approved for you) can bridge painful days.
• Is pelvic floor training important if my pain is at the back?
  Absolutely. The pelvic floor is part of the ring—coordinated lifting during exhalation improves sacroiliac stability and reduces pressure at the pubic symphysis.
• Will another pregnancy make pelvic girdle pain worse?
  Not necessarily. Entering pregnancy strong—especially in gluteal, hip, and deep core endurance—dramatically lowers the risk of recurrence. Early use of a belt during long days can also help.
• When should I worry about something more serious?
  Red flags include fever, severe unrelenting night pain, progressive leg weakness or numbness, loss of bladder or bowel control, or trauma (like a fall). Seek urgent care.

• Switch to symmetry for baby carries and household tasks.
• Learn and practice breath-plus-pelvic-floor lifts daily.
• Do Phase 1–2 exercises three times this week (fifteen to twenty minutes each).
• Use a pelvic belt for outings or longer walks if relief is clear.
• Sleep with a pillow between knees and avoid twisting.
• Schedule a visit with a pelvic health physiotherapist if you have not already.
• Track triggers and wins in a quick phone note—the trend will motivate you.

Returning to the driver’s seat after total knee replacement should never feel like a gamble. Treat it as a skill you rebuild: calm inflammation, restore strength, rehearse emergency stops, and respect the legal rules about medications. For left-leg surgery in an automatic car, many people resume around the two- to three-week mark. For right-leg surgery, most are confident and safe by four to six weeks. Manual transmissions and commercial driving call for more patience and more practice. If you use the checklist and drills in this guide—and keep your surgeon in the loop—you will get back on the road safely, smoothly, and with confidence.