Roughly one in five pregnant women experiences pelvic girdle pain, and low back pain is more common still. Both are frequently met with the same advice — that it is normal, and that it will resolve after birth. The first part is true. The second is unreliable: a meaningful proportion of women who have pelvic girdle pain in pregnancy still have it a year later, and the ones who do best are generally those who were treated during pregnancy rather than told to wait.
Antenatal physiotherapy is safe throughout pregnancy, and it addresses two things at once: the pain you have now, and the preparation that makes birth and recovery go better.
What we treat in pregnancy
Pelvic girdle pain (PGP/SPD)
Pain at the pubic joint, in the buttocks or at the back of the pelvis — often worse turning in bed, climbing stairs or standing on one leg. See pelvic girdle pain treatment.
Low back pain
Driven by changing load, altered posture and ligament laxity. Responds well to specific exercise, manual therapy and load-management advice.
Rib and mid-back pain
As the ribcage widens and the diaphragm is displaced upwards, mid-back and rib pain is common — particularly in the third trimester.
Bladder symptoms
Leaking and urgency in pregnancy predict postnatal symptoms. Starting pelvic floor training antenatally reduces that risk substantially.
Carpal tunnel and wrist pain
Fluid retention can compress the median nerve. Splinting, positioning and nerve-glide exercises usually help, and it typically resolves after birth.
Abdominal separation
Some separation of the abdominal muscles is normal and expected in pregnancy. What matters is how you manage load in the meantime. See diastasis recti.
Antenatal pelvic floor training: the strongest evidence in the field
If there is one intervention in pregnancy with consistently good evidence behind it, this is it. Supervised pelvic floor muscle training started in pregnancy reduces the likelihood of urinary incontinence both in late pregnancy and after birth — a substantial effect for something that costs nothing and takes a few minutes a day.
The catch is the word supervised. Studies that check technique repeatedly find that a large proportion of women perform the contraction incorrectly when working from a leaflet — squeezing the buttocks, holding the breath, or bearing down rather than lifting. Bearing down is not a smaller version of the right exercise; it is the opposite of it, and in pregnancy it is exactly what you do not want to be practising.
A single appointment to confirm you are doing it correctly is often all that is needed, and it is worth more than months of unsupervised effort.
Preparing for birth
Perineal massage
From around 34 weeks, regular perineal massage is associated with a reduced likelihood of perineal trauma requiring stitches, particularly in first pregnancies. Technique matters, and it is easier to learn with proper instruction than from a diagram.
Learning to relax the pelvic floor
For birth, the pelvic floor needs to lengthen and release — not contract. Many women have practised only the squeeze. Learning the downward, releasing phase is a genuinely useful skill for the second stage of labour.
Positions for labour
Upright and forward-leaning positions increase pelvic outlet dimensions. Practising them beforehand — and knowing which ones your particular pelvis and pain pattern tolerate — is more useful than improvising on the day.
Breathing and pushing mechanics
How you manage breath and pressure during the second stage affects both efficiency and pelvic floor load. This is straightforward to teach and hard to work out under pressure.
Planning your recovery
Knowing what the first six weeks should look like, what is normal, and when to seek help makes the postnatal period considerably less bewildering. See postnatal physiotherapy.
Is physiotherapy safe in pregnancy?
Yes. Assessment and treatment are adapted to your stage of pregnancy: positioning avoids prolonged lying flat on your back from the second trimester onward, exercise is prescribed within appropriate limits, and certain electrotherapy modalities are not used.
Exercise in pregnancy is actively recommended by UK guidance for uncomplicated pregnancies — around 150 minutes of moderate activity a week — and physiotherapy helps you keep doing it safely rather than stopping altogether.
Internal pelvic floor assessment can be performed in pregnancy where clinically indicated, and as always it is optional and fully explained beforehand. Many antenatal appointments involve no internal assessment at all.
Seek urgent medical advice rather than physiotherapy for: vaginal bleeding, leaking fluid, reduced fetal movements, severe or persistent headache, visual disturbance, sudden swelling of the face or hands, or calf pain and swelling. Contact your midwife, maternity triage or NHS 111.
When to come
For pain, as soon as it starts. Pelvic girdle pain treated early is easier to settle and less likely to escalate to the point where walking, working and sleeping are affected.
For prevention and preparation, a first appointment in the second trimester works well: pelvic floor training can be established and checked, and load-management strategies are in place before the third-trimester demands arrive. A follow-up around 34 weeks covers perineal massage, labour positioning and pushing mechanics.
It is never too late. Women seen at 38 weeks with significant pelvic girdle pain still benefit from support, positioning advice and a plan for the birth and the weeks after it.
Frequently Asked Questions
Is physiotherapy safe during pregnancy?
Yes. Assessment and treatment are adapted to your stage of pregnancy — positioning avoids prolonged supine lying from the second trimester, exercise is prescribed within safe limits, and some electrotherapy modalities are avoided. Exercise in uncomplicated pregnancy is actively recommended by UK guidance, and physiotherapy helps you continue safely.
When should I start pelvic floor exercises in pregnancy?
As early as you like — there is no reason to wait. Supervised pelvic floor muscle training during pregnancy reduces the risk of urinary incontinence in late pregnancy and after birth. The important part is having your technique checked, because a large proportion of women contract incorrectly when working from written instructions alone, some bearing down rather than lifting.
Will pelvic girdle pain go away after I give birth?
For many women it improves substantially in the weeks after birth, but a meaningful proportion still have symptoms a year later. That is why treating it during pregnancy rather than waiting is worthwhile — outcomes are generally better in women who were treated antenatally, and the pain is more manageable in the meantime.
Can I have an internal examination while pregnant?
It can be carried out in pregnancy where it is clinically indicated, and as at any other time it is entirely optional and explained fully beforehand. Many antenatal appointments involve no internal assessment at all — pelvic girdle pain, back pain and birth preparation can all be addressed without one.
What is perineal massage and does it work?
Perineal massage involves gently stretching the perineal tissues, usually from around 34 weeks of pregnancy. It is associated with a reduced likelihood of perineal trauma requiring stitches, with the clearest benefit in first pregnancies. Technique and timing matter, and it is easier to learn with instruction than from written guidance alone.
Do I need a referral from my midwife or GP?
No. You can book directly. If you are under consultant-led maternity care or have a complication such as placenta praevia, a shortened cervix or a multiple pregnancy, please mention it when booking so treatment can be adapted appropriately.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
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