Pregnancy Physiotherapy: Safe Relief for Back, Pelvic, and Hip Pain

Published 6 August 2026 · 9 min read · By the Platinum Physiotherapy Clinical Team

Back and pelvic pain during pregnancy is extremely common — a large proportion of pregnant people experience it at some point, and for many it is significant enough to affect sleep, work, and daily activity. It is also, unfortunately, one of the most commonly dismissed complaints in maternity care: "it is just part of being pregnant" is something we hear from new patients constantly. Pregnancy-related pain is common, but common is not the same as inevitable or untreatable. Physiotherapy during pregnancy is safe, evidence-supported, and often produces meaningful relief within a few sessions. This guide covers what causes the pain, what treatment looks like, and what you can safely do at home.

Why Pregnancy Causes Back and Pelvic Pain

Three things change simultaneously. Load increases and shifts forward as the baby grows, moving your centre of gravity and increasing demand on the lower back, hips, and pelvic floor. Hormonal changes — relaxin and others — increase laxity in ligaments, which is often blamed for everything but is more nuanced than popular explanations suggest: relaxin levels do not correlate neatly with who develops pain, so laxity alone is not the whole story.

Muscular demand changes. The abdominal wall stretches progressively, reducing its ability to support the trunk, which shifts more work onto the back muscles and pelvic floor. The result is a system under more load with less support — which is precisely why strengthening, rather than rest, is the most effective response for most people.

Pelvic Girdle Pain: The Most Common Complaint

Pelvic girdle pain, sometimes called symphysis pubis dysfunction, presents as pain at the front of the pelvis over the pubic bone, at the back over one or both sacroiliac joints, or both. The signature signs are pain when standing on one leg — putting on trousers, climbing stairs, getting out of a car — pain rolling over in bed, and sometimes an audible or palpable clicking.

The mechanism is usually a load-tolerance problem: the joints of the pelvis are not moving "out of place" as is often described, but they are being asked to transfer load they are not currently able to manage. Treatment that works includes targeted strengthening of the deep abdominal, gluteal, and pelvic floor muscles; specific manual therapy; movement strategies that reduce asymmetrical loading — sitting down to dress, keeping the knees together when rolling in bed, avoiding wide steps; and a pelvic support belt, which many people find genuinely helpful in the third trimester. Improvement is usually noticeable within a few weeks.

Low Back Pain and Sciatica-Like Symptoms

Pregnancy-related low back pain typically presents as an ache across the lower back, worse at the end of the day, after standing, or with prolonged sitting. It responds well to a combination of manual therapy, postural and positioning advice, and progressive strengthening.

Some people also develop leg symptoms. True sciatica from a disc is less common in pregnancy than most people assume; pain down the back of the leg during pregnancy more often comes from the pelvis or the deep gluteal muscles. The distinction matters for treatment, so it is worth having it assessed properly rather than assuming. Genuine nerve symptoms — persistent numbness, pins and needles, or weakness in the leg or foot — should always be assessed.

The Other Aches: Ribs, Wrists, and Round Ligament

Round ligament pain is a sharp, brief pain low in the abdomen or groin, usually on one side, triggered by standing up quickly, coughing, or rolling over. It is a normal stretching response of the ligaments supporting the uterus, most common in the second trimester, and it responds to moving more slowly into those positions and gentle support.

Rib and upper back pain becomes common in the third trimester as the ribcage expands and the growing uterus pushes upward; manual therapy to the thoracic spine and ribs often gives quick relief. Carpal tunnel syndrome is genuinely common in pregnancy — fluid retention increases pressure in the wrist, causing numbness and tingling in the hand, classically worse at night. Night splinting is often very effective, and the good news is that pregnancy-related carpal tunnel usually resolves after delivery.

Pelvic Floor Physiotherapy Before Birth, Not Just After

Most people first hear about pelvic floor physiotherapy after they have given birth. Assessment during pregnancy is arguably more valuable. A pelvic floor physiotherapist can assess whether your pelvic floor is weak, overactive, or poorly coordinated — and an overactive, tense pelvic floor is just as much a problem as a weak one, particularly for birth.

Prenatal pelvic floor work covers learning to both contract and fully relax the pelvic floor, breathing and pushing mechanics, perineal massage technique from around 34 weeks, and management of any leaking, urgency, or heaviness that has already developed. It also gives you a baseline, which makes postpartum recovery considerably more straightforward. Our guide to pelvic floor physiotherapy for women explains what an assessment involves.

What Is Safe to Do During Pregnancy

Current Canadian guidance encourages most pregnant people without contraindications to be physically active throughout pregnancy — aiming for regular moderate activity across the week, including both aerobic activity and strength work. Exercise in pregnancy is associated with reduced back and pelvic pain, better outcomes, and no increase in risk for uncomplicated pregnancies.

Practical modifications: after the first trimester, avoid prolonged flat-on-your-back positions; avoid activities with a meaningful fall or impact risk; skip exercises that cause coning or doming of the abdomen; and use the ability to hold a conversation as your intensity guide. Avoid deep, wide-legged movements if you have pelvic girdle pain. Walking, swimming, stationary cycling, prenatal yoga, and modified strength training are all appropriate for most people. If you have a high-risk pregnancy, placenta praevia, cervical insufficiency, or any bleeding, get clearance from your obstetrician or midwife first.

What to Expect at a Prenatal Physiotherapy Appointment

Your first appointment is a one-on-one assessment in a private treatment room. We take a full history including your stage of pregnancy and any complications, assess your movement, strength, and the specific joints involved, and identify what is driving your symptoms. Treatment begins the same visit and typically includes hands-on manual therapy in comfortable, well-supported positions — side lying with pillow support rather than face down — and a home program.

Positioning is adapted throughout, and treatment is modified as your pregnancy progresses. Internal pelvic floor assessment is optional and always fully consented; plenty of useful work can be done without it if you prefer. Most people with pregnancy-related back or pelvic pain notice meaningful improvement within three to six sessions. Contact your obstetrician, midwife, or emergency care rather than a physiotherapist for vaginal bleeding, fluid leakage, regular contractions before term, reduced fetal movements, severe headache with visual changes, or calf pain and swelling.

Prenatal Physiotherapy in Brampton

At Platinum Physiotherapy in College Plaza, prenatal assessment and treatment is delivered one-on-one by a registered physiotherapist in a fully private room with a door — which matters for a great many patients, particularly for pelvic health care. Our team includes clinicians with post-graduate pelvic health training, and we speak English, Hindi, Punjabi, and Gujarati.

We are open seven days a week with same-day and next-day appointments, and we direct-bill most major insurers, so prenatal physiotherapy is generally covered by extended health benefits at no cost to you. If you are pregnant and in pain, you do not need to wait it out — and you do not need a referral to book. Read more about postpartum physiotherapy for what comes next.

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