Prefer to watch? 4-minute lesson13 slides · same content, shorter

1 · SNAPSHOT

Pelvic Girdle Pain (Pregnancy / Postpartum) body chart — Illustrative, not diagnostic. Canva body chart for Pelvic Girdle Pain (Pregnancy / Postpartum).

Who: During or after pregnancy.
What: Pelvic girdle pain — a clinical pain presentation around the posterior pelvis and/or pubic region (Vleeming et al. 2008; Pulsifer et al. 2022).
How it behaves: Pain over the SIJ, gluteal region or pubic symphysis. Aggravated by stairs, turning in bed, standing on one leg. Often described as sharp, unstable, or "giving way." Eased by rest or compression.

The one thing to take from this page:

Pain is real; its mechanism is not established by the pain map. Avoid displaced-pelvis explanations or assuming that laxity and failed load transfer explain every presentation. [1].

What she's been told vs what's happening

What she's been told	What's actually happening
"Your pelvis is out"	Pain does not establish displacement or a single mechanical cause
"It needs putting back"	Manual therapy here is gentle and supportive — not corrective
"It'll go once the baby's out"	Usually settles. Persistence is a real outcome
"Rest it"	Graded re-exposure to single-leg loading

⚠️ The European guideline is the only guideline, it is not Australian, and it is not recent. The structure is well founded; a 2026 systematic review is still asking what the exercise dose should be.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order. Two questions get skipped here every time: what has she been told, and how is she going.

MAIN PROBLEM

"My pelvis feels like it's coming apart."
"Rolling over in bed is agony."
"I can't stand on one leg to get dressed."

BODY CHART

SIJ, gluteal region, pubic symphysis — often more than one.
Mark the symphysis separately. Central pubic dominance changes the emphasis.
Below the knee, dermatomal, or with weakness? That is a lumbar and neurological question.
Mark anything that isn't musculoskeletal in behaviour.

BEHAVIOUR

	Fits PGP	Points elsewhere
Aggs	Stairs, turning in bed, single-leg tasks, walking distance	Flexion-dominant, coughing → lumbar
Eases	Rest, compression, support	Nothing eases it → screen
Severity	VAS 0–10 at best / at worst / right now	—
Onset	During or after pregnancy	Non-pregnancy onset → SIJ dysfunction page
Weight-bearing	Painful but able	Unable to weight-bear → fracture question
Neuro	No deficit	Deficit → lumbar, neurological

HISTORY

Which pregnancy, what week, and was there PGP last time?
Sleep. Turning in bed. Getting out of the car. These are the functions she has lost.
Walking distance and single-leg tolerance. Your outcome measures.
What has she been told, and by whom? This is the barrier, and it is usually the word "alignment."
How is she going in herself? Ask it directly. Depression prevalence in this group has been systematically reviewed [2], and self-efficacy has been associated with regression from pregnancy-related pelvic girdle and back pain [3].

SPECIAL / SCREENING QUESTIONS

Can she weight-bear? Inability is a fracture question, not severe PGP.
Fever, feeling unwell, offensive discharge, calf pain or swelling? Postpartum, this list matters.
Any bowel, bladder or saddle symptoms?
Night pain unrelated to position, weight loss?

Assessing this region? Download the Hip & Groin assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
SIJ dysfunction (non-pregnancy)	Same tests, different context. Pregnancy or postpartum onset is what defines this page.
Lumbar-related pain	Lumbar behaviour — flexion and extension pattern — and the pelvic provocation tests are negative.
Pubic symphysis–dominant pain	Central pubic pain, waddling gait, positive single-leg stance and squeeze.
Hip-related pain	Groin-dominant, FADIR, restricted internal rotation in flexion.
Coccydynia and pelvic floor–related pain	Different location and behaviour; worth naming because it coexists.

The two that outrank the table

Pelvic or femoral neck stress fracture. Inability to weight-bear, night pain, and a low bone density or low energy availability risk profile. Pregnancy and lactation-associated bone changes make this a live question, not a theoretical one.

Postpartum medical complications. Fever, feeling unwell, offensive discharge, calf pain or swelling. Infection and venous thromboembolism present in this window, and this population under-reports.

And the differential that overlaps

Pelvic girdle pain, SIJ dysfunction and pubic symphysis pain are often taught as separate — and the honest answer is that they overlap. Describe the symptoms, assess meaningful function and consider competing explanations.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Unable to weight-bear	Pelvic or femoral neck fracture	Urgent imaging. Do not load
Acute hip or groin pain in the last trimester or just after birth	Transient osteoporosis of the hip — 12.1% went on to fracture (Hadji et al. 2017) [21]	Medical review and imaging before you load it
New thoracolumbar back pain in the last 3 months of pregnancy or first 3 months after delivery	Pregnancy- and lactation-associated osteoporosis with vertebral fracture — usually multiple levels (Qian et al. 2021) [22]	Medical review. Don't treat it as PGP until it's excluded
New unilateral leg pain, swelling or warmth in pregnancy/postpartum	Possible DVT	Contact maternity/medical services immediately; breathlessness is not required (RCOG)
Fever, feeling unwell, offensive discharge	Postpartum infection	Urgent medical review
Sudden unexplained breathlessness, chest pain, coughing blood or collapse	Possible PE	Emergency help now (RCOG)
Severe headache, visual change, swelling — late pregnancy or postpartum	Pre-eclampsia	EMERGENCY
Bowel or bladder change, saddle numbness	Cauda equina	EMERGENCY
Night pain unrelated to position, weight loss	Malignancy, infection	Medical review
Progressive neurological deficit	Neurological cause	Urgent medical review

The rule: load- and position-related pelvic pain in a pregnant or postpartum woman who can weight-bear, with a clean systemic and neurological screen, is yours. Inability to weight-bear, anything systemic, and anything in the postpartum medical list is not.

Cross-links: SIJ dysfunction · Pubic-related groin pain · Non-specific low back pain · Hip / pelvic stress fracture

Members

The 4-minute lesson is for members

Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

Australian anchor: the Australian Pregnancy Care Guidelines (Australian Government living guideline), whose pelvic girdle pain recommendation advises that pregnancy-specific exercises, physiotherapy, acupuncture or a support garment may provide some pain relief.

It is a weak recommendation and covers pregnancy only; no Australian guideline covers postpartum pelvic girdle pain. Anchored for diagnosis to the European guidelines for the diagnosis and treatment of pelvic girdle pain (Vleeming et al. 2008, PMID 18259783), which supply the diagnostic definition and the test battery this page uses, and to the contemporary reframing paper (Pulsifer et al. 2022, PMID 35948414) for the message.

PubMed Source

The Australian Pregnancy Care Guidelines carry one weak, pregnancy-only recommendation; the European guideline is the only dedicated pelvic girdle pain guideline, and it is not Australian and not recent. The management evidence since then is systematic reviews and small trials, and a 2026 systematic review is still asking what the exercise prescription parameters should be — so the structure is well founded and the dose is not.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2022Pulsifer et al. (2022). Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. British journal of sports medicine, 56(22), 1262-1265. https://doi.org/10.1136/bjsports-2022-105724
2024Halliday et al. (2024). The prevalence of depression in women with pregnancy-related pelvic girdle pain: A systematic review and meta-analysis. Health science reports, 7(8), e2308. https://doi.org/10.1002/hsr2.2308
2023Chunmei et al. (2023). Self efficacy associated with regression from pregnancy-related pelvic girdle pain and low back pain following pregnancy. BMC pregnancy and childbirth, 23(1), 122. https://doi.org/10.1186/s12884-023-05393-z
2022Remus et al. (2022). Outcome Measurement Instruments and Evidence-based Recommendations for Measurement of the Pelvic Girdle Pain Core Outcome Set (PGP-COS): A Systematic Review and Consensus Process. The journal of pain, 23(12), 2052-2069. https://doi.org/10.1016/j.jpain.2022.08.003
2025Vesting et al. (2025). Educating women to prevent and treat low back and pelvic girdle pain during and after pregnancy: a systematized narrative review. Annals of medicine, 57(1), 2476046. https://doi.org/10.1080/07853890.2025.2476046
2018Almousa et al. (2018). The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review. Physiotherapy research international : the journal for researchers and clinicians in physical therapy, 23(1). https://doi.org/10.1002/pri.1699
2023Mamipour et al. (2023). Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women With Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial. Journal of manipulative and physiological therapeutics, 46(1), 27-36. https://doi.org/10.1016/j.jmpt.2023.05.005
2023Santos et al. (2023). Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations. Physiotherapy, 118, 1-11. https://doi.org/10.1016/j.physio.2022.09.004
2023Burani et al. (2023). Predictive Factors for Pregnancy-Related Persistent Pelvic Girdle Pain (PPGP): A Systematic Review. Medicina (Kaunas, Lithuania), 59(12). https://doi.org/10.3390/medicina59122123
2022Starzec-Proserpio et al. (2022). Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study. BMC musculoskeletal disorders, 23(1), 928. https://doi.org/10.1186/s12891-022-05864-y
2024Robinson et al. (2024). Pelvic girdle pain in pregnancy and early postpartum - prevalence and risk factors in a multi-ethnic cohort. BMC musculoskeletal disorders, 25(1), 21. https://doi.org/10.1186/s12891-023-07135-w
2026Ashrafi et al. (2026). Identifying risk factors for pregnancy-related pelvic girdle pain: A modified eDelphi study. Musculoskeletal science & practice, 82, 103528. https://doi.org/10.1016/j.msksp.2026.103528
2008Vleeming et al. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 17(6), 794-819. https://doi.org/10.1007/s00586-008-0602-4
2015Gutke et al. (2015). Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta obstetricia et gynecologica Scandinavica, 94(11), 1156-67. https://doi.org/10.1111/aogs.12681
2022van Benten et al. (2022). Differences in balance control despite self-reported resolution of pregnancy-related pelvic girdle pain. A cross-sectional study. Musculoskeletal science & practice, 62, 102620. https://doi.org/10.1016/j.msksp.2022.102620
2023Sward et al. (2023). Pelvic Girdle Pain in Pregnancy: A Review. Obstetrical & gynecological survey, 78(6), 349-357. https://doi.org/10.1097/OGX.0000000000001140
2024Hrvatin et al. (2024). Pregnancy-related pelvic girdle pain affects balance in the second and third trimesters of pregnancy. PloS one, 19(3), e0287221. https://doi.org/10.1371/journal.pone.0287221
2025Halliday et al. (2025). Evaluating the Management of chronic Pelvic girdle Pain following pregnancy (EMaPP): a randomised controlled feasibility trial. Pilot and feasibility studies, 11(1), 54. https://doi.org/10.1186/s40814-025-01638-0
2026Ekdahl et al. (2026). Individually tailored physiotherapy interventions for pregnancy-related pelvic girdle pain: functioning, physical activity, and treatment satisfaction four months postpartum. A cross-sectional study. BMC pregnancy and childbirth, 26(1). https://doi.org/10.1186/s12884-026-09617-w
2026Lu et al. (2026). Exploring exercise prescription parameters for pregnancy-related pelvic girdle pain: A systematic review and meta-analysis of effects on pain and function. The journal of pain, 106401. https://doi.org/10.1016/j.jpain.2026.106401

Mapped to this pattern

PGQ
Pelvic Girdle Questionnaire
pelvic girdle pain activity and symptoms · 25 items · 6 min

Generic measures that also apply

Did this page do its job?

CliniStudy is in beta. One tap is enough — it decides what gets fixed first.