Pregnancy asks an enormous amount of the body in a short time. Over roughly forty weeks, your centre of gravity shifts forward, your weight changes, your abdominal muscles stretch to make room, and hormones loosen the connective tissue around your pelvis in preparation for birth. It is no surprise that back and pelvic pain are among the most common complaints of pregnancy.
Common does not mean you have to grit your teeth until delivery. There is a great deal that can be done safely, both during pregnancy and in the months afterwards. This article explains the two main types of pain, what helps, when to seek medical advice, and how to rebuild strength after birth without rushing.
Two kinds of pain
Pregnancy-related pain around the lower back usually falls into one of two categories, and many people have a mix of both. Telling them apart helps because the advice differs a little.
Pregnancy-related low back pain is felt above the pelvis, around the lumbar spine. It tends to be worse with prolonged standing or sitting and is often linked to the changing curve of the spine and tired back muscles.
Pelvic girdle pain, sometimes called symphysis pubis dysfunction when it affects the front, is felt lower down: over the pubic bone at the front, in one or both sacroiliac joints at the back near the dimples, in the buttocks or in the groin. It is typically worse with activities that load one leg at a time or separate the legs — climbing stairs, getting in and out of a car, turning over in bed, standing on one leg to dress, and walking longer distances.
| Low back pain | Pelvic girdle pain | |
|---|---|---|
| Where | Above the pelvis, lumbar spine | Pubic bone, sacroiliac joints, buttocks, groin |
| Worse with | Long standing or sitting, bending | Stairs, turning in bed, single-leg activities, parting the legs |
| Often feels like | Ache or tightness | Sharp, catching, sometimes clicking |
| Helpful first steps | Posture variety, back strength, heat | Symmetrical movement, pacing, support belt |
Why it happens
Several factors combine. The growing uterus increases the load on the spine and pelvis and shifts your centre of gravity, so the back muscles work harder to keep you upright. The hormone relaxin, along with others, increases the flexibility of ligaments, including those around the pelvis. The abdominal muscles stretch and become less effective at supporting the trunk. Sleep is often disrupted, which lowers pain tolerance.
Previous back or pelvic pain, a physically demanding job and pain in a previous pregnancy all increase the chance of pain. None of these factors mean the pelvis is unstable or damaged; the pain reflects how the joints and muscles are coping with load, which is exactly what physiotherapy addresses.
When to call your midwife or doctor
Most back and pelvic pain in pregnancy is musculoskeletal, but some symptoms need prompt medical assessment rather than physiotherapy. Contact your midwife, obstetrician or family doctor, or go to the hospital, if you have any of the following.
- Back pain that comes and goes in a regular rhythm, which can be a sign of labour, especially before 37 weeks.
- Vaginal bleeding or fluid leaking.
- Fever, chills, or pain with urination — possible kidney or bladder infection.
- Severe one-sided pain under the ribs or in the upper back.
- Numbness around the genitals or buttocks, or new difficulty controlling your bladder or bowel.
- Weakness in the legs, or pain with a hot, swollen calf.
- A sudden severe headache, visual changes or swelling of the face and hands.
What helps during pregnancy
Staying active is one of the most effective things you can do. Canadian guidelines encourage most people with uncomplicated pregnancies to accumulate around 150 minutes of moderate activity each week, and regular exercise is associated with less back and pelvic pain. Walking, swimming, stationary cycling, prenatal yoga or Pilates and strength training with appropriate modifications are all good options.
Physiotherapy adds an individual assessment and a targeted plan: exercises for the deep abdominal, gluteal and back muscles, manual therapy to ease stiff or painful joints and muscles, advice on positions for work and sleep, and sometimes a pelvic support belt, which helps some people with pelvic girdle pain feel more comfortable when walking. Treatment is adapted as the pregnancy progresses — for example, avoiding lying flat on the back for long periods later in pregnancy.
Everyday changes for pelvic girdle pain
Pelvic girdle pain is often provoked by asymmetrical movements, so the most effective changes are about keeping the legs together and the load even. These sound small but make a real difference across a day.
- Keep your knees together when turning over in bed; a pillow between the knees helps.
- Sit down to put on underwear, trousers, socks and shoes.
- Get into the car by sitting first, then swinging both legs in together.
- Take stairs one at a time, leading with the less painful leg going up and the more painful leg coming down.
- Avoid carrying a toddler on one hip; spread shopping across both hands.
- Break walks into shorter stretches and rest before pain builds.
- Avoid wide-legged positions and deep lunges if they provoke pain.
Labour and birth
Pelvic girdle pain usually does not prevent a vaginal birth. If separating your legs is painful, let your birth team know in advance and measure your comfortable range beforehand, so that positions during labour and any examinations can respect it. Many people find side-lying or upright, forward-leaning positions more comfortable. Symptoms settle for most people within weeks of the birth.
The first weeks after birth
Recovery starts gently. In the early weeks, the priorities are rest, gradual walking, gentle pelvic floor contractions when comfortable, and deep breathing that engages the abdominal muscles. After a caesarean section, recovery from abdominal surgery adds a few more weeks before lifting and more demanding exercise.
It is common to experience some leaking, a feeling of heaviness, or weakness in the abdomen in the early weeks. These usually improve, but if they persist beyond the first couple of months, or if you notice a bulge or dragging sensation, a pelvic floor assessment is worthwhile. Many postpartum programmes recommend a check-up around six weeks or later regardless of symptoms, especially if you plan to return to running or high-impact sport.
Abdominal separation
Diastasis rectus abdominis is a widening of the connective tissue between the two sides of the six-pack muscle. It happens to almost everyone by the end of pregnancy, and for most people it narrows naturally over the first few months postpartum. It is not a hernia and it is not dangerous.
Research has shifted away from a single focus on the width of the gap. What matters more is whether the tissue can generate tension and the trunk can manage load comfortably. Graded abdominal exercise, including curl-ups and other exercises once feared, is now considered helpful rather than harmful when it is progressed sensibly. A physiotherapist can assess the gap and how it behaves, and build a plan from there.
Returning to running and impact
Running and jumping put repeated load through the pelvic floor, and returning too early is a common cause of leaking and heaviness. Postnatal guidance generally suggests waiting until at least around three months after birth before running, following a graded build-up of walking, strength and low-impact exercise.
Before returning, you should be able to walk for 30 minutes, do single-leg balance and squats, and perform low-impact tasks like jogging on the spot and hopping without pain, leaking or heaviness. If you cannot yet, that is not failure; it simply tells you what to work on. Breastfeeding, sleep deprivation and weight changes all affect recovery, so the timeline is individual.
Prenatal and postnatal physiotherapy in Woodbridge
At Med Wellness in Woodbridge, our physiotherapists support people through pregnancy and the postpartum period with assessment of back and pelvic pain, pelvic floor rehabilitation, abdominal separation, and guided return to exercise and sport. We coordinate with your midwife, obstetrician or family doctor whenever something needs medical input.
You can book without a referral, and most extended health plans cover physiotherapy. Call +1 (905) 605-8889 to arrange an appointment at a time that works around your pregnancy or your new baby.
References
Written by Paramjeet Kaur Bassi, Registered Physiotherapist · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
