Pregnancy is a massive musculoskeletal, hormonal, and neurological adaptation.
As your body grows and shifts to support your baby, your pelvis and core system undergo continuous biomechanical change. For many people, this leads to discomfort, instability, leakage, or fear of movement.
These symptoms are common, but they are not something you simply have to tolerate.
As pelvic health physical therapists, we view pregnancy through a whole-system lens:
not just “alignment,” not just “strength,” and definitely not just Kegel exercises.
Let’s break down what’s really happening.
Understanding the Core During Pregnancy
Your core is a pressure regulation system, not just abdominal muscles.
It includes:
- The diaphragm (breathing muscle)
- Deep abdominal wall (transversus abdominis)
- Multifidus and spinal stabilizers
- Pelvic floor muscles
- Thoracolumbar fascia and connective tissue
- Hip musculature
Together, these structures manage:
- Load transfer through the pelvis
- Intra-abdominal pressure
- Force generation
- Shock absorption
- Continence
- Organ support
During pregnancy, several changes occur:
1. Hormonal Influence
Relaxin and progesterone increase ligament laxity.
This does not mean joints are “falling apart,” but it does mean the body relies more on muscular coordination for stability.
2. Progressive Abdominal Expansion
The abdominal wall lengthens and thins as the uterus expands.
This alters force transmission and pressure management.
3. Center of Gravity Shift
The body adapts with:
- Increased lumbar lordosis
- Rib cage flare
- Forward trunk shift
These are adaptive changes, but they can become symptomatic if coordination is limited.
4. Increased Pelvic Floor Load
The pelvic floor must support:
- Increased uterine weight
- Changes in posture
- Pressure fluctuations from coughing, lifting, and daily movement
Over time, this system can become either underactive, overactive, or poorly coordinated.
Common Pregnancy-Related Pelvic & Core Concerns
Pelvic Girdle Pain (PGP)
Pelvic girdle pain affects up to 1 in 5 pregnancies.
Symptoms may include:
- Pubic bone pain
- SI joint discomfort
- Groin pain
- Tailbone pain
- Sharp pain with rolling in bed
- Difficulty with single-leg tasks
This is often a load transfer issue, not simply “loose joints.”
When deep stabilizers and hip muscles aren’t coordinating efficiently, stress concentrates at the pelvic joints.
Low Back Pain
Back pain during pregnancy is multifactorial:
- Increased anterior load
- Reduced abdominal tension support
- Thoracic stiffness
- Altered movement patterns
- Fatigue
Often the back is overworking because the system is under-supported elsewhere.
Diastasis Recti (Abdominal Separation)
Abdominal separation is a normal and necessary adaptation.
The concern is not the gap itself,
but how well the abdominal wall can generate tension and manage pressure.
Signs of pressure mismanagement include:
- Coning or doming
- Visible bulging with effort
- Lower back discomfort
- Pelvic pressure
The goal is not to “close the gap,” but to restore functional tension and coordination.
Urinary Leakage & Pelvic Floor Dysfunction
Leakage during pregnancy is common but not inevitable.
Causes may include:
- Reduced reflexive pelvic floor activation
- Increased downward pressure
- Overactive (tight) pelvic floor
- Impaired breathing coordination
Pelvic floor muscles must both contract and relax effectively.
More Kegels are not always the answer.
Pelvic Heaviness or Prolapse Symptoms
You may notice:
- A dragging sensation
- Heaviness toward the end of the day
- Increased pressure with standing
This often reflects pressure system imbalance rather than structural failure.
Rib Pain & Breathing Restriction
As the uterus expands upward:
- The diaphragm’s range changes
- Rib mobility decreases
- Breathing shifts to accessory muscles
Since the diaphragm and pelvic floor work together, altered breathing affects pelvic symptoms.
The Missing Link: Pressure Management
Every time you:
- Stand up
- Lift
- Cough
- Exercise
- Get out of bed
Your body generates pressure.
If pressure is not well distributed, it increases strain on:
- Pelvic joints
- Abdominal wall
- Pelvic floor
- Lumbar spine
Prenatal pelvic PT focuses heavily on:
- Breath mechanics
- Coordinated abdominal tension
- Pelvic floor timing
- Functional lifting patterns
This protects both you and your baby.
What Prenatal Pelvic Physical Therapy Looks Like
Care is individualized and trimester-specific.
It may include:
Movement Assessment
- Walking mechanics
- Single-leg control
- Sit-to-stand
- Squatting patterns
- Load tolerance
Breathing Retraining
- 360° rib expansion
- Diaphragm mobility
- Reducing rib flare
- Synchronizing pelvic floor and breath
Core Coordination Work
- Deep abdominal activation
- Anti-rotation control
- Functional tension training
- Progressive load adaptation
Hip & Glute Strengthening
Strong hips reduce strain on pelvic joints.
Manual Therapy
Gentle techniques may address:
- SI joint irritation
- Pubic symphysis sensitivity
- Thoracic stiffness
- Rib restriction
Labor Preparation
We also focus on:
- Pelvic floor relaxation
- Perineal mobility
- Positioning strategies
- Efficient pushing mechanics
- Reducing fear of tearing
Preparation emphasizes adaptability, not rigidity.
Exercise During Pregnancy: Safe and Encouraged
Unless medically restricted, movement is beneficial.
Research supports:
- Moderate strength training
- Cardiovascular activity
- Mobility work
- Pelvic floor coordination training
Avoiding movement due to fear often worsens pain.
With guidance, most people can remain active safely.
Psychological & Nervous System Considerations
Pregnancy pain is not purely mechanical.
Stress, sleep changes, and fear can heighten pain sensitivity.
Education matters.
Understanding that pain does not automatically equal damage reduces protective guarding and improves outcomes.
When Should You Seek Pelvic PT During Pregnancy?
You do not need severe symptoms to benefit.
Consider evaluation if you experience:
- Pain with daily movement
- Leakage
- Pelvic heaviness
- Abdominal doming
- Fear of exercise
- History of prior pelvic injury
- Previous traumatic birth
- Desire for proactive birth prep
Early intervention often leads to smoother postpartum recovery.
Preparing for Postpartum Starts Now
The way you move during pregnancy influences recovery after birth.
Optimizing:
- Core coordination
- Pelvic floor function
- Load tolerance
- Breathing patterns
Creates a stronger foundation for:
- Postpartum healing
- Return to exercise
- Long-term pelvic health
Final Thoughts
Pregnancy is a period of adaptation.
Your body is not fragile.
But it does benefit from guidance.
Pelvic health physical therapy during pregnancy is about:
- Improving coordination
- Supporting adaptability
- Reducing pain
- Building confidence
- Preparing for delivery
- Protecting long-term function
You deserve more than “just deal with it.”
If you are pregnant and unsure about your symptoms, we’re here to help.
Want to learn more or book a session?
Book your visit here and start your recovery journey!
