I am pregnant and feel my hips pulling apart; what causes this sensation and how should I manage pelvic girdle pain or symphysis pubis dysfunction?

Pregnancy-Related Hip and Pelvic Pain: Causes and Management

What You're Experiencing

The sensation of your hips "pulling apart" during pregnancy is pelvic girdle pain (PGP), a common condition affecting nearly 20% of pregnant women, caused by pregnancy hormones that soften the ligaments connecting your pelvic bones, combined with biomechanical stress from your growing baby. 1

Why This Happens

Your body undergoes specific hormonal and mechanical changes that create this sensation:

• Hormonal ligament softening: Pregnancy hormones (relaxin, progesterone, and estrogen) deliberately reduce ligament rigidity throughout your pelvis, particularly at the symphysis pubis (front center joint) and sacroiliac joints (back joints), weakening joint stability to allow your pelvis to expand for delivery. 1, 2

• Biomechanical overload: Your growing uterus shifts your center of gravity forward, placing additional load on your musculoskeletal system and forcing postural compensations that stress the pelvic joints. 1, 3

• Increased muscle demand: As ligaments become lax, your stabilizing muscles must work harder to maintain pelvic stability, leading to muscle fatigue and pain. 1

This is an evolutionary adaptation—your body is preparing for childbirth by allowing the rigid bony pelvis to expand slightly to accommodate your baby's head during delivery. 1

When Symptoms Typically Occur

• Pain prevalence peaks at 6-7 months of gestation, though symptoms can begin earlier. 1, 2
• The condition affects up to two-thirds of pregnant women when including all forms of musculoskeletal pain. 1

First-Line Treatment: Structured Exercise Program

You should begin a structured exercise program combining aerobic activity with resistance training, accumulating at least 150 minutes of moderate-intensity physical activity per week distributed over a minimum of 3 days. 1

This recommendation is based on strong evidence from the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, which demonstrates that:

• Combined aerobic and resistance training is more effective than aerobic exercise alone for reducing musculoskeletal pain. 4, 1
• Regular exercise decreases pain severity and prevents progression to severe symptoms. 1
• Even lower intensity activity provides benefits if you cannot meet the full 150-minute recommendation. 1

Safe Exercise Guidelines During Pregnancy

Follow these safety parameters while exercising: 4

• Include warm-up and cool-down periods, as ligaments are relaxed and injury risk is increased. 4
• Choose low-fall-risk activities like brisk walking, stationary cycling, swimming, or aquafit rather than activities with balance challenges. 4
• Avoid breath-holding (Valsalva maneuver) if it causes lightheadedness. 4
• Stay hydrated and avoid vigorous activity in excessive heat or high humidity. 4
• High-intensity exercise should only occur in monitored environments due to limited safety data. 4, 1

Additional Management Strategies

Beyond exercise, implement these evidence-based interventions:

• Pelvic support belt: Use a pelvic girdle support device to provide external stabilization. 5, 6

• Stabilizing exercises: Perform specific pelvic stabilization exercises, though evidence quality is limited and results are mixed. 7

• Activity modification: Avoid heavy lifting (10-20 kg more than 20 times per week), as this significantly increases musculoskeletal pain risk. 1, 2

• Analgesia: Use appropriate pain relief as needed (discuss safe options with your provider). 5

• Physiotherapy: Seek specialized physiotherapy for targeted treatment and exercise guidance. 6

Warning Signs Requiring Immediate Medical Attention

Stop all activity and seek urgent care if you experience: 4

• Persistent excessive shortness of breath that doesn't resolve with rest
• Severe chest pain
• Regular and painful uterine contractions
• Vaginal bleeding
• Persistent fluid loss from vagina (ruptured membranes)
• Persistent dizziness or faintness
• Urinary retention or incontinence (potential cauda equina syndrome) 2, 8
• Bilateral leg weakness or saddle anesthesia 2, 8

What to Expect After Delivery

• For most women, pelvic pain resolves spontaneously after delivery. 1, 2

• You are at higher risk for persistent postpartum pain if you have: 2

  • Higher pain severity during pregnancy
  • Both low back pain and pelvic girdle pain simultaneously
  • Back pain that started before pregnancy
  • Early onset of symptoms during pregnancy

• Prevalence drops to 5% at two months postpartum, 4% at six months, and 2% at twelve months. 9

• In rare cases of severe symphysis separation (the joint literally separates excessively), conservative treatment with a pelvic brace remains the gold standard, with symptom reduction typically occurring within 6 weeks to 6 months. 6

Common Pitfalls to Avoid

• Don't dismiss or underreport your symptoms: Many women don't report pelvic pain to prenatal providers, leading to insufficient treatment. 1, 2

• Don't continue heavy lifting or demanding physical work: Inadequate activity modification worsens symptoms and increases risk. 1, 2

• Don't ignore severe or persistent symptoms: Severe pain can lead to sleep disturbances, impaired daily activities, elevated depression risk, and delayed postpartum recovery. 1

Risk for Future Pregnancies

If you have pelvic girdle pain in this pregnancy, you have an increased risk of recurrence in subsequent pregnancies, with pelvic pain in a previous pregnancy being the most important predisposing factor. 5, 9