SI Joint Pain in Pregnancy: What It Is and What Actually Helps
That deep ache at the base of your back during pregnancy has a name — pelvic girdle pain. Here is what is causing it, why it gets confused with sciatica, and what actually helps beyond resting and waiting it out.
That deep, achy pain right at the base of your back. Sometimes sharp, sometimes constant. Usually worse when you roll over in bed, get in and out of the car, or climb the stairs. Often one-sided, though sometimes both.
If you are pregnant and dealing with this, there is a good chance someone has told you it is just part of the process. That you need to rest, take it easy, and wait it out until after the baby comes.
That answer is not good enough. What you are experiencing has a name, it has a cause, and it has care options.
What most mamas call that deep ache at the base of the back is clinically known as pelvic girdle pain, or when specifically involving the sacroiliac joint, SI joint dysfunction. Research estimates that pelvic girdle pain affects close to half of all pregnant women. It is one of the most common and most undertreated complaints in pregnancy — and most women who have it were never given a proper explanation of what is driving it.
In this post you will learn what pelvic girdle pain and SI joint dysfunction actually are, what causes them in pregnancy, how they differ from sciatica, round ligament pain, and SPD, and what kinds of care can meaningfully support your body through it.
What Causes Pelvic Girdle Pain in Pregnancy?
Your sacroiliac joint is where your sacrum, the triangular bone at the base of your spine, meets your iliac bones on either side. You have two of them, one on each side of your pelvis. Under normal circumstances these joints are built for stability, not mobility. They are held tightly in place by some of the strongest ligaments in the body and move only minimally.
Pregnancy changes that entirely.
The hormone relaxin, which your body begins producing from early pregnancy onward, progressively loosens the ligaments throughout your pelvis in preparation for birth. At the same time, your pelvis is shifting to accommodate your growing baby, your center of gravity is moving forward, and the load on the whole lumbopelvic system is increasing week by week.
The result: joints that were designed for stability are suddenly being asked to move and load under conditions they were not built for. That creates mechanical stress, inflammation, and the characteristic pain pattern of pelvic girdle pain.
It is important to understand that this is not something you caused. It is a normal physiological process that becomes a problem when the body is not adequately supported through the structural changes it is going through. The pain is not a sign that something is catastrophically wrong. It is a signal that the system needs more support than it is currently getting.
Research confirms this picture. A systematic review published in the European Spine Journal examined the relationship between relaxin levels and pregnancy-related pelvic girdle pain, and while the relationship between relaxin concentration and pain severity is not perfectly linear, the role of relaxin-mediated ligament laxity in the development of PGP is well established across the literature.
Where Does It Hurt? Pelvic Girdle Pain vs. Round Ligament Pain vs. SPD
One of the most common sources of confusion in pregnancy is distinguishing between different types of pelvic and lower abdominal pain. The location and character of the pain provides the best clues.
Pelvic Girdle Pain and SI Joint Pain
SI joint pain typically presents as a deep ache or sharp pain right at the base of the spine, usually on one side, centered around the posterior superior iliac spine (PSIS), which are the two dimples you can feel just above your glutes. The pain often worsens with asymmetrical loading, meaning activities where one leg is doing more than the other, such as climbing stairs, walking long distances, or standing on one leg to dress.
Rolling over in bed, getting in and out of the car, and transitions from sitting to standing are classic aggravating movements. The pain can also refer into the gluteal region or upper thigh on the affected side.
Round Ligament Pain
Round ligament pain is felt differently and in a different location. Your round ligaments run from the top of your uterus down into your groin on each side. As your uterus grows, these ligaments are under sustained tension.
Round ligament pain presents as a sharp, sudden, stabbing sensation on one or both sides of your lower abdomen, often shooting toward the groin or hip. It is typically triggered by sudden movement, sneezing, coughing, or rolling over quickly. It tends to be more fleeting than SI joint pain, though the surrounding muscular and fascial tension that develops around it can create a more persistent ache.
Symphysis Pubis Dysfunction (SPD)
SPD involves the pubic symphysis, the joint at the front of the pelvis where the two pubic bones meet. When relaxin affects this joint significantly, it can become hypermobile and painful.
SPD pain is typically felt at the front of the pelvis, centered over the pubic bone. It can radiate into the inner thighs and is often described as a sharp pain or grinding sensation. Like SI joint pain, it is often worse with asymmetrical loading and activities that require spreading the legs, such as getting in and out of a car or climbing stairs.
The practical distinction: SI joint pain is at the back. Round ligament pain is on the sides of the lower belly. SPD is at the front.
Is It Sciatica? The Common Misdiagnosis
This is one of the questions we hear most often, and for good reason. SI joint pain and sciatica can feel remarkably similar, particularly when SI joint pain refers into the gluteal region.
Sciatica occurs when the sciatic nerve is directly irritated or compressed, typically by a herniated disc, bone spur, or in pregnancy, by the uterus or piriformis muscle pressing on the nerve. True sciatica produces pain that follows the nerve's path, typically running from the lower back through the glute and down the leg, often past the knee and sometimes into the foot. It may have a burning, electric, or shooting quality and can be accompanied by numbness, tingling, or weakness in the leg.
SI joint dysfunction, on the other hand, is not caused by nerve compression. The pain it produces is referred pain, meaning the joint is sending pain signals into areas beyond its own location, but it is not directly compressing or irritating the nerve. SI joint referred pain commonly goes into the gluteal region and may extend to the posterior thigh, but it typically stays above the knee and does not have the same electric, shooting quality as true sciatica.
Research published in NIH StatPearls confirms that pain radiation from SI joint injuries is observed in up to 50% of cases, most commonly into the gluteal muscles and posterior thigh, and that the presentation can overlap with sciatica, which is why accurate assessment matters so much.
The distinction is clinically important because the two conditions respond to different approaches. Treating sciatica when the real issue is SI joint dysfunction, and vice versa, produces at best temporary relief and at worst makes the problem worse.
Can Pelvic Girdle Pain Be Treated?
Yes. Pelvic girdle pain during pregnancy can improve significantly with appropriate care. That said, the degree of improvement depends on what is driving the pattern, how long it has been present, and what kind of support is applied.
Language matters here. Pelvic girdle pain cannot always be completely eliminated during pregnancy, because the underlying hormonal and structural factors are ongoing. What can be meaningfully addressed is the mechanical load on the SI joints, the compensatory tension in the surrounding muscles and connective tissue, and the overall function of the lumbopelvic system. When those things are supported properly, pain levels can reduce significantly and the pattern often becomes much more manageable.
It does not necessarily get worse as pregnancy progresses if it is being properly supported. Many women who receive appropriate care earlier in pregnancy report that their pain stabilizes or improves in the third trimester rather than worsening.
When It Lingers: Pain That Gets Worse as Pregnancy Progresses
For some women, pelvic girdle pain begins subtly in the first or second trimester and becomes progressively more limiting as pregnancy advances. This pattern is worth taking seriously rather than attributing it entirely to the natural progression of pregnancy.
When SI joint pain is worsening significantly as pregnancy progresses, it often indicates that the mechanical demands of the changing body are outpacing the support available. The pelvis is under more load, the ligamentous laxity is increasing, and if the surrounding muscular and structural support is not keeping pace, the pain pattern escalates.
A 2024 systematic review and meta-analysis published in Health Science Reports examined the prevalence of depression in women with pregnancy-related pelvic girdle pain and found that 24% of women with PPGP experienced depression. This is not incidental. Pain that limits sleep, mobility, and daily function takes a significant toll on overall well-being. Managing the physical component is part of taking care of the whole person.
If your pain is significantly limiting your daily function, affecting your sleep, or worsening week by week, that is the right time to get a proper evaluation rather than waiting.
Common Approaches: What Actually Helps
There are several conservative approaches to pelvic girdle pain that are supported by the research and genuinely useful.
Pelvic Girdle Pain Exercises
Exercise for PGP focuses primarily on supporting lumbopelvic stability without aggravating the affected joints. The goal is not to stretch the SI joint further, it is already too mobile, but to support the system around it.
Exercises that are commonly recommended include pelvic floor activation, which supports the base of the pelvis from below; transverse abdominis engagement, which is gentle deep core activation that helps stabilize the pelvis; and side-lying clamshells, which address gluteal strength without loading the SI joint asymmetrically.
Water-based exercise is particularly well-supported for pregnancy-related pelvic girdle pain, as the buoyancy of the water reduces compressive load on the joints while still allowing meaningful movement.
Pelvic Girdle Pain Support Belt
A pelvic support belt or SI joint belt works by providing compression around the pelvis, which helps stabilize the hypermobile joints by substituting mechanically for the loose ligaments. Research supports their use as a component of conservative management for PGP during pregnancy.
They are most effective during specific activities that tend to aggravate symptoms, such as walking, standing for extended periods, or stairs. They are not designed to be worn all day, as constant compression can reduce the body's own muscular stabilization effort over time.
KT Tape for Pelvic Girdle Pain
Kinesiology tape applied to the sacroiliac region can provide light proprioceptive support and reduce the sensation of instability in some women. The evidence for KT tape specifically in PGP is limited but the clinical experience is generally that it can be a useful adjunct, particularly between appointments or during activities.
Sleeping and Positioning
Positioning during sleep and daily activity makes a significant practical difference. Sleeping on your side with a pillow between your knees reduces the asymmetrical load on the SI joints during the hours you spend in bed. Avoiding wide-legged positions, stepping symmetrically rather than swinging one leg out, and sitting on firm surfaces rather than sinking into soft chairs all reduce SI joint stress throughout the day.
Why Tape and Support Belts Alone Are Not Always Enough
Support belts and tape manage symptoms. They reduce load on the joint during the time they are applied. But they do not address the underlying reason the joint is under excessive stress in the first place.
When the pelvis is misaligned, when one SI joint is moving differently from the other, when the lumbar spine and surrounding soft tissue are compensating for an unstable foundation, the mechanical pattern driving the pain remains even when external support is in place. The belt comes off and the pattern resumes.
This is why many women who use support belts alone find that they provide relief during activity but the pain returns fully when the belt is removed, or that they need to wear the belt more and more to get through the day.
Addressing the structural and neurological component of the picture, how the pelvis is actually aligned and moving, what the whole lumbopelvic chain is doing, and where the compensatory tension is being stored, fills the gap that external support alone cannot.
Who Can Help With Pelvic Girdle Pain in Pregnancy?
Several different providers have a meaningful role depending on what is driving the pattern.
Physical therapists assess muscular imbalances, pelvic floor function, and movement patterns. A PT can build a structured exercise program that supports pelvic stability and guide you through the rehabilitation process with hands-on care.
Osteopaths and other manual therapists work with the soft tissue and joint components of pelvic girdle pain and can address compensatory tension in the surrounding structures.
Chiropractors trained in prenatal care address the joint and neurological component of the picture. A randomized controlled trial published in BMC Pregnancy and Childbirth examined chiropractic management of one-sided pelvic girdle pain in pregnant women and found that chiropractic care was associated with a significantly lower occurrence of sick leave due to pelvic pain compared to conventional primary care alone.
A systematic review of chiropractic care for pregnancy-related low back and pelvic girdle pain, published in the Journal of Manipulative and Physiological Therapeutics and examining 50 articles including 30 randomized controlled trials, found inconclusive but favorable evidence for chiropractic care in this population, noting the need for further high-quality research but supporting its role as a complementary option.
The Webster Technique, a chiropractic protocol specifically designed for pregnant women, addresses sacropelvic alignment and the tension in the ligaments and soft tissues surrounding the uterus. When the pelvis is aligned and moving symmetrically, the mechanical load on the SI joints distributes more evenly, which takes pressure off the inflamed joint and gives the surrounding tissue a chance to settle.
For most women with significant pelvic girdle pain, the most effective approach involves more than one provider. Manual care that addresses joint function, combined with exercise that supports muscular stability, produces better outcomes than either approach alone.
Ready to Get Some Answers?
At Heal Within Chiropractic in Schaumburg, IL, Dr. Desiree Lombos is Webster Technique Certified and an ICPA member with extensive experience supporting pregnant women through pelvic girdle pain at every stage of pregnancy. Your first prenatal consultation is complimentary.
Book Your Complimentary Prenatal Consultation Today →
Related Reading
Prenatal Chiropractic Care: What Every Pregnant Woman Needs to Know
Postpartum Chiropractic Care: What Your Body Needs After Baby
Chiropractic Care During Pregnancy: What to Expect at Your First Visit
Frequently Asked Questions
What is pelvic girdle pain in pregnancy? Pelvic girdle pain (PGP) is pain involving the sacroiliac joints, pubic symphysis, or lumbosacral region during pregnancy. It is estimated to affect close to half of all pregnant women and is most commonly driven by the combined effect of relaxin-mediated ligament laxity and the structural demands of a changing center of gravity.
Is SI joint pain the same as pelvic girdle pain? SI joint dysfunction is one of the most common presentations within the broader category of pelvic girdle pain. PGP is the umbrella term for pain involving the pelvic joints generally. SI joint pain specifically refers to dysfunction at the sacroiliac joints, which is the most frequently affected structure in pregnancy-related pelvic girdle pain.
How do I know if it is SI joint pain or sciatica? SI joint pain typically presents as a deep ache or sharp pain centered at the base of the spine and gluteal region, usually on one side, worsening with asymmetrical loading. It generally stays above the knee and does not have the electric, shooting quality of true sciatic nerve pain. Sciatica tends to radiate from the lower back down the leg, often past the knee, and may be accompanied by numbness, tingling, or leg weakness. A clinical evaluation is the most reliable way to differentiate the two.
Can pelvic girdle pain be treated during pregnancy? Yes. Pelvic girdle pain can improve significantly with appropriate conservative care. Exercise targeting lumbopelvic stability, pelvic support belts, positioning modifications, and manual therapy including chiropractic care all have evidence supporting their use. The degree of improvement depends on the severity and duration of the pattern and the approach used.
Does pelvic girdle pain go away after pregnancy? For many women, pelvic girdle pain improves significantly or resolves after delivery. However, research shows that a meaningful percentage of women continue to experience pelvic girdle pain postpartum, particularly if it was not adequately addressed during pregnancy. Early care during pregnancy improves the likelihood of full resolution after birth.
Is chiropractic care safe for SI joint pain during pregnancy? Yes. Chiropractic care adapted for pregnancy, particularly techniques like the Webster Technique, is considered safe throughout all trimesters. It involves gentle, specific adjustments that are specifically adapted for the pregnant body. Always inform your OB or midwife that you are receiving chiropractic care so your providers can communicate appropriately.
References
Gausel, A.M., et al. Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women: a randomized controlled trial. BMC Pregnancy and Childbirth, 17(1), 331. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622492/
Weis, C.A., et al. Chiropractic care for adults with pregnancy-related low back, pelvic girdle pain, or combination pain: a systematic review. Journal of Manipulative and Physiological Therapeutics, 43(7), 573–579. 2020. https://pubmed.ncbi.nlm.nih.gov/32900544/
Aldabe, D., et al. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European Spine Journal, 21(9), 1769–1776. 2012. https://doi.org/10.1007/s00586-012-2162-x
Halliday, B., et al. The prevalence of depression in women with pregnancy-related pelvic girdle pain: a systematic review and meta-analysis. Health Science Reports, 7(8). 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11322010/
Devin, C.J. & McCullough, M.L. Sacroiliac joint injury. NIH StatPearls. Updated 2025. https://www.ncbi.nlm.nih.gov/books/NBK557881/
Ceprnja, D., et al. Prevalence and factors associated with pelvic girdle pain during pregnancy in Australian women: a cross-sectional study. Spine, 46(14), 944–949. 2021. https://pubmed.ncbi.nlm.nih.gov/33492087/
