Pregnancy is a remarkable and life-changing journey. As your body adapts to support the growth of new life, it goes through an extraordinary series of physical and hormonal changes. While this time is often filled with joy and anticipation, it can also bring discomfort, aches, and unexpected challenges. In this blog we will look at the connection between physiotherapy and pregnancy.
The good news? Many of the musculoskeletal (MSK) changes and physical symptoms that arise while pregnant are not only common but also manageable with the right support.
This blog aims to help you understand the common musculoskeletal changes and discomforts that occur during pregnancy. By sharing clear explanations, practical strategies, and evidence-based treatment options, our goal is to help you feel informed, confident, and supported as you adapt to this incredible journey.
Common Muscular Skeletal Changes During Pregnancy
Pregnancy brings with it a mix of expected, and sometimes unexpected, changes to your body. Many of these changes are the result of hormonal shifts, postural adaptations, and the increasing physical demands of carrying a growing baby. Below is a breakdown of some of the most common musculoskeletal (MSK) changes and what they can mean for how you feel and move throughout pregnancy:
Hormonal Effects
One of the most influential hormones during pregnancy is relaxin. Its primary role is to prepare you for labour by softening the ligaments around the pelvis, but it doesn’t stop there. Relaxin affects the entire body, leading to increased joint laxity. While this flexibility is essential for childbirth, it can also result in feelings of instability or discomfort. This is felt mostly in the hips, lower back, pelvis, and even smaller joints like the wrists and knees.
Postural Changes
As your baby grows, your centre of gravity gradually shifts forward. To maintain balance, many pregnant individuals naturally develop an increased lumbar lordosis (a deeper curve in the lower back). This often leads to compensatory changes in upper back posture, such as increased thoracic kyphosis (rounding of the upper back). Together, these postural adaptations can alter the load on your spine and muscles, contributing to back pain, muscle fatigue, and stiffness.
Weight Gain and Increased Biomechanical Load
Gaining weight during pregnancy is normal and necessary, but it can also place additional stress on the weight-bearing joints of your body, including the hips, knees, ankles, and feet. When combined with ligamentous laxity, this increased load can contribute to joint discomfort, swelling, and fatigue, especially during prolonged standing or walking.
Balance and Coordination Shifts
As your body adapts to these changes, your balance and coordination may also be affected. The forward shift in your centre of gravity and the loosening of ligaments can make you feel less stable or more clumsy, particularly in the second and third trimesters. This can increase the risk of trips or falls, making appropriate footwear, mindful movement, and strength training especially important.
Common Musculoskeletal Issues Seen in Clinic
Some physical discomforts are almost considered a rite of passage during pregnancy, but that doesn’t mean you have to simply put up with them. Many of these are common and manageable with the right support and treatment. Here are some of the most frequent musculoskeletal (MSK) complaints, along with how they typically present:
Low Back Pain
Low back pain affects between 50% to 70% of pregnant women and is often mechanical in nature. It typically arises due to a combination of factors including postural changes, increased joint laxity from pregnancy hormones, and the additional load on the lumbar spine as your baby grows. The increasing curvature of the lower back (lumbar lordosis) can place extra stress on the vertebrae, discs, and muscles, leading to discomfort or stiffness. Proper posture, core strengthening, and supportive footwear can help manage these problems.
Pelvic Girdle Pain (PGP)
PGP encompasses pain around the pelvic joints, primarily the sacroiliac joints (SIJs) and the pubic symphysis.
- Sacroiliac Joint Pain typically presents as pain or aching at the back of the pelvis or buttocks. It is often unilateral, but can affect both sides. Activities that require single-leg loading, such as climbing stairs or standing on one leg, tend to aggravate the SIJ .
- Pubic Symphysis Dysfunction (PSD) refers to pain at the front of the pelvis where the two pubic bones meet. This can cause sharp or aching pain during activities that involve leg separation or weight shifting, like walking or turning in bed.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is very common in pregnancy due to fluid retention causing swelling in the wrist. This swelling compresses the median nerve as it passes through the carpal tunnel, leading to symptoms such as numbness, tingling, burning, or weakness in the thumb, index, and middle fingers. This often worsens in the third trimester and at night, and sometimes interferes with sleep. Wrist splints, gentle nerve gliding exercises, and avoiding repetitive hand strain can give relief.
Neck and Upper Back Pain
The growing weight of the breasts and the shift in posture towards increased lumbar lordosis often leads to increased strain on the neck, shoulders, and upper back muscles. Poor posture, especially during prolonged sitting or when working at a computer, can worsen this discomfort. Many women also experience tension headaches linked to these muscular imbalances. Stretching, postural awareness, ergonomic adjustments, and strengthening of the upper back can be beneficial.
Foot Pain and Plantar Fasciitis
Weight gain and ligament laxity can cause the arches of the feet to flatten (pronation), which changes gait and increases stress on the plantar fascia—a thick band of tissue supporting the sole. This can lead to plantar fasciitis, characterised by sharp heel pain, especially with the first steps after rest. Swelling and changes in foot shape may also cause discomfort and the need for new, supportive footwear to prevent further problems.
Sciatica / Nerve Root Irritation
Sciatica refers to pain radiating down the buttock and leg due to irritation or compression of the sciatic nerve or its nerve roots. True disc herniation causing sciatica is less common in pregnancy, but many women report similar symptoms caused by muscle tension or pelvic misalignment. Tightness in muscles like the piriformis or gluteals can compress the sciatic nerve, leading to shooting or burning pain, numbness, or weakness along the nerve’s pathway. Stretching, strengthening, and manual therapy can often give relief.
Rib Flare Pain / Costochondritis
As the uterus expands, the rib cage also enlarges to make room, which can place strain on the costochondral joints (where ribs attach to the sternum). This can lead to costochondritis, an inflammation that causes sharp, burning, or aching pain in the ribs—especially the lower ribs. Poor posture, such as slouched sitting, can exacerbate this pain. Gentle stretching, postural correction, and breathing exercises may ease discomfort.
Diastasis Recti Abdominis (DRAM)
DRAM is a separation of the two halves of the rectus abdominis muscles along the midline of the abdomen. It often becomes noticeable in the second or third trimester as the growing uterus pushes against the abdominal wall. While DRAM is usually painless, it can reduce core stability, impair posture, and contribute to lower back pain or pelvic floor dysfunction. Specific exercises focused on safe core engagement and gradual rehabilitation postpartum are important for recovery.
How Physiotherapy Can Help
Pregnancy physiotherapy is safe and effective, and it can make a real difference to your comfort and function. Here’s how we help:
Exercise Therapy (Modified for Each Trimester)
Targeted and safe exercise is essential during pregnancy to maintain strength, improve posture, support your joints, and prepare yourself for labour. Typical focus areas include pelvic floor strengthening, core and hip stability, gentle stretching for the back and legs, and safe cardiovascular activities such as walking or swimming.
Manual Therapy
Hands-on treatments like gentle joint mobilisation, soft tissue massage, and trigger point release can help relieve pain and improve mobility. We always carefully assess your comfort and stage of pregnancy to ensure that any manual therapy is safe and effective.
Pelvic Belts and Taping
For those experiencing pelvic girdle or lower back pain, pelvic belts offer external support and stability. Additionally, taping techniques can be applied to support abdominal muscles, reduce strain, and encourage better posture throughout pregnancy.
Postural Education and Movement Advice
As your body changes, practical guidance on posture and movement becomes invaluable. We provide advice on optimal sitting, standing, and sleeping positions, as well as safe lifting techniques. This is especially important if you’re caring for older children. Simple day-to-day tips like using pillows to support your belly and legs during sleep, rolling out of bed in stages, wearing supportive footwear, and avoiding prolonged standing or awkward twisting can significantly ease discomfort and protect your body.
When to Refer or Be Cautious
While many aches and pains are common, it’s important to know when something may need further investigation. Some red flags include:
- Severe, unrelenting back or pelvic pain
- Sudden swelling in hands, feet, or face
- Headaches with visual disturbances
- Pain with fever
- Loss of bladder or bowel control
These may indicate conditions like preeclampsia, urinary tract infections, or neurological involvement, and should be assessed promptly by a GP or obstetrician. As physiotherapists, we work closely with other healthcare providers to ensure you receive the care you need.
If we feel a condition falls outside our scope (e.g., pelvic floor prolapse, urinary incontinence, or significant diastasis recti), we refer to specialist women’s health physiotherapists for more targeted support.
Postpartum Considerations
The recovery journey after birth is just as important as the pregnancy itself. Here are some of the areas we can support you with
Returning to Exercise and Activity
It’s important to ease back into activity safely, particularly if you’ve had a C-section, tearing, or pelvic floor dysfunction. A tailored program helps you build strength gradually.
C-Section Recovery
Physio can help with scar management, core retraining, posture, and safe lifting techniques as you heal.
Pelvic Floor Rehab
Regardless of delivery type, all women benefit from assessment and pelvic floor exercises for strengthening post-birth. Issues like leakage, heaviness, or pain with intercourse should be addressed early.
Managing Postural and Feeding-Related Strain
New mums often spend long hours feeding or carrying their baby. We can help reduce neck, back, and wrist pain with ergonomic tips and gentle stretches.
Pregnancy is a time of immense change. While some discomfort is expected, you don’t have to “just put up with it.” Physio offers safe, effective, and evidence-based support to help you feel more comfortable, confident, and prepared.
Whether you’re early in your pregnancy or navigating the final trimester, our team is here to help you every step of the way. If you’re experiencing pain or discomfort during your pregnancy, feel free to book in for some physiotherapy treatment. We’d love to help you feel stronger and more supported through your journey.
You can contact us on 0298753760 if you have any questions. Otherwise you can just book online.
Let’s work together to make your pregnancy a more empowered, comfortable experience.
For more information, you can check out an article by the Australian Physiotherapy Association about Pre and Post Natal Motherhood.