Pregnancy Physiotherapy

Support for comfortable movement and physical activity during pregnancy

Pregnancy brings significant physical changes to the body. As your baby grows, changes in posture, joint loading, muscle function and movement can sometimes lead to pain or make everyday activities more difficult.

Pregnancy physiotherapy provides assessment, treatment and practical guidance for musculoskeletal and pelvic health problems that develop during pregnancy.

Treatment is adapted to your stage of pregnancy, symptoms and usual level of activity, with the aim of helping you remain comfortable, mobile and appropriately active throughout pregnancy.

When pregnancy physiotherapy may help

Physiotherapy may be useful if you are experiencing:

• Pelvic girdle pain
• Lower back pain
• Hip or buttock pain
• Pain around the pubic bone
• Groin discomfort
• Pain when walking
• Difficulty turning in bed
• Pain using stairs
• Discomfort getting in and out of a car
• Reduced mobility
• Pelvic floor weakness
• Urinary leakage
• Pelvic heaviness or pressure
• Difficulty exercising comfortably
• Muscle weakness
• Changes in balance
• Rib or upper-back discomfort
• General stiffness
• Difficulty remaining active as pregnancy progresses

You do not need to wait until symptoms become severe before seeking physiotherapy.

Early advice can sometimes make it easier to adjust movement, exercise and everyday activities before symptoms begin significantly limiting mobility.

What happens during your first appointment?

Your first appointment begins with a discussion about your pregnancy, symptoms and everyday routine.

The physiotherapist may ask about:

• How many weeks pregnant you are
• When your symptoms started
• Where you feel pain or discomfort
• Activities that make symptoms worse
• Walking
• Stairs
• Sleep
• Turning in bed
• Work
• Exercise
• Previous pregnancies
• Previous back, hip or pelvic problems
• Bladder or bowel symptoms
• Pelvic floor symptoms
• Other medical conditions
• What activities you would like to continue

The physical assessment may include:

• Posture
• Walking
• Hip movement
• Back movement
• Pelvic movement
• Muscle strength
• Balance
• Functional movements such as sitting, standing or stepping
• Pelvic floor function where relevant

The assessment helps identify what may be contributing to your symptoms and which treatment approaches are appropriate during pregnancy.

What treatment may include

Treatment will depend on your symptoms and stage of pregnancy.

Movement and mobility exercises

Pregnancy-related pain can sometimes lead to reduced movement and stiffness.

Gentle exercises may be used to maintain comfortable movement through areas such as:

• The lower back
• Pelvis
• Hips
• Upper back
• Shoulders

Exercises should feel manageable and can be modified as your pregnancy progresses.

Strengthening

Strengthening can help support the physical demands of pregnancy and everyday movement.

Depending on your assessment, exercises may focus on:

• Hips and gluteal muscles
• Legs
• Trunk muscles
• Upper body
• Pelvic floor

Exercises can be adjusted according to your previous activity level and current symptoms.

Pelvic floor rehabilitation

Pregnancy places additional demand on the pelvic floor.

Treatment may include learning how to:

• Identify the pelvic floor muscles
• Contract them correctly
• Relax them fully
• Build strength and endurance
• Coordinate them with breathing and movement

Pelvic floor exercises may also be useful when managing urinary leakage or preparing for recovery after childbirth.

Manual therapy

Where appropriate, hands-on treatment may be used alongside exercise to help manage pain or stiffness.

This may involve treatment around areas such as:

• Lower back
• Pelvis
• Hips
• Upper back

Manual therapy is normally one part of a broader rehabilitation programme rather than the only treatment.

Activity and movement advice

Small changes to the way activities are performed can sometimes make pregnancy-related symptoms easier to manage.

This may include advice around:

• Walking
• Stairs
• Sitting
• Standing
• Getting dressed
• Turning in bed
• Getting into a car
• Lifting
• Work
• Exercise

The aim is to reduce unnecessary aggravation while helping you remain active.

Home exercise programme

You may receive a simple programme to continue between appointments.

Exercises can be changed throughout pregnancy as symptoms and physical demands change.

Pregnancy-related pelvic girdle pain

Pelvic girdle pain can cause discomfort around the joints and muscles of the pelvis during pregnancy.

Pain may be felt around:

• The front of the pelvis
• Pubic bone
• Lower back
• Buttocks
• Hips
• Groin
• Inner thighs

Symptoms can vary from mild discomfort to pain that significantly affects mobility.

You may notice pain during:

• Walking
• Stairs
• Standing on one leg
• Getting dressed
• Turning in bed
• Getting into or out of a car
• Longer periods of standing

Physiotherapy can assess how you are moving and develop a programme around your particular symptoms.

Walking with pelvic girdle pain

Pelvic pain can sometimes make walking slower or more uncomfortable.

You may notice that longer steps, hills or longer walking distances increase symptoms.

Treatment may involve:

• Adjusting walking distance temporarily
• Strengthening
• Improving movement control
• Reviewing footwear
• Planning rest periods
• Gradually rebuilding walking tolerance

The aim is usually to find an amount of walking that remains manageable rather than avoiding walking completely.

Managing stairs

Stairs can place increased demand on the hips, pelvis and legs.

If stairs are painful, physiotherapy may work on:

• Leg strength
• Hip control
• Step technique
• Pacing
• Using a handrail where useful

You may also receive practical strategies for managing stairs during periods when symptoms are more noticeable.

Turning in bed

Turning in bed is a common difficulty for people experiencing pregnancy-related pelvic pain.

You may notice discomfort when:

• Rolling from one side to the other
• Moving your legs apart
• Getting into bed
• Getting out of bed

Physiotherapy can help you explore movement strategies that reduce unnecessary strain through the pelvis.

Pillows or other positioning changes may also improve comfort for some people.

Getting in and out of a car

Moving one leg at a time while entering or leaving a car can sometimes aggravate pelvic pain.

Practical movement strategies may help reduce symptoms.

Treatment can also address the strength and mobility needed to make the movement easier.

These small changes can be particularly useful when pelvic symptoms are affecting normal daily routines.

Lower back pain during pregnancy

Lower back pain is common during pregnancy and may be influenced by changes in posture, muscle demand, activity and general mobility.

Symptoms may occur during:

• Sitting
• Standing
• Walking
• Lifting
• Turning
• Longer periods of activity

Physiotherapy may include:

• Mobility exercises
• Strengthening
• Movement advice
• Activity modification
• Manual therapy where appropriate

Treatment should be based on your individual presentation rather than assuming all pregnancy-related back pain has the same cause.

Hip and buttock pain

Pain around the hips or buttocks can sometimes develop as pregnancy progresses.

It may be noticeable during:

• Walking
• Sleeping on one side
• Stairs
• Standing
• Exercise
• Getting out of a chair

The assessment can look at hip movement, muscle strength and the activities that are contributing to symptoms.

Treatment may include targeted strengthening, mobility work and changes to aggravating activities.

Pubic bone and groin pain

Some people experience pain around the front of the pelvis or pubic bone.

Activities involving greater separation or uneven loading through the legs may become particularly uncomfortable.

This can include:

• Walking quickly
• Taking large steps
• Standing on one leg
• Getting dressed
• Turning in bed
• Getting into a car

Treatment can focus on improving strength and control while finding more comfortable ways to manage these movements.

Rib and upper-back discomfort

As pregnancy progresses, changes in posture and increasing abdominal size can sometimes contribute to discomfort around the upper back, ribs or shoulders.

Treatment may involve:

• Upper-back mobility
• Shoulder exercises
• Postural variation
• Breathing exercises
• Gentle strengthening
• Changes to sitting or working positions

Persistent or unusual rib or chest pain should be appropriately medically assessed, particularly if it is associated with other symptoms.

Pelvic floor health during pregnancy

The pelvic floor helps support the pelvic organs and contributes to bladder and bowel control.

Pregnancy increases the physical demand placed on these muscles.

Pelvic floor rehabilitation may help if you are experiencing:

• Urinary leakage
• Difficulty controlling wind
• Pelvic heaviness
• Reduced pelvic floor awareness
• Difficulty performing pelvic floor exercises correctly

An assessment can help determine whether strengthening, relaxation or coordination work is most appropriate.

Urinary leakage during pregnancy

Some people begin experiencing urine leakage during pregnancy, particularly when:

• Coughing
• Sneezing
• Laughing
• Exercising
• Lifting

Pelvic floor rehabilitation may help improve muscle strength and timing.

Treatment may also consider bladder habits, breathing and how pressure is managed during everyday movement.

Urinary leakage is common, but this does not mean it needs to be ignored until after childbirth.

Pelvic floor relaxation

Pelvic floor rehabilitation is not only about strengthening.

The muscles also need to relax appropriately.

If the pelvic floor remains unnecessarily tense, treatment may focus more on:

• Breathing
• Muscle awareness
• Relaxation
• Comfortable movement
• Reducing guarding

Your exercise programme should therefore be based on assessment rather than simply completing as many pelvic floor contractions as possible.

Exercise during pregnancy

For many people with an uncomplicated pregnancy, remaining physically active can continue to form part of normal pregnancy.

The type and amount of exercise will depend on:

• Previous exercise experience
• Current symptoms
• Stage of pregnancy
• General health
• Pregnancy-related medical advice

Activity may include:

• Walking
• Strength training
• Swimming
• Cycling on suitable equipment
• Modified gym exercise
• Pregnancy-appropriate exercise classes
• Mobility work

Exercises can be modified as your body and pregnancy change.

Returning to exercise after pregnancy-related pain

Pelvic or back pain does not necessarily mean you need to stop all exercise.

The programme may initially reduce movements that significantly aggravate symptoms while maintaining other activities that remain comfortable.

As symptoms become more manageable, rehabilitation may gradually increase:

• Strength exercises
• Walking
• Squatting
• Lunging
• Cardiovascular activity
• Gym-based exercise

The aim is to maintain physical capacity without repeatedly aggravating symptoms.

Strength training during pregnancy

If you already performed strength training before pregnancy, it may be possible to continue with appropriate modifications.

Adjustments may involve:

• Changing resistance
• Reducing exercise volume
• Modifying position
• Adjusting range of movement
• Taking longer recovery periods
• Changing exercises that have become uncomfortable

Pregnancy does not automatically require every exercise to become very light.

However, the programme should reflect your current health, symptoms and medical guidance.

Returning to or maintaining the gym

A gym programme may need to change as pregnancy progresses.

Exercises that were comfortable earlier may become less practical later.

Your programme can be adapted according to:

• Pelvic or back symptoms
• Balance
• Abdominal size
• Fatigue
• Pelvic floor symptoms
• General comfort

The aim is to maintain appropriate strength and activity rather than trying to preserve exactly the same routine throughout pregnancy.

Running during pregnancy

Some people who regularly ran before pregnancy may wish to continue.

Whether running remains appropriate depends on individual health, pregnancy-related medical guidance and symptoms.

Running may need to be reduced or modified if you experience:

• Pelvic pain
• Urinary leakage
• Pelvic heaviness
• Significant discomfort
• Balance difficulties

Physiotherapy can help assess strength, pelvic floor function and how your body is responding to impact activity.

Work during pregnancy

Pregnancy-related symptoms may be affected by work activities.

Challenges can include:

• Prolonged sitting
• Prolonged standing
• Frequent walking
• Lifting
• Repeated bending
• Driving
• Physically demanding work

Physiotherapy may help identify practical changes that make the working day more manageable.

This could involve changing position more frequently, adjusting certain movements or planning physically demanding tasks differently.

Sitting and desk work

Long periods in one position can contribute to discomfort for some people during pregnancy.

Rather than trying to maintain one perfect posture, it may be more useful to change position regularly.

You may benefit from:

• Standing periodically
• Short walks
• Adjusting chair position
• Supporting the feet
• Gentle movement during the day
• Changing working positions where possible

The most comfortable setup can change as pregnancy progresses.

Standing for longer periods

Prolonged standing may increase pelvic or back discomfort.

Strategies may include:

• Changing position regularly
• Avoiding locking the knees
• Alternating tasks
• Taking short movement breaks
• Using supportive footwear
• Planning periods of rest where needed

Strengthening may also help improve tolerance to standing over time.

Lifting during pregnancy

Lifting requirements vary considerably.

Someone caring for another child, for example, may not be able to simply avoid lifting throughout pregnancy.

Physiotherapy can help you consider:

• How close the load is to your body
• Leg strength
• Breathing
• Pelvic floor coordination
• Repeated lifting
• Whether the load or frequency can be modified

The aim is to make necessary activities more manageable rather than creating unrealistic restrictions.

Support belts and mobility aids

Some people with significant pregnancy-related pelvic pain may benefit from additional support.

Depending on the assessment, this could include:

• A pelvic support belt
• Crutches for a temporary period
• Other practical mobility support

These are not needed for everyone.

Where equipment is recommended, you should also receive guidance on how and when to use it rather than relying on it without addressing strength and movement.

Sleep and positioning

Pelvic, hip or back discomfort can make comfortable sleep difficult.

You may need to experiment with:

• Pillow positioning
• Support between the legs
• Support around the abdomen
• Different ways of turning
• Adjusting how you get into and out of bed

Physiotherapy can provide practical suggestions based on where you experience pain.

Managing fatigue

Pregnancy can affect energy levels, particularly at certain stages.

Fatigue may influence how much exercise, walking and work feels manageable.

Activity can be adjusted without stopping completely.

This may involve:

• Shorter exercise sessions
• Reducing resistance temporarily
• Breaking longer walks into sections
• Planning more demanding activities around times when energy is better
• Allowing appropriate recovery

The aim is to maintain useful activity within what your body can currently manage.

Preparing physically for childbirth

Pregnancy physiotherapy is not about guaranteeing a particular type of birth.

However, maintaining mobility, strength and pelvic floor awareness may help you feel physically better prepared.

Depending on your needs, physiotherapy may include:

• Hip and pelvic mobility
• Comfortable movement
• Breathing
• Pelvic floor awareness
• Pelvic floor relaxation
• General strength
• Position changes

The focus is on maintaining useful movement and body awareness rather than following one fixed preparation programme.

Preparing the pelvic floor for childbirth

The pelvic floor needs strength, but it also needs the ability to relax.

Later in pregnancy, treatment may include improving awareness of both contraction and relaxation.

Where appropriate, your maternity or pelvic health team may also discuss other birth-preparation strategies.

Advice should be individual and take account of your pregnancy and medical history.

Preparing for recovery after birth

Pregnancy physiotherapy can also help you understand what physical recovery may involve after childbirth.

Topics may include:

• Early pelvic floor exercises
• Gradual return to walking
• Managing abdominal and pelvic symptoms
• Lifting and caring for your baby
• Returning to exercise
• When postnatal physiotherapy may be useful

Having a plan before birth can make it easier to recognise which symptoms may benefit from rehabilitation afterwards.

Pregnancy after a previous pelvic or back problem

If you had significant back, hip or pelvic symptoms before pregnancy, you may be concerned that pregnancy will make them worse.

This does not always happen.

An assessment can help establish your current movement and strength and provide an exercise programme suited to pregnancy.

Treatment may focus on maintaining physical capacity and identifying manageable strategies if previous symptoms return.

Pregnancy after a previous difficult pregnancy

If you experienced significant pelvic or back pain during a previous pregnancy, you may wish to seek advice earlier in a later pregnancy.

Treatment may focus on:

• Maintaining strength
• Keeping active
• Monitoring symptoms
• Managing early changes
• Planning work and exercise

Previous pregnancy-related pain does not automatically mean that the same level of symptoms will occur again.

Pregnancy physiotherapy after a fall or injury

Falls, muscle injuries and joint problems can still happen during pregnancy.

Assessment and rehabilitation can be adapted around the pregnancy while addressing the injury itself.

The approach will depend on:

• The injury
• Stage of pregnancy
• Pain
• Mobility
• Any medical restrictions

A significant fall during pregnancy should also be discussed with the appropriate maternity or medical team.

When symptoms need medical assessment

Not every symptom during pregnancy should be treated as a musculoskeletal problem.

Contact your maternity or medical team if you experience symptoms such as:

• Vaginal bleeding
• Loss of fluid from the vagina
• Regular painful contractions earlier than expected
• Significant abdominal pain
• Severe or unusual headache
• New visual disturbance
• Sudden significant swelling
• Chest pain
• Significant or unexplained shortness of breath
• Feeling faint or losing consciousness
• A significant change in your baby’s usual movements
• Fever or feeling significantly unwell

Seek urgent medical attention for severe or sudden symptoms.

Physiotherapy should work alongside, rather than replace, appropriate maternity care.

Treatment based on your goals

Pregnancy affects everyone differently.

Your goals may include:

• Walking more comfortably
• Managing pelvic girdle pain
• Reducing back pain
• Sleeping more comfortably
• Managing stairs
• Continuing work
• Maintaining strength
• Exercising during pregnancy
• Managing urinary leakage
• Improving pelvic floor function
• Continuing gym training
• Preparing physically for childbirth
• Preparing for postnatal recovery

Your treatment programme can be developed around the activities that matter most to you.

How long does pregnancy physiotherapy take?

The amount of physiotherapy required depends on your symptoms and stage of pregnancy.

Some people may need only a small number of appointments for assessment, exercise and advice.

Others may benefit from ongoing review as pregnancy progresses, particularly where symptoms affect walking, work or normal daily activities.

Exercises and management strategies can be adjusted as your body changes.

The aim is to provide you with practical ways to remain comfortable and active while also helping you understand how to manage symptoms independently.