Pelvic Girdle Pain After Birth: How Pilates Helps and What to Modify

Yes, Pilates can help with pelvic girdle pain after birth, and the best-studied treatment for it looks a lot like good Pilates: slow, controlled work on the deep muscles that steady your pelvis. But it only helps if the programme is shaped around your pain rather than a class plan. Wide-legged moves, single-leg work and anything that loads one side of the pelvis at a time can flare it up. As a physiotherapist, I would rather you did five careful, symmetrical exercises that feel fine than a full reformer session you pay for over the next three days.

What Pelvic Girdle Pain Is (and How Long It Lasts)

Your pelvis is a ring. At the back, the sacrum joins the two pelvic bones at the sacroiliac joints. At the front, the two sides meet at the pubic symphysis, a joint held together with cartilage and ligaments. Pelvic girdle pain, often shortened to PGP and sometimes called symphysis pubis dysfunction or SPD, is pain from that ring. Physiopedia describes it as pain between the back of the iliac crest and the fold of the buttock, near the sacroiliac joints, sometimes spreading into the back of the thigh, with or without pain at the pubic bone.

It is not the same thing as a pelvic floor problem, although the two can show up together. The pelvic floor is a sheet of muscle. PGP is about the joints and how well the muscles around them share load.

The NHS lists the classic triggers: walking, climbing stairs, standing on one leg, turning over in bed and moving your legs apart. Some people also notice clicking or grinding at the front of the pelvis.

The good news is that most people recover. Physiopedia notes that it typically settles by around three months after birth. That is not everyone, though. Britt Stuge's review for the Pelvic, Obstetric and Gynaecological Physiotherapy group cites research finding that 7% of women report serious problems from PGP that last for years. If you are still sore at your postnatal check, that is worth raising, not waiting out.

What the Research Says About Stability Work

The trial most physios point to is Stuge and colleagues' 2004 randomised trial in Spine. It followed 81 women with pelvic girdle pain after pregnancy through 20 weeks of physiotherapy. Both groups got individual treatment, but only one group did specific stabilising exercises. The exercise group reduced disability by more than half, while the control group barely changed. Evening pain also showed a 30 mm difference in the exercise group's favour on a visual analogue pain scale.

The programme focused on motor control. That meant learning to switch on the deep trunk and pelvic muscles, coordinate them with the larger muscles around the hips and back, and hold a neutral lower back while building strength and endurance. The European guidelines on pelvic girdle pain, summarised in the same POGP review, recommend exactly this after birth: clear information and reassurance alongside specific exercises for motor control and stability.

A caveat I owe you: none of this was a Pilates study. I could not find strong trials testing Pilates classes specifically for postpartum PGP. What we can say is that the ingredients overlap heavily, because Pilates is built on breath, deep abdominal control and a steady pelvis. The review is also blunt that one size does not fit all. The exercise has to match the person.

Pilates Moves That Usually Suit a Sore Pelvis

I start people with work that keeps both legs doing the same thing and keeps the range small. The POGP guidance for new mothers tells you to keep going with pelvic floor exercises and gentle tummy and hip exercises after birth, and to avoid anything that brings the pain back. Within those limits, these are sensible places to begin:

• Breathing with a pelvic floor and deep abdominal connection. On your back with knees bent and feet hip-width apart, breathe out and gently lift the pelvic floor while the lower belly draws in lightly. Let it all go as you breathe in. This is the base the stabilising programmes build on.
• Small pelvic tilts. Rock gently between neutral and a slight imprint, keeping the movement tiny and pain-free.
• A symmetrical bridge. Knees and feet stay parallel and hip-width. Lift only as high as feels steady, and lower slowly.
• Four-point kneeling. On hands and knees, practise finding a neutral spine and holding it for a few breaths before you add any arm reach.
• Standing posture work. Weight even through both feet, pelvis level, breathing easily. This is exactly what you need while holding a baby.

Use pain as your guide during the exercise and for the next day. Mild awareness is fine. Pain that lingers or builds means the dose, range or position needs to change.

What to Skip or Modify for Now

The movements the NHS and POGP tell you to avoid in daily life are standing on one leg, crossing your legs, twisting as you lift, and moving your legs wide apart. Plenty of popular Pilates exercises do exactly those things. This is how I would adapt them in the early weeks.

Usually aggravating	Try instead
Single-leg circles, or leg circles and frog in reformer straps	Both feet down, with small symmetrical pelvic tilts or bridges
Lunges, scooter and standing single-leg work on the reformer	Two-footed footwork with a narrow, parallel stance and modest springs
Side-lying leg lifts through a big range	Leave them out until one-leg standing is pain-free
Mermaid and other twisted sitting on the floor	Sit square on a chair or box, spine tall
Jump board and other impact work	Hold off for a few months, as POGP advises

Transitions matter as much as the exercises. The Royal Berkshire NHS leaflet suggests log rolling with your knees together to get in and out of bed. Use the same trick getting on and off a mat or a reformer carriage. It also recommends carrying your baby in front of you rather than on one hip, which undoes a lot of good work if you ignore it.

When to Get a Physio Involved

POGP's guidance is clear: if you still have PGP after the birth, you should be referred to a physiotherapist for early assessment and treatment. A pelvic health physio can check which joints are involved, test how well you transfer load through the pelvis, and build the individualised programme the evidence supports. Please check with your own doctor, midwife or physio before you start any postnatal exercise, and go back to them if your pain is getting worse rather than better.

Don't underestimate the mental side. A 2026 Swedish study of 164 women treated for PGP in pregnancy found that three-quarters still had pain four months after birth. Worry about pain was the only factor linked to how disabled they felt. Fear and uncertainty were also among the reasons they gave for not being active.

Most people with pelvic girdle pain are not fragile. They need a plan they trust, so movement stops feeling like a gamble.

Felix Okoye

The Honest Verdict

Pilates is a good fit for postpartum pelvic girdle pain when it looks like rehab. That means symmetrical positions, small ranges, lots of breath and deep abdominal work, and patient progression. It is a poor fit when it looks like a busy class full of single-leg and wide-legged work. Start with the handful of moves above, keep your transitions tidy, and let a pelvic health physio decide when to reintroduce the harder material. POGP notes that PGP can come back in a later pregnancy, though symptoms may be milder with good management. So the habits you build now are worth keeping.

Frequently asked

Is SPD the same as pelvic girdle pain?

Mostly, yes. Symphysis pubis dysfunction describes pain at the front joint of the pelvis, while pelvic girdle pain is the broader term that also covers the sacroiliac joints at the back. The NHS uses the two names together.

Can I do reformer Pilates with pelvic girdle pain after birth?

Often, yes, once you have been checked by a clinician and the session is adapted. Stick to two-footed, parallel footwork and symmetrical exercises, and leave out lunges, scooter, straps work with wide legs and jumping until those feel settled.

How long does postpartum pelvic girdle pain last?

For most people it settles within the first few months after birth. A minority still have pain long after that, which is why UK physiotherapy guidance recommends early physio assessment if the pain is still there after delivery.

Will pelvic girdle pain come back in my next pregnancy?

It can recur, but guidance from pelvic health physiotherapists notes that symptoms may be milder when it is well managed. Keeping up your exercises between pregnancies and seeing a physio early next time both help.