Pregnancy and Postpartum Musculoskeletal Pain: What Is Normal and What Is Treatable

Common, but Not Something to Simply Endure

Low back pain and pelvic girdle pain are among the most frequent musculoskeletal complaints of pregnancy. A systematic review of the prevalence literature estimated that around 45% of pregnant women and 25% of women after giving birth experience pelvic girdle pain, low back pain, or both, with strenuous work and a previous history of low back pain among the identified risk factors (Wu et al., 2004).

Being common does not make it untreatable. The same review noted that, for a minority, pain and disability are serious, and that the problem deserves clinical attention rather than being dismissed as an expected part of pregnancy.

Why Pain Tends to Appear

The causes are not fully understood. Pregnancy brings changes in hormones, posture, load on the pelvis and lower back, and sleep, and these probably interact. Wu and colleagues noted that the mechanisms behind disability remain unclear, and that altered muscle activity and motor coordination have been observed but are still poorly understood (Wu et al., 2004).

After birth, pain often eases but does not always resolve quickly. Carrying, feeding and lifting a baby add repetitive load at a time when sleep and recovery are limited, which can keep symptoms going in some women.

What Has Some Evidence

A Cochrane review of 34 randomised trials found low-quality evidence that exercise may reduce pregnancy-related low back pain, and moderate- to low-quality evidence that it can improve function and reduce sick leave compared with usual prenatal care. Adverse effects, when reported, were minor and transient (Liddle & Pennick, 2015).

For postpartum pain, a later systematic review of physiotherapy approaches found the evidence for specific treatments to be very limited (Gutke et al., 2015). In practice, this supports a cautious approach: education and reassurance, graded activity, modifying aggravating tasks, and individualised exercise, with the plan adjusted to the person rather than applied as a template.

When to Seek Medical Review

Musculoskeletal pain in pregnancy and the postpartum period is usually mechanical, but some symptoms should be reviewed promptly by a GP, midwife or obstetrician, or in an emergency department:

• severe, constant pain that does not change with position or rest, or pain with fever or feeling unwell
• numbness around the groin or genital area, new difficulty passing urine, or loss of bowel control
• a swollen, hot or tender calf or leg, chest pain, or sudden shortness of breath
• vaginal bleeding, severe abdominal pain, or reduced fetal movements
• new leg weakness, or pain that is worsening despite appropriate care

Any of these takes priority over musculoskeletal treatment. Individual advice, including which activities and techniques are suitable at each stage, depends on an assessment and, where relevant, input from the treating maternity team.