I’m pregnant and have pelvic pain; is my pelvis unstable?
All pain is real, but no, the pelvis is remarkably robust.
Even yours.
Even if you’re hypermobile or pregnant with twins or haven’t exercised in a long time. There’s quite a bit of redundancy in the pelvis that makes it extremely strong.
There can be nuance here for some people with more symptomatic hypermobility spectrum disorder (HSD) or hypermobile Ehler’s Danlos Syndrome (hEDS) where there can definitely be some more mobility in the joints of the pelvis, BUT the joints still do not tend to fully displace unless there’s an obvious trauma with significant force (like falling off your bike zooming downhill because you forgot to tighten the quick release wheel; don’t ask me why I know). There can be slight variations in joint position at the pubic bone and sacroiliac joints (SI joints) and these can sometimes contribute to pain, but the possibility of a true joint dislocation is extremely low and would probably require surgical intervention.
When we develop pain, it’s super logical to think something is physically wrong. But outside of obvious injuries or trauma, try to hear me when I insist that you are not broken.
If you’ve been told your pelvis is unstable because of hormones, you have a weak core, or your pain is because you’re out of alignment, it’s probably not true and I’d love to prove it to you.
I have had a lot of patients (pregnant, postpartum, or years after childbirth) come to me afraid that something is structurally wrong in their pelvis, spine, or abdominal wall. Some well-meaning healthcare provider or exercise teacher told them they need to be careful with movement and be vigilant about sitting up straight or bracing their core. Some are afraid to move at all.
Even despite their lifestyle changes and allegiance to their weekly manual manipulations, their pain hasn’t gone away and sometimes has even gotten worse over the years. So what the heck is happening?
I don’t want to argue with your other practitioners or with your lived experience, but I do want to gently challenge some of these beliefs in a way that echoes what modern science and my clinical experience have shown over and over again.
You do not need to wait until birth for your pregnancy pain to go away.
You don’t need to avoid using your abs.
You don’t need to be afraid of movement.
Because: pain doesn’t equal damage.
Pain is an experience that lives in the brain. All of it! Any pain at any time is your brain’s interpretation of the information it’s getting from your nerves, the environment, your beliefs, your history, etc. Our brains can create pain from very obvious injuries like broken bones or paper cuts, but we can also have a pain experience from normal healthy tissue when other things are happening at a systemic level, like normal body changes from pregnancy.
Pain is always multifactorial. Let’s go back to the paper cut:
Scenario 1: You’re having an awful day, skipped breakfast, are late for a deadline, and then on top of everything you get a freakin’ paper cut from the notice on your desk that you have to go on mandatory unpaid furlough. What does that feel like?
vs
Scenario 2: You slept in on a Saturday, got breakfast with a group of old friends, found the coolest sweater at a thrift store that was exactly your size, and then oops, you got a paper cut re-reading an old letter from your favorite penpal. How does this one feel?
Our environment can change a pain experience. Your energy level can change a pain experience. Your outlook can change a pain experience.
Here’s one more example:
Scenario 1: You’re in the third trimester of your first pregnancy. Your partner has been making you breakfast in bed and massaging your feet. You just had super adorable pregnancy photos taken and got a billion Instagram comments about how excited everyone is for you to start your family. You’ve been exercising three times a week, you’re setting up a very cute baby bedroom, and have been feeling pretty good.
vs
Scenario 2: You’re in the third trimester of your second pregnancy. Your toddler just took off their diaper and peed on the living room rug. Now they’re screaming to be picked up, but your partner is at work, you’re trying to start dinner, and all you’ve eaten since breakfast is goldfish crackers. Your toddler is in a sleep regression, so you haven’t had the energy to do any kind of deliberate exercise in months and even getting out on a 10 minute walk has been a struggle. It hurts like hell every time you roll over in bed, your back has been achy, you’re afraid something is really wrong.
What if it’s just that we have an energy limit?
Your body is going to try to slow you down when your energy reserve runs out. Sometimes this manifests as pain, sensitivity to movement, or fatigue. Sometimes it can even feel like anxiety or overwhelm.
In addition to energy reserve, sensitivity to sensory input is deeply connected to the nervous system, hormonal state, sleep quality, stress level, and emotional safety. Things like:
Broken sleep in pregnancy or early parenthood can lower your pain threshold, meaning your brain might create the experience of pain from sensations that would otherwise feel normal or just mildly annoying.
Stress or trauma history can set your muscles up to hold excessive tension. The pelvic floor is highly sensitive to threat response and stress and may tense up just from the added weight of your growing belly. Past trauma can include all kinds of things like previous births or surgical procedures, but can also include less obvious things like feeling dismissed by medical providers, being repeatedly misgendered, infertility challenges, or childhood trauma.
Your body might feel like it’s under threat, even when there’s no immediate danger. This response is heightened in the time around pregnancy and birth, with a special bias to protect the pelvis. Lucky you. It may have something to do with pregnancy hormones and more laxity in the system, but the lore around relaxin making the pelvis unstable is not true!
To review, pain does not always mean weakness or tissue damage.
Pain is your body’s way of asking for support. Pain is an opinion, not a fact.
What if you don’t need to be fixed?
Manual manipulation can release endorphins and help you feel good short term, but this is not necessary and research shows it doesn’t lead to long term changes.
You don’t need to walk around bracing your core, in fact, please don’t. Just like the pelvic floor, the abdominal muscles need to be able to reflexively react and they can’t do that if they’re constantly holding.
There’s no single magic exercise that will change your symptoms.
What you need is a plan to change the way your brain interprets the body’s sensations. We need to decrease sensitivity and fear and increase feelings of safety.
In sessions at Soft Power, we might work on:
Building confidence with new movements so your brain has an opportunity to learn
Learning how to let go of tension and decrease guarding and then strengthening so it actually sticks
Sleep and recovery practices that help build resilience and increase your energy reserve
Reframing your beliefs with education about neuroscience and physiology and the brain
Your body is not doomed.
Pain can change and I see it every day.
It’s not because I’m going to fix you. You are already strong and resilient. My job is to give you strategies to help you and your nervous system learn to feel safe. It’s possible! Even if you feel like you’ve tried everything else. There’s a whole person attached to your pelvis and you probably just need a different approach.
This content is for informational purposes only and is not medical advice. Please consult your qualified medical provider for an individual assessment or plan of care.
