Pelvic Girdle Pain

When imaging is “normal,” core work makes it worse, and the pain keeps shifting between SI joints, pubic symphysis, hip, and groin.

The Clinical Reality

Pelvic girdle pain is often a regional load-transfer problem rather than a single “joint out of place.” The SI region, pubic symphysis, hips, and trunk have to share force and coordinate timing with each step, hinge, and rotation. When one area becomes sensitized or guarded, the system compensates. That can increase shear and compression across the SI region or pubic symphysis, overload hip stabilizers, and amplify protective tone in deep pelvic and abdominal muscles.

In postpartum and active populations, common drivers include changes in tissue sensitivity, altered motor control, and uneven load tolerance. Symptoms can move from side to side, feel mechanical one day and “nervey” the next, and flare with gait speed, single-leg stance, rolling in bed, or transitional movements. The goal in care is to identify which tissues are sensitized, which patterns are over-recruited, and what load exposures are exceeding current capacity.

Why Standard Care Fails

Standard care often treats pelvic girdle pain as either a structural problem (a joint that needs alignment or imaging confirmation) or a generic strengthening problem (“do more core”). Medications can reduce symptoms but rarely change load transfer or muscle guarding. Imaging can rule out serious pathology, but it often does not explain why walking, stairs, or single-leg tasks reproduce pain. Generic stabilization programs may miss the real limiter, such as adductor or obturator internus overload, poor hip rotation control, or a sensitized dorsal rami pattern.

When the underlying issue is functional, progress usually requires a gait and movement lens, hands-on tissue assessment, and targeted downregulation of overactive structures paired with progressive re-loading. For postpartum presentations and pelvic floor involvement, coordination with pelvic floor physical therapy often improves efficiency and results.

Signs & Symptoms

Do any of these sound familiar?

SI region pain with walking or longer strides

Often worse with faster pace, hills, or uneven surfaces and may alternate sides depending on fatigue and gait compensation.

Pubic symphysis or groin pain with rolling, bed mobility, or getting in and out of a car

Commonly triggered by asymmetrical movements or squeezing the legs together, sometimes described as sharp, pinching, or “front-of-pelvis” instability.

Pain with single-leg tasks

Stairs, lunges, step-downs, or standing on one leg reproduce symptoms, often with a sense of pelvic shift or hip giving way.

Hip and deep buttock tightness that feels like it never releases

May involve glute med, deep rotators, or adductor attachments and can feel like a constant clamp that returns quickly after stretching.

Radiating or “zinging” sensations into buttock, groin, or upper thigh

Can reflect local nerve irritation or sensitized referral patterns and may worsen with prolonged sitting, loaded hip flexion, or end-range rotation.

Root Cause Contributors

The mechanical drivers behind your symptoms

Load-transfer asymmetry at the SI region and pubic symphysis

Uneven timing and stiffness between trunk, pelvis, and hips can increase shear and compression during gait and transitional movements.

Hip stabilizer overload and adductor dominance

Glute med and adductor complexes may overwork to substitute for delayed trunk or pelvic control, provoking groin, lateral hip, and pubic pain.

Pelvic floor and deep hip rotator hypertonicity

Protective tone in obturator internus, levator ani, and related myofascial lines can limit hip rotation and alter pelvic mechanics, especially postpartum.

Lumbar dorsal rami and peripheral nerve mechanosensitivity

Irritable segmental referral patterns can mimic joint pain and drive guarding, even when imaging shows only age-typical findings.

What to Expect

Your roadmap to recovery
Weeks 1 to 2
Clearer identification of primary drivers and aggravating movements, with early improvement in baseline tightness and more predictable flares during walking, stairs, or bed mobility.
Weeks 3 to 6
Improved tolerance to single-leg tasks and transitional movements, better gait efficiency, and less reliance on constant bracing. Setbacks become easier to interpret and manage.
Weeks 7 to 12
Meaningful gains in load capacity for training, lifting, or longer walking demands, with a clearer plan for return to run or sport-specific exposure when appropriate.

Frequently Asked Questions

Get answers to common questions

Sometimes the SI region is the loudest pain site, but pelvic girdle pain is often a regional load-transfer issue involving the SI region, pubic symphysis, hips, and trunk. The clinical priority is identifying which tissues are driving symptoms during your specific movements, not labeling a single structure as the only cause.

No. Imaging can be essential for ruling out fractures, inflammatory disease, or other medical pathology, but many load-transfer and motor control problems do not show up clearly on scans. A hands-on exam and movement assessment can reveal tissue irritability, guarding, and coordination issues that are very real and treatable.

Yes, pelvic girdle pain is common postpartum and can involve sensitivity changes, protective tone, and altered coordination. Care is individualized and often benefits from collaboration with pelvic floor physical therapy, especially when symptoms include pelvic floor heaviness, urinary changes, or pain with internal muscle involvement.

Frequency depends on irritability and goals. Many patients start with 1 to 2 visits per week for a short period to reduce sensitivity and establish movement changes, then taper as capacity improves. Timelines vary based on chronicity, postpartum factors, training load, and how consistently triggers can be modified.

It can, especially when the limiter is protective tone or focal tissue sensitivity. The intent is not to replace strength work, but to make it tolerable and better targeted by reducing overactivity in key structures and improving motor sequencing. Strengthening is then reintroduced with a dose and strategy that matches your exam findings.

Seek prompt medical evaluation for significant or progressive neurologic symptoms (new weakness, numbness in the saddle area, bowel or bladder changes), major trauma, fever, unexplained weight loss, systemic illness signs, or severe night pain that is not position-related. If you are unsure, we can help direct you to the appropriate provider.

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118 W. 72nd, Rear Lobby, Upper West Side, NY 10023 Evidence-based acupuncture and dry needling on the Upper West Side, NYC. From chronic pain, headaches, and pelvic floor dysfunction, Dr. Jordan Barber integrates the highest level of training with compassionate care to help you thrive. Disclaimer: This site does not provide medical advice. Always consult a qualified healthcare professional before making changes to your health. Read our full disclaimer

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