Pregnancy Aches: What Physio Can Safely Help With

Aches in pregnancy get waved away far too readily. "It's just part of it" is something I hear from patients who have spent weeks unable to turn over in bed without waking up in tears, and while it is true that most pregnancy-related aches are normal and not dangerous, normal is not the same as untreatable. Pregnancy physiotherapy is one of the more satisfying parts of my week, precisely because so many people arrive assuming nothing can be done and leave with something that works.

Here is what physiotherapy can safely help with during pregnancy, what it cannot, and a few things you can change this week.

Why pregnancy changes how your body loads

Three things happen at once. Your centre of mass shifts forwards and upwards, which changes how your spine, hips and pelvis share load. Hormonal changes increase tissue laxity, so joints move a little more freely than your muscles are used to controlling. And the sheer pace of change means your body is adapting to a moving target for nine months.

None of that is damage. It is a mechanical rearrangement, and mechanical problems generally respond well to mechanical solutions: adjusting how you load things, and building enough strength and control to cope with the new arrangement.

Pelvic girdle pain

Pelvic girdle pain is the classic one — pain at the front of the pubic area, over one or both sides of the back of the pelvis, or radiating into the groin or the back of the thigh. It is usually worst when your legs are doing different things: getting out of a car, climbing stairs, rolling over in bed, standing on one leg to put your knickers on.

Physiotherapy for this genuinely helps, and national guidance supports it. Treatment typically combines advice on how to move (keeping your knees together when you turn in bed or get out of the car, sitting down to dress, taking stairs one at a time), targeted strengthening of the hips and deep trunk muscles, and hands-on treatment where it settles symptoms. Some people benefit from a pelvic support belt, though it is an adjunct rather than the treatment.

Three things you can try this week: put a pillow between your knees at night, swing both legs together when getting out of the car, and stop trying to power through a long walk in one go — split it into shorter trips.

Lower back and rib pain

Back pain in pregnancy responds to much the same principles as back pain at any other time, with modifications. Gentle mobility work, hip and glute strengthening, and avoiding long static positions all help. Sitting for two hours then hauling yourself upright is a reliable way to feel awful.

Rib and upper back pain becomes more common in the third trimester as the ribcage flares and the baby presses upwards. Thoracic mobility work, breathing exercises and side-lying positioning tend to be the useful tools here, and honestly, the relief from a well-directed stretch between the shoulder blades is one of the quicker wins in pregnancy physiotherapy.

Wrists, hands and legs

Carpal tunnel symptoms — night-time pins and needles or numbness in the thumb, index and middle fingers — are common in pregnancy because of fluid retention, and they usually settle after the birth. Night splinting, activity modification and nerve gliding exercises can make the interim far more bearable.

Swollen, heavy legs late in pregnancy respond to elevation, gentle walking, and calf pumping. If one calf becomes painful, hot or swollen on its own, that is different and needs same-day medical assessment.

Staying active is the recommendation, not the risk

The UK Chief Medical Officers' guidance encourages physical activity throughout pregnancy for those without complications, and research consistently supports it for pain, mood, sleep and general health. The old advice about keeping your heart rate below an arbitrary number has long been superseded.

The sensible principles: stay at a level where you could hold a conversation, avoid contact sports and anything with a real falls risk, avoid lying flat on your back for prolonged periods after the first trimester, drink enough and do not overheat. Walking, swimming, stationary cycling and appropriately adapted strength training are all reasonable. If you were a regular exerciser before, you can generally continue in modified form — you do not have to start from zero because you are pregnant.

Stop and seek advice for bleeding, regular painful contractions, leaking fluid, dizziness, chest pain or calf pain.

What I do, and what I refer on

I am a musculoskeletal and sports physiotherapist, so the pregnancy work I do is the joint, muscle and nerve side of it: pelvic girdle pain, back and rib pain, hip and knee problems, nerve symptoms, and safe exercise planning. Home visits across Liverpool and Merseyside make particular sense in late pregnancy, when travelling to a clinic is the most uncomfortable part of the day, and online consultations work well for exercise progression and advice.

What I refer on: pelvic floor problems. Bladder or bowel leakage, a sensation of heaviness or dragging in the vagina, or pain with intercourse should be assessed by a specialist pelvic health physiotherapist, who has training and internal assessment skills that I do not. Many NHS trusts across Merseyside have pelvic health services you can be referred into by your midwife or GP, and you should not accept being told these problems are simply the price of having a baby. They are common, and they are treatable.

When to contact your midwife or maternity unit urgently

Physiotherapy is for musculoskeletal aches. Contact your midwife, maternity triage or 999 straight away for any of the following:

• Reduced or changed fetal movements
• Vaginal bleeding, or fluid leaking from the vagina
• Severe or persistent headache, visual disturbance, sudden swelling of the face or hands, or pain under the ribs on the right — possible signs of pre-eclampsia
• Regular painful contractions before 37 weeks
• Pain, heat or swelling in one calf, or breathlessness and chest pain
• A high temperature, or feeling generally very unwell

Never let a physiotherapy appointment delay any of that.

Getting help

If pregnancy aches are stealing your sleep this autumn, that is worth a proper assessment rather than another month of gritted teeth. I offer home visits across Liverpool and Merseyside at £90, and online appointments at £60 UK-wide, evenings Monday to Friday, plus Saturday and Sunday daytimes. Book at /portal/book or call +44 7443 357020 to talk it through first. Details of how home appointments run are on my home visit physiotherapy page.