Prenatal Care

Prenatal physiotherapy addresses the musculoskeletal and pelvic floor changes that come with pregnancy — from pelvic girdle and low back pain to rib discomfort, round ligament pain, and preparing the pelvic floor for labour and birth. As your body adapts to a growing uterus, shifting hormones, and a changing centre of gravity, physiotherapy can help you stay comfortable and active, and can support your preparation for birth itself. It is provided alongside — never instead of — the ongoing care of your obstetrician or midwife, and is intended to complement your regular prenatal medical appointments.

How your body changes across pregnancy

Early in pregnancy, the hormone relaxin begins loosening the ligaments that stabilize the pelvis and spine, allowing the pelvis to adapt for birth later on but also reducing passive joint stability in the meantime. As the uterus grows, your centre of gravity shifts forward, which typically increases the curve of the lower back and changes how your hips, abdominals, and pelvic floor share load. The rectus abdominis muscles — the paired muscles that run vertically down the front of the abdomen — are connected at the midline by a band of connective tissue called the linea alba, which stretches and thins as the uterus expands; this is a normal, expected adaptation of pregnancy rather than an injury. Meanwhile, the diaphragm is pushed upward and the ribcage flares outward to make room, which changes breathing mechanics and can bring on new rib or upper-back discomfort.

Why pelvic girdle and back pain develop

The sacroiliac joints at the back of the pelvis and the pubic symphysis at the front are both weight-bearing joints that normally rely on a combination of ligament tension and coordinated muscle control for stability. When ligament laxity increases in pregnancy, the deep stabilizing muscles — particularly the deep core and pelvic floor — need to work harder to keep these joints controlled during walking, stair climbing, and rolling in bed. If those deeper muscles are not activating efficiently, more superficial muscles such as the lower back extensors or hip flexors often take over, which can create pain from overuse rather than from joint damage. Asymmetrical habits — carrying a toddler on one hip, standing with weight shifted to one leg, or always sleeping on the same side — can add uneven load to one side of the pelvis and reinforce this pattern.

Round ligament and rib pain

The round ligaments are fibrous cords that suspend the uterus from the front of the pelvis on either side. As the uterus grows and the ligaments stretch and thicken to support it, sudden movements — rolling over, standing up quickly, or coughing — can cause a sharp, catching pain in the lower groin or side, which is typically the ligament reacting to a quick stretch rather than a sign of harm to the pregnancy. Rib pain works on a similar principle: as the ribcage flares and the diaphragm is displaced upward to accommodate the growing uterus, the joints and muscles between the ribs can become irritated, especially later in pregnancy when space is more limited.

What prenatal physiotherapy can help with

• Pelvic girdle and sacroiliac pain: manual therapy and targeted exercise to improve deep muscle control around the pelvis, reducing reliance on compensatory muscles.
• Low back pain: addressing movement patterns and load distribution as your centre of gravity shifts, rather than simply stretching the painful area.
• Round ligament and rib pain: positioning strategies, breathing techniques, and gentle manual therapy to ease irritated tissue.
• Pelvic floor preparation for birth: this includes both building coordinated strength and, just as importantly, learning to consciously lengthen and relax the pelvic floor, since the ability to release these muscles is often just as relevant to labour as strength; may include guidance on perineal massage in later pregnancy.
• Pressure and exercise management: adapting how you brace, lift, and exercise trimester by trimester, with attention to intra-abdominal pressure as the abdominal wall stretches.

What a thorough assessment involves

Assessment typically includes a review of your pregnancy history, current symptoms, and activity level, followed by an evaluation of posture, movement, and breathing patterns. Pelvic floor function is assessed not just for strength but for the muscles’ ability to relax and lengthen, since an overly tense pelvic floor can be just as relevant to pain and birth preparation as a weak one. An internal examination can be included to assess this directly, but it is always optional, explained in full beforehand, and performed only with your consent; a useful picture can often be built externally as well, and your physiotherapist will work with whichever approach you are comfortable with.

How treatment works

Care is adapted to each trimester. Early pregnancy may focus on establishing efficient breathing and deep core activation patterns; the second and third trimesters often shift toward manual therapy for joint and soft tissue discomfort, supportive taping or garments where helpful, and modifying exercise to manage load safely as the abdominal wall stretches. Later in pregnancy, sessions may include education on positioning and breathing techniques that can support labour, along with guidance on perineal preparation. Throughout, physiotherapy works alongside the prenatal care provided by your obstetrician or midwife, and any concerning symptoms are always directed back to your primary maternity care provider.

Who this can help

• Anyone experiencing pelvic girdle, low back, round ligament, or rib pain during pregnancy.
• People who want guidance preparing the pelvic floor for labour, including learning to relax these muscles.
• Anyone unsure how to modify exercise safely as pregnancy progresses.
• People experiencing diastasis-related discomfort or a sense of abdominal separation during pregnancy.
• Anyone who wants a proactive, hands-on complement to their existing prenatal medical care.

Our High Park, Toronto clinic offers pelvic health physiotherapy throughout every stage of your prenatal journey. You can book an appointment at any point in pregnancy — you do not have to wait for something to feel wrong.