Most pain that gets called sciatica in pregnancy is pelvic girdle pain, a different problem with different treatment. True sciatica runs in a narrow line down one leg, often past the knee, and is genuinely uncommon in pregnancy. Pelvic girdle pain spreads across the back of the pelvis or the pubic bone, is often on both sides, and responds to keeping the knees together when you move.
Getting this right is worth more than any stretch on this page: the exercises that help one condition aggravate the other.
Which one do you have?
| True sciatica | Pelvic girdle pain | |
|---|---|---|
| Where the pain is | A narrow line down one leg, often past the knee | Across the back of the pelvis, the buttocks, or over the pubic bone |
| One side or two | Almost always one | Often both, and it can swap sides |
| Can you point to it | Yes, you can trace the line with a finger | No, it is diffuse and it moves |
| Pins and needles | Common, in the foot or calf | Unusual |
| What makes it worse | Sitting, coughing, sneezing | Turning in bed, stairs, standing on one leg, walking distance |
| Who helps | Midwife, then GP or MSK physiotherapy | Midwife, then perinatal pelvic health physiotherapy |
The quickest home check: stand on one leg. If that is what really hurts, or if turning over in bed is the worst moment of your day, the pelvic joints are the problem. If instead the pain shoots down the back of one leg when you cough, and you can trace its route with a finger, those symptoms point to the sciatic nerve.
Why pelvic girdle pain happens
Three things change in your body during pregnancy and all three load the same structures. Hormones increase the give in the ligaments holding the pelvic joints together. The bump shifts your centre of gravity forwards, tipping the pelvis and tightening the lower back muscles. And the deep abdominal muscles that stabilise the pelvis are stretched and lose leverage.
The result is a pelvis whose two halves move slightly more than they used to, with the muscles around it working harder to control that movement. That is why single-leg activities hurt most: dressing, stairs, getting out of a car, turning over in bed. Pain sitting on the bony point on the outside of one hip rather than across the back of the pelvis is a gluteal tendon problem, which flares with single-leg loading too and is common in the same months.
This is not damage. Nothing is coming apart and no scan will show a problem that needs fixing. Pelvic girdle pain is a control problem, and control is trainable, which is why physiotherapy works for it.
What to do in the first week
What to do in the first week
WORK OUT WHICH ONE YOU HAVE
Sciatica runs down one leg in a narrow line, often past the knee. Pelvic girdle pain sits across the back of the pelvis or the pubic bone, moves around, and is often on both sides.
CHANGE HOW YOU MOVE, NOT HOW MUCH
Keep your knees together turning over in bed and getting out of a car. Sit down to put trousers on. Take stairs one at a time. Trivial-sounding, and the highest-value changes there are.
TELL YOUR MIDWIFE AT THE NEXT APPOINTMENT
Ask about referral to the perinatal pelvic health physiotherapy service. Most NHS trusts have one, and most women are never told it exists until they ask.
SLEEP WITH A PILLOW BETWEEN THE KNEES
On your side, bump supported, a pillow between the knees so the top leg does not drop across the midline. This is the change that most often improves the mornings.
KEEP MOVING WITHIN COMFORT
Three walks of 10 minutes rather than one of 30 minutes. Swimming, avoiding breaststroke leg kick.
Getting NHS help for it
Your route is through your midwife, not your GP. Most NHS trusts run a perinatal pelvic health physiotherapy service and referral comes through maternity. Since 2024 these services have been expanding across England specifically to pick up pelvic girdle pain and related problems earlier, but you generally have to raise it, because a busy antenatal appointment does not always get round to asking.
The professional network in this area is Pelvic, Obstetric and Gynaecological Physiotherapy, and the Royal College of Obstetricians and Gynaecologists publishes patient information on pelvic girdle pain. Ask for either by name and you get taken more seriously than by calling it backache.
What a pelvic health physiotherapist actually does: assess how your pelvis controls load, give you deep abdominal and gluteal work, fit a support belt, provide crutches if walking is genuinely limited, and write to your maternity team about positions for labour. That last item is easy to overlook.
What helps the muscles, including massage
Whichever condition you have, the muscles around the area tighten protectively, and that spasm becomes a second source of pain on top of the first. This is where massage earns its place.
Pregnancy massage from a therapist trained in it, given in side-lying rather than face down, reliably reduces that protective tension in the buttock and lower back muscles. It will not change the mechanics of your pelvis or move a disc, and any practitioner claiming it will is overselling. Used as comfort alongside the exercises, it is genuinely useful, and for many women it is the thing that makes the evening bearable.
Two cautions. Avoid deep pressure over the lower back and inner ankles in the first trimester, and check with your midwife first if you have a placenta praevia, high blood pressure or any bleeding.
Heat is the other underrated option. A warm bath or a wheat bag across the lower back does much the same job for muscle guarding, and costs nothing. Warmth helps partly because it thins the fluid between the fascial layers of the lower back, which is what stiffens after a spell of sitting still.
How much movement is the right amount
How much to do: the two-hour rule
settled in an hour
right amount
rest of the day
slightly too much
morning
reduce next time
Two things to avoid. Breaststroke leg kick reliably aggravates pelvic girdle pain, because it forces the legs apart against resistance. And wide-legged stretches, including many pregnancy yoga positions, pull on the joints you are trying to settle. Front crawl and gentle backstroke are fine.
If it really is sciatica
For the smaller number of women whose symptoms really are nerve root pain, the plan is much the same as outside pregnancy, with two adjustments.
The centralisation rule still applies: pain moving up towards your back means carry on, pain moving further down your leg means stop. Side-lying with a pillow between the knees is the most reliable relieving position. And gentle gliding of the sciatic nerve, straightening the knee slowly while tipping the head back, keeps it moving without stretching it.
The adjustments: anti-inflammatory tablets are generally avoided in pregnancy, particularly after 20 weeks, so paracetamol and physical measures do more of the work. And imaging is rarely appropriate, which matters little, because a scan would not change the first weeks of treatment anyway.
What about supplements
Here the honest answer is to take less rather than more. Pregnancy changes what is safe, several herbal anti-inflammatories including turmeric at supplement doses are not recommended during it, and nothing in a capsule addresses a control problem in the pelvis. Speak to your midwife before taking anything beyond your antenatal vitamin. Our sciatica support formulation and the wider bioavailable natural anti-inflammatory range are formulated for adults outside pregnancy and breastfeeding, and this is the moment to say so plainly rather than in small print.
Frequently asked questions
How to fix sciatica pain while pregnant?
Start by checking whether it is sciatica at all, because most pregnancy-related pain here is pelvic girdle pain and the two are managed differently. If the pain runs in a line down one leg, use side-lying with a pillow between the knees, short frequent walks and gentle nerve gliding. If it is spread across the pelvis, keep the knees together when you move and ask your midwife to refer you to a pelvic health physiotherapist.
Is it common to get sciatica when pregnant?
Pain in that area is very common: around 20 per cent of pregnant women report pain around the pelvis. True sciatica, meaning compression of a nerve root by a disc, is much less common in pregnancy than the search volume for it suggests, and it is not usually caused by the growing baby. That mismatch is exactly why so many women are told they have sciatica and get treatment aimed at the wrong structure.
How long does pregnancy sciatica last?
For the large majority of women, pelvic girdle pain resolves after the birth or within a few weeks of it. True sciatic nerve pain follows its own course and usually improves substantially within 4 to 6 weeks, pregnant or not. Neither is a reason to stop moving.
Can barely walk with sciatica during pregnancy, what should I do?
Tell your midwife today rather than waiting, and ask for an urgent referral to pelvic health physiotherapy. Severe pelvic girdle pain that limits walking is a recognised reason for crutches, a support belt, and a birth plan that takes your comfortable range of hip movement into account. It is not something to endure quietly until the birth.
Is massage good for sciatica during pregnancy?
It helps the muscle spasm that builds up around the problem and does not change the underlying mechanics. Used that way it is worthwhile, particularly for the buttock muscles that tighten protectively. Use a therapist trained in pregnancy massage, lie on your side rather than face down, and treat it as an addition to the exercises rather than a replacement.
What can I take for sciatica pain in pregnancy?
Paracetamol is the usual first choice at standard doses. Ibuprofen and other anti-inflammatory tablets are generally avoided, particularly after 20 weeks, so do not reach for them without asking. Heat packs, a warm bath and a maternity support belt are reasonable, and any supplement should be cleared with your midwife first.
When should I worry about back pain in pregnancy?
Get urgent help if you have difficulty passing urine, numbness around the back passage or genitals, weakness in both legs, or a fever with the pain. Rhythmic lower back pain coming and going at regular intervals may be labour, and needs your maternity unit rather than a physiotherapist.
What to take away
Do the one-leg test, then read the right column of the table. If turning over in bed is the worst part of your day, this is pelvic girdle pain, and the highest-value change you can make tonight is a pillow between your knees and keeping them together every time you move.
Then ask your midwife, by name, for a referral to perinatal pelvic health physiotherapy. It is the part of the plan women are least often offered and the part with the best evidence behind it.
Sources
Vleeming A., Albert H.B., Ostgaard H.C., Sturesson B., Stuge B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794-819. DOI: 10.1007/s00586-008-0602-4
Jensen R.K., Kongsted A., Kjaer P., Koes B. (2019). Diagnosis and treatment of sciatica. British Medical Journal, 367, l6273. DOI: 10.1136/bmj.l6273
Hartvigsen J., Hancock M.J., Kongsted A. et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367. DOI: 10.1016/S0140-6736(18)30480-X
Foster N.E., Anema J.R., Cherkin D. et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383. DOI: 10.1016/S0140-6736(18)30489-6
GBD 2021 Low Back Pain Collaborators (2023). Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050. The Lancet Rheumatology, 5(6), e316-e329. DOI: 10.1016/S2665-9913(23)00098-X
