How To Avoid PPP During Pregnancy

As I’ve discussed in earlier posts, I developed Posterior Pelvic Pain (PPP) at week 29 of my 2nd pregnancy.  One of the first questions I asked my chiropractor and my OB-GYN was what caused PPP?  I had made it through my first pregnancy with no complications, so why was I having issues this time around?

Was it something specific that I did?  Could it have been avoided?  Was it my fault???

PPP is pain felt at or near the sacroiliac joints (SIJ) of your pelvis as a result of sacroiliac joint dysfunction.   This dysfunction occurs when the stability of the SIJ is comprised.  During pregnancy, mechanisms stabilizing the SIJ is affected. This instability allows for increased motion, stressing the SIJ.

  1. Hormones (specifically, relaxin) released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth
  2. Due to the growing uterus, some of the core muscles around the pelvis get ‘stretched’ and weakened. (Source:

After a detailed discussion with my chiropractor, we came up with a handful of reasons why I developed PPP.  According to him, it probably wasn’t just one thing – it was the combination of all of these things.  My body was already dealing with the stress of pregnancy – piling on another 4-5 new stresses (for me) was too much for my body to handle.

I have been asked by many females who are currently pregnant if there is anything they can do to avoid developing PPP.  By no means am I saying that you will avoid PPP if you follow the things listed below, however, based on what my doctor has told me, these things likely caused my case of PPP.

  • Attempting to transition to minimalist shoes while 3 months pregnant: I spoke about this in my last post.  It’s one of those things that you look back on and hit yourself in the forehead asking Could I really be that stupid?  The minimalist shoes  (significantly less cushioning) coupled with my increase in body weight (hello 20 pounds!) resulted in a significant stress for my body with each step I took on my runs.
  • Carrying my son too often:  I have been advised to limit the periods of time that I am holding him.  I still pick him up when he wants to be held but I am trying really hard to limit the walking (and holding) and extended stretches where he is in my arms.
  • Only carrying my son on my right hip: The first question my OB-GYN asked me when I told her about the PPP diagnosis was what side I carry my son on.  I only have the pain on my right side – which correlates with how I carry him.  Carrying him on my hip is the easiest way to hold him – he’s too heavy for me to hold only with my arms for an extended period of time…so I often put him on my right hip.
  • Sudden increase in stairs:  I’ve lived in one-floor apartments the last 10 years of my life.  I didn’t walk up and down stairs on a regular basis.  We moved in to our two-floor (plus basement) home on June 1st.  The number of trips up and down each day is totally unknown to me – but I can tell you that it’s a lot.
  • Sudden increase in hills on my runs: For the last few years, my running routes have been almost completely pancake flat.  Before we moved, 95% of my runs were either completed on the treadmill or along the Staten Island Boardwalk – so hills were NOT a part of my daily routine.  Since moving into our new home, I have been running along Hylan Blvd – slightly hilly if I run south and extremely hilly if I run north (three pretty big inclines on the return trip to the house).  I have been trying to alternate  which way I run so I have some variety to my runs while also giving my legs a chance to recover.

I also often combined several of these at the same time (carrying my son on my right hip while going up and down stairs).  Ultimately, ALL of these (which were ALL new stresses to my body) were too much to handle while dealing with the effects of pregnancy.

My advice would be to be aware of any new stresses to your body during pregnancy.  I had this notion that I was invincible since I had such an easy and wonderful first pregnancy and so I didn’t give a second thought to all the new things I was introducing to my pregnant body.  Additionally, my OB-GYN cautioned me to limit the hip carrying with my son – but if I had to do it, to try to alternate sides as often as possible to prevent one side from taking the brunt of the weight and stress.

Since being diagnosed with PPP almost FOUR weeks ago, I have tried my best to avoid as much of the above “stresses” as possible.  Thankfully, I am virtually pain-free the last few days – and I am hopeful that I can begin to run again within a few days.

Did you suffer from PPP during pregnancy?  What brought on your case of PPP?


For more information about PPP

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    8 thoughts on “How To Avoid PPP During Pregnancy

    1. Great post! Thanks so much for sharing. I am 15 weeks and still running…i find 16km is my max currently for my long runs as i get way too tired after if i try to do more! Even after 16km i feel like i have run 25km ish and need a big nap after:)

    2. One other thing that I think is really important and will help women stay active (running or otherwise) during pregnancy is strength training. During my first pregnancy, I slowed down a LOT more, and had a LOT more pelvic pain, mostly after runs. I still managed to ‘wog’ until about 36-37 weeks, but I was sore for a day or two after each run.

      During this pregnancy, I’ve been very very diligent in keeping up my strength training workouts, specifically doing leg, and back exercises so that as my abs get weaker, there are other core muscles in there helping to hold everything together. I have not reduced the amount that I’m lifting on any exercise – I’ve been willing to – but have been letting my body be the guide.

    3. That makes a lot of sense. I didn’t deal with it in my first pregnancy, but I think about it sometimes how imbalanced my hips must be from always holding my daughter on one side, and how things would change if I were pregnant. Thanks for the great info. Hope you continue to feel better, or have the patience you need to hang in there til delivery!
      Laura @ Mommy Run Fast recently posted..Flashback: Running in the 70′sMy Profile

    4. I had hip pain while pregnant with my twins but it became very severe after they were born. When I asked my doctor about it he said that I had started running too soon after their birth and my body was still not void of the relaxin. It also caused very severe pain in my feet. Not sure if it was just the twins (perhaps you produce more with multiples) or if I indeed started running too soon (6 weeks post partum) but it did clear up in time. Thank you for these tips will pass on to my Momma’s. I hope you are feeling better warp speed. Have a good weekend!
      Lisa @ RunWiki recently posted..Nuun “Practice” CoolerMy Profile

    5. I wasn’t diagnosed specifically for PPP, but like I told you before, it sounds very much like what I experienced, too. And I will add that I think the constant carrying of a child on one hip affects us for ages–honestly, I got horrible ITBS on my right side a few years ago, when my youngest was four. I was still picking her up here and there, always on that same hip. I really think that contributed.

      Hopefully your experience will help others!
      misszippy1 recently posted..SacrificeMy Profile

    6. I would add be careful of any quicker motions on one leg ie stepping off curbs. The SI joint (a component of PPP issues) can get out of alignment quickly with one wrong step. Glad you are doing better. Swimming will work all those stabalizers needed to keep the joints in place ( no wall turns tho). Good luck!
      Andrea recently posted..5K-The Forgotten Race and Why You Need It?My Profile

    7. Same with carrying Brance! I have to make a conscious effort to switch it up, plus Levi and I have to make sure when he is home he does all the Brance lifting. This effort combined with my weekly chiropractor and pre-natal yoga class have relieved my pain tremendously!!! Glad to hear you are making progress!!