symphysis pubis dysfunction in pregnancy: what it is and how to ease the pain
Symphysis pubis dysfunction or pubic symphysis dysfunction or SPD pain ( I know it goes by so many terms), is a fairly common symptom experienced during pregnancy. It is generally described as pain in the front of your pelvis or lightening crotch (great names we come up with for things that cause pain in females but it is a good description!). Unfortunately, it is often brushed off as something you just need to deal with until the baby is born. Generally, the pain will go away once the baby is born but who wants to suffer in pain for many months (not me!) especially when there are things we can do to help. Keeping your pain decreased allows you to stay more active during your pregnancy, making pregnancy and delivery easier, and helps improve your postpartum recovery.
Let’s dive into what SPD is, why it happens, and what we can do to help decrease and manage the pain to keep you enjoying your pregnancy!
What is Symphysis Pubis Dysfunction (SPD) in Pregnancy?
Symphysis Pubis Dysfunction (SPD) is a condition that affects many women during pregnancy. Your pubis symphysis is the part in the center of your pelvis where the right and the left sides come together. In the center of these 2 bones is also a piece of cartilage. Pain is usually the biggest complaint, however some people may describe a grinding or a clicking. Intensity can vary from person to person from sharp intense pain to mild achy pain. Generally, pain is felt when your legs are moving in different positions for example: walking, stairs, turning in bed, or getting out of the car.
The good news is there are things to do to decrease your pain!
Why Does SPD Happen During Pregnancy?
So why does SPD happen.
Pubic symphysis pain occurs when the joint where your pelvic bones meet becomes inflamed. This inflammation often stems from muscle imbalances affecting the pelvis. As your posture changes, some muscles stretch while others tighten, creating an uneven pull on the pelvis that can lead to pain.
A common imbalance occurs in the inner thigh muscles, which attach just below the pubic symphysis. When these muscles are overworked or not functioning evenly between the left and right sides, they can create an asymmetric pull, contributing to pain. A similar issue can arise with the muscles on the outside of the hip. These muscles help keep the pelvis stable, especially when standing on one foot. If they are weak or too tight, they may cause excessive movement or pulling on the pelvis, further exacerbating discomfort.
Your abdominal muscles also play a crucial role in pubic symphysis pain. As your pregnancy progresses, all of your abdominal muscles lengthen, which can reduce their strength. The most significant loss often occurs in the deep core muscles, the deepest layer of your core responsible for pelvic stability. When these muscles weaken, they provide less support, leading to increased mobility at the pubic symphysis and more pain. Additionally, a loss of deep core engagement can place more downward pressure on the joint. Strengthening these muscles can help lift the baby off the joint, reducing discomfort.
Compensation patterns can also contribute to inflammation. When deep core muscles weaken, the body may rely more on the rectus abdominis—the "six-pack" muscle—to compensate. Since this muscle attaches at the top of the pubic symphysis, overuse can create excessive pulling at its attachment point, leading to further irritation and pain.
Hormones can potentially play a role in SPD as well. There is an increase in relaxin produced during pregnancy. The primary role of relaxin is to improve the mobility of ligaments and tendons to accommodate the growing baby. It has been thought that it can contribute to a decrease in stability at certain joints which can cause pain. The literature is fairly mixed on this with a lot more showing it is more and more likely not the cause. Yes, there is a change in hormones but it is not making your pelvis overly lax that everything is moving too much and causing the pain.
Are there factors that make you more at risk for developing Pubic Symphysis pain in pregnancy?
Are there things that make you more at risk for developing SPD during pregnancy? Literature is a little mixed on if there are risk factors. There are unforunately limited studies on what what could potentially be risk factors however with some of the research that is currently present this is what has been found:
A history of pelvic pain, or history or pelvic pain in past pregnancies
If you have had a previous pregnancy
History of depression and/or anxiety as well as higher daily stress levels
Some studies have reported use of hormone contraceptives before their first birth increased pelvic girdle pain in the first pregnancy
Hacks for SPD Pain Relief
So how can we help you get through your day with less pain.
Positional changes
Keeping your legs together when you move is one thing that will help decrease pain. Turning in bed is a common source of pain so instead of moving legs separately, try and keep them together by lightly squeezing or putting a pillow in between your knees and lightly squeezing and then moving them together.
check out the below video on more tips:
If you have pain exercising some times we need to make some modifications until we calm down some of the inflammation. Lunges are one of the most common movements that are painful for people. Generally start by decreasing how far apart your feet are and if that doesnt significant reduce the pain i would modify staying into a squat until pain decreases.
supportive gear
Outside of positional changes there are some support belts that can help decrease pain. They are generally called SI belts. They unfortunately give the notino that your pelvis is unstable and they are making in stable but really it is just improving howo the muscles act at your pelvis which decreases tha pain.
SPD friendly positions
Sitting we recommend always keeping both feet on the ground. SPD falres most when our legs are doing different things so we want to try and minimize this as much as possible. Same thing with our postures in standing. Try to stand with equal weight on both feet versus shifted with all of your weight on one leg.
treating SPD: what works?
Pelvic floor physical therapy
A pelvic floor physical therapist can help determine where there are tight muscles and weak muscles that are contributing to the imbalance pul on your pelvis. This can include specific mobility exercises and targeted strengthening exercises as well as manual treatments to decrease pain. We often also utilize dry needing which can give immediate changes in pain.
Safe strengthening movements
Building strength is really important to get rid of pubic symphysis pain. The important part is it needs to be the right strengthening exercises for you. Important muscles that strengthening should focus on is your core specifically your deep core, your glutes (you have 3 and they are all important) as well as your adductors or your inner thigh muscles. It is important that the strength’t flare your pain. Then we are just going to be in a cycle of activity and pain which we don’t want.
Chiropractic Care
Chiropractors are also a treatment we recommend in combination with pelvic floor physical therapy. They can help to keep the bones moving well and in a well-balanced position
Lifestyle adjustments
Avoiding asymmetrical movements and using pillows for support. Making lifestyle adjustments are important initially to help decrease the inflammation that is occurring at the joint. This will help decrease pain initially but also let us build strength and stability around the joint easier.
when to seek professional help?
If you are experiencing pain, when is it time to get professional help?
We recommend always seeing a professional if you have SPD. It is much easier to decrease pain when it has been going on for less time and when it has not gottne the chance to cause a big inflammatory response. If we can decrease pain faster then we can work toward building strength, control and balance quicker is what will keep the pain away.
In pelvic floor physical therapy will help to decrease inflammation at the pubic symphyssis by decreasing imbalances at the pelvis which are cuasing more of a pull on one side or less of a pull on the other. This imablance can lead to inflammation at the pubic symphysis pain. We use manual techniques to decrease pain like muscle energy techiques, soft tissue mobilizations as well as joint mobilications. We look to maintain all of the muscles and ligaments to be in balance This also involves your pelvic floor as well as some of the ligmanets attaching to the uterus. We also utilize dry needling a lot to immediately decrease tension in certain spots; some of the most common spots to help decrease pain immediately are the adductors and piriformis. Determining the right strengthening exercises and the right mobility exercises
We hope this helped you learn more about SPD and some simple changes you can make to ease the pain. The most important thing to remember is that getting treatment sooner rather than later makes it much easier to relieve pain and keep it from coming back. And you don’t have to just suffer through pregnancy—there are ways to manage SPD so you can stay active and keep moving!
If you're experiencing SPD pain, we highly recommend scheduling an appointment with a pelvic floor PT. And if you're in the Atlanta area, click below to get in touch with us!
Dig Deeper: Uncover More Secrets to Pelvic Floor Health
Hi! We are Dr.Aimee and Dr. Lauren
We are the owners of Empower Physical Therapy and Wellness. We are pelvic floor physical therapists who specialize in helping women from pregnancy, into postpartum and through perimenopause, menopause and then beyond! We believe all women deserve to do all of the things they love without symptoms!
You can contact us via our website, email at hello@weempowerpt.com or social media!
The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or symptoms. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The opinions expressed in this blog are those of the author and do not necessarily reflect the views of any medical or healthcare institutions.
