Pregnancy Fitness: Symphysis Pubis Dysfunction in Pregnancy

I have had a couple of requests for more information on this recently. Symphysis Pubis Dysfunction (SPD) is a painful condition affecting the groin and pubic area during pregnancy and if you get a bad case it can be really debilitating.

What is Symphysis Pubis Dysfunction in Pregnancy?

The pelvis is made up of 3 large bones – the sacrum (the flat bit of your pelvis at the back), and the two ossa coxae (hip bones). These bones are connected by tough ligamentous tissue that allow for some very minor flexibility. The ligament which connects the bones at the front is called the Symphysis Pubis.

No-one really knows what causes SPD, but the most likely probable cause is due to the pregnancy hormones. During pregnancy the hormones relaxin and progesterone soften up the pelvic ligaments allowing a lot more flexibility so that the pelvis can open accordingly as the pregnancy progresses.

Although this laxity is neccesary it does mean that the pelvis of a pregnant woman becomes unstable and is less able to provide postural support for the increasing load. The discomfort felt in the symphysis pubis is due to the pelvis not functioning as it should and most likely results from strain referred by one or both of the sacro-illiac joints.

Other contributing factors to SPD could be:

History of pelvic trauma

Misaligned pelvis

Sensitivity to pregnancy hormones / overproduction of pregnancy hormones

Previous multiple pregancies or large babies

How do you know if you have SPD?

Do you have pain and tenderness in the pubic area? If no then it could be Round Ligament Pain

If yes it could also be associated with pain through the hips, buttock and lower abdomen.

Does walking, getting in and out of a car, climbing stairs or any other one legged activity make the pain worse?

Are you shuffling/waddling to avoid the pain?

If all of the above are sounding very familiar then it’s probable that you have SPD.

What Can You Do About It?

1) Avoid all positions and activities that aggravate SPD. These are all one legged activities such as climbing the stairs and getting in and out of the car.

Try going up and down stairs on your bum.

To get in and out of the car, sit down in the seat sideways on facing out of the door. Then swing both legs in together to avoid splitting the legs and pulling on the ligament.

Keep the knees together when turning in bed

Avoid twisting the upper body – turn your whole body to face the direction you want to look

Avoid straddle positions (definitely NO lunging!)

Avoid breaststroke

Take weight off the pelvis wherever possible by sitting down to get dressed, prepare food, brush your teeth etc…

Treatment

There is no way of tightening up the affected ligaments but you can improve pelvic support through strength work.

Kegels and TA work should be a daily part of your Pregnancy Fitness program anyway but if you are suffering with SPD, make sure you are doing these 3 times daily.

A pelvic girdle can often help with the pain and you should be able to get one from your oseteopath or physiotherapist – but make sure it is fitted properly.

Try and keep mobile, doing nothing will make it worse. While the pelvic ligaments are overly mobile, they still need daily movement to keep them supple. Depending on how severe the pain is, you may still be able to do some gentle pregnancyexercise like hip bridges, pelvic tilts to increase the stability of your pelvis and back or swimming which will take the load off of the Symphysis Pubis ligament.

If you do choose to go swimming do not attempt to get in and out of the pool using the stairs or with one leg up and the other down – most pools have a wheelchair ramp which you can use easily.

Minimise leg movement and torsion of your body – Swim using your arms only – its a great upper body workout – or you can just float. The buoyancy of the water will provide immediate pain relief.

Drugs

If the pain is severe then you may want to visit your GP to discuss if there are any anti-inflammatory drugs you can take to reduce pain.

You can also take paracetamol during pregnancy but you should speak with your GP before taking ANY medication as what may be safe for one person is not neccesarily safe for you.

Homeopathy is also worth a try – I don’t personally know of any remedies for SPD in particular or if there is a homeopathic anti-inflammatory remedy which is suitable for pregnancy but definitely worth asking your local registered homeopath.

12 Responses to “Pregnancy Fitness: Symphysis Pubis Dysfunction in Pregnancy”

nomorexcuses on January 25th, 2010

Great post Nisha! This is something that so many women don’t seem to get the information they need on. Keep it coming!
Jacqueline on January 29th, 2010

Nisha, great post and right back at you so timely. I actually saw a woman this week that is a personal trainer and pilates instructor that had this issue during her pregnancy. She has since been to many practitioners and still having residual issues. A bit of the right information goes a long way- good stuff.

Jacqueline
kazs on June 12th, 2010

I have had psd for 8 years now, i am heavily medicated and in severe pain most of the time. Been to see specialists, physio, pain management clinics etc. Is there any hope?
Nisha on June 14th, 2010

Hi Kazs,

I’m afraid without knowing your medical history it really is impossible for me to answer you. Not the answer you were looking for I know.

I guess my first question would be are you in the UK and is your physio NHS? Because in this case I would suspect that you are not being given the full range of treatment available, simply beacuse it is NHS funded. A private osteopath working with a specialist personal trainer would be a lot more effective in treating your condition.

Personally, if you came to me as a potential client I would be working very closely with your osetopath/physio to progressively increase your range of pain free movement through realignment of your pelvis and strengthening the supporting structures with specific resistance and manual therapy work. (But if your physio is good I expect you are already doing this?)

I would also be looking at your diet as toxin buildup in pelvic ligaments can severely inflame tissues, adding load to your problem.

I would restrict all wheat and dairy from your diet and increase magnesium and calcium through supplementation and increasing leafy green veg, nuts, beans and fish. (however these strategies work hand in hand and you won’t see improvement without implementing both).

I’m sorry I can’t be more help
kazs on June 15th, 2010

Yes i’m afraid it is NHS that is working with me and due to financial restrictions I can’t improve on that situation. I will however take your advice on my diet. My other concern is the long term effects that my painkillers are having on me as I am on co-codamol, diclofenac sodium and tramadol 4 times a day. I know that this is not good but i rely on them heavily. Thank you so much for replying it is good to know that i am not on my own. Thanks again.
Nisha on June 15th, 2010

Oh Kazs, I do feel for you, I only suffered briefly with RLP during my pregnancy and it was awful – I can’t imagine the pain you have to endure every day.

One other suggestion – do you have private healthcare with your job? A good osteopath will be able to treat you through the private scheme and although you may have to search pretty hard – there are also some PT’s who will be able to bill through private healthcare too (I used to when I worked at a spinal rehabilitation centre in Bristol).

If you let me know which city/towyou are in I may be able to reccomend someone for you.
kazs on June 21st, 2010

The nearest city to me is Elgin in Scotland. My job does not come with health insurance unfortunately. After an accident on my bike during pregnancy mypelvis and back was knocked out of alignment this caused me to be in and out of hospital but the hospital didn’t pick up on the PSD or my mis-aligned pelvis. When I gave birth to my baby the labour was particularly painful and not in a very good position for someone with PSD. I later learned that I should havehad a c-section, and there are cetain ways to have the baby if you have PSD. After physio hadn’t worked it came to light about my mis-aligned pelvis and i was told that the physio would never have worked in the first place.:(
Nisha on June 21st, 2010

Kazs – that is seriously negligent on the hospitals part – it is not difficult to see a misaligned pelvis and is something they should have automatically checked in your case. (there may be a case there for you – its worth speaking to someone about it) I only wish I were nearer to have a look at you and see what I could do!
kazs on June 22nd, 2010

It was 8 yrs ago would that go against me if I were to do something about it?
Nisha on July 1st, 2010

Hey Kazs – sorry for the delay – you know I have no idea – you would nee to talk to a solicitor specialising in that area, but worth a chat to see what your options are
kazs on July 3rd, 2010

Thankyou for all your help. I will have a good long think about it. I will keep in touch thankyou again