There are a lot of physical changes that occur during pregnancy. Some may lead to pelvic discomfort and pain, making exercise or even the smallest movement hurt. One of the most common causes of pain during pregnancy and the postpartum period is a condition called symphysis pubis dysfunction (SPD). The pubic symphysis is one of several joints that may cause pain as a result of pelvic girdle relaxation during pregnancy. Let’s explore this a bit more.
What is the pubic symphysis?
The pubic symphysis joint is located at the front of the pelvis where the right and left side of the pelvic bones meet. The joint has typically 2 mm of movement, but pregnancy hormonal and musculoskeletal changes can affect the stability of the joint. This results in pelvic ligament relaxation and increased joint mobility. A hormone called relaxin is released during pregnancy. It causes the joint to become more flexible anteriorly and laterally, allowing it to widen up to 9 mm. This widening provides room for the baby to pass during birthing. This shift in joint flexibility, along with changes in the load put on the pelvis during pregnancy, can result in joint instability and SPD.
Symptoms of SPD can range from mild to severe. Plus, the degree of separation isn’t always correlated with the level of pain or disability experienced. SPD can occur during or after pregnancy. For many women, stress on the joint during vaginal delivery causes the joint to become painful.
The condition can present as tenderness and pain with movement, especially when the movement causes shear forces at the front of the pelvis. The pain can be localized in the front of the pelvis. However, it may also radiate down the inside of the thigh to the lower back. There can also be a clicking or popping noise with movement.
It’s estimated that up to one in five women experience some form of pelvic pain during and after pregnancy, including SPD. For most women, these conditions resolve during the postpartum period, but some cases require treatment.
Common Movements That Trigger SPD Pain
- Going up or down stairs
- Moving legs in different directions (scissor kicks) or dropping one leg down or up while the other is stationary
- Moving from a supine to an upright position
- Turning in bed and getting out of bed
If you are experiencing SPD to the degree that it impedes your daily routine and pain limits your movement, ask for a referral to a physical therapist that specializes in women’s health. The earlier you get a diagnosis and start treatment, the better your chances are for reducing pain and the development of further damage. Colleen McAllister, MS, DPT, RAC says that a physical therapist can provide techniques that can ease pain and improve joint position and function. She says that the following are some of the treatments that may be used.
- Manual therapy
- Icing to reduce inflammation
- Use of crutches
- Pelvic support devices
- Stabilization and strengthening exercises that focus on the pelvic floor, glutes, and hip rotator muscles.
McAllister says that strengthening the glutes, hip rotator, and low back muscles will help stabilize the joint. But the forceful contraction of the adductors, or abduction, that causes a stretch on the abductors may aggravate the condition. She finds that strengthening the adductor muscles during pregnancy with an unstable pubic symphysis can increase the joint pain and should be avoided.
Tips for Reducing SPD Pain
- Don’t overdo it. Rest often, especially if you feel the pain coming on.
- Single leg activities increase the stress on the pubic symphysis and worsen the pain. Dress from a sitting position instead of standing on one leg to pull on pants.
- When getting out of your car, turn your body as far to the door side as possible, so that both legs are at the same level as you drop down and out.
- Prop one or two pillows between your legs when sleeping to keep your hips level.
- When getting out of bed, roll towards the edge of the bed, bring your knees up towards your body, and roll up letting both legs drop down together.
- If going up and down stairs brings on pain, try slowing down and taking one step, then bring the other leg up to that step before taking the next step, or go up sideways.
- Avoid twisting at the waist, instead turn and face the direction that you need to be looking.
- Don’t cross your legs. Keep them at the same level by using foot support or sitting with feet flat on the ground.
- Avoid standing on one leg, and don’t stand for long durations.
- If walking hurts, try shortening your steps and wearing a pelvic support belt. If pain continues with walking exercise, try swimming instead.
- Post-delivery, don’t hip carry your baby.
- Get someone else to do household chores, such as vacuuming or heavy lifting.
Always talk to your doctor.
If you’ve developed SPD during your pregnancy, talk with your health care provider. Discuss techniques that can be used to ease stress on the joint during labor and delivery. Determine what your pain-free range of movement is by measuring the distance you can separate your legs without pain, and make sure that your delivery care staff is aware that you have SPD and know what positions and degree of movement cause pain. For some women with SPD, a side-lying position may be more comfortable during labor, and water birth is a good option for reducing joint stress during the birthing process.
McAllister stresses that when dealing with SPD postpartum, the focus should be on increasing strength, flexibility, and balance, along with restoring your ability to stand on one leg, as all are impaired after having SPD during pregnancy. She states that in her experience as a physical therapist (and as someone who experienced SPD with her pregnancies) the muscles that help stabilize the pubic symphysis joint may not regain strength without doing specific exercises. McAllister adds that as your SPD condition improves, gradually increase your activity and pace and slow down if the pain starts to return.
Catherine Cram is an exercise physiologist and a leading expert in the field of maternal fitness. Her consulting company, “Prenatal and Postpartum Fitness” specializes in providing the most current maternal exercise information and continuing education courses to health and fitness professionals.