Symphysis Pubis Dysfunction (SPD)

Symphysis Pubis Dysfunction (SPD) happens when the ligaments that keep your pubic bone and pelvis stable become overstretched and no longer stabilize your pelvis. Essentially, a structure that is designed to move very little begins to move a lot, and it can be very painful and difficult to move with ease. SPD is a condition that sometimes arises during pregnancy, though it can also first occur during labor and birth or in the postpartum period. Pelvic girdle pain in general is quite common during pregnancy—between 48% and 71% of women report feeling significant pelvic discomfort. About 30% of women report that the area of the pubic symphysis is painful. While SPD does involve the pelvis and the integrity of the pelvic floor muscles, a general pelvic floor dysfunction treatment like kegels is often not the answer to symphysis pubis dysfunction.

Where is the Symphysis Pubis Located?

The pubic symphysis is a cartilage joint that resides in between the pubic bones: above the genitals and in front of the bladder. In most cases, the joint can rotate and move a few millimeters without causing any issues. 

What are the Symptoms of Symphysis Pubis?

The symptoms of SPD can vary for different people, both in terms of severity and presentation. The most commonly experienced symptoms are:

The symptoms will vary from person to person – both in severity and in presentation. However, if you’re concerned that you have pubic symphysis dysfunction, these symptoms may be present:

• Pain in the pelvis in general, and specifically in the groin and inner thighs; pain moving around into the buttocks
• Clicking sounds in the pelvis
• Pain while sleeping
• Activities like getting out of bed, in and out of cars, stepping up and down from steep stairs, really, any position that widens the legs can be very painful

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Are you looking for more tips for your pelvic floor/core symptoms?

Visit the RYC Learning center

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What Causes Symphysis Pubis Dysfunction

Symphysis pubis dysfunction is most often pregnancy related. However, the factors that predispose people to SPD are quite varied. The medical literature on symphysis pubis pain seems to agree that the hormone relaxin is not entirely to blame. Factors as different as hypermobility, bearing twins or other multiples, and a history of back pain can play a role in pubic symphysis pain during pregnancy. SPD usually resolves for most pregnant people after delivery, with most returning to normal function by 6-12 months postpartum. Rarely, some people find that SPD becomes a longer-term problem. Most people are able to have a vaginal birth even with symphysis pubis dysfunction—finding pain-free ranges of hip movement prior to labor can be helpful if such a delivery is in your birth plan.

What Causes Symphysis Pubis Pain?

Symphysis pubis dysfunction (SPD) and pelvic girdle pain occurs when the ligaments and joints that help support and align your pelvic bone become overly stretched or relaxed. This often leaves the pelvic joint unstable and can lead to various painful sensations, including pelvic pain. During pregnancy, it is common for these joints and ligaments to become stretched, especially as you are nearing the time for delivery. When the pubis symphysis becomes too loose too early in your pregnancy, you may begin to notice more pain in your pubic region.

Although the most common cause of symphysis pubis dysfunction is pregnancy, SPD is not entirely pregnancy related. In some cases, the cause of SPD is unknown.

It may be common to experience pain during pregnancy or postpartum in these areas:

• hips
• stomach
• pelvic floor
• pelvis

What Does Pubic Symphysis Pain Feel Like?

Discomfort and pelvic pain are usually the most common symptoms of symphysis pubis dysfunction. The pain is generally located in the front of the pelvis, above the genitals and pubic bone. In some cases, people report feeling a clicking or popping sensation as they walk or shift their weight. It is common for many men and women to experience the pain in their lower back, lower abdomen, hips, groin, and legs. The severity of their pelvic pain may range from a mild discomfort to pulsating, chronic pain that may interfere with their daily activities and sleep patterns.

In some cases, those who are experiencing this pain may have difficulty climbing stairs, painful hips, legs, and back during pregnancy, while lifting, and may have difficulty walking with a steady gait. It may also be painful to stand for prolonged periods of time.

Will Symphysis Pubis Dysfunction Go Away?

What Not to Do with Symphysis Pubis Pain

Stretching may feel good, but it ultimately will create more instability. Limit activities like:

• Sitting cross legged
• Prolonged sitting (e.g., in a car)
• Standing with more weight on one leg (with hip hiked up) to hold groceries, kids, etc.
• Hips waddling while walking
• Intense stretching of the hips (e.g., wide-legged and asymmetrical moves like wide-legged forward bends and pigeon pose)

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What to Do with Symphysis Pubis Dysfunction

Once you’ve checked in with your care provider, you can take some simple steps to manage SPD pain. Your goal when moving to relieve pain due to pubic symphysis dysfunction is to create more stability in the pelvis.

• Sleep with a pillow between the legs.
• Sit on the sitting bones rather than the tailbone.
• Learn good movement habits and alignment for pregnancy (and the rest of your life!)
• Lie on your side rather than your back to sleep—take some of the load off of your pelvis.
• Keep your knees together when doing things that aggravate SPD—for example, getting in and out of the car, swivel your legs to one side and then stand up.
• Build up strong hips and glutes. The video below has my favorite go-to SPD exercises.
• Some people find a support belt to be a helpful tool while building up stability in the pelvis.

Treatment

Physiotherapy is one of the most beneficial treatments for SPD. Physiotherapy can help with:

• Pelvic pain
• Improving muscle function and mobility
• Pelvic joint stability and alignment
• Help give helpful tips for proper weight bearing and muscle movement

A physical therapist or physiotherapist may provide manual manipulation and therapy to access whether your muscles and joint move correctly. If they find any issues, they can be helpful in recommending various therapies and exercises that will increase range of motion and strengthen the muscles in your pelvis, back, abdomen, and hips. The kinds of exercises that will help with SPD pain are movements that help build strength and stability in the glutes and core.

Below is a short exercise you can do to help relieve sacroiliac joint pain:

1. Come down to hands & knees, inhale, and exhale or hiss to blow out candles to engage your core. Repeat 5 times

2. Add pelvic movement: exhale, tuck your pelvis under. Stay stable in your upper back & try to isolate the pelvis by tucking deeply under. Then inhale and untuck gently to release the tuck. Relax your pelvic floor as you inhale. Repeat 8 times

3. Come to stand in a mini-squat: put a fist or squishy ball between your legs. Exhale as you squeeze the ball strongly, then release on the inhale. Repeat 8 times

4. Candles on your back: Lie on your back with feet flat and do candles breathing. Make sure your pelvis isn’t tucked; aim for neutral (if needed, bolster your head a little bit). Repeat 8 times

5. Breath + pelvic rocking: Add pelvic tucking as you exhale (feel your pelvic floor drawing in), then inhale to release. Repeat 8 times

6. Bridge: On an exhale, push straight down through your feet to lift your pelvis (it will naturally tuck slightly), and gently lower down. Repeat 8 times.

With mindful movement and a more stable pelvis, SPD can be much less painful.