Pretty much anyone who has experienced pregnancy will agree that the experience is absolutely magical, but wow can it push you to the limit. As your body progresses through countless changes, some aches and pains are inevitable. One type of pain that's surprisingly common is symphysis pubis dysfunction (SPD), which is also known as pubic symphysis dysfunction, pelvic girdle pain, and even (we're not kidding) "lightning crotch."
What is Symphysis Pubis Dysfunction?
SPD is a dysfunction of the pelvic joint located at the front of your pelvis, between your legs and just above the vulva. Approximately 20-30% of women experience SPD during pregnancy. On the bright side, 80% of postpartum individuals see their SPD symptoms resolve within 6 months of giving birth, and over 90% experience relief within a year.
Depending on the severity of your SPD, you may notice a nagging pain when you do specific movements, like rolling over in bed — or you could have extreme pain every time you try to walk. Whatever level of pain you experience, we don't recommend trying to"power through it." If a joint is inflamed and irritated, continuing to perform activities that increase pain will only make matters worse. Instead, book a visit with a physical therapist right away to learn strategies to reduce inflammation, modify your activities, and build strength for increased stability at the joint.
Need immediate help with managing the pain of SPD? Below are some recommended tips and exercises that can soothe the pain and keep you moving comfortably.
Why is SPD so common during pregnancy?
The pubic symphysis is a disc-like joint made of cartilage that bridges the gap between the two bones that form the front of your pelvis. When all is working properly, ligaments on each side of the pelvis hold the pubic symphysis joint in place and allow for a normal range of motion.
During pregnancy, your body produces hormones to support the growth and delivery of your baby, including the hormone relaxin. Relaxin helps ligaments throughout your body to loosen up so that your joints become more flexible. Unfortunately, for some individuals, the increased relaxin (as well as progesterone, which has similar effects) causes the muscles and ligaments stabilizing the pubic symphysis joint to become hyper-mobile and unbalanced.
These hormonal and anatomical changes, along with a growing baby adding pressure on your pelvis, make the perfect cocktail for pelvic girdle pain.
What does pubic symphysis dysfunction feel like?
The symptoms and pain caused by pubic symphysis dysfunction can vary from minor annoyances to debilitating pain and (temporary) loss of mobility. As with any medical condition, it will feel different from case to case.
Symptoms of pubic symphysis dysfunction can include:
- Pain in the front center of the pubic bone
- Lower back pain
- Perineum pain (area between the vagina and anus)
- Pain that radiates into your thighs
- Grinding feeling and/or clicking sound in the pelvis
- Difficulty or pain when trying to widen or close your thighs in abduction or adduction motions
- Intensified pain when walking, standing on one leg, carrying heavy loads, walking up or down stairs, and standing up from a seated position
- Pain that’s often temporarily relieved by rest before returning
Along with these symptoms, you may experience nerve compression leading to numbness and discomfort, sciatic pain, and other obstetric complications. If you’re concerned that your pelvic pain might be SPD, always consult a physical therapist. Even though SPD typically resolves itself after delivery, seeking an early diagnosis can help save you from potential side effects and long-term complications.
Tips for soothing the pain of SPD
Pubic symphysis dysfunction can be tricky to treat on your own. A physical therapist can recommend personalized strategies that help you prevent and ease the pain of SPD. Below are some common tips that our PTs share with their patients.
Reduce inflammation with a cold pack
Try to apply a cold pack or ice to your pubic joint for 10-20 minutes following activities that increase pain and at least once a day. Be sure to have a layer of clothing and potentially a pillowcase or dish towel around the pack, so that the cold is more tolerable.
Wear a pelvic support belt when you walk
If simply walking increases your pubic symphysis pain, consider purchasing a pelvic support belt like the Serola Belt. You can use this during pregnancy or postpartum. While no support belt is perfect, it may reduce your pain for those moments when you simply can't avoid walking.
Put it on as soon as you get out of the car to go shopping. Put it on when you're planning to meet friends for a hike. Or put it on as soon as you get out of bed in the morning.
Avoid asymmetrical postures & movements
It's important to keep moving with SPD, since movement increases the circulation of blood and lymph in the legs, which helps reduce pain and inflammation. But to avoid making the pain worse, you also want to keep both legs parallel and beneath your hips, as often as possible. That means you have to choose your workouts very carefully!
A prenatal yoga class may sound gentle and ideal for pelvic pain, but beware: Any exercise that asks you to stand on one leg or shift your weight into one leg more than the other or enter a lunge position is likely to increase your pain.
When moving and exercising, aim to avoid asymmetrical postures and modify your workout to eliminate single-leg exercises. For example, you might replace tree pose with chair pose and lateral lunges with squats.
Try swimming or stationary bicycling
While running, hiking, or even walking may no longer be exercise options for a person experiencing pubic joint pain, there are other strategies to help you stay strong and maintain your cardiovascular health and endurance. Consider workouts that don't require you to stand on one leg over and over again.
Two potential options are riding a stationary bicycle or getting in the pool. In both of these scenarios, gravity isn't tugging at your pubic joint and increasing inflammation.
When on a bicycle, avoid standing up and taking your butt out of the saddle. When in the pool, consider walking laps if this doesn't irritate your pubic joint — or try swimming for a full-body workout. Whatever cardio workout you try, pay attention to your body and stop if any activity causes pain at the pubic joint.
Simple Exercises for Symphysis Pubis Dysfunction
The exercises below will help you move, stretch, and strengthen your body while keeping your legs parallel and beneath your hips. If any exacerbate your pain, stop immediately and talk to a physical therapist about the best options for you.
How to do a bridge:
- Lie on your back with both knees bent. Your feet are flat and hip distance apart.
- Keep your core engaged as you push into your heels and lift your hips off the ground.
Tip: Imagine you are balancing a glass of water on your lower belly as you perform the movement. This will help keep your core working to stabilize your pelvis.
- Return to starting position.
Note: You can progress this exercise by holding a weight in your lap for a greater challenge. If you're currently pregnant, a growing belly will serve the same function.
How to stretch your hips:
- Sit in a chair with your feet flat on the floor.
- Lift one foot off the floor and rest it on top of your opposite knee.
- Keeping your back straight, lean your trunk forward, hinging at the hip.
- Apply gentle pressure downwards into your bent knee for a deeper stretch.
- Hold this position before sitting upright and returning your foot to the floor.
- Repeat on the other side.
Note: Stop if this causes pain. Also, do not make sudden movements when releasing this stretch — be slow and gentle to return to neutral.
How to do a belly lift:
- Start on your hands and knees with your hands under shoulders and knees under hips. Focus your gaze between your hands.
- Inhale, filling your belly with air and relaxing it towards the ground.
- Exhale as you pull your belly button IN towards your spine.
Tip: Keep your back flat and unmoving for the duration of the movement — only your belly moves.
Note: A strong core will help stabilize your pelvis. If it is difficult to get on or off the floor, try hinging at the hips and leaning your forearms onto a table or the back of a couch to perform this same exercise standing.
How to do a seated kegel:
- Sit in a chair with feet flat on the floor and hip distance apart.
- Inhale deeply, allowing air to fill the bottom of your lungs. Feel your lower abdomen, your low back, and your pelvic floor gently stretch outwards with your breath.
- As you exhale, contract your pelvic floor muscles in a kegel, feeling your pelvic floor lift up and in, and your belly button move towards your spine.
- Inhale as you relax your pelvic floor.
Note: If symptoms increase with doing kegels, stop and reach out to a pelvic floor physical therapist for a program that is tailored to fit your needs.
How to do a supported squat:
- Stand behind a chair or table with your feet slightly wider than hip distance apart. Place your hands on the backrest for support.
- Pull your belly button in towards your spine to activate your core. Keeping your core engaged, push your hips back and bend your knees as though lowering to sit in a chair.
Tip: Use the chair for balance or to help you drop into a lower squat.
- Squeeze your glutes and straighten your legs to return to standing.
Note: Avoid allowing your knees to push forward past your toes and instead push your hips backward.
Seated Adductor Ball Squeeze
How to do a ball squeeze:
- Start seated upright on a chair with your thighs parallel to the floor and ankles directly under your knees.
- Place a small exercise ball between your knees.
Tip: If you don't have an exercise ball, use a standard bed pillow that's been folded in half.
- Exhale and pull your belly toward your spine to engage your core as you squeeze the ball between your knees.
- Inhale and release.
Note: Perform this exercise slowly and with control. Stop if this causes pain.
To make sure you recover from pubis symphysis dysfunction as quickly and comfortably as possible, book a visit with a pelvic floor physical therapist or schedule a free info call to find out more. We're here to help!