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  • Writer's pictureNadine Mulder

Symphysis Pubis Dysfunction (SPD)

Updated: Oct 11, 2022


This particular issue is one of my favourites to work with. It can be debilitating to say the least but if caught early enough, can be stopped in it’s tracks.


SPD is characterised by pain at the pubic joint, in the centre - right above your groin. Some people may have more pain on one side or the other but the majority present with central pain. (See video of pubis.)


This joint is very narrow and made of cartilage. It is designed to be flexible enough to allow for movement of your pelvic bones. But if that movement becomes excessive or there is too much pressure on it from structures above, it can be a source of excruciating pain. And in worst cases, can tear completely leading to complete bed rest for the rest of pregnancy.



What are the SYMPTOMS of SPD?

Symptoms of SPD include:


  • Tearing, pulling or aching sensation at the pubic joint;

  • Inability to weight bear or walk without pain;

  • Inability to stand on one leg without pain – such as trying to put pants on;

  • Pain with climbing stairs;

  • Pain when rolling over in bed; and

  • You can sometimes feel a click within the joint.


These symptoms can start off very manageable, and you may feel like they will go away with rest. Unfortunately though, if the factors that are causing this pain are not addressed, typically the bigger you grow, the worse these symptoms will become.



What causes SPD?


Due to the ligament laxity related to pregnancy, any existing muscle imbalances you have will become more pronounced and symptomatic. SPD is usually caused by poor alignment of the pelvis due to asymmetrical weakness in the muscles that support the pelvis. This causes excessive torsional forces through the pubic joint and results in pain that is worse on one side of the groin. Another common cause is poor abdominal strength that allows the pelvis to tilt too far forward during pregnancy which causes excessive pressure down the front of your pelvis. This typically results is pain that is central in the pubic joint/groin or pain that is equal on both sides. Occasionally it can be caused by a traumatic event like a fall or a trip that results in an acute injury of the pubic symphysis.


What can you do if you have SPD?


Women get a lot relief from treatment with SPD. This includes gentle muscle releases and stretches, pelvic mobilisations and alignment – no cracking or manipulation required.


However, stopping it from getting worse requires a small amount of rehabilitation to fix those muscle imbalances that caused it in the first place. Your Chiropractor or physiotherapist should be able to advise you on the best exercise and movement for your pelvis if they are trained in the management of pregnancy.


Avoiding activities that will make it worse is also important in the management of this issue.


You must try to avoid:


  • Standing on one leg. Sit down to put pants/shoes/sock/undies on;

  • Avoid lunges or exercises that involve one leg standing or excessive torsion at this joint;

  • Getting in and out of the car with one leg first. Put your bottom in first the bring your legs in together;

  • Moving/sliding objects on the floor with one foot – especially relevant for mothers with young children and their toys;

  • Carrying a toddler on one hip;

  • Excess twisting of the pelvis during activities like vacuuming; and

  • Turning over in bed. Try squeezing a pillow between your knees as you go or sit up first.




POSTURE and SPD


Posture is also a big factor when it comes to preventing or minimising SPD. Standing with your knees locked back and your hands resting on the back of your hips pushes your pelvis to tilt forward so the weight of your belly is resting largely on that small, cartilaginous pubis joint instead of the large supporting bones of your sacrum and pelvis.


Always keep your knees loose and your tailbone tucked under. If you are standing for extended periods, it’s a good idea to engage your abdominal muscles to “hug” your baby closer to your spine as often as possible. This will allow you to keep your shoulders back and down and create space for your rib cage to expand and your diaphragm to descend sufficiently when breathing.



Note: Just because you had SPD in one pregnancy does not mean that with the proper treatment and rehabilitation that you will get it in subsequent pregnancies. So be sure to seek treatment as soon as possible!


Image Credit: Thanks to @duvetdays for image 1, @tinamariaelena for image 2 and 4, @danielmaidman for image 5 and pinterest for image 6.

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