Symphysis Pubis Dysfunction in Pregnancy

Simone Ross is an osteopath who specializes in musculoskeletal pain in pregnancy. She believes that pain in pregnancy is common but not normal and can generally be treated effectively with osteopathic treatment. She has over 15 years experience and is runs two busy clinics in Central London. She also has 4 children of her own.

 

What is Symphysis Pubis Dysfunction (SPD)?

SPD, also known as pelvic girdle pain (PGP), is defined as mild to severe pain over the pubic symphysis, which can extend down into the groin and medial thighs. Some studies report that up to 50% of pregnant women have some type of PGP prior to 20 weeks gestation.

The pain may be related to an underlying problem that has not previously caused pain, or may start after an injury, often minor, during pregnancy or birth. There may be factors which can make it more troublesome including weak ‘core stability’ and pelvic floor muscles, previous injuries, spinal problems, muscle tensions or other structural imbalances. Such underlying conditions combined with the increasing weight of the growing baby and softening ligaments affect the normal transference of weight and movement through the pelvis and hips.

What are the symptoms?

The foremost symptom of SPD is pain or discomfort in the pelvic region, usually concentrated around the pubic symphysis at the front. Pain can also extend to the sacro-iliac joints at the base of the spine, the groin, thighs, hips, lower abdomen and back.

The amount of pain women with SPD experience can vary. Some women only feel occasional mild discomfort whist in more extreme cases, pain can be severe and disabling. Symptoms can appear anytime from the end of the first trimester and may even occur after birth. Symptoms most commonly appear around mid-pregnancy.

Symptoms are aggravated by anything that puts a shearing or pulling movement through any of the joints of pelvis, particularly the pubic symphysis, in particular…

•Standing on one leg for too long a period – get changed sitting.
•Movements which take your knees apart – sitting crossed legged, swimming breast stroke, getting in and out of the car, rolling over in bed, sex.
•Walking, especially vigorous walking with long strides.

 

How does osteopathic treatment help?

If a patient is seen early enough within 16-22 weeks, we can normally get symptomatic relief after 4-5 treatments.

Using osteopathic techniques, we can…

•correct the imbalances that exist in the pelvis and lumbar spine (normally pre-existing dysfunctions and asymmetries)
•Release any tension in the muscles and joints
•Give advice about posture and exercise
•Give advice on pelvic supports

 

What can someone suffering with PSD or lower back pain in pregnancy do to help?

PELVIC AND BACK PAIN IS NOT NORMAL DURING PREGNANCY. Ask for help as soon as you discover pain and consult with a good manual therapist (osteopath).

•If something hurts, avoid doing it!
•Sleep with a cushion between your legs.
•Keep your knees together when rolling over in bed.
•Keep your knees together when getting in and out of the car – use a plastic bag on the seat to help you swivel (remove before driving!)
•Rest as often as you can
•Avoid sitting on hard chairs – Take a cushion with you if necessary.
•Use a birth ball to sit on.
•Try reducing the number of times you go up and down stairs.
•Measure your pain free gap between your knees and give it to your midwife.
•Use a side lying position during sex with your knee supported.

 

Should I avoid any exercises?

•Squats
•Lunges
•Sit ups
•Running
•Swimming breaststroke

 

What exercises are recommended?

• Core stability exercises for pelvic floor

• Strengthening of the deep abdominal muscles (they are the only muscles that can attach directly onto the pubic symphysis). This needs professional advice and if you are working with a trainer they should speak to your osteopath.

 

Post-Natal Recovery

If you had pubic pain during pregnancy, it is advisable to see an osteopath or manual therapist as soon as you can after birth to ensure that your pelvic joints are aligned to speed up your recovery and to receive specific advice about starting exercise ASAP!

Many women find that the pain and discomfort felt during pregnancy soon go after the birth. However, it is important that the first few days and weeks are spent resting as much as possible; still no weight bearing or long strident walks.

After this, you may start doing appropriate gentle exercises to strengthen your core abdominal and pelvic floor muscles.