Demystifying the Mysterious Symphysis Pubis Dysfunction:
During pregnancy, up to 71% women will experience pelvic pain. More specifically, symphysis pubis dysfunction (SPD), has been reported in 32% of all pregnant women. It is commonly misdiagnosed and mismanaged – most women who present to my office have told me that their health care provider has told them that it is a pregnancy pain that will just go away after birth. Although it is the case that delivery of your baby will end the sharp discomfort, you do not have to “live with it” while pregnant and, in 25% of cases, this pain is still present 4 months postpartum.
What is SPD?
SPD most often occurs due to the separation of the pubic symphysis – a joint in the very front part of the pelvic girdle. At this joint, two bones on either side of your pelvis come together and are connected by a piece of cartilage. During pregnancy, the hormone relaxin softens our cartilage so that we can increase the flexibility of our pelvis to expand and deliver our babies. This piece of cartilage at the pubic symphysis is no exception and, due to the hormonal changes that accompany pregnancy, the risk for separation of this joint is increased.
How do I know if I have SPD?
There are many symptoms associated with SPD and every woman’s experience is different. The following are some of the more common symptoms – you may have one or all of them.
- Shooting pain in the front of the pelvis, in the area of the pubic symphysis.
- Tenderness to touch at the pubic symphysis – it may also feel hot to the touch. Many women with SPD tell me that they experience an increase in pain when their midwife/OB is pressing on the bone while measuring the fundal height of the uterus.
- Pain can be significant and can feel like it’s ‘on the inside.’
- Radiating pain into the abdomen, lower back, groin, thigh and/or leg.
- Marked increase in pain with movements like walking, climbing stairs, lifting your legs (say, to put on your socks), standing on one leg and when opening your legs to get out of the car.
- Clicking, grinding or popping noises heard or felt in the area of the pubic symphysis.
- Some women experience a state of ‘freezing,’ particularly when they move from one stagnant position to another (like getting up out of bed in the morning or standing up from their chair after being seated for a meal). I often hear descriptors like “it takes time for my body to move” or “my pelvis needs to pop into place before I can move.”
- Some women have round ligament pain associated with their SPD, and many therapists believe that round ligament pain can be a sign of SPD to come.
Chiropractic treatment of SPD:
As each affected woman will experience SPD differently, the approach to treatment must be unique as well. At Vita B+B KIDS, our care may include some, or all, of the following:
- Webster’s technique – a chiropractic assessment and treatment protocol specific to the pregnant woman.
- Adjustments to the joints of the spine or limbs (either by hand or by special adjusting tools).
- Muscular and/or ligament release.
- Release of the diaphragm and training on proper breathing techniques.
- Kinesiotaping of the abdomen to relieve pressure/weight on the pubic symphysis.
- Pelvic blocking techniques.
- Fitting for a pelvic support belt.
- Referral to associated practitioners (acupuncturist, pelvic health physiotherapist, etc.).
- Home exercises and advice, including a postpartum exercise program to retrain muscular support and strength after recovering from your delivery.
My best tips for SPD home care – what you can do right now at home to manage your pain:
- Narrow your gait and walk with your legs closer together.
- Walk up and down stairs one step at a time.
- When sleeping, use a pillow between the legs and under your belly for support (see my previous post on the Healthy Moms blog regarding pregnancy postures).
- Avoid crossing your legs when you sit, or bringing one leg up under your bum – sit with both feel flat on the floor and an even weight across your sit bones.
- Stand “square” with even weight on each foot.
- Avoid lifting, twisting, prolonged standing, and strenuous activity
- Keep your legs “glued together” when turning in bed. Silk or satin sheets can help with movements into and out of bed as they provide more slip.
- Place a plastic shopping bag on your car seat – this will help you slide and turn your body so you can get out of the car with two feet on the ground and without opening your legs too wide.
- Avoid straddle and squatting movements.
- Move slowly – especially in this winter weather. Slipping will cause your gait to widen and can make the pain and condition worse.
- An ice pack over the pubic bone can be helpful to reduce inflammation at the pubic symphysis.
- LISTEN TO YOUR BODY! It whispers first, then it screams. If it hurts, don’t do it!
The best thing you can do when you start to feel this discomfort is to seek out a chiropractor who specializes in prenatal care and the Webster technique. We will work with you to balance your pelvis, align the pubic bones, improve muscular activation, strength and support, alleviate your symptoms, and help you enjoy your pregnancy.
Shaila Callaghan is a prenatal and pediatric chiropractor and the owner of Vita Brain + Body KIDS, where Healthy Moms cardholders can receive an initial exam for $49 ($135 value) and 10% off ongoing appointments. Find out more here: https://gohealthymoms.com/vita-brain-body-kids