Here at Recharged PT, we know how important the pelvis is when we treat pelvic floor dysfunction. In fact, the sacroiliac joint (SIJ) is probably one of our favorite joints in the body. Made up of three bones forming a cradle shape – your tailbone (sacrum) and hip bones (os coxae) on either side –the SIJ can be a common place to experience pain during pregnancy. While a little pain is normal, some pregnant people can experience discomfort and dysfunction at the front of their pelvis along a firm joint called the pubic symphysis.

The pubic symphysis connects the front of your pelvic bones and also assists with shock absorption during high impact activities like jumping and running. Commonly referred to as symphysis pubis dysfunction (SPD), this occurs when certain hormones relax and loosen the ligaments – making the joint more mobile in preparation for birth. The average gap between the pubic symphysis when not pregnant is 4-5 mm, increasing by 2-3 mm during pregnancy. 

Normally-

Your body is able to adapt to this increase in joint laxity. However, sometimes a preexisting movement imbalance (aka issues you had before pregnancy) in the pelvis or muscles & joints around it can cause increased pain.

SPD can be triggered by the joints in your pelvis moving unevenly, muscle imbalances, or even a restriction on one side of the pelvis. SPD can develop at any time throughout pregnancy, although it's more common at later stages. People who have a history of low back pain or pelvic issues prior to pregnancy may be more at risk of developing SPD. Many also call SPD- Lightening Crotch & Pubic Symphysis.

Common symptoms of SPD include: 

• Pain in the pubic area and groin with or without a popping or clicking sensation

• Increased difficulty with walking or single leg activities such as lower body dressing and going up stairs 

• Increased pain at night or when going to the bathroom

• Pain referral down thighs or around to the back / tailbone

• Pain with abduction or adduction of the legs

• Increased pain with rotational movements like turning over in bed and getting into or out of a car

When experiencing increased pelvic pain, activity modification is important to help the pelvis obtain relative rest. This may include: 

• Avoiding abduction/adduction of the legs (e.g., when turning over in bed or getting out of a car, keep your legs together and move them as one unit; sleep with a pillow between your knees to avoid your legs crossing midline)

• Do a step-to pattern when going up or down stairs 

• When sitting or standing, keep your knees straight and avoid crossing your legs

• Change positions frequently as tolerated

• Avoid pushing or heavy lifting and when carrying something, hold it in front of you as opposed to on one hip

• When getting dressed, sit down to put on your pants and shoes

Having a plan to manage pelvic pain during birth may also be important. Women with SPD may tolerate birthing positions that encourage sitting up right, such as on a stability ball. Lying on your back with the legs abducted or in stirrups should be avoided as it will put further pressure/stress on the front of pubic bones. This can increase your chance of a Pubic Symphysis Separation.

The good news is that the pain generally resolves after birth (but doesn’t always- its generally a 60/40 split for those who will have it resolve postpartum on its own). In the meantime, seeing a pelvic floor physical therapist to help manage symptoms and improve pelvic control may be helpful. It is important to remember that though some discomfort with pregnancy is normal- but pain that limits your ability to do daily activities is not! Taking care of your body will help you mentally and emotionally as well as physically so that you can be ready for the next big stage. 

What questions do you have?? Send us a text!

<3 The Recharged Performance Therapy Team

www.rechargedperformancetherapy.com

(321) 802-1630

References

https://my.clevelandclinic.org/health/diseases/22122-symphysis-pubis-dysfunction

https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/

https://www.babycenter.ca/a546492/pelvic-pain-in-pregnancy-symphysis-pubis-dysfunction-spd

https://www.physio-pedia.com/Pubic_Symphysis_Dysfunction