How to Manage Symphysis Pubis Dysfunction “SPD”

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Pubic Stress On                               Pubic Symphysis                               Pubic Stress Off

Did you know that your pubic bones are in their most stable position when your pelvis is upright?

SPD is the common pregnancy-related complication in which the pubic symphysis, the joint that connects your two pubic bones together, is compromised by your baby’s front loaded weight within the uterus as well as your loosening soft tissues (think cartilage, muscles, and ligaments).

With SPD, the result of this “looseness” and pressure is that your pubic bones “uncouple” and get driven downward and apart by your baby’s front loaded weight.  The common symptoms associated with SPD include: pain felt across front side of your pelvis; localized pain over the pubic zone, and/or or pain projecting into the groin area (the upper / inner thighs).

In addition, SPD can produce a generalized feeling of weakness in the lower body “I feel like my legs are going to give-out underneath me” when standing or walking.

To effectively manage SPD, focus on resetting and supporting your upright pelvis, the most stable position for your pubic bones. This is your best way to get relief.

Our guest for this blog post is Marissa, she is one of our patients who is presently managing SPD, and has consented to tell her story and join the conversation, in hopes of helping other women suffering from this condition.

“My name is Marissa, I have a five year old daughter, and work full-time with a job that requires being up on my feet for extended periods of time. During my first pregnancy, I did not encounter any kind of pain and had a normal birth experience. With this pregnancy, I first started experiencing groin pain toward the end of my first trimester. It was daily and chronic, but not overwhelming at first. I called my physician who recommended that I purchase a maternity belt to help support my ligaments. I obliged and found that it did not help at all (the belt wrapped around my hips and attached in front with velcro). In the meantime, my pain was getting worse (groin and now into the pubic zone) and I would have days that I would truly waddle, even though I was barely into my second trimester. I decided I needed more help and went to physical therapy. Once Kevin identified SPD, and found that my pubic bones were shearing downward, I started by doing some light exercises to help reset my upright pelvis and did notice some short term relief following the exercises, but my symptoms would still come back and escalate over the course of my workday. At that point, Kevin suggested that I try a Maternalift support. Once I started wearing this new support, there was a noticeable reduction in my pain level by the second day- it was truly amazing. I continue to go to PT once every other week, but I am able to function during the day without much discomfort. I still have considerable pain at night when trying to sleep, but I have been able to continue with my regular work schedule and I am now in my third trimester. I wear the Maternalift daily and it is on for approximately 14-hours a day. I never leave the house without it on. My pain is now just a nuisance, instead of a true hindrance. If it weren’t for PT and the Maternalift support, I would be in much worse shape and unable to enjoy the joys of pregnancy.”

Discussion Point One:

Despite our best efforts, notice that Marissa has not achieved a perfect outcome. Why is that?

With SPD, there is a wide range of instability that can occur over the pubic symphysis, think of a bell curve for SPD.  On one end of the curve is just slight instability in which the pubic bones are relatively stable and only get strained when the body is challenged with higher stress activities. On the other end of the curve is severe instability in which basic movements or weight bearing create significant shearing of the pubic bones and high levels of pain.

If your SPD is mild, it is possible that you can get sustained relief with the daily execution of your corrective exercises done to reset your upright pelvis.

Though, for Marissa, her level of pelvic instability is towards the higher end of our SPD bell curve. Did you notice that she was only able to get partial, short term relief of her pain with the corrective exercises? This means that her symphysis is so unstable that her pubic bones quickly shear back into their downward strained position soon after completed her exercises. Even with her MaternaLIFT on, she is still getting some downward shearing stress on her pubic bones during movement. This is why she still feels irritation and instability over the pubic zone when she takes the garment off to rest at night.

The bottom line is that if your SPD, like Marissa’s, is on the higher level of our bell curve, you will likely need the added use of maternity support to help you “hold” your upright pelvis and get sustained relief. Due to its innovative design,  MaternaLIFT is usually more effective to supporting the upright pelvis and providing relief then traditional maternity belts and braces.

The question for you is:   Which side of our SPD bell curve are you on?

Discussion Point Two:

Did you notice that she had no problems in her first pregnancy, and then developed her SPD symptoms early in her second pregnancy?  What changed between her first and second pregnancies?

This is a pattern that I see quite often with women who have gone through previous child birth(s), especially previous C-section births. In general, your pelvis tends to get less stable each time you go through  successive pregnancies and births. You can mitigate this to some extent by re-strengthening your core following the birth of your child.

For Marissa, we know that there is not much stress on the pubic bones from her baby’s weight at 12 weeks pregnant. However, there are other factors which can contribute to the destabilization of the pelvis, even early in the pregnancy.

My suspicion is that a combination of factors contributed to her early onset of SPD including, deconditioning of her core from her previous pregnancy and child birth, her muscles and ligaments getting excessively loose in response to the pregnancy hormones, and her busy daily activity schedule.

To learn more about factors that can destabilize your pelvis in pregnancy as well as a more detailed discussion about the differences between MaternaLIFT support and traditional maternity support braces, check out my last blog post entitled, When Should You Consider Using Maternity Support?

To summarize, if you are suffering from SPD, the best way to manage your symptoms is to focus on resetting and supporting your upright pelvis.

Our patient’s with SPD utilize a specific HOME PROGRAM that involves specific exercises to help reset the upright pelvis and the use of a MATERNALIFT (if needed) to help support their upright pelvis as they function throughout the day.

Please consult directly with your health care practitioner to develop your care plan to help support your upright pelvic and  manage your SPD symptoms.

Marissa has agreed to participate in this conversation, Feel free to ask questions to either of us.

Kevin Hansen, M.P.T., is an obstetrics physical therapy specialist, who practices in Bellevue, Washington State.

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website.


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