During pregnancy women experience a variety of changes in their bodies.
Hormonal shifts help the fetus grow properly and prepare her for child birth. While this is expected and normal, there are times when hormones start functioning too early. This causes instability and pain.
Symphysis Pubis Dysfunction, also known as SPD, is a common painful condition associated with pregnancy in which the ligaments responsible for holding the pelvic bones become too relaxed and stretchy. As a result, the symphysis pubis or the pelvic joint becomes unstable, causing moderate to severe pain. Women with symphysis pubis dysfunction during pregnancy often face major functional difficulties resulting in a considerable decrease in quality of life.1 Many women report mild to severe pain in the pubic region, groin, and inner aspect of the thigh, frequently accompanied by sacroiliac, low back, and suprapubic pain (pain above the groin and in the center of the lower stomach). Generally, pain is worst during standing activities and when lifting one leg. Occasionally you may hear or feel a clicking or grinding sensation in the joint at your lower stomach. Many women have difficulty walking (a “waddling style” walk).2
The incidence of this condition has increased significantly in recent years. A study by MacLennan and MacLennan reports that 31.7% of respondents to a retrospective survey had experienced symphysis pubis pain.
Some signs of this dysfunction are:
- Severe pain that tends to get worse when you lift your legs for getting into bed or a car
- Difficulty to move the lower part of your body
- Pain that increases when you lie on your back
- Pain that worsens when you try to turn over in your bed
- Reduced motion in your hips
- Pain shooting down your buttocks and legs
- A clicking sound near the pelvic area when you walk or move your legs
- In rare cases urinary incontinence
Physical Therapy can go a long way towards minimizing these symptoms and ensuring this issue does not continue beyond childbirth. Although no studies have addressed the management of symphysis pubis pain specifically, several studies have shown some positive effects (decreased symptoms) of management of posterior pelvic pain with or without the presence of symphysis pubis pain. Interventions used in these studies for management of posterior pelvic pain included individually designed back care programs3, exercise4 and patient education for back care and protection.5
After a comprehensive evaluation, physical therapy treatment may include soft tissue mobilization/massage, strengthening and stabilization exercises to improve support of the pelvic girdle, pelvic floor strengthening exercises, postural exercises, and education on body mechanics and strategies to minimize pain with activities of daily living. If the issue persists after childbirth, physical therapy is indicated to reduce pain, promote proper alignment and return stability to this joint.
The use of pelvic support belts to manage pelvic joint pain during pregnancy if often advocated clinically. The rationale for using belts to provide an external force that stabilizes the pelvic joints has come from bio-mechanical studies primarily with cadavers, and the focus has been on the sacroiliac joints.6 However, a search of MEDLINE, the Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine (AMED), and the Cochrane Library indicated that no experimental clinical studies have investigated the effect of wearing a pelvic belt to treat symphysis pubis pain, and few studies have investigated the effect of wearing a belt on posterior pelvic pain. Nilsson-Wikmar et al7 compared the use of education and belts with different exercise programs across 3 groups; the results showed no statistically significant differences among the groups at baseline and at week 38 of pregnancy with respect to pain intensity and activities of daily living. In their conclusion, the authors stated that the belts and information about the condition (which all groups received) seemed to be important for the reduction of pain intensity and the ability to accomplish activities of daily living.
Some ways to manage at home are:
Lift both legs together during activities like getting in a car and rolling in bed. Squeeze the knees together instead of separating them as this helps to stabilize the pelvic joint.
Use a pillow to support the lower back region when sitting.
Using a cushion for support while riding in the car
Avoid sitting straight in an unsupportive chair for a long time
Do not wear heels higher than 3 to 4 cm for reducing the strain on your lower back
Never sit with your legs crossed
Avoid any exercise that involves standing on 1 foot, bouncing or jarring
Avoid riding on a bike
Pregnancy is the ultimate strain on the body. Physical Therapy lessens this strain and can make the experience a positive one.
References
- Physical Therapy, Volume 85, Issue 12, 1 December 2005, Pages 1290–1300,https://doi.org/10.1093/ptj/85.12.1290
- Sheppard S. Symphysis pubis dysfunction: launch of clinical guidelines. Journal of the Association of Chartered Physiotherapists in Women’s Health. 1997:81:29-33.
- Ostgaard H, Zetherstrom G, Roos-Hansson E, et al. Reduction of back and posterior pelvic pain in pregnancy. Spine .1994 ;19:894–900.
- Dumas G, Reid J, Wolfe L, et al.. Exercise, posture, and back pain during pregnancy, part 2: exercise and back pain. Clin Biomech.1995;10:104–109.
- Mantle M, Holmes J, Currey H. Backache in pregnancy, II: prophylactic influence of back care classes. Rheumatol Rehabil.1981;20:227–232.
- Snijders C, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs, part 1: biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech .1993 ;8:285–294.
- Nilsson-Wikmar L, Holm K, Oijerstedt R, et al.. Effects of different treatments on pain and on functional activities in pregnant women with pelvic pain. Paper presented at: Third Interdisciplinary World Congress on Low Back and Pelvic Pain; November 19–21,1998; Vienna, Austria.
