Symphysis Pubis Dysfunction / Pelvic Girdle Pain

Research has shown that these symptoms can occur in 1:36 pregnancies (Owens at al 2002) and therefore it can affect a large number of women.

These symptoms are frequently passed off as the ‘normal achey pains of pregnancy’ which is unfair to these women and it can be embarrassing for them, as they try and put up with the pain. Symptoms do not always resolve after giving birth either.

What is SPD / PGP?

Part of the difficulty in diagnosing it is that SPD is a group of symptoms as opposed to a specific diagnosis. Symptoms usually include pain which can vary from a dull heavy ache to a sharp shooting pain, and occasionally are associated with clicking or grinding. Pain is usually felt in the groin, inside thigh, perineum or over the coccyx, sacro-iliac joint, or the sympyhsis pubis joint over the front of the pelvis.

When does it occur?

These symptoms rarely occur in the first trimester, but more commonly in the second and third trimesters, and can carry on long after the baby is born, but frequently mothers do not seek help after delivery as they normally have a few other things occupying their time!

Why do symptoms occur?

This is very debatable!

During pregnancy there is an increase in your hormone levels of oestrogen and relaxin. These hormones are needed to provide laxity for the ligaments during labour. It was thought that due to this laxity the symphysis pubis joint at the front of the pelvis, had more movement which would lead to more pain. This theory has been disputed recently as most symptoms occur in the latter stages of pregnancy, however the peak in relaxin levels occurs at 12 weeks, followed by a drop and then levels stabilise at about 24 weeks (Hansen, 1996). Some studies have shown that it is perhaps more to do with the joints on one side of the pelvis being stiffer compared to the other side and therefore not to do with laxity at all (Damen, 2001) however other studies suggest that one side of the pelvic girdle is more lax than the other (Buyruk, 1999).

So, it would appear that it is likely to be due to a mechanical problem with pelvic asymmetry. As a woman in pain, you probably don’t care which the cause of the pain is, as long as it can be treated! Well, the good news is that it can be fully assessed and treated by Chartered Physiotherapists.

Treatment Tips:

Below are some tips that you can try out and see if they help the pain:

1. Sit down whilst dressing when putting on socks, pants or shoes and try not to lift one leg up too high. This helps reduce the shearing force of the symphysis pubis joint at the front of the pelvis reducing pain.
2. Trial walking up one stair at a time so that each foot goes on every step rather than every other step, again reducing the amount of movement at the pubic joint. It will take longer to get anywhere, but at least you’ll get there!
3. Try wearing tighter underwear which will offer increased support around the pelvic girdle; alternatively you can try a pelvic support belt.
4. Many pregnant women enjoy swimming and this can be continued within limits of pain. You may however want to avoid breaststroke completely and avoid moving your hips too much when kicking.
5. As with any pregnancy related back pain, try and avoid heavy lifting and pushing for example, break up your weekly shop into several smaller shops so that you do not have to push a heavy supermarket trolley.
6. Do not overdo it and work through the pain. Pain is a sign that the body is not happy and therefore take regular breaks / naps.
7. When getting in and out of the car or bath, or when turning over in bed try to avoid separating the legs as this puts more shearing pain through the pubic bones.
8. Trial an ice pack over the front of the pubic bone to reduce any inflammation and pain. Alternatively try using a hot water bottle or heat pack.

For further information discuss it with your doctor, midwife or physiotherapist. Feel free to drop us a line at enquiries@prophysiotherapy.co.uk or telephone us on 020 8879 1555.