Top 3 Ways to Reduce Pubic Symphysis Pain in Pregnancy
Why do we get pubic symphysis pain during pregnancy?
Symphysis pubis dysfunction (SPD) is a result of muscle imbalances around the pelvis, that then lead to increased pressure and movement going through the pubic symphysis. When pregnant, there is increased flexibility in the ligaments which allows the pelvis to prepare for birth. This flexibility causes too much movement to occur in this part of the pelvis, which can lead to pain. This is all very functional and helpful for labor, but not helpful in those last few months of pregnancy when you are just trying to live your life.
How do you get rid of pubic symphysis pain?
The quick solution is to reduce excessive movement around the pubic symphysis. You can do this by changing the way you move so that your pelvis works as one unit, rather than opening and rotating more than it needs to
Getting in and out of bed with your legs together (throwing a pillow between your legs for a bonus).
Getting in and out of the car with your legs together
Sleep with a pillow between your knees and ankles
Go up and down stairs sideways
Sit in a good supported posture when you need to sit (think about even pressure getting placed through your “sit bones”
Limit the total time you are sitting. Going for short walks or frequently changing positions can limit stiffness in your hips/pelvis.
External support to reduce pubic symphysis movement: many different SIJ joint belts are available that can gently apply pressure around your pelvis to reduce the amount of movement that happens at the pubic symphysis
Address muscle imbalances around the pelvis: this is a more complicated thing to do independently, so it is recommended working with a pelvic floor physical therapist to get assessed and determine which muscles you need to work more or less to help reduce pressure around the pubic symphysis
Try this exercise for pubic symphysis pain
This is an exercise I have had a lot of success with for my SPD patients. The goal of this exercise is to try to find the muscle group that is not working as much as it should be. When you find it, you can activate it by squeezing the ball, etc. This normalizes the pressure around the pelvis, and therefore reduces pain. If you add repetitions to this exercise it will train this muscle to engage more for you in other parts of the day.
Use an exercise ball or pillow
First try standing up from a chair to see if it is painful, and how severe the pain is
Now grab the ball and place it between your knees.
Squeeze the ball gently. No pain? Then try standing up while squeezing the ball. If this reduces your pain then this is your exercise. Does this hurt? Then stop & move to step 5.
Squeeze the ball again, shift your left knee back behind your right one. No pain? Stand up and see if this reduces your pain. If yes, then this is your exercise. Pain? Then stop & move to step 6.
Repeat the above test but put your right knee behind your left one. Pain? Then move on to step 7.
If none of that works, get rid of the ball. Engage your left hamstring by applying pressure through your heel down and slightly back (should feel the back of your thigh tense up). Keep that tension and stand up. If this reduces pain then this is your exercise. Repeat with the right leg.
If none of this works, find a pelvic floor PT who can help you with this technique
Watch this video as I take someone through this series of tests to help their SPD pain.
The good news is most pubic symphysis pain will resolve postpartum, but the more you do during pregnancy to manage pain, the better off you will be postpartum.
I know SPD pain is very activity specific, and you can just push through the pain really quickly getting out of bed, etc. But I encourage everyone to not be a hero and feel like you are tough enough to push through the pain. Changing the way you do things on a daily basis in order to reduce pain can make a big impact. The little changes you make to your movement throughout the day can reduce your inflammation and make life overall more comfortable.
If you are still struggling with pubic symphysis pain despite making these changes, it may be time to get a consult from a pregnancy pelvic floor physical therapist near you. If you live in Portsmouth, NH we would love to meet you and help you feel better.
References
Verstraete EH, Vanderstraeten G, Parewijck W. Pelvic Girdle Pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013;5(1):33-43. PMID: 24753927; PMCID: PMC3987347. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987347/
Kanakaris, N.K., Roberts, C.S. & Giannoudis, P.V. Pregnancy-related pelvic girdle pain: an update. BMC Med 9, 15 (2011). https://link.springer.com/article/10.1186/1741-7015-9-15
Vermani E, Mittal R, Weeks A. Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review. Pain Practice 2010;10(1):60–7. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=0cb4b6ee0f713ed6dac7e49848c6ad5e28a001e5
