Physical and physiological transformations that occur during pregnancy can give rise to various discomforts and pains in the pelvic region. If you have ever experienced intense pain in the pubic area, it could be an indication of a common pregnancy-related ailment known as Symphysis Pubis Dysfunction (SPD). In this article, we aim to provide you with an understanding of the symptoms associated with SPD, its common causes, and effective exercises to alleviate or prevent the pain. We will also discuss activities to avoid in order to prevent the condition from worsening.
Symptoms of SPD
The primary symptom of SPD is severe pain in the pubic area, located at the front of the pelvis. In some instances, the pain may extend beyond this region and radiate down to the upper thighs and perineum (the area between the anus and vagina). Similar to SI Joint Pain, another form of pelvic girdle pain experienced in the posterior (or back) of the pelvis, SPD pain typically intensifies during weight-bearing activities, particularly those involving a single leg (such as walking, running, climbing stairs, or getting in and out of a car). Pain may also be experienced when widening the legs.
SPD is primarily caused by heightened stress on the pubic symphysis joint, which connects the left and right pelvic bones at the base of the pelvis (indicated by a red circle in the image below).
What causes SPD
During pregnancy, several factors contribute to this increased stress:
- Pregnancy Alignment Shifts: The body tends to deviate from its neutral alignment during pregnancy, often resulting in a forward tilt of the pelvis known as anterior pelvic tilt, as depicted in the image below. This shift in alignment, coupled with a repositioning of the body’s center of gravity higher and farther forward, places additional weight on the pubic symphysis.
- Hormonal Changes: Pregnancy triggers hormonal changes, particularly an increase in a hormone called relaxin. Relaxin helps relax the soft tissues in the body, including those surrounding the pelvic area. While this soft tissue laxity assists in preparing the pelvis for childbirth by enhancing mobility, it also decreases the stability of the bony structures. As a result, the pubic symphysis joint becomes hypermobile, allowing for more movement than usual, which can lead to pain.
- Increased Body Weight: As pregnancy progresses, the growing weight of the baby and the expanding uterus exert greater force on the pelvis. This further amplifies the impact of the aforementioned alignment shifts and hormonal changes.
It’s worth noting that certain hormonal changes may persist into the postpartum period, and the increased mobility and decreased stability in the pelvis could endure (the duration of this period is subject to debate). Consequently, SPD can also occur during the postpartum period.
Exercises to Focus on if you have SPD during Pregnancy
- Get in neutral alignment
- Practice your Inner Core Exercises. It activates your deep core muscles, which are critical for providing stability to the SI Joint. Master your TVA Belly Breathing and Pelvic Floor Exercises.
- Bridges. Your glutes work with your core to stabilize your pelvis, so strengthening your glutes is important for mitigating joint pain. Bridges are a great way to target your glutes because they keep your pelvis in a stable position.
- Deadlift. Great exercise to strengthen your glutes and hamstrings.
- Incline Plank. A plank targets the core muscles at the front of your body, training these muscles to help you resist that excessive lower back arch we showed at the beginning. During pregnancy we must be very careful about managing intra-abdominal pressure. Full planks performed with a larger belly will create too much intra-abdominal pressure. Therefore, beginning in the second trimester, we regress these by performing them at an incline.
Exercises to Avoid if you have SPD during Pregnancy
If you are experiencing symptoms of SPD, it is advisable to avoid the following exercise movements. However, if you are not experiencing SPD pain, there is no need to avoid these movements.
- Single-leg movements. Exercises like lunges, step-ups, or any other exercises that involve single-leg patterns place uneven load on the pelvis, worsening the pain. Focus on bilateral movements, such as squats and deadlifts, where the load is distributed evenly on both sides.
- Impact exercises. High-impact activities like running, jumping, or other ballistic movements can intensify the pain due to the hypermobility of the pelvis. Listen to your body, as it will provide indications if these movements are unsuitable for you.
- Simultaneous spreading of both legs. Movements where both legs are spread apart, such as wide plies, straddle positions, or stretches that involve spreading the legs, can place excessive strain on the pubic symphysis joint. If you wish to stretch the inner thigh/groin area, do so gently on one side at a time.
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