How to Heal Symphysis Pubis Dysfunction During Pregnancy
Symphysis pubis dysfunction (SPD) can make any movement painful during pregnancy.
The most common movements that are painful are rolling in bed, walking, sit to stand, walking up or down stairs, lifting a leg to get dressed, and getting in/out of a car.
There are several possible causes beyond the natural softening of the pubic joint during pregnancy including:
musculature imbalances causing pulling on the pelvis
core & pelvis support muscle weakness
poor posture &
muscular trigger points
To heal SPD or at least to manage the pain during pregnancy you need to approach it from several areas to address all possible causes.
Self-Exam
First, do a screen of your muscles around the pubic bone, by palpating or feeling the muscles. Feel for any tension or pain that stays or refers to the pubic bone. Do this down into the legs and up in to the abdomen, using just enough firmness that doesn’t provoke lasting pain.
Second, check your posture. Is your ribs and pelvis stacked over each other like nesting bowls? Or is one (or both) of them tipped? You can move your pelvis by tipping it forward and backward like a bowl of water pouring out the front body and the back body to see if you tend toward one position. You can do the same with your ribs, lifting up and tucking up, like a bell ringing.
Third, check your core control. Do this two different ways. The first is to see if you bulge or dome your belly and the second is to see if your core is able to control your pelvis during limb movement or loaded. [explain how to do both]
To see if you dome or bulge your belly when it contracts, pay attention when you get up from a leaning back in a chair or on the couch. This is a sign of your abs not being able provide enough tensile strength along the linea alba and can contribute to pulling on the pubic bone and lack of structural support.
Since SPD is most provoked with leg or whole trunk movement, try a simple leg move, like sliding it along the floor while lying on your back, to see if your pelvis moves with your leg or the opposite side lifts. If you are unable to keep a stable pelvis with simple movement, it is less likely you can with more complex movement.
Heal What You Find
After your quick exam, you can start to heal your findings.
As I said before, it is a multifaceted approach to healing, not just stretching or strengthening, etc. It’s a combination of strategies to bring balance.
Body work is a great way to ease tension and reduce trigger points. A common area to find issues are the muscles lining the inner thighs, because they are working really hard to provide stability. To ease some of the tension or pain points sit in a comfortable and supported position, stroking along the tense muscle toward your pelvis with your hands or a small firm (but not hard) ball.
Your belly is another area that you may find pain points in the muscles. As your abdomen expands the muscles stretch and with will add more fibers to adjust to the change in length. Unfortunately, this does not always mean the muscles will remain functional without purposeful training to teach the new fibers their supporting role. Body work for pain points in the abs during pregnancy requires special training, and I suggest you seek out care with a Physical Therapist who works with pregnant women.
The tense muscles, once massaged need to relearn where they are most efficient. Posture training focuses on bringing your joints into optimal positioning to balance the forces going through them, especially your pelvis and spine. By stacking your head, ribs and pelvis you are also lining up your three diaphragms (vocal chords, respiratory diaphragm and pelvic floor) to help them be more in sync, thus contracting and relaxing with more ease.
Even though you want your body to be able to move through many postures throughout the day with ease, you may find for longer periods a posture that is neutral is more comfortable. This is not necessary 24/7 as long as the posture you are in or come out of does not cause pain or other dysfunction.
The most neutral posture to take is what is anatomically aligned. Thus, head over shoulders, over ribs, or pelvis, or hips and feet. Now that is a very simplistic way of looking at it and may still leave you uncomfortable. Since your body follows where your head goes, start there. Bring your head over your shoulders, by thinking about growing taller and lengthening your spine, without arching your back. Soften through your shoulders allowing them to roll open and your shoulder blades to drop into your armpits. You may feel your ribs draw back and soften in the front. Then you want to settle into a neutral position with your pelvis, which isn’t tucked under or arched. If you are sitting, you’ll be on top of your sit bones. If you are standing your pubic bone and “hip bones” (those two bones on the front of your pelvis” should be lined up with each other. Then if you are standing, equal out your weight from right to left with a little extra weight in your heels.
Being mindful of your posture and movement through out the day is important. Not only for force management, but so your body can train into how to move safely and without pain through non-ideal postures and patterns. This can be done by first knowing how to move safely through an ideal posture then applying that to other positions. During pregnancy, especially with any type of pelvic girdle pain like SPD, you need to be mindful of how you are using your core muscles to provide support to your pelvis.
If your deep core muscles, which include your pelvic floor, transverse abdominals, respiratory diaphragm and multifidus muscles, are off line or not contracting or relaxing when needed, it can cause dysfunction. So practicing bringing these muscles on board during functional tasks helps reestablish their on demand role in support. One simple way to do this is by exhaling when you are performing the task. You may need to slow down, make smaller movements and exhale all at the same time to help you body complete the task without pain.
When you exhale what is suppose to happen is your pelvic floor and abdomianls (transerve abdominus) shorten in a natural contraction, automatically increasing support of your pelvis. Now with pregnancy both of these muscles are stretched and not in ideal length-tension relationship, thus having to work harder to get them to provide support. Which is why you have to be more intentional and mindful of using them when your body is being loaded in task. So you may need to contract the pelvic floor and deep abdominals when you exhale in ideal posture to get any form of relief. This includes while sneezing, coughing, laughing, lifting, pushing, pulling, swinging, reaching, etc.
In addition to mindful movements doing isolated core corrective exercises can help you improve your on demand core contraction. Performing pelvic-core contractions with varied arm, leg and whole body exercises improves how your core functions. It also tells the other supporting muscles (like the inner thigh muscles) they don’t need to work as hard which eases the tension and subsequent pulling on the pubic bone. Improving your core function also helps you maintain ideal posture for longer, thus putting less strain on your joints.
Typically for SPD, symmetrical exercises are more likely to help, or using muscles in a more balanced way. This is not a hard and fast rule, but an observation that continually adds to this theory. However, as I mentioned about posture, you also want to progressively train into movements that are outside “perfect.” Meaning if a mini lunge doesn’t cause an pain, but a deep lunge does, improve your strength through the non-painful range. If you avoid moves out of fear you may cause more harm in the long run, because your muscles won’t know how to handle the new situation when presented.
A good example of this is rotating or spine twists. Avoiding all twists during pregnancy is really hard to do, but is advised to do during exercise. When in reality, working through safe twists or oblique work during your core corrective exercise can actually improve your SPD. So you need to test some limits to see what your body is capable of doing, without over doing it. If you have never exercised before, don’t start up something completely new without guidance.
Again, core corrective exercise is about using your pelvic floor, transverse abdominus, respiratory diaphragm and multifus to create a supportive brace around your pelvis so you can move your extremities. If you bulge your abs or pelvic floor, if you hold your breath, if you slouch, or if your muscles are incapable of holding your pelvis in a fixed position they will not help you with SPD. So practicing through ranges of movement that your core is able to fix your pelvis, and not bulge or dome, while breathing and in ideal alignment will improve your SPD. Then gradually working up to bigger ranges and outside ideal alignment, without going to extremes.
To watch a SPD safe exercise sequence head over to my youtube channel!
In addition to these four main strategies to heal SPD during pregnancy, there are supporting tips like using kinesiotape or a belly/pelvic band for additional abdominal support. And of course you can get all of this by seeing a pelvic therapist.
Yes, you can give it a go on your own, but seeing a professional takes some of the guess work out of the healing, plus they are able to provide more complex body work and education around preparing for birth with SPD and if necessary more strict modifications.
*This blog is not meant to replace medical advice. Contact your medical provider if you have pain that lasts longer than 24 hours.