Why Does My Pelvis Hurt In Pregnancy? It Could Be Pubis Symphysis Dysfunction
- Sabrina Thorpe
- Apr 3
- 8 min read
One of the most common problems that brings women into my clinic during pregnancy is pelvic pain. The pain I’ve been seeing more of lately in our Waukesha area moms is specifically related to the pubic bone, the bone at the front of the pelvis. When a mom is complaining of pain in this part of her pelvis, it immediately gets flags waving in my head that she is likely dealing with what is called pubis symphysis dysfunction. It is also referred to as symphysis pubis dysfunction and abbreviated “SPD”. We’ll use that abbreviation moving forward for the sake of simplicity.
What exactly is the pubis symphysis?
The pubis symphysis is a joint at the front of the pelvis in what most people refer to as their pubic bone. The pelvis can be thought of like a bowl that has three parts: the sacrum in the back of the bowl, and then two winged segments on either side that narrow and wrap around the front to connect in the middle. This connection in the front is where the pubis symphysis is. For most people, they don’t even realize there is a joint here because when that joint is happy and unstressed, it essentially feels like one continuous bone. However, pregnant women have a pelvis that is under stress, so they can become acutely aware of this little joint.
What does pubis symphysis dysfunction feel like?
There is some variation in how moms present in pregnancy when they have SPD, but here are the most common things I hear from moms about how it feels:
Pain is sharp and stabbing, rather than aching
It can feel like a pulled groin muscle
It’s tender to pressure and pushing on the bone
It feels like massaging their inner thighs would help but it doesn’t bring any lasting relief
Many moms will also have additional complaints of round ligament pain that is more severe, hip pain, as well as pain into the legs and feet as they compensate for pain.
Why does SPD hurt so much with movement?
The pelvis has several jobs, one of which is to transmit forces from one side of the body to the other, like when walking. Under normal circumstances, this little joint has tiny micro-movements that allow it to transmit these forces in coordination with the SI joints in the back of the pelvis, and then it returns back to normal. These movements are so small, you don’t even notice them. However pregnancy brings laxity to the soft tissues throughout the pelvis, and the growing uterus can place pressure on this little joint and create more movement than there should be. This excessive movement is irritating to the joint and can cause pain. Common movements that I see pregnant moms with SPD struggle with are:
Rolling over in bed
Getting in and out of the car
Standing on one leg when dressing their lower body
Climbing stairs
Walking
These movements are painful because they place the pelvis in a position where it has to transmit forces across the pubic bone, often involving use of one leg at a time. When this little joint is in dysfunction, these movements become excruciating, if not impossible.
How to treat SPD pain
The first thing I recommend is that you get in to see a pelvic floor physical therapist. We can do a full assessment of how your pelvis is functioning: bones, muscles, ligaments, and fascia, and we can perform an internal muscle assessment to see if some of the dysfunction is stemming from the pelvic floor.
When moms come in to Foundation PT for SPD, they can expect me to assess and treat the following things:
Positional abnormalities of the pelvic bones
Hip strength and mobility
Pelvic floor muscle tension and strength
Core strength
Movement patterns for commonly painful tasks like rolling in bed, in and out of a car, etc.
Uterine ligament and abdominal fascia balance
Hip adductor tone
The most common finding I see across the board is that these moms often have positional abnormalities in their pelvic bones. Once we correct that, pain almost immediately resolves. Many moms will have a little bit of residual pain from the pubic bone joint being irritated, but typically they tell me the pain is gone within a couple of days. I also give them a set of exercises that help them
reset their own bones if they have a flare up outside of our sessions.
The next thing we do is assess what exactly irritates the joint. Many moms take to the internet and find the advice to keep their knees pressed together when doing things like rolling over in bed. Unfortunately, I simply haven’t seen this be helpful advice in my clinical practice. Pressing the knees firmly together activates the adductor muscles (inner thigh muscles) which attach to and pull on the pubic bone. It’s more irritating than helpful when this joint is irritated. What tends to work better is to keep the knees apart without putting an excessive stretch on the inner thigh muscles. Keeping the knees apart with movement encourages the glutes to activate and provide better stability for the pelvis. Strengthening for the lateral glutes in particular should be prescribed regularly to moms suffering with SPD to help re-establish stability. It should also be said that core strength is also important to address for supporting the pelvis from the top, as the abdominal muscles attach to the pubic bone and provide a measure of stability for it.
It is also worth noting that many moms find relief with a pelvic support belt. This type of belt compresses the pelvis and helps provide stability. These will provide you with some measure of relief from pain which is important, but it will not fix the underlying cause of SPD.
How do I deliver with pubis symphysis dysfunction?
This is an excellent question, because most women with SPD find that positions that stretch their inner thigh muscles pull on this joint and cause a lot of pain. In most hospital settings, women are often placed in their backs with their knees pulled up and out to the side- which stretches the inner thigh muscles and causes a lot of pain. This is an extremely stressful position for the pubic bone. If you have SPD and are under the care of a physical therapist, they can work with you on alternate pushing positions that can protect your pubis symphysis joint. It should also be noted that midwives tend to be more open about alternative pushing and delivery positions. This includes both hospital-based midwives (CNMs) and community based midwives (CPMs) who attend births at stand alone birth centers and at home. If you choose an obstetrician as your primary maternity provider, you are significantly more likely to be limited in what pushing positions you can choose from and will likely end up being told you must push on your back. In that case, if a vaginal birth is your priority vs a c-section, you may want to consider an epidural for pain management. For others, they may make the decision to have a c-section if their SPD is severe enough. A pelvic floor PT can help you with your specific situation and taking into account what your personal priorities are to help you come up with the best plan possible. At our Waukesha clinic, this is regularly done in our prenatal appointments for our moms with SPD.
Does SPD go away after delivery?
SPD does not go away immediately after birth. For most women, it will start feeling better over the first couple of weeks. This is entirely dependent on the severity of the dysfunction however, and I have seen it persist several weeks and even months after delivery if not addressed appropriately. I am a major advocate for early postpartum care with a pelvic floor therapist. Typically I recommend being seen within the first 2-3 weeks postpartum, but if you had severe SPD in pregnancy that may have been made worse during delivery, you may benefit from being seen in the initial days after delivery. Our clinic routinely offers home visits in the first 6 weeks postpartum to moms who were receiving prenatal care with us. If you aren’t local to the Waukesha area, there are many providers who offer home visits or even run entirely mobile practices who could come and treat you at home.
Pelvic pain that stems from pubis symphysis dysfunction does not have to keep you immobile or miserable during your pregnancy. There are effective ways to treat this condition and help get back to feeling good and enjoying your pregnancy. Finding a good pelvic floor physical therapist is always your first step.
Local to the Waukesha area and looking for help with SPD in pregnancy? Foundation PT is currently accepting new clients. You can click here for more information about prenatal physical therapy with us and to book an appointment. We would love to help you enjoy a pain free pregnancy.
FAQ
What other positions can I push in if I have SPD?
This is dependent on your care provider, but common positions that I find women feel less SPD pain in are sidelying, hands and knees, and tall kneeling. We can put the hip in alternative positions in each of these main positions as well to help take some of the stress off of the pubic bone while still allowing the pelvis to open. Seeing a pelvic floor physical therapist with specialized prenatal training can help you find the best positions for your body and your situation.
Can I have intercourse during pregnancy if I have SPD?
Yes, in most cases you can still have intercourse during pregnancy even if you have SPD. You may find that some positions cause more pain than others, so it is a matter of modifying what positions you are using.
Do I need to stop exercising if I have pelvic pain in pregnancy?
No, you do not need to stop exercising. If someone is giving you that advice, run. You should be working with a specialist like a pelvic floor physical therapist to find what exercise works for your body and get to the root of why you are in pain. Exercise is extremely important for the health of both mom and baby in pregnancy, and to be told not to do so is extremely detrimental. Modifications are likely going to be necessary, but this does not mean you should become inactive.
Can I see a pelvic floor therapist during pregnancy even if I'm not having any pain?
Yes, you can see a pelvic floor physical therapist during pregnancy even if you aren't having pain. We are big advocates of proactive care at our clinic, and seeing a PT during pregnancy and help prevent common pain complaints like pubis symphysis dysfuction, SI joint pain, pelvic pressure, back pain, and hip pain. Pelvic floor PT with a therapist who specializes in pregnancy can also help you with general birth prep including teaching you how to push and making sure that you have adequate pelvic and hip mobility for a smooth birth. At our clinic, we also add on fetal positioning interventions to help baby find the best possible position leading up to birth.
Dr. Sabrina Thorpe is a Doctor of Physical Therapy with a decade of clinic experience. She specializes in treating pregnant and postpartum women and their infants at Foundation Physical Therapy in Waukesha, WI.
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