SPD: Symphysis Pubis Dysfunction

The pubic symphysis is the large joint in the centre of the pelvis. SPD is a condition in which this joint becomes painful and unstable.

Symptoms of SPD

Pain is the most obvious symptom of SPD. This may be local to the front of the pelvis, or it may spread into the abdomen, perineum, or legs. The nature of the pain is often described as shooting, burning, or stabbing. It may also be accompanied by a sound or sensation of clicking, which may be painful in itself.

Movement can become difficult due to both the pain and instability. Movements that require the legs to separate can be particularly aggravating, such as getting in or out of a car or bed. During pregnancy, we do expect the pubic symphysis to stretch, and for the gap between the two bones to increase a little. We expect that an increase of 2 or 3mm by the time the baby is full term, which should be comfortable. If the gap becomes too wide, the symphysis can rupture, so intervention is important before this stage is reached. It should also be noted that SPD at the time of birth can limit the range of birthing positions that are appropriate.

Often the symptoms resolve as the body heals after birth. However this is not always the case, and we may be able to help if your symptoms are still present months or years after your pregnancy.

Risk Factors

Pregnancy is the largest risk factor in developing SPD. From the first trimester, the body begins to produce a hormone that relaxes ligaments. This circulates throughout the body, but its aim is to relax the pelvic ligaments to allow increased movement during labour. The pelvis has three joints: two at the back and the pubic symphysis at the front. The three act on each other, so changes in one area will affect the others. Increased movement from the two joints at the back (the SIJs) puts additional demand on the front.

Research is limited, but studies suggest that in addition to hormonal changes, the following may exacerbate SPD:

• pelvic instability
• low vitamin D or calcium
• inflammatory conditions such as sacroiliitis or pubic symphysitis
• arthritis of the pubic symphysis

Excessive physical activity in pregnancy has also been associated with more severe symptoms.

Managing SPD

Physical therapy is recognised as an key part of managing SPD. Recognising the risk factors and reducing them where possible is also important. A number of additional therapies have been reviewed for their effects: acupuncture, pelvic support belts, pelvic floor exercises, and water aerobics may all be helpful. Your osteopath can take another approach, looking at the function of the pelvis as a whole, and other areas such as the lower back. We expect that the lower back may not be working as efficiently as normal as it adapts to the changing centre of gravity and demands of pregnancy. Treatment during pregnancy is gentle, and nothing will be done without your consent.

Note that NSAIDs like ibuprofen are not recommended during pregnancy.

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