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Pubic Pain – Symphysis Pubis Dysfunction (SPD)

What is The Pubic Symphysis?

The pelvis is made up of three bones. This circle of bones is shaped like a bowl with a hole and it has three joints. The joint in the front, which joins the front pubic bones together is known as the pubic symphysis (PS). It is the most stable joint in the pelvis.

Where Do You Feel The Pain From Pubic Symphysis?

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Pain from the pubic symphysis is generally felt in the front part of the pelvis, right at the joint, just above the genitals.   It can radiate outwards into the hips (on one or both sides), into the groin and and/or genitals.

Why Does The Pain Happen?

Your hormones change a great deal throughout the course of your pregnancy, as well as after it. During pregnancy, the pubic symphysis joint softens. It needs to be more mobile to allow for the baby to pass through it during the birthing process. This increase in mobility can affect different women in different ways as it has an impact on the muscles, ligaments and nervous system.

Because the ligaments provide a passive form of support as they soften, some of the muscles and tendons will increase their workload to try and compensate for this. These muscles and tendons can then become fatigued and tired, resulting in spasm, which can cause pain.

As the hormones affect the whole nervous system, a sensitisation of the nervous system occurs, which can result in an increased pain response to normal movement.

What Can You Do About Managing The Pain?

Reduce Shearing Stresses Across the Pubic Symphysis Joint

The key to successfully managing Pubic Symphysis Pain is to try and avoid activities that make the pain worse and at the same time build strength around your pelvis.  Things that make pain worse are often causing a shearing like force over the joint.

Some good pointers to help stop this joint shearing stress therefore stop the pain from happening:

1) Reduce step size when walking
2) Go up and down stairs one step at a time
3) Try pillow between knees when sleeping
4) Keep Knees Together When:
      • Moving from one position to another
      • Getting out of a car
      • When having sexual intercourse
      • When getting out of bed or off the sofa – see video below

Rest and Offload With Crutches If Pain Very Severe On Walking

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If the pain is very severe on weight bearing and walking try to take some rest and put your feet up.  If need to walk then try using some crutches to help offload the area and relieve the pain hopefully helping it to settle down.

Learn to Activate Your Pelvic Floor & Core

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In the HUB there is the ‘Pregnancy Pelvic Floor & Core Workouts’  in the WORKOUTS Program which will help to engage your core pelvic floor and deep abs (tranversus abdominis) muscles.  These muscles will help provide support around your pelvis reducing the effect of stresses on your pubic joint area.   Learn easy ways of how to activate them now.

See a Physio, Osteo Or Chiro

First they will take a thorough history from you and do a full examination of your posture, strength, flexibility and pelvic floor core strength.  They will then be able to determine the issues that are causing the pain.  They will advise you on lifestyle modifications and then devise an individualised treatment plan which may include the following:

      • Hands on treatment which when done correctly can be highly effective at relieving pain
      • Custom designed exercise programme to be followed at home which will help address the issues relating to strength – some of the exercises that are commonly recommended are below
      • Different modalities like hot and cold treatments or sometimes electrical pain relieving devices may be prescribed
      • Various taping techniques or prescription of a bump belt support – which will be determined during your exam where the physio will take you through some specific functional stability tests.

Try These Strengthening And Movement Exercises At Home That Can Help

Exercise can be of great help as we try and strengthen up the muscles surrounding the pelvis as the pelvis is the attachment site for 35 different muscles.  Some of these important muscles that provide support are the gluteal buttock muscles and adductor inside thigh muscles.  Our Symphysis Pubis Pain Relieving Exercises are shown below.  Try practicing these exercises every day to help relieve your symptoms.  If you start feeling the pain on any of the exercises do not push further into the exercise but try to do in non pain producing range. Ie. if squeeze the pillow or ball between knees if you start feeling the pain stop there and release – do not continue the squeeze through the pain.  With time you should be able to squeeze more without the pain starting.  If you feel you need more supervision and help then seek the help of a physio.

Do the Leg Push exercise below both left and right sides

Do the Band Pull exercise below both left and right sides

Do the Clam exercise below for both left and right sides



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