10 Tricks for Reducing SPD (Pubic Symphysis Dysfunction)

Musculoskeletal challenges are one of the most common hurdles in pregnancy. More than two-thirds of pregnant women experience low back pain. Almost a fifth experiences pelvic pain.

Pubic Symphysis Dysfunction (PSD) occurs at the front, centermost part of the pelvis. It can happen in both males and females. It’s most commonly diagnosed in the pregnant female population. That's because of evolving body weight distribution. Your center of gravity is shifted more anteriorly. This shifts ligamentous laxity and changes gait patterns. 

Ligamentous laxity caused by the hormone, relaxin, is often blamed. Relaxin breaks down collagen in the pelvic joint. This causes softening, as does the hormone progesterone. But, fascinatingly, relaxin has no correlation with symptoms of symphysis pubic dysfunction. 

Here is a good YouTube video describing the anatomy. 

The onset of pregnancy-related SPD can vary, with:

• 74% in a first pregnancy 
• 12% in the first trimester
• 34% in the second trimester 
• 52% in the third trimester.
• Most women’s pain regresses over the first 1–6 months postpartum. 25% have pain 4 months postpartum, and only a small number after 12 months.

• The exception is patients who may develop SPD after a traumatic delivery. Approximately 1–17.4% of women have traumatic deliveries.

Common symptoms of PSD:

• “shooting” pain in the front/middle of your pelvis 
• radiating pain into the lower abdomen, back, groin, perineum, thigh, and/or leg
• pain with movement, especially walking, or standing on one leg, or bringing your leg out to the side 
• Pain with turning in bed
• Pain in your SIJ (sacrum)

It also has a good deal to do with glute strength. This is because when your glute muscle becomes weak, it causes something called a hip drop. Hip drop can be almost indescribable to the untrained eye. It’s usually pretty subtle. 

So, How Do We Alleviate PSD Symptoms?

Everyone’s body is uniquely different. But these gentle exercises are a good action plan:

Strengthen glute medius

Clamshells

Lie on your side and bend your knees to a 90-degree angle. Keep your heels together and lift your tops leg’s knee upward. Press the bottom leg down into the ground at the same time. Your torso can be slightly rotated forward. I recommend doing 3 x 10 on each side to start.

Sidestepping

So much of our movement and posturing involves either sitting or forward motion. This means that our glute med, a muscle that helps us with lateral movement doesn’t get worked very often. So, literally, just take steps to the side for 10-15 feet. Then going back the other way. You can do this on your way to check the mailbox each day. It can be a nice little cue for your glute med to turn “on”.

Gentle hip hikes

I emphasize GENTLE on these because you don’t want to create more of a sheering action at the pubic symphysis. Here you stand on a thick book. Or step with one leg and let your other leg hang off the side. Then, without bending your knees on either leg, “hike” your other hip up toward your shoulder. Think cowgirl move. For reference, check the video at the top of the page. 

Modify your gait pattern. 

Make sure you are pushing off with your forefoot when you walk. Avoid the hard heel stride.  The “pregnancy waddle” sends a lot of the ground reaction forces up from the ground to your pelvis with each step. When you walk with more momentum, however, the ground reaction forces rebound less.

Gently stretch your adductors. 

This is the muscle group in your inner thigh. A gentle side lunge and hold for 10-30 seconds helps.

Gently massage the fascia above your pubic symphysis. 

Gently roll your skin in this area here for about 2 minutes a day. This can help decrease the pull around your pubic symphysis.

Sleep with a pillow between your knees. 

This keeps your legs from torquing your pelvis for 8 hours every night.

Side plank. 

Knees down. The forearm is on the ground. Your torso is lifted off the surface of the floor. I recommend starting your hold for 15 seconds 3xs each side.

Pelvic floor range of motion. 

Lift and lower your pelvic floor. Help strengthen and stretch it to ensure it’s not putting too much pull on the pelvis itself.

Should I Wear a Stability Belt?

I get a lot of questions about this. It’s usually better if you can train your muscles to offer the support your body is asking for. But there are some exceptions:

If you have other kids you’re responsible for.

If your symptoms are extreme

If this is the case, wear a supportive belt when you’re sleeping. It's best to use this technique when your joints are the laxest. It can provide some relief throughout the day.

SPD Affects Your Birth Plan

Another thing to think about if you do have SPD is the optimal birthing position. An upright position is usually recommended (so gravity can help).

Intentional foot placement can also help. If possible, avoid putting your feet up in stirrups. Don't spread your legs too far out to the side. This can keep from straining the ligaments around the pubic symphysis.

The Good News

Women who develop SPD during pregnancy generally have good outcomes. When it's addressed and managed conservatively, of course. Barring a traumatic delivery, having a baby out of the womb usually makes things better.

Any questions?

Don’t hesitate to reach out!