Symphysis Pubis Dysfunction: A condition that may arise in Pregnancy.
by Joanna Norman, BMW
Many pregnant women experience pain over the pubic region, groin and/or inner thigh in the second and third trimesters. This condition is often referred to as Symphysis Pubis Dysfunction (SPD). SPD may be mild or severe and can make walking or even parting the legs quite painful. Lifting one leg, as in getting out of a bath tub or going up stairs, may become excruciating. Some women feel or hear a clicking or grinding sensation in the pubic joint.
A woman’s pelvis forms a bowl shaped structure providing support for the hip joints and pelvic organs. Where the pelvic bones meet in the front, or pubic area, the bones are connected by fibro-cartilaginous tissue and supported by pelvic ligaments. This ‘joint’ is called the Pubic Symphysis and plays an important role in both the mobility and stability of the pelvis.
Often women experience mild cramping sensations or brief shooting pains on one or both sides of the low abdomen, sometimes extending into the groin or inner thighs. The condition may be exacerbated by walking, lifting or periods of physical or emotional stress. This type of pain is usually accountable to the increased workload of the pelvic ligaments supporting the growing uterus, especially entering the second trimester. Though uncomfortable, this type of pain is generally not a cause for concern and may serve to bring a woman’s awareness squarely into her body and the changes occurring there. While exercise during pregnancy is of enormous benefit to both the mother and her fetus, her body will need periods of physical rest and she will benefit from a heightened sense of self-care, especially if she has a demanding job or is experiencing emotional stress.
In contrast to ligament pain, SPD symptoms usually involve exquisite tenderness over the pubic bone, pain in the groin, inner thighs and/or low back. This may be accompanied by ligament pain as the body shifts alignment to support the pubic area. Women with SPD find any activity involving lifting one leg at a time or parting the legs very painful. Putting on clothes, getting out of a bathtub, climbing stairs, getting into or out of a vehicle, rolling over in bed, and walking all tend to be very difficult with this condition.
Other symptoms include ‘waddling’ or a sensation that the pelvic bones may just fall apart when walking. Women sometimes describe a stuck or frozen hip bone that temporarily won’t move and needs to ‘pop into place’ before normal movement is achieved. Sciatica or sciatic-like pain through the buttocks may be present with SPD. Clicking or grinding sensations, as well as feelings of increased pressure in the pubic area are all commonly reported by women suffering with SPD.
Fortunately, SPD most often self-resolves in the early post-partum period. However, for some women the condition, while diminished, continues to cause discomfort, including low-back pain and residual pubic discomfort.
Yoga is effective in both the prevention and treatment of SPD. With the guidance of a knowledgeable instructor, prior to pregnancy or in early pregnancy, women can begin strengthening the muscles and ligaments that surround and support the low abdomen and pelvic girdle, thereby decreasing the likelihood of developing SPD. For women already suffering from SPD, the gentle strengthening and lengthening asanas of guided yoga may help to alleviate the pain of SPD during pregnancy while facilitating the healing process in the post partum period.
Chiropractic realignment of the pelvis and soft tissue can be of great benefit and relief to women suffering with SPD. Malpresentation of the fetus, such as breech or acynclitism, is more common when the pelvis is not in healthy alignment. Correct alignment of the pelvis, therefore, may relieve the pain of SPD as well as increasing the likelihood of optimal fetal position for a natural labour.
Some health care providers recommend pelvic support belts such as the Prenatal Cradle or the Reenie Belt. These may be helpful in alleviating the discomfort of SPD, however if the pelvic bones have become misaligned, some women experience increased pain with a pelvic support belt.
Move with thoughtfulness. Before you start an action that may cause pain, consciously brace and support your pelvis by contracting your pelvic floor muscles, as with mula bandha.
When standing, be aware of your posture. Engage the abdominal muscles and pelvic floor muscles to support the pelvis. You may find it more comfortable to sit down for many routine activities such as preparing food, getting dressed, folding laundry, etc.
Avoid lifting heavy loads. Lifting adds weight and strain to the pelvis. When lifting lighter loads, take time to be conscious of your posture and give attention to proper alignment: do not twist but face your object directly, keep your knees close together if possible, engage your pelvic floor (as in mula banda) and engage the abdominal muscles to support your lower back, pelvic muscles and ligaments. Lift with a straight spine, legs either bent or straight, according to your preference.
Avoid twisting motions of the torso. Instead, turn your entire body. This ensures the integrity of your body alignment and prevents strain on the pelvic ligaments.
Take up swimming or aquacise. Deep water relieves pressure on the pubic joint, aids in blood return to the heart thereby decreasing excess fluid retention in the limbs, and increases your exercise level when nothing else is comfortable! Regular exercise is extremely important in pregnancy to ensure optimal health of both you and your growing baby. Regular exercise, as well as good nutrition, helps you to maintain appropriate weight gain and prevent macrosomia (infant birth weight over 10lbs), prepare for the rigorous event of childbirth, and facilitates postpartum healing.
Most importantly, listen to your body. Pain is a messenger that the body needs our close attention and care. Work toward proper alignment, strengthening and healing for long term mobility and health.
© 2008 Six Senses Yoga Society