Do you suffer from symphysis pubis dysfunction (also known as SPD) in pregnancy?
You are not alone.
After reading this post you will learn:
- What SPD is and why it happens,
- 7 exercises you can do during pregnancy for SPD, and
- 5 exercises you need to avoid to prevent further injury to your pelvis.
So if you are ready to get started, let’s dive right in!
What is SPD?
Symphysis pubis dysfunction (or SPD for short) is a condition where the ligaments and joints that hold the two halves of your pelvic bone together, begin to stretch and become mobile.
One of the primary joints involved is the pubic symphysis.
The pubic symphysis is a cartilaginous joint that is normally very stable.
In SPD however, the pubic symphysis joint can become mobile and stretchy. As a result, the joint becomes unstable, resulting in severe pain with normal everyday movement.
Is This Different From Pelvic Girdle Pain?
SPD and pelvic girdle pain are synonymous- they mean the same thing.
Sometimes, people also refer to sacroiliac joint pain as pelvic girdle pain which is actually different.
Why Does SPD Happen?
SPD occurs as a result of the hormonal changes of pregnancy.
During pregnancy, your body releases a lot of hormones to help your body accommodate the growing fetus.
One such hormone is relaxin. Relaxin is the hormone responsible for creating laxity (or increasing the mobility) of your joints – especially in the hips.
If you think about it, you actually need your pelvis to expand. Otherwise, how could you expect a full-term baby to come out of it? :).
The problem is, these hormonal changes can cause too much laxity at the pubis symphysis. The increased laxity can lead to joint instability and too much range of motion at the pelvis.
That is why daily activities such as walking, going up the stairs, or getting out of a car can be so painful.
How can I help my SPD while pregnant?
So how do you relieve SPD pain in pregnancy?
The very first thing you need to do is to speak with your healthcare provider.
If you have severe pelvic pain that gets worse with movement, go get an evaluation. Your provider likely has someone whom they can refer you to such as a pelvic floor physical therapist.
These professionals are trained to help you manage the pain associated with pubic symphysis dysfunction.
With that said, here are a few things you can do right now.
#1 Wearing a support belt/pelvic binder
Many women find that wearing a support belt while walking can help alleviate some of the pain and tension. A support belt is designed to keep your pelvis stable by providing gentle compression.
This pelvic support belt on Amazon has good reviews. Read through the reviews and see if this belt fits your needs.
#2 Avoiding aggravating activities
This next tip should go without saying. With any type of musculoskeletal pain, it is important that you avoid any activity that makes the pain worse.
In general, you want to avoid activities where you are standing on one leg at a time or spreading your legs far apart.
For example, here are a few things you could try:
- Go up the stairs one at a time or go up sideways.
- When putting on and taking off pants, do it from a seated position.
- Use shorter strides while walking.
- When getting out of a car, swivel your hips and keep your knees together.
- Sleep on your side with a pillow between your legs
#3 Performing SPD Safe Exercises
The last thing you can try are exercises to help relieve some of the pain associated with SPD. These exercises should focus on strengthening three core areas:
- Your pelvic floor muscles,
- Your gluteal muscles, and
- Your abdominal muscles (including the rectus abdominis, the transverse abdominis, and the obliques)
Now with that said:
****MAKE SURE TO SPEAK WITH YOUR PROVIDER FIRST****
They may or may not want you performing these exercises. Similarly, check in with your personal physical therapist.
If they give you a list of exercises different from these, then DO THOSE EXERCISES instead.
One last thing.
If any exercise causes you ANY level of pain or discomfort- then stop doing it immediately. Okay?
I hope that was all clear! 🙂
Let’s go over the exercises now.
What exercises can I do with SPD?
If you have received clearance from your medical providers, here are 7 great exercises you can do to help strengthen the muscles around your pelvis.
Make sure to go through these exercises slowly and with intent. I want you to feel each exercise training the appropriate muscle groups.
And don’t forget to breathe as you are going through them.
The first exercise is the kneeling squat. This movement is great because it teaches you how to strengthen your glutes and hip muscles from a safe position.
Here’s how to do it:
- Kneel down on top of a cushion or rolled-up yoga mat with your knees separated slightly.
- Next, sit back and down until your buttocks are in contact with your heels.
- From here, brace your core and then squeeze your buttock muscles to extend your hips.
- Hold the top position for 2 seconds, and then slowly come back down to the starting position.
- Perform 6-10 repetitions before taking a break.
Seated Ball Squeeze
The next exercise is the seated ball squeeze. This movement will help strengthen the muscles of your inner thighs as well as the muscles of the pelvic floor.
You can do this exercise with a ball, a cushion, or you could even use your fists in between your knees.
Here’s how it looks:
- Sit up tall on a chair with your feet flat on the floor.
- Next, place the ball/cushion between your knees, and place your feet directly underneath your knees.
- From here, squeeze the ball between your legs by trying to bring your knees closer together.
- Keep your feet flat on the floor.
- Hold this contraction for 3 seconds and then release.
- Repeat this for 10 repetitions before taking a break.
Side-Lying Hip Adductions
The next exercise is the side-lying hip adduction. This is another great exercise for isolating the muscles of the inner thigh while teaching you how to maintain a tight core and stable hip position.
Here’s how it looks:
- Lie on your side, using your elbow and forearm to support your upper body.
- Next, straighten your bottom leg completely.
- Then, bend your top knee and place that foot flat on the ground in front of your bottom knee.
- From here, you are going to lift the bottom leg off the floor while keeping your leg extended.
- The range of motion won’t be very large.
- Hold the end position for 2-3 seconds before lowering it back down.
- Do 8-10 repetitions per side.
Next up are the quadruped exercises. The quadruped position refers to being on your hands and knees.
This is a great alternative to the push-up position, as it lessens the load your body has to support. It also teaches you how to use your core muscles effectively.
Here’s how it looks:
- Assume a quadruped position with your hands directly underneath your shoulders, and your knees directly underneath your hips.
- Do your best to keep your back as flat (neutral) as possible.
- From here, you are going to perform a pelvic contraction, aka a kegel exercise.
- Pretend as if you were trying to prevent yourself from pooping.
- Hold this contraction for 3-5 seconds and then release.
- Repeat for 6-8 repetitions before taking a break.
Quadruped Diaphragmatic Breathing
The next quadruped exercise is very simple yet very important. It will teach you how to properly use your diaphragm muscles and activate your transverse abdominis muscles.
Here’s how to do it:
- Assume a quadruped position with your back as flat as possible.
- From here, begin inhaling by expanding your belly as much as you can.
- This inhale should last anywhere from 3-5 seconds
- Focus all your efforts on your abdomen. Do not let your shoulders shrug as you inhale.
- Next, begin exhaling by contracting your abdomen.
- Keep exhaling until you feel your ab muscles engage – this should last about 5 seconds.
- Continue doing this for 5 total inhales/exhales.
The last quadruped exercise is the bird dog. This simple exercise is so beneficial for many different things. It teaches you how to engage your core, activates your glutes, and improves your balance.
It can also help alleviate lower back pain.
Here’s how to do it:
- Assume a quadruped position as you did before.
- From here, lift one knee off the ground and begin extending that leg straight out behind you.
- At the same time, lift your opposite hand off the ground, and extend that arm straight out in front of you.
- Once you reach the end position, make sure to keep your ab muscles turned on, and squeeze the glute of your back leg.
- Hold this position for 3 seconds before bringing your arm and leg back to the starting position.
- Repeat for 6-8 repetitions and then switch sides before taking a break.
Modified Side Plank
The side plank is hands down, one of the best core exercises out there.
It also helps that this exercise is extremely simple!
The side plank will activate your oblique muscles while teaching you how to maintain your core and pelvis in a stable position.
In addition, you could modify this exercise in several ways depending on your skill level.
Here is how to do a basic modified version:
- Lie on your side and prop yourself up on your elbow and forearm.
- Next, keep your knees bent and in contact with each other.
- From here, elevate your hips off the floor by squeezing your glutes and engaging your core.
- Hold this position for 20 seconds and then switch sides before taking a break.
Bonus Exercise: Standing Pelvic Tilts
I just wanted to throw in an 8th exercise into the mix. The bonus exercise is the standing pelvic tilt. This is one of the key movements in learning:
- how to activate your transverse abdominis muscles
- how to improve your posture,
- and how to perform core exercises safely if you have diastasis recti.
The best part is- this exercise is extremely simple.
Here’s how to do it:
- Stand with your back against a wall, with your feet 6 inches away.
- Make three points of contact – your head, your upper back, and your butt.
- Standing in this way, there should be a natural curve in your lower back – i.e your lower back shouldn’t be touching the wall.
- From here, draw your abdominal muscles in pretending as if you are bringing your belly button toward the wall.
- This should naturally tilt your pelvis posteriorly and flatten your lower back against the wall.
- Hold this position for 3 seconds and release.
- Repeat for 6-8 repetitions before taking a break.
So those are the exercises that should help strengthen the muscles of your core, glutes, and pelvis without causing further damage to your pubic symphysis.
However, if any of these movements cause pain or discomfort, don’t do it!
You can do 3-4 of these exercises 3-4 times per week.
Next, let’s go over exercises you should avoid.
SPD exercises to avoid
In general, you want to avoid any exercise that has you standing and/or balancing on one leg against resistance. These include:
Avoid all types of lunges- forward walking lunges, reverse lunges, and lateral lunges.
Step-up exercises place too much stress on individual legs while separating your pelvis more.
The stair master creates similar stress to the legs and pelvis as step-ups do.
Any other activity that causes pain:
The above isn’t a comprehensive list. As always, you must listen to your body.
There will be other exercises that you should avoid based on the feedback your body gives you. In other words, do not perform any exercise activity that causes pain.
This is true for any of the exercises above as well!
Does SPD go away during pregnancy?
Unfortunately, SPD does not go away during pregnancy. In the most severe cases of SPD, you may need crutches or even a wheelchair to help you mobilize.
However, many women are able to recover from SPD postpartum, with rest, and/or with proper guidance from pelvic floor physiotherapists.
How can I prevent SPD during pregnancy?
The best way to try and prevent SPD in pregnancy is to:
- be active before your pregnancy,
- stay active during your pregnancy,
- adhere to the recommended weight gain guidelines, and
- strengthen your core and pelvic floor muscles.
With that said, you might still develop SPD even if you do all these things. Unfortunately, there are no definitive ways to prevent it completely.
Does SPD mean a big baby?
SPD does not necessarily mean you will have a big baby. You can develop SPD even with an appropriately sized baby.
With that said, having a large baby is a risk factor for SPD, as is having had multiple children.
Does SPD affect delivery? (Does it make Labor easier?)
For the majority of cases, SPD should not affect your delivery. However, if you have pain severe enough to prevent you from spreading your legs apart, your provider may offer you a cesarean section.
Vaginal deliveries will require you to separate your legs far apart to open up the pelvic outlet.
If you have an epidural for pain relief, you may not be aware of the excessive strain that these positions could place on your pubic symphysis.
Other Related Questions
What are the symptoms of SPD?
The most common symptoms of SPD are:
- Frontal pelvic pain with activity such as walking and climbing stairs. The pain is worse with activities that require you to stand on one leg at a time.
- Pelvic pain radiating toward your low back
- Pelvic pain radiating toward your inner thighs
Sometimes, SPD could be associated with a clicking noise whenever you separate your legs or walk.
How Is It Diagnosed?
SPD is generally a clinical diagnosis, meaning it can be diagnosed with a physical examination. However, imaging (such as an ultrasound or an x-ray) can be done to confirm if the pubic symphysis is abnormally separated.
Anything greater than 1 cm is considered pathologic and referred to as pubic symphysis diastasis.
In general, we avoid imaging studies in pregnancy and defer them to the postpartum period.
How common is SPD in pregnancy?
There is no concrete data on the prevalence of SPD in pregnancy. Some sources say it occurs in about 1 in 300 pregnancies. Other sources state that SPD can occur in up to 25% of women.
Complete pubic symphysis diastasis has been quoted to be 1 in 300 to 1 in 30,000 pregnant women.
Can you squat with SPD?
In general, you should avoid deep squats with SPD, especially if they cause you pain or discomfort. Instead, you can use the kneeling squat variation, which is a safer alternative.
Can you be put on bed rest for SPD?
In general, complete bed rest is not routinely recommended during pregnancy due to the increased risk of blood clot formation. However, it may be necessary to rest periodically throughout the day to manage your pain.
Can SPD cause permanent damage?
80% of women will have a resolution of symptoms within 6 months, and over 90% by one year after delivery.
Be sure to follow closely with the appropriate healthcare provider if you still have significant pain in your pelvic joints after 1 year.
Final Words On Pubic Symphysis Dysfunction
SPD is a common issue that many women face.
As debilitating as it can be, you have the power to do something about it!
Now I want to hear from you.
How many weeks pregnant were you when the diagnosis of SPD was made?
Did you do physical therapy?
Comment below and let me know!
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Brittany Robles, MD, MPH, CPT
Brittany Robles is a full-time OBGYN physician, a NASM certified trainer, and a prenatal and postnatal fitness specialist. She holds a Master of Public Health degree in maternal health with a special interest in exercise and nutrition. She is also the co-author of The White Coat Trainer. Learn more about her here.
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