Symphysis Pubis Dysfunction (SPD) / Pelvic Girdle Pain (PGP)
Symphysis Pubis Dysfunction or SPD is one of the complications experienced during pregnancy. It occurs when the symphysis pubis joint becomes sufficiently relaxed to allow significant ‘gapping’ or instability in the pelvic girdle. In severe cases where the symphysis pubis partially or fully rupture, and the gap increases by more than 10mm, it is known as diastasis of the symphysis pubis (DSP). Pain is usually localized over the symphysis pubis with occasional grinding or audible clicking. Pain may also be felt in the groin and inner thighs. Activities such as walking, lifting and carrying items and getting in and out of the car may also be painful.
The symphysis pubis is a fibro-cartilaginous (a mixture of fibrous tissue and cartilaginous tissues) joint that connects the two halves of the pelvis together and keeps them steady during activity (see image). This joint is supported by a network of muscles and ligaments that allow very little movement to occur under normal circumstances. During pregnancy, the symphysis pubis widens an average of 2-3 mm from the usual 4-5mm gap. The average gap is about 7.7mm. This widening of the pelvic ring helps facilitate the delivery of baby.
Symphysis Pubis Dysfunction is when this joint becomes overly relaxed, allowing the pelvic girdle to become unstable. This leads to pain and inflammation.
In severe cases, the symphysis pubis partially or fully ruptures, increasing the gap to more than 10mm. This is known as the diastasis of the symphysis pubis (DSP).
SPD typically starts in the second trimester. The start of pain is usually gradual and can be very intense. It is usually relieved by rest. The good news is that symptoms commonly disappear shortly after delivery. A small percentage of women however, continue to experience pain for several months after delivery.
Why does it happen?
SPD is a result of a combination of factors; an altered pelvic load, hormonal and biochemical alterations causing ligament laxity and a weakening of pelvic and core musculature during pregnancy, leading to instability.
You may have SPD if you have one or more of the following:
*Pain localised to your symphysis pubis, including shooting, stabbing and burning pains, grinding and audible clicking sensations and/or persistent discomfort.
*Pain radiating to lower abdomen, groin, perineum, thigh, leg and back
*Difficulty in walking, climbing up or down stairs, rising up from a chair, impaired weight bearing activities, e.g. standing on one leg or lifting/parting the legs, turning in bed.
SPD today is becoming more widely understood by GPs, obstetricians and midwives. It is diagnosed by a combination of your own description of symptoms and a battery of tests designed to look at the stability, movement and pain in the pelvic joints and structures surrounding it. Imaging, such as X-rays, is the only way to confirm the misalignment of the pelvic bones. However, due to the concerns of fetal exposure to radiation, ultrasound is the preferred modality for assessing symphyseal widening in pregnancy.
Your doctor or midwife may refer you to a physiotherapist who has experience in treating this condition.
A specialist physiotherapy assessment and review should be arranged. The physiotherapist can advise on back care and strategies to avoid activities that put unnecessary strain on the pelvis and on safe exercise during pregnancy. Maternity Reflexology is also very effective relief
Exercises for the pelvic girdle and core stabilizers of the trunk will form a large part of the treatment and are aimed at improving the stability of the pelvis and back. In some cases, mobilisation (a gentler form of manipulation) of your hip, back or pelvis may be used to correct any underlying movement dysfunction. Other manual techniques include muscle energy technique (MET) and myofascial release.
The physiotherapist may also prescribe a pelvic support belt to give quick relief.
Other alternative treatments include hydrotherapy (exercise in water) Reflexology and acupuncture which sometimes can be useful.
SPD Home Advice
Here are some things pregnant women with SPD can do to minimize their discomfort.
1. Avoid activities which cause discomfort, e.g. lifting, carrying, prolonged standing, walking and strenuous exercise
2. Rest more frequently in a position which is comfortable, such as: lying with your knees bent and supported, lying on your side with a pillow between your knees, sitting with your knees slightly apart, avoid sitting with legs crossed.
A pregnancy pillow makes a brilliant support for those suffering from SPD. Simply lie with the legs between yours and rest your tummy into the cushion at night.
3. Mild to moderate exercise, including abdominal wall and pelvic floor exercises, is acceptable.
4. Avoid straddling and squatting movements, which means moving with knees apart (hip abduction), when getting in and out of car.
5. Try to keep knees together getting in and out of bed.
6. When moving in bed, try to keep legs together particularly when moving from side to side. Do not push with one foot as this will worsen the pain. Push equally with both feet to move about the bed.
7. Adopt good posture, avoid bending and twisting.
8. If swimming, avoid the breast-stroke with the legs kicking outwards.
9. Ice packs can be used for five minutes at a time or an ice cube can be rubbed on the symphysis pubis for 20–30 seconds
General Advice on Pregnancy and back pain
Unless you have a small, neat baby bump, it is hard to maintain good posture in the second and third trimesters of pregnancy as you have a changed centre of gravity, extra weight and the muscles in your back and abdomen are being worked in ways that they are not used to causing aches and pains.
The body does a good job of adapting and changing to accommodate a growing baby bump but sometimes the lower back and pelvis are put under too much pressure from the localised extra weight resulting in Symphysis Pubis Dysfunction.
SPD can occur at any time throughout a pregnancy and sometimes even after the birth, but it most commonly develops at around three to four months, affecting one in three pregnancies.
The condition is caused by the symphysis pubis joint at the base of the pelvis being put under pressure from increased pregnancy weight causing it to move several millimetres more than normal during activities such as walking, stair climbing and getting up out of a chair. The joint can make an audible clicking or popping noise and cause a sharp pain or dull ache in the pelvic area.
Symptoms can vary greatly from occasional mild discomfort to such severe pain that elbow crutches or wheelchair use is recommended in extreme cases. It can be particularly painful when walking, as the simple action of shifting weight from one foot to the other is uncomfortable making stairs extremely difficult.
Keeping the knees together when standing up, getting in and out of a car and sleeping with a pillow between the knees are all ways to relieve mild symptoms of backache and lower pelvic pain during pregnancy.
Wearing a maternity support band can alleviate some of the milder symptoms of SPD and is effective in alleviating general backache caused by weight gain and the resulting change in posture. The band works by supporting the lower back area through light corsetry and a soft girdle wraps around the top and bottom of your bump, supporting the baby`s weight away from your hips providing greatly improved posture with minimal effort.
Back pain is common in pregnancy but most mums-to-be are reluctant to take any type of medication and in particular anti inflammatory painkillers for nine months, but there are plenty of other non invasive pain relief methods such as Tens machines and maternity support bands and some mums-to-be choose to wear their band as a support aid simply to help take the daily strain out of doing the housework or carrying shopping.
Constant discomfort or mild pain can become debilitating and ultimately depressing and during pregnancy when changing hormone levels are thrown into the equation, anything that can make life a little more comfortable has to be a good thing.
Maternity support bands are very useful as a pregnancy progresses just to give added relief from the pressure of a blossoming baby bump and no-one will know you are wearing one unless you choose to tell them, keeping your maternity fashion credentials intact.
For proven effective pregnancy Back pain relief use our innovative Hug-a-Bump ® SPD Maternity Support Band