Symphysis Pubis Dysfunction (SPD), also referred to as Pelvic Girdle Pain (PGP) describes pain in the joints that make up your pelvis. They include the symphysis pubis joint (SPJ) at the front +/or the sacroiliac joints (SIJ) at the back. The result is pain felt across the front or back of the pelvis, which can range from mild discomfort to severe pain.
If your SPD / PGP is causing you pain, you should be referred to a physiotherapist (see further resources at the bottom of this post) who can assess the position + the symmetry of movement of your pelvic joints, especially the sacro-iliac joints at the back of the pelvis. Treatment may involve a combination of joint realignment or mobilisation + soft tissue or muscle treatment.
When the body is experiencing pain, muscles tighten + compensate, causing asymmetry + misalignment of joints. It is important that you receive treatment from a physiotherapist, chiropractor or osteopath to correct this, + also try to carry out gentle exercises such as these, preferably daily. Complimentary therapies such as acupuncture or cranial sacral therapy may also provide relief. Please share your stories on what has or hasn’t worked for you!
Appropriate exercise + alignment shifts can help to stabalise the pelvis by relieving pressure + strengthening + releasing the muscles that support it.
The muscles that need to be strengthened to improve stability for SPD / PGP are the core muscles, particularly the Tranverse Abdominus (TVA) + the pelvic floor. Depending upon the level of pain + range of movement, bodyweight exercises such as a supported squat (adapting the depth of the squat + how far your open your legs) will also improve strength + stability.
SPD / PGP Exercise No.1 TVA connection + Activation: To start identifying + ‘engaging’ your transverse abdominus, you need find the right muscles, + ‘connect’ with them. Try this: sit in good alignment – that means sitting upright on your sit-bones, not back on your tailbone, + with a straight back. Sit on the front edge of a solid chair, or kneel or sit cross legged on the floor, using a bolster or cushion under your bottom for support + to enable you to sit up on your sit bones with a straight back. Place your hands on your ribs. Breathe in, fill your lungs + let your ribcage expand. Then exhale, emptying your lungs, whilst drawing your belly button gently back towards your spine. Keep your shoulders down + your neck relaxed. Your tailbone should NOT tuck under – try to keep it unclenched, out + proud!
SPD / PGP Exercise No.2 SuperMum: From all fours, with your hands directly underneath your shoulders + your elbows slightly bent, engage TVA as above on an exhale + raise your left hand + right knee approximately one cm off the ground (no higher). If you feel wobbly at all, just raise one limb at a time! Remember to breathe… + hold this position for 5 seconds before lowering + repeat with the right hand + left knee (or just one!). If you start to wobble, lower + re-focus, then try again to lift slightly, engaging TVA to stabilise yourself. Keep alternating sides for 2 minutes.
Try not to let your pelvis load (shift) into the hip that is in contact with the ground. Your core muscles should be doing the work.
SPD / PGP Exercise No.3 Not-Quite-Kegels: Kegels or Pelvic Floor Exercises are often described as the action of stopping yourself from urinating, but are actually more effective if you imagine you’re trying not to pass wind! As you exhale, gently pull up your sphincter muscles (DON’T SQUEEZE YOUR BUTTOCKS OR TUCK YOUR TAILBONE), your vaginal muscles will also engage. Then move your focus to your vagina + imagine you are drawing a tampon up inside you. It’s more a *lift* than a *squeeze*! Inhale + relax (don’t push away, just let it go). Then exhale + lift again. repeat 5 times. Quality is much more important than quantity!
SPD / PGP Exercise No.4 Hip Bridge: Lie on your back with your knees bent + feet flat on the floor. Push down into the floor with your hands + raise your hips, off the floor. Your feet, shoulder blades + head remain on the floor, + your chin will tuck slightly into your chest. Hold for 3 seconds before lowering hips back to the floor. Again remember to engage TVA as you raise + exhale, take a breath as you hold, then lower as you inhale.
Only exercise on your back for short periods of time during pregnancy + only if you are comfortable. If at any time you feel breathless, dizzy or uncomfortable, simply roll onto your left side + then slowly come up.
SPD / PGP Exercise No.5 Squat: Strengthening the muscles of the lower body will also help to stabilise the pelvis, + so squat, but with support. Hang on with both hands to a strong + fixed stair bannister or heavy furniture in front of you, or just rest your hand on one side on the back of a chair or table. With legs only just wider than hip distance apart, lower your bottom down, out + back as if you were going to sit down. Keep your shins vertical + your knees behind your toes + only go as low as is comfortable + as low as you can go without tucking under (have someone look at you from the side). Try to keep your butt + tailbone untucked – sit right back into the squat, holding onto something for support if you need to. Place a chair behind you for reassurance so you know something is there to catch you if you like. To come back up, exhale, engage TVA + push up through the outside of your feet + your heels. You want to feel the muscles in your backside + thighs working, rather than the fronts of your thighs. Shift your weight into your heels to shift ‘the work’ to the backs of your legs. Repeat 10 times.
STRETCHING is vital to release tight muscles which will be extra tense as your body anticipates + compensates for discomfort. Your calves, hamstrings + adductors (inner thighs) will need particular attention, but always work within your limits – if a stretch hurts, if your muscles start to shake or your body twists + turns to enable the position… It’s not working. Take the tension off + stretch only where you can feel release + are able to breathe steadily + easily.
Keep as active as you can, as doing nothing at all will make the pain worse. Walk as much as you can, using smaller strides if large steps are painful. Wear minimal shoes without a heel, walk with good alignment (more on walking here) don’t hunch your shoulders or bend forward from the hips. Drop your shoulder blades down + draw them together, breathe deeply + look straight ahead.
Try these exercises at least once a day. They will only take a few minutes. If your pain is severe + debilitating make sure you also get referred to a physio, chiropractor or osteopath to realign your pelvis (see resources below). Your muscles will be inhibited from allowing these exercises to work for you properly if they are overcompensating for misalignment or pain.
MuTu System Programs are safe + beneficial during a healthy, low risk pregnancy. The 12 Week Program contains low impact, intensive workouts. MuTu Focus is especially safe for pregnant women. It contains no intensive workouts, + focuses only on alignment, muscle stretching + release, core + pelvic floor muscle connection + engagement . You can see all program options in the Store here.
MuTu System programs are recommended + endorsed by specialist Physiotherapists + Industry experts.
But please, if you are suffering with pelvic, abdominal or any other pain during or following pregnancy, please consult your Doctor as a matter of urgency. Please also read the MuTu System guidelines on Referral to a Specialist Women’s Health Physiotherapist.
FURTHER USEFUL LINKS
The Pelvic Partnership | Great resource for pelvic pain in pregnancy
Aligned and Well | Alignment resources + education products from renowned Biomechanist Katy Bowman
Please also see the MuTu System Medical Disclaimer here.