There are no clear causes and risk factors for symphysis pubis dysfunction or pelvic girdle pain during pregnancy.
Like much in women’s health, even very severe pelvic girdle pain maybe regarded as ‘common’ and so is undiagnosed. But also like many symptoms women suffer with, ‘common’ does not mean normal or acceptable pain.
According to the POGP* pelvic girdle pain affects around 1 in 5 women, but it’s hard to know for sure. There is a wide range of symptoms, and of severity of symptoms.
Causes of Symphysis Pubis Dysfunction
SPD occurs when there is excessive movement (instability) of the pubic symphysis, the joint that connects the pubic bones at the front of the pelvis. During pregnancy this joint widens in preparation for delivery, and some women experience pain and dysfunction as a result of the expansion.
Factors may include:
- the pelvic girdle joints moving unevenly
- a change in the activity of the muscles of your tummy, pelvic girdle, hip and pelvic floor, which can lead to the pelvic girdle becoming less stable and therefore painful
- a previous fall or accident that has damaged your pelvis
- a small number of women may have pain in the pelvic joints caused by hormones
- Occasionally, the position of the baby may produce symptoms related to PGP.
Risk factors for SPD
Not all women have any identifiable causes and risk factors for symphysis pubis dysfunction, but for some, the following physical risks may apply:
- a history of previous low-back and pelvic girdle pain
- previous injury to the pelvis
- more than one pregnancy
- a hard physical job or workload/awkward working conditions/poor working postures
- PGP in a previous pregnancy
- increased body weight and body mass index before and/or by the end of pregnancy
- increased mobility of other joints in the body
The following are *not* identifiable risk factors:
- time since last pregnancy
- age and height
- the contraceptive pill
While most cases resolve after pregnancy, the condition can linger after giving birth. Due to sometimes-debilitating symptoms, SPD can take an emotional and psychological toll on your mental health as well as physical.
Why is the Symphysis Pubis Vulnerable?
There are no clear causes and risk factors for symphysis pubis dysfunction, however, the pain experienced is associated with a misalignment of the pelvis (at any of the joints) and maybe (less so) related to hormone levels.
If you have suffered from SPD / PGP in previous pregnancies; have been subject to pelvic injury or any misalignment to the spine or pelvis (including due to poor alignment, ergonomic working positions or heavy workloads); if your joints were particularly mobile pre-pregnancy or if you were very overweight – you may be more susceptible.
The iliac bones meet at the front of the pelvis, forming a joint called the symphysis pubis. This joint is vulnerable during pregnancy. Both raised levels of the hormone relaxin and pressure from your baby cause the joint to become more elastic and to widen in preparation for birth. This makes the whole pelvic joint less stable. The pain of SPD is not necessarily related to the degree of separation but owes more to the instability of the whole pelvis.
What can you do?
The MUTU System Program is safe and beneficial during a healthy, low-risk pregnancy. The 12 Week Program is safe for pregnant women. It focuses on alignment, muscle stretching and release, core and pelvic floor muscle connection and engagement, and includes low impact, more intensive workouts for you to progress to when you’re ready.
MUTU System programs are recommended and endorsed by specialist Physiotherapists and Industry experts.
More information on SPD here and Exercises for SPD here.
*Pelvic Obstetric and Gynaecological Physiotherapy 2018
Indeed raising awareness about SPD and the difficulties women have with this often debilitating problem is very important. I’ve been trying to promote the good work that Osteopaths can do to help women in pain with this condition. We often have pregnant ladies turn up to our clinics that have been told by their GP’s and physiotherapist that nothing can be done.
This is simply incorrect and osteopaths have been successfully treated this conditon for many years. My wife suffered from severe SPD during our last pregnancy, the symptoms carried on long after birth. After just a single treatment with an osteopath 95% of this had gone (this is one of the reasons I chose osteopathy as my career). There is really no need sit around In pain, give osteopathy a try and if/when it works, inform other of your success.