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 and/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 and 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 and soft tissue or muscle treatment.
When the body is experiencing pain, muscles tighten and compensate, causing asymmetry and misalignment of joints. It is important that you receive treatment from a physiotherapist, chiropractor or osteopath to correct this, and 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 and alignment shifts can help to stabalise the pelvis by relieving pressure and strengthening and 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) and the pelvic floor. Depending upon the level of pain and range of movement, bodyweight exercises such as a supported squat (adapting the depth of the squat and how far your open your legs) will also improve strength and stability.
SPD / PGP EXERCISE NO.1 TVA CONNECTION AND ACTIVATION:
To start identifying and ‘engaging’ your transverse abdominus, you need find the right muscles, and ‘connect’ with them. Try this: sit in good alignment – that means sitting upright on your sit-bones, not back on your tailbone, and 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 and to enable you to sit up on your sit bones with a straight back. Or try kneeling astride a large bolster or cushions. Place your hands on your ribs. Breathe in, fill your lungs and let your ribcage expand. Then exhale, emptying your lungs, whilst drawing your belly button gently back towards your spine. Keep your shoulders down and your neck relaxed. Your tailbone should NOT tuck under – try to keep it unclenched, out and proud!
SPD / PGP EXERCISE NO.2 SUPERMUM:
From all fours, with your hands directly underneath your shoulders and your elbows slightly bent, engage TVA as above on an exhale and raise your left hand and 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… and hold this position for 5 seconds before lowering and repeat with the right hand and left knee (or just one!). If you start to wobble, lower and 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 and imagine you are drawing a tampon up inside you. It’s more a *lift* than a *squeeze*! Inhale and relax (don’t push away, just let it go). Then exhale and 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 and feet flat on the floor. Push down into the floor with your hands and raise your hips, off the floor. Your feet, shoulder blades and head remain on the floor, and 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 and exhale, take a breath as you hold, then lower as you inhale.
Only exercise on your back for short periods of time during pregnancy and only if you are comfortable. If at any time you feel breathless, dizzy or uncomfortable, simply roll onto your left side and then slowly come up.
SPD / PGP EXERCISE NO.5 SQUAT:
Strengthening the muscles of the lower body will also help to stabilise the pelvis, and so squat, but with support. Hang on with both hands to a strong and 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 and back as if you were going to sit down. Keep your shins vertical and your knees behind your toes and only go as low as is comfortable and as low as you can go without tucking under (have someone look at you from the side). Try to keep your butt and 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 and push up through the outside of your feet and your heels. You want to feel the muscles in your backside and 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.
is vital to release tight muscles which will be extra tense as your body anticipates and compensates for discomfort. Your calves, hamstrings and 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 and turns to enable the position… It’s not working. Take the tension off and stretch only where you can feel release and are able to breathe steadily and 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 and draw them together, breathe deeply and look straight ahead.
Try these exercises at least once a day. They will only take a few minutes. If your pain is severe and 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 and 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, and focuses only on alignment, muscle stretching and release, core and pelvic floor muscle connection and engagement .
MuTu System programs are recommended and endorsed by specialist Physiotherapists and Industry experts.
FURTHER USEFUL LINKS
The Pelvic Partnership | Great resource for pelvic pain in pregnancy
Aligned and Well | Alignment resources and education products from renowned Biomechanist Katy Bowman
Please also see the MuTu System Medical Disclaimer here