Ouch! Symphysis What Dysfunction!?
Hi! My name is Erica Santos and I am an Occupational Therapy Student Intern at The Perinatal Pelvis. This is my story of my pregnancy while struggling with Symphysis Pubic Dysfunction.
I’ll never forget waking up to the pain of feeling like someone had just socked me in the crotch. I would wake up grabbing my groin in shock because I literally felt like I had been hit by a softball in my vagina. I was in my third trimester of pregnancy during a global pandemic, and getting so uncomfortable in my own body. What was going on with me?
Like most moms, when we can’t figure stuff out in the early hours of the morning, we turn to Dr. Google. After typing in “third trimester morning pain in crotch” I saw the words: Symphysis Pubic Dysfunction (SPD). SPD is a group of symptoms that cause pain in the pelvis.
What Causes SPD
When pregnant, several hormonal changes create change in the body. One may experience being tired, bloated, emotional, and notice several physical changes in the body. The hormone relaxin during pregnancy is responsible for loosening up the joints in the pelvis which can cause pain in the pubic symphysis. Pain can also be caused by a shift in the pelvis which causes an imbalance and for certain muscles to work harder on one side.
SPD was very much a rude awakening for me. It caused me so much pain when I woke up in the morning, got in and out of bed, in and out of the shower, and in and out of the car. With all of that pain in my crotch, I didn’t even dare attempt to have sex.
At my next prenatal appointment, I informed my OBGYN of the pain. She acknowledged the SPD pain and reconfirmed the diagnosis. To help alleviate the symptoms and manage the pain, I was referred to a pelvic floor therapist.
Pelvic Floor Therapy Does What for SPD?
Check with your provider to see if you would be a good candidate for pelvic floor therapy. Especially if your insurance requires that you need a referral. However, it is important for you to also advocate for yourself and follow your instinct if you are in tune with your body.For me, pelvic floor therapy helped me significantly with the pain caused by symphysis pubic dysfunction. I learned alternative ways to position my body when doing any movement that caused me so much pain. Specifically getting in and out of anything (bed, shower, car etc.)
In addition to proper body mechanics, I was given manual therapy via myofascial release massage (MFR) around my pelvic girdle, MFR allowed me relaxation and eased the pain in my pubic symphysis and lower back.
Another modality that was used in increments of 10 minutes was ice. Ice brought comfort to my pubic symphysis when applied as it would ease some of the pressure away.
Lastly, what’s a therapy session without homework? I was sent home with a home exercise plan tailored to my needs and had another rude awakening. I had been doing the infamous kegel in the most basic way possible, and it turns out I could have been causing more damage to my pelvic floor than good.
Now, don’t get me wrong. Kegels are important, but incorporating them with other exercises is extremely important to not overwork the muscle tone in the pelvic floor which we will get to in another post.
Maternity Support Belt for SPD Management
My pelvic floor therapist also let me try on a maternity support belt during therapy, and it provided immediate relief while I was walking. I used one called a serola belt, which is used to decrease SPD pain by putting pressure on the sacroiliac joints and pushes the pubic symphysis together. Use of a support belt is a great way to decrease SPD pain with activity.
5 Exercises for SPD
At last, below are 5 exercises for SPD. These 5 exercises assist with strengthening the pelvis and the muscle groups around it to help ease the pain. Always try to use 360 breathing during these exercises to ensure optimal range of motion and optimal muscle activation when exhaling. Keep in mind when attempting these exercises to watch for any pain or discomfort. As always, consult with your physician before beginning any exercise routine and discontinue exercises if pain exacerbates.
Pelvic Tilts- Loosens up tight back muscles which provides pain relief in your pelvis.
Step 1: Lay on your back (if it still feels comfortable) or siit on the edge of a chair with a firm seat.
Step 2: Tilt your pelvis backwards.
Step 3: Tilt your pelvis forwards.
Step 4: Repeat this back and forth rocking motion ten times.
Kneeling Squats- Kneel down on top of a cushion/mat with your knees slightly separated.
Step 1: Next, sit back and down until your glutes are in contact with your heels.
Step 2: From there, brace your core and then squeeze your glutes to extend your hips.
Step 3: Hold the top position for 2 seconds, then slowly come back down to starting position.
Step 4: Perform 5-10 repetitions, then take a break.
Side-lying hip adduction- Lay on your side, using your elbow/forearm to support the upper body. Your bottom leg should be complete straight.
Step 1: With the top knee bent, place that foot flat in front of your bottom knee.
Step 2: Lift the bottom leg off the floor while keeping your leg extended. The range of motion won’t be very large.
Step 3: Hold the end position for 2-3 seconds before lowering it back down.
Step 4: Do 8-10 repetitions per side.
Quadruped breathing with abdominal activation- Assume a quadruped position on all fours with your back as flat.
Step 1: Begin inhaling by expanding your ribs, belly, and into your pelvic floor. Focus on your abdomen and do not let your shoulders shrug as you inhale.
Step 2: Start exhaling by contracting your abdomen.Keep exhaling until you feel your core engage. This should last about 5 seconds.
Step 3: Continue this for a total of 5 cycles (1 cycle = 1 inhale+1exhale).
Bird/Dog- Assume a quadruped position on all fours with your back flat.
Step 1: Lift one knee off the ground and extend 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.
Step 2: Once you reach the end position, engage the core muscles and squeeze the glute of the back leg.
Step 3: Hold this position for 3 seconds before bringing your arm and leg back to the starting position.
Step 4: Repeat for 6-8 repetitions and then switch sides before taking a break.
Other Specialists That May Help
Other specialists I saw in conjunction with doing pelvic floor therapy and a home exercise program include a chiropractor and a massage therapist. I saw a specific kind of chiropractor that specialized in the Webster technique, which is a method of chiropractor that specializes in treating women while pregnant. I also saw a masseuse that used a combination of reiki and myofascial release massage.
Lastly, a woman’s lived experience with SPD can significantly impact optimal function for activities of daily living. Many women, like myself, may have felt anxious to go out to do simple tasks such as walking the dog or going up and down the stairs in fear of pain. Occupational therapists who are pelvic floor therapist use a more holistic approach to treating SPD and focus on the occupation and psychosocial component of SPD which can help women alleviate pain and symptoms in order to fulfill meaningful occupations.
References
Brennan, D. (2020, November 19). 6 exercises for symphysis pubis dysfunction: Best bets, getting started, and more. WebMD. Retrieved June 6, 2022, from https://www.webmd.com/baby/best-exercises-symphysis-pubis-dysfunction#3
Duvall, S. E. (n.d.). Pregnancy and Postpartum Corrective Exercise Specialist. Exercise Sollutions LLC.
Herren, C., Sobottke, R., Dadgar, A., Ringe, M. J., Graf, M., Keller, K., ... & Siewe, J. (2015). Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases. Injury, 46(6), 1074-1080.
O’Connor, A. (2020, October 22). Symphysis pubis dysfunction (SPD) during pregnancy. What to Expect. Retrieved June 6, 2022, from https://www.whattoexpect.com/pregnancy/symptoms-and-solutions/symphysis-pubis-dysfunction
Robles, B. (n.d.). Brittany Robles, MD, MPH, CPT. Postpartum Trainer MD Stories. Retrieved June 6, 2022, from https://postpartumtrainer.com/exercises-for-spd/
Young, B. (2018, December 5). What is symphysis pubis dysfunction? Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health/symphisis-pubis-dysfunction
