SPD & Pregnancy: What to Know
Pregnancy brings many changes to the body, but discomfort and pain do not need to be one of those changes.
All those “Oh, you're just pregnant” comments do not need to be accepted as part of this stage; relief is possible.
One of the complaints we often hear is pelvic pain at the front of the pelvis, often when rolling in bed or getting in and out of the car.
This is often symphysis pubis dysfunction, or SPD.
SPD is pain at the pubic symphysis, the area of your pelvis low and in the front. SPD often occurs in pregnancy due to changing body dynamics, hormones, and changes in where your weight is balanced in your body.
There are many ways to reduce the pain so you can live your best, full life while pregnant.
What is SPD in Pregnancy?
The pelvis is made up of multiple bones, ligaments, cartilage, and muscles that work together to support your trunk, maintain stability, and allow your legs to perform necessary movements.
The pelvis is the middle part that has to manage forces between your trunk and legs.
In the front of the pelvis, the two bones come together with a piece of cartilage; this is called the pubic symphysis.
In pregnancy, the changes can put uneven pulls and stress on the pubic symphysis, causing discomfort for some.
How your Pelvis Changes in Pregnancy
So many changes are happening during pregnancy and the postpartum stage.
As the baby grows and your stomach changes shape, the weight of the baby causes your center of gravity to move slightly forward.
As the baby grows, your abdominal muscles have to lengthen and shift to allow for your growing belly. This creates more length in the abdominal muscles, another change in how your pelvis is stabilized and moves throughout the day.
Hormonally, there are many changes as well.
These are necessary to prepare for birth, but often contribute to laxity, increasing the likelihood of symphysis pubis dysfunction in pregnancy.
Each pregnant person goes through similar changes; some experience pain, while others are spared. Often, it's a person's habits, hobbies, past injuries, muscular strength, and range of motion in not just the pelvic floor muscles but also the legs, back, and abdominals that contribute to dysfunction, not merely the phase itself.
With the number of contributing factors, it is helpful to have an evaluation by a pelvic floor therapist to find and correct the root cause.
Common Symptoms of SPD in Pregnancy
Although the experience with discomfort is different for everyone, many report:
Pain in the front of the pubic bone or inner legs
Pain with rolling in bed
Pain getting in and out of the car
Pain turning to hand the kids something in the backseat
Pain when putting on leggings, socks, or shoes
Discomfort with stairs
Discomfort walking on uneven surfaces
Discomfort standing on one leg
Pain getting up from a chair
Clicking, popping, or sharp pain in the pelvis
For some, this pain waxes and wanes; for others, it is a dull pain throughout pregnancy.
Some experience a significant change and increased pain seemingly all of a sudden. Any pain that is keeping you from enjoying your typical day-to-day activities needs to be addressed to keep you comfortable and enjoying this stage of life.
When Does SPD Tend to Peak?
Symphysis pubis dysfunction begins at different times for each person, but can occur at any point in time. In the second and third trimesters, it is more noticeable due to the changes in the baby’s size and position.
Activities that were once performed without a thought are now placing more demand on the pelvis, causing more stress on the joints and muscles.
Many people also experience an increase in pain after an active day, trying a new exercise, sitting or sleeping in an awkward position, or standing for a long period of time.
In pelvic therapy, we address the specific event that may have contributed and teach you how to still do these activities, but comfortably.
Activities that Make SPD Worse
No activity is inherently bad or damaging. However, there are some known movements or activities that often contribute to an increase in pubic pain, including:
Standing on one leg
Climbing stairs with large strides
Putting on pants, shoes, or socks while standing
Hoisting yourself into the car leading with one leg
Rolling in bed with one leg first
Sitting with crossed legs
Carrying a baby with an uneven pelvis (hiking a hip, shifting forward to let them rest on your belly)
Walking or standing for most of the day without seated rest breaks
Lunges, lifting too heavily, or squats
At Bloom, we never have a person stop what they are doing completely; we find a way to still move through the day, but with comfort- such as sitting to put on pants, resting throughout the day, or getting into the car by first sitting on the car seat.
Stopping exercise, walking, or the problematic movement often causes more stiffness and results in more pain down the line.
If the pain persists despite modifying activities, we often see an increase in SPD pain with the lengthening of the abdominal muscles as the baby gets bigger, changing the pull on the pelvic bones, at times leaving the inner leg muscles overpowering the pull and contributing to this pain.
It is essential that we look at abdominal activation, the adductors or inner thigh muscles’ range of motion and strength to create a more even pull on the bones, decreasing pain.
How is SPD Diagnosed?
There is not a formal diagnosis; there is no imaging or testing. Rather, it is based upon your symptoms and muscular findings.
At Bloom Pelvic Therapy, we look beyond the pelvic bones and assess:
Strength and movement of the hips
Strength and movement of the legs
Core activation
How you are performing problematic movements or tasks
Pelvic floor strength and the ability of the muscles to move well
Lower back
Stability
Posture
Looking beyond the pelvic bones, or pubic symphysis is necessary, as the root cause is most often outside the area that is experiencing discomfort.
With all the relevant areas evaluated, paired with what your experience has been, we will be able to make a determination of whether SPD is the cause and begin to remedy it.
Ways to Manage Pelvic Pain
Each person's management and remedy for the pain are going to be different, which is where our google searches and general video recommendations leave us still with symptoms.
Some initial things to consider when experiencing SPD pain:
Change up how you are doing painful movements or tasks
Try taking small seated breaks when doing something that requires you to be on your feet
Try getting up occasionally to move or stretch when you have been in one position for a while
Sit when putting on your pants, socks, or shoes
Keep your legs squeezed together when rolling in bed
Sit on the car seat first, then swing both your feet into the car together
Take smaller steps closer to the middle of your body, rather than a wide stance
We instruct our clients to try these as a first defense against SPD pain. Often, these small things make a large difference and the pain dissipates. These modifications are not forever, but rather for a short period of time when symptoms are at their worst. If this is not working or the pain is persisting, an evaluation would be extremely helpful in reducing your pain.
Move gently and intentionally
Moving throughout the day is extremely helpful in getting stiff muscles to move and easing stiffness. This can look like taking a short walk around the house between meetings, fitting in a couple of stretches between daily tasks, taking a short family walk after dinner, or alternating sitting and standing while doing computer work.
Overall Strengthening
The general consensus that workouts stop in pregnancy is old news, and gratefully, we do not hear that recommendation often anymore.
It is important to continue strengthening in a way that feels good to you. We recommend a well-balanced program that addresses the glutes, adductors, core, back, pelvic floor, legs, and hips.
The answer is never kegels, just one region of the body, or just one side.
There is more relief when we are moving through different muscle groups and movements. Slow and controlled movement with a weight that feels manageable is the way to go.
Keep the Pelvic Floor Onboard
Although SPD does not scream pelvic floor to most people, it is an important consideration when looking at the drivers of pain. Often, with this discomfort, people are clenching their pelvic floors, either out of a long-term habit or due to this new discomfort.
This constant tension is likely worsening the discomfort and will have other implications as pregnancy progresses and we prepare for labor.
External Support Belts
There are support belts specifically designed for pubic symphysis pain. The belts provide support to the pelvis externally and can be helpful for longer events or short-term resolution of pain, especially as you reach the late third trimester.
An external belt does not replace the need for mobility or strength.
If you are interested, make sure the belt is the correct size and not squeezing too tightly- you should be able to fit your hand between the belt and your body.
Too much tension in the area is not better. When placed on your body, it should be low on the pelvis to provide support in the right location. Adjust this as necessary; oftentimes, it rides up with walking or sitting.
Get to Pelvic Therapy While Pregnant- You don’t have to wait until after delivery!
A misconception with SPD is that it will remain until delivery, or that you should just wait to go to pelvic floor therapy until you are done having kids. Seeking pelvic therapy when pregnant leads to a greater understanding of what is happening and a resolution of the pain so you can fully enjoy this phase of life, stay active no matter how far along you are, prepare for birth, and recover with ease.
Where to Find Pelvic Floor Therapy for SPD in Tampa Bay
Pelvic Pain May Be Common in Pregnancy- But it does not need to be the norm.
Pain during pregnancy can be eliminated- you do not need to push through or chalk it up to pregnancy pains. If SPD is impacting your routines, hobbies, or daily activities, it's time to find a pelvic floor therapist to help.
At Bloom Pelvic Therapy, we take a comprehensive look at what is driving the discomfort and create a plan to keep you comfortable, active, and enjoying your pregnancy to the fullest.
If you are experiencing pelvic girdle pain, SPD, pubic symphysis pain, “lightning crotch”, back pain, or heaviness in pregnancy, there is help!
Schedule an evaluation with Bloom Pelvic Therapy in Lutz, St. Petersburg, or South Tampa to get you feeling strong, comfortable, and confident in your pregnancy!