SPD & PGP: Symphysis Pubis Dysfunction & Pelvic Girdle Pain

SPD: anterior view diagram to show the pelvis and pubic symphysis during pregnancy

The abbreviations “SPD” and “PGP” are thrown around a lot in pregnancy. SPD refers to dysfunction of the pubic symphysis, which is the joint at the front of the pelvis. “Dysfunction” in this case is a broad term, and typically does not refer to any injury or damage. PGP stands for Pelvic Girdle Pain, which encompasses both SPD and pain over the sacroiliac joints (SIJs). Symptoms can occur within all three joints- if you imagine the pelvis as a ring or a bowl this makes sense. A problem in one joint will cause compensation through the other two.

Anatomy of the pelvis

The main reason these joints can be irritated during pregnancy is due to the hormone relaxin. As the name suggests, it causes structures to relax: specifically ligaments. The pelvis is very stable and usually the role of its joints are for shock absorption. But during vaginal delivery, the bones need to move to make room for the baby to exit. Evidence shows that birthing in positions that allow the sacrum (bone in the centre of the pelvis at the back) to move “might be favourable to facilitating spontaneous birth”. So movement is important, at least during birth.

However… just like you might have gone up a cup size or two well before the third trimester, relaxin can kick in early too. It is estimated that up to 1/4 of pregnancies may cause SPD.

Symptoms of SPD and PGP

Both SPD and PGP are often unnoticeable at rest. Pain over the front or back of the pelvis, or into the groin, tends to only peak on movement. Changing position, such as going from sitting to standing, is a common trigger. Turning in bed can also be painful. Weight bearing on one side, for example when leaning to one side to pick something off the floor, can be particularly uncomfortable.

Walking or other repetitive movements may initially be a trigger, but can often reduce the pain and be useful as a management strategy.

Management

Strengthening the muscles around the pelvis before and during pregnancy may be a way to minimise symptoms. Muscles in question include the lower back, buttocks, hamstrings, and quadriceps.

Identifying patterns is an important part of working out a strategy. You may find that the day after particularly strenuous activity symptoms are worse, but the next day you are pain free. Finding the sweet spot for a comfortable level of daily activity is possibly the easiest fix.

As with most things- the sooner you can make changes the better. Most* PGP resolves at birth, but suffering can typically be reduced beforehand. Don’t wait til you’re on crutches to see your osteopath! You may prefer to see an osteopath who specialises in treating pregnant women, although PGP is not too different to other types of back pain.

Alongside treatment for the joints and muscles that act on the pelvis, your osteopath can give you advice to keep the area happy up to birth. This may include specific exercises tailored to you, or more general advice on how much movement could be right for you. Ideas for adapting the way you sit, sleep, and move generally can also help. They may also recommend crutches or supports if they are things you would like to try.

NHS

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