Symphysis Pubis


Congratulations! You’re pregnant! It’s nine months of excitement; but also involves some planning and lot of research. The last three months can also involve physical restrictions. Symphysis Pubis Dysfunction (SPD) is a real complication of pregnancy that arises from increasing size and weight.
The pelvis is made up of three bones – the two iliac bones and the sacrum. The sacrum is connected to the iliac bones through the sacro-iliac joints (found along the posterior aspect of the pelvis). The two iliac bones are connected to each other in the front through the symphysis pubis. Minimal movement occurs at these joints. Their function is to provide a stable platform for the movements of the arms and the legs.

A hormone called relaxin is released in the pregnant body during the second trimester. This hormone loosens up the ligaments of the pelvis, allowing the baby to pass through without any difficulties or complications.

As the ligament of the symphysis pubis loosens, the body increasingly relies on the muscles of the pelvic floor, hips, and the overlying fascia, to maintain the alignment of the pelvis. The inability to do so may result in pain and instability in the pelvis; and is termed symphysis pubis dysfunction (SPD). Although not very common, experts believe that more than 2% of all pregnant women will experience the symptoms of this dysfunction. SPD often goes undiagnosed and unmanaged, possibly because the symptoms are considered “normal” during pregnancy.

Signs and symptoms:
  • 1. Back and/or hip pain
  • 2. Pain in the pubic area, accompanied with a grinding or clicking sensation
  • 3. Pain and/or tenderness along the inside of the thighs
  • 4. Pain that increases during weight transfer (walking/running/going up or down stairs), when stepping side-ways, turning in bed
  • 5. Pain that is worse at night and possibly stops you from sleeping. Getting up to go to the toilet in the middle of the night can be especially painful
  • 6. Weakness in the legs; inability to support oneself in a seated or standing position

These symptoms can be quite distressing in the prenatal period. Symptoms persisting into the postnatal period could affect the new mother’s ability to look after a newborn, as well as her self-confidence. Early diagnosis is key.

A women’s health physiotherapist will be able to provide ergonomic advice (movements to avoid), supports (trochanteric or SIJ belts) and exercises critical for the effective management of SPD. Make an appointment with the Physio department if you experience any of the symptoms listed above; or if you want exercises to keep your pelvis supported through your pregnancy.

Article written by Aparna Shah, Physiotherapist