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Pubic Bone Pain: More than a matter of instability

A common issue during pregnancy and even afterwards, pubic bone pain (aka “symphysis pubic dysfunction” or SPD) can cause a lot of discomfort and can limit one’s function. Most women will complain of pain or clicking in the pubic bone with walking, going from sitting to standing, and with one legged activities (e.g. putting on pants while standing, with stairs,etc.).

Many people, including doctors, may tell you this is a normal part of pregnancy/ post-partum due to the laxity (loosness) and instability (lack of stability/ too much movement) in the pelvis and will go away on its own. While it may resolve spontaneously, and is common, it can be treated both during and after pregnancy, so why live with it?

The pelvic floor connects above to the ribcage and shoulder girdle through the hip flexors, abdominals and ​paraspinals, and down into the legs through the thigh and hip muscles.

I have found that while a portion pubic symphysis pain can be contributed to by a general “instability” in the pelvis and core, or a malalignment of the pelvic girdle itself, it can also have some contributions from a compensatory increase in the groin and pelvic floor muscles, as well as the stretched abdominal muscles. All of these muscle groups share a bony attachment at the pubic bone and when tight can pull, shear, and torque the pubic joint causing pain. This is especially true with, and can be aggravated by, any asymmetrical activities where you ar​​e causing one side of your hips and pelvis to work independently of the other, as well as any repetitive movements, despite them being reciprocal (e.g. walking, stairs, etc.).

So what can you do?

1. Maintain symmetry: Pain may be a sign that your pelvis is not balanced.

  • Watch your alignment. Make sure to stay away from any exercises or resting positions where you are asymmetrical (e.g. one leg in front of the other, standing on one leg, crossing legs, etc.)

  • When sitting down, never hold your knees together or press them against each other.

  • Don’t cross your legs. It is ok to cross at your ankles allowing your hips to remain open, or put one ankle on top of your opposite knee.

  • While standing, place your weight evenly on both legs, with your knees slightly bent and slightly turned out.

  • Do “symmetry exercises” to help maintain alignment in your hips and pelvis.

  • Consult a women’s health physiotherapist, chiropractor, or registered massage therapist for treatment to help realign the pelvis, hips, and lower back and to provide you with appropriate exercises.

2. Decrease tension in the groin and pelvic floor:

  • Adapt or stop your Kegels! Kegels focus on strengthening the pelvic floor and will make the pelvic floor more tight, causing more pulling and pain at the pubic bone.

  • Try to actively relax the hips and pelvic floor. Imagine a balloon in your lower belly expanding to your perineum. Working with the pelvic floors’ natural rest phase, on your inhale, imagine that balloon expanding and opening/ relaxing the pelvic floor and inner thighs. Continue this visualization for 2 minutes twice per day, working with your natural breath. Other vizualizations that can be helpful are: as you breathe in, imagine your sits bones or pbic bone and tailbone gently floating apart; or imagaine your perineum as a tightly closed rose bud, gently blossoming as you breathe in.

  • Consult a pelvic floor physiotherapist for help on proper cueing for pelvic floor activation/ relaxation, manual therapy directly to the pelvic floor and other tight areas to help them relax, and for exercises you can do at home.

3. Improve core control:

  • More than just sit ups or planks, you need to work your deeper core muscles including your respiratory diaphragm, pelvic floor, transversus abdominus, and multifidi. It is a pressurized system, so make sure you are actively breathing and doing your work on exertion/ exhale.

  • Planks, birddogs, supermans, and all the core exercises you know are good (crunches of any kind are NOT good). Focus more on proper alignment, form, and breathing pattern rather than number of repetitions or speed.

4. Consult a women's health physiotherapist, chiropractor or registered massage therapist:

  • To assess and determine the root cause of the pain and dysfunction.

  • To provide quick and safe treatment to reduce and resolve symptoms and dysfunction.

  • To determine if you would benefit from a compression/ SIJ belt BEFORE you invest.

Published in the Spring 2014 Edition of Ottawa's Prenatal Journal From Belly to Baby.

Photo credit:

Disclaimer - Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.

#pregnancy #SPD #pubicpain

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