Symphysis Pubis Dysfunction, SPD. (Sandy Boniface, DC)
Symphysis pubis dysfunction (SPD), also referred to as pubic symphysis dysfunction, is a common and debilitating condition predominantly affecting women.
It is usually associated with pregnancy and childbirth, with an incidence of up to 1 in 50 pregnancies, but it can continue after childbirth for some women.
It can also be caused by trauma to the area, sports injuries and in some cases osteoarthritis.
The symphysis pubis is found at the front of the pelvis, and together with the sacro-iliac joints at the back of the pelvis, forms part of the stable pelvic ring.
The joint contains a disc, similar to those found in your spine, and is held together by strong ligaments, which need to function effectively to avoid excessive strain on the pelvic joints.
The width of the symphysis pubis is normally about 4-5mm in women (less in men), but can widen by 2-3mm during the third trimester of pregnancy, due to the action of the pregnancy hormone relaxin. This softens the pelvic ligaments, allowing the pelvic joints to widen, and making it easier for the baby to pass along the birth canal. This widening usually decreases within a few days of delivery, but the ligaments can take up to 6 months to tighten up again.
During pregnancy, the increased weight in the abdomen and the weakening of the abdominal muscles, together with the softening of the pelvic ligaments, can lead to instability and misalignment of the pelvic joints, and subsequent pain.
SPD is characterised by pain over the symphysis pubis joint.
The pain can be a mild discomfort or tenderness to the touch, but may become more severe and prolonged, with a burning, stabbing or grinding quality.
It can also be referred to the lower back, the sacroiliac joints, groin, hips, abdomen, perineum (the area between the vagina and anus) and the inner thighs.
Hip mobility, especially moving the legs sideways, may be reduced and painful, leading to a waddling or shuffling gait.
Normal daily activities such as walking, going up and down stairs, sitting down and getting up, getting in and out of a car, turning over in bed, getting dressed, standing on one leg, moving the legs apart, bending down, and lifting may become more difficult and painful to do.
The pain is often relieved by rest, and usually resolves as the ligaments tighten up again after giving birth, but it can be so severe for some women that it affects their quality of life, and can lead to depression, anger and guilt, especially as they may be unable to take care of their baby without help.
Chiropractic treatment can be very successful in improving the function of the pelvic joints and reducing the pain caused by SPD.
Treatment could include soft tissue work, mobilisation of restricted joints, blocking techniques, activator, ice packs to reduce inflammation, exercise advice, and the use of a sacroiliac support belt.
Other advice is to sleep on your side with a pillow between your knees, sit with your back supported and without crossing your legs, sitting rather than standing to perform tasks where possible e.g. getting dressed, go up or down stairs one stair at a time, avoid straddle type movements, keep your legs tightly together when changing positions, avoid lifting, avoid twisting movements, strengthen your pelvic floor muscles, and do not do anything for a prolonged period of time.
If you are suffering from pelvic pain associated with pregnancy and would like further advice or management of your condition, please contact clinic reception for further details. If you would like to request a call back, one of our chiropractors would be happy to speak to you.