Pubic symphysis dysfunction (PSD), what is it? And what can you do about it?

• Research shows that 48-71% of pregnant women suffer from pelvic pain while pregnant. The number of women who suffer from pubic symphysis dysfunction- condition during pregnancy, and sometimes postpartum, is 31%. The symptoms can range from mild to severe. Every pregnancy is different and this condition should not be ignored. Sometimes it’s described as: “shooting” pain, radiating pain, clicking, snapping or grinding, that can be heard or felt within the symphysis pubis. For some women, the pain is manageable, to others is excruciating.

The pain is felt during daily activities: walking, bending forward, standing on one leg, rising from a chair, going up or down stairs, and even turning in bed. Whenever you perform a unilateral movement, you may experience it.

Possible causes of PSD:

• Bio-mechanical strains of the pelvic ligaments and associated hyper lordosis, (lower back lordosis often increases during pregnancy)
• Anatomical pelvic variations
• Metabolic (calcium) and hormonal (Relaxin and Progesterone) changes leading to ligamentous laxity
• Pathological weakening of the joint
• Muscle weakness
• Increased fetal and pregnancy-related weight gain.

It can be a serious condition, and dealing with it will be different for every woman, depending on their situation and severity.

Recommended Pain management:

Physical therapy:

• Soft tissue trigger point therapy
• Lateral recumbent diversified mobilization of the sacroiliac joints
• Pelvic blocks and instrument-assisted pubic symphysis adjustments

Home instructions include:

• Wearing a pregnancy support belt as needed, if you are using a support belt that puts you in the locked position, you need to remember the importance of activating and strengthening your deep core muscles
• Stretching bilaterally the: iliopsoas, quadratus lumborum and piriformis muscles, (muscle activation and specific stretches recommended by your trainer)
• Staying as active as possible, moving as a unit (legs together)
• Icing the pubic symphysis and lower back (as needed)
• Using a pillow between the knees while sleeping
• Regular breaks from sitting
• Doing pelvic floor (Kegel) exercises
• After delivery: Do not carry your baby in a front carrier

Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports
Emily R. Howell, BPHE (Hons), DC, FCCPOR(C)^*

Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts.
Depledge J¹, McNair PJ, Keal-Smith C, Williams M.