Pubic Bone Pain (SPD)
Condition Overview
Pubic bone pain aka symphysis pubis dysfunction (SPD) falls under the umbrella term of pregnancy related pelvic girdle pain (PGP). PGP is related to an increase in hormones causing ligaments and joints to be more lax allowing your pelvis to expand and accommodate a growing fetus. However, this laxity can lead to instability, pain, and difficulty getting around on a day to day basis. SPD specifically is felt in the front of your pelvis at the pubic bone; it can feel sharp and shooting, and may radiate to your groin, vagina/perineum, or abdomen.
SPD Signs and Symptoms
If you are experiencing SPD, you may or may not hear a clicking sound in the front of your pelvis. However, pain increases when walking, rolling over in bed, moving your legs apart rather quickly (such as getting out of a car), standing on one leg, and going up or down stairs.
Our pelvic floor is a basket of muscles that attaches to the pubic bone and slings to the tailbone and SIT bones on each side. During pregnancy, these muscles are naturally lengthening, so with on top of ligament laxity, these muscles tend to need to work a little harder during pregnancy to keep the pelvic structure stabilized. Other muscles that attach to the pubic bone and play a major role in stabilizing this area are the inner thigh muscles, glute muscles, and abdominal muscles. Therefore, it is necessary to assess muscle tone, strength, and coordination of all of these systems in order to prevent and manage pubic bone pain through the entirety of your pregnancy.
What Can Physical Therapy Do?
At Nola Pelvic Health, we offer a 4 session package of childbirth preparation - this typically works best for those who are not having many symptoms. However, if you are having symptoms this may be a good place to start and we can add sessions as necessary to make sure you feel your best throughout your pregnancy and onward.
In physical therapy, we will discuss all pelvic health related symptoms including bladder, bowel, sexual health, and gynecological history (including previous births and pregnancies). We will then do a thorough muscle assessment of all muscles attached to the pelvic structure. This includes the abdominal wall, the glutes, the inner thighs, and the pelvic floor.
In your second and third trimester we may perform an internal pelvic floor muscle assessment with your consent. Testing these muscles helps us determine their muscle tone, tenderness, strength, endurance, and coordination.
Assessing the abdominal wall allows us to assess your pressure management and note if you have diastasis recti abdominus (DRA). If this is occurring you may have deeper core weakness and it could be causing more pressure to your pubic bone.
With our findings, we will educate and instruct you on improved pressure management and appropriate body mechanics for functional activities throughout the day including but not limited to getting into and out of bed/chair/car, lifting/carrying, and changing your clothes. We will review your exercise routine and offer modifications to reduce pain at pubic bone during or after exercise as well as provide a thorough warm-up and cool-down routine.
If there is mal-alignment of your pelvic structure, we may perform pelvic mobilizations to improve stability throughout the day as well as offer options for pubic bone and sacroiliac joint stabilization belts. If you are experiencing a lot of pain prior to being seen by the therapist, try to reduce single leg activities, prevent deep squatting or lunging, sit down to change your clothes and shoes, and ice the area at the end of the day.
Pain can cause muscle tension and tenderness, so our main goal will be to improve the tissue length and sensitivity as we near your due date so you can have an effective labor and delivery. It is rare but possible for these symptoms to continue into the postpartum phase, so be sure to schedule an appointment 6 weeks postpartum to ensure good muscle tone and function in order to return to your normal activities pain free!
Reach out and schedule an appointment if you are pregnant and looking for guidance through the process of pregnancy, labor, delivery, and postpartum