Pubic Symphysis Dysfunction (PSD) is a common problem experienced by women in both pregnancy and postpartum, typically resulting in pain or discomfort in the pubic symphysis area.
The pubic symphysis is a cartilage ‘padded’ joint found at the front of the pelvis between the two large pelvic bones called the ‘iliea’, and can be felt just above the genital area.
When this area is in dysfunction, the pubic symphysis area can feel tender and/or painful, making normal activities such as walking or rolling in bed uncomfortable.
What are the symptoms of Pubic Symphysis Dysfunction?
PSD can be expressed as a sharp or dull sensation in the pubic bone area, or even as hip or lower back pain.
The intensity of the pain experienced can depend on the angle of the legs to each other, the type of activity carried out (walking, climbing in/out of the car), or the time of day.
Typically, PSD will worsen towards the end of the day through repeated strain, exacerbated by the physical demands of the growing baby on the pregnant woman’s body.
What causes Pubic Symphysis Dysfunction?
Like many other musculoskeletal problems, PSD often arises from a number of underlying causes.
Structural misalignment throughout the entire spine may contribute to the problem, with often a particularly strong influence from the pelvic ‘sacroiliac joints’.
The sacroiliac joints have a huge influence on the entire alignment and function of the spine. With increases in the hormone ‘relaxin’ and weight gain during pregnancy, the supporting ligaments across the sacroiliac joints are more susceptible to strains and sprains. These ligaments are filled with highly sensitive nerve endings which, when strained, tell the brain to trigger a protective muscle-splinting response around the pelvic joints to help support the structural weakness
It is this defensive nerve-muscle-splinting response which over time can create the abnormal muscle pull, creating pelvic misalignment.
Several muscles which can be involved in pelvic misalignment attach near the pubic symphysis: the adductors (inner thigh muscle) and the abdominals. The abnormal pulling force of these muscles experienced during pregnancy may irritate and inflame the pubic symphysis causing PSD.
What are other possible symptoms of Pelvic Misalignment?
The pelvis and body can compensate to abnormal strain and stress in many different ways, particularly during pregnancy. In addition to PSD, symptoms of pelvic misalignment may include a ‘catch in the hip’, sciatic nerve pain, lower back pain, even lower limb problems like knee and ankle pain (1, 2).
What can be most confusing to some people is that the symptoms of pelvic misalignment can move around the body, expressing itself as PSD one day and hip pain or sciatica the next.
One very important but often overlooked relationship is that between pelvic subluxation and weakened core muscle strength (3). This occurrence can explain why some women find it very difficult to build strength, particularly once their baby has been born, even when they are exercising regularly.
Quite often, a pregnant or postpartum woman with a subluxated pelvis will report feeling like they are out of alignment due to the impact on muscles which directly affect posture. Combine this with the hunching forward and turning of mum’s neck to breastfeed their baby, and the entire body can feel pretty stiff and out of sorts.
What to Avoid
Swimming can be a great form of exercise at any stage of life and can help you keep moving during the heavier, weight-bearing stages of pregnancy. But it is best to avoid breaststroke movements of the legs whilst pregnant as this can further exacerbate any pelvic problems. To prevent too much twisting of the hips and pelvis, it is best to swim freestyle which keeps the legs relatively straight and together.
Crossing your legs while sitting is a big no-no as it can strain the pelvis generally, including the pubic symphysis joint. This positioning of the legs is also not ideal for foetal positioning. Even if you don’t have PSD or pelvic pain, it’s a good idea to avoid crossing your legs while sitting.
Wearing high heels is one of the greatest contributors to pelvic instability and lower back pain but some woman just don’t feel complete without them! If this is you, try opting for a low heel or even better, a low wedge heel for greater stability.
Sleeping can prove challenging with PSD due to ongoing pain in the pelvic region. As it is not recommended that you lie on your tummy (ouch!) or back during pregnancy, it is important to make sure that your pillow height is correct for side-lying. A simple check is to lie down on your pillow and see if your shoulder wants to tip forward or backwards behind you. Start with a low pillow and keep adding towels (about a centimetre at a time) until your shoulder feels balanced. Then add a large pillow for you to rest your top knee on. Some people prefer to place a pillow between their knees.
Spinal adjustments work by activating the nerves around the sacroiliac joint to restore proper communication to the nervous system, helping balance muscle function. New evidence demonstrates that adjustments not only improve joint and muscle function but also help maximise the benefits of exercise. Combining chiropractic adjustments with exercise has been shown to result in better resolution of pain in comparison to the effects of either exercise or adjustments in isolation (4).
There have been great technological advances with how chiropractic adjustments can be delivered using the Chiropractic Adjusting Instrument, which is a tool aimed at delivering a gentle amount of corrective pressure to a specific area of the body. The instrument can be directed into the problem joint without mum having to be moved into a position that is not comfortable for the growing belly.
The adjusting instrument has been scientifically designed to maximise nerve function to restore proper joint motion. Because the speed is rapid (100x faster than by hand) but over a very short distance, the adjustment feels like a light vibration.
Many chiropractors who have a special interest in pregnancy, also use specifically designed pregnancy cushions for the belly and chest areas, and treatment tables to accommodate the growing belly and baby in complete comfort.
Core strengthening exercises/muscle treatment
Some practitioners use core strengthening exercises to balance pelvic function, while others may use muscle treatments for the adductor muscles like massage, Tens Machines, and heat and cold packs, which can also offer relief from debilitating pelvic pain.
Sacroiliac belts are designed to support the unstable sacroiliac joint and prevent excessive motion which can further sprain or tear the ligaments across the joint. Some body types work better with different types of belts, which can provide incredible support to the pelvis and can help adjustments maintain their effectiveness for longer.
It is important to understand that you do not have to put up with annoying pain associated with pelvic instability and PSD during and pregnancy. There are ways that you can help yourself by modifying your activities, and there are practitioners who can help you to cope with the daily rigours of life during pregnancy and beyond.
– by Alan Brown from Windsor Chiropractic
(1). Schamberger, The Malalignment Syndrome: Implications for Medicine & Sport, 2002, Elsevier
(2). Bernard & Kirkaldy-Willis, Clinical Orthopaedics and Related Research, 1987: 217(266-280)
(3). Hungerford, et al, “Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain,” Spine, 2003:38
4). UK BEAM. United Kingdom back pain exercise and manipulation randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1377.