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SPD: Symphysis Pubis Dysfunction

SPD is a problem that can occur in pregnancy, in which the joint at the front of the pelvis becomes unstable and painful. It is the combined effect of hormones that relax the pelvic joints, and the mechanical demand on the joints themselves. Unmanaged SPD can lead to the need for crutches and impact suitable birthing positions. Fortunately, most cases fully resolve spontaneously after birth.

Birthing joint issues

The Anatomy of SPD

The SPD is a problem with the pelvis. The pelvis has 3 joints: two at the back (the SIJs), and one at the front (pubic symphysis). These three joints all affect each other, as the pelvis acts like a ring. Problems with the SIJ may be the first sign that SPD will develop, as additional strain is put on the pubic symphysis.

The pubic symphysis itself is a thick cartilage joint. It is much more mobile than the SIJs, but the cartilage itself can be dislodged by excessive movement.

Symptoms and Diagnosis

Pain is the main symptom of SPD, both focused over the pubic symphysis itself, but also radiating into the abdomen, perineum, back or thighs. It is often worse with movement, especially turning in bed, getting in and out of a car, or sitting to standing. The symphysis itself is usually tender, and there may be a larger gap between the bones than usual. Your osteopath may be able to feel this if you are comfortable to do so, or symptoms and other examinations may be enough to reach a diagnosis.

SPD is more likely in women who perform very physical work in pregnancy, and adversely those who do not exercise. A study suggested that other possible factors include:

  1. weight gain

  2. carrying twins or triplets

  3. having had one or more baby before

  4. previous difficult births


The less severe cousin of SPD is PGP: pelvic girdle pain. This is a term that simply refers to pain anywhere in the pubic symphysis or SIJs. It is important to note that it does not include pelvic organ pain, for which your midwife is your first port of call. Most women develop back pain in pregnancy, which may or may not involve the pelvic joints. Your osteopath can help with ensuring other joints are working well to take some of the load off the lower back.

Managing SPD

Ideally, your osteopath wants to see you with time before the birth to make the change. The shorter the time that you’ve had your symptoms, the better your potential outcome. If you feel yourself getting to the point where you need crutches, do book in with someone who can try to treat some of the factors involved.

Of course we are working against biology to manage SPD, so there is only so much we can do in terms of getting to the bottom of the problem. Some of the buttock muscles often become less efficient, making walking harder and asking more of the pelvis. Work to correct this is a good starting point, and can be consolidated with exercises. Depending on your case, strengthening the muscles that act on the pelvis may be an important strategy too. We can also advise you on changes to lifestyle- if you have to do physical work then there may still be changes that can be made to ease the pressure on the pelvis.


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