Ouch! Understand SPD in pregnancy and 3 of the best exercises to help
Waddle baby, waddle baby! I see you mama: you’re over the thrill of being pregnant and starting to feel a little (or a LOT) uncomfortable.
Maybe you’re feeling some aches and pains for the first time, or those pesky problems that waited till 3rd trimester with your last pregnancy are now showing up WAY sooner. UGH!
As a pelvic floor therapist specializing in pregnancy and postpartum, one of the most common issues I treat is SPD in pregnancy, or symphysis pubis dysfunction, which is pain right over the thick joint that connects the two sides of your pubic bone.
Maybe you’ve been experiencing:
Tenderness right underneath your baby bump
Difficulty walking or a feeling of walking “weird”
Inner thigh pain
Difficulty standing on one leg
Difficulty or pain climbing stairs
We’ll dive into these symptoms and more in today’s post, all about SPD in pregnancy, exercises to help, and when to seek out more assistance from a pelvic floor physical therapist.
SPD in pregnancy is just one form of pregnancy-related pelvic girdle pain.
Pelvic girdle pain in pregnancy is a general term to describe pain in the area of the pelvic region - which can include pain in your low back (who doesn’t have lower back pain during pregnancy?), hips, SI (sacroiliac) joints - which just describes where your sacrum meets your ilium bones - those butterfly wing-shaped bones that make up the majority of your pelvis.
One of the most common areas to feel pelvic girdle pain is right over the symphysis pubis - which is where your pelvic bones join in the front.
Where is my symphysis pubis?
To feel where these bones join together, use your fingertips or the heel of your hand to go downward from your belly button along the soft part of your belly until you hit bone. That is the top of your pubic symphysis joint. It joins the two symmetrical pubic bones together with a thick, fibrous disk.
The symphysis pubis joint itself is very, very thick and strong - from the top of the pubic bones, you can keep following the bones and joint further down until it drops off - right around the opening of your labia minora and vagina. (this is why sometimes experiencing sharp pain in the vaginal area can ACTUALLY be SPD in pregnancy)
What are the symptoms of SPD in pregnancy?
The most common symptoms of SPD in pregnancy are:
Tenderness over the symphysis pubis
Sharp pain in vaginal area, particularly with movement
Difficulty walking or a feeling of walking “weird”
Pain getting in and out of bed
Inner thigh pain
Difficulty standing on one leg
Difficulty or pain climbing stairs
Why is SPD in pregnancy so common?
Pelvic girdle pain can happen to anyone, but it is particularly common in pregnancy, with SPD in pregnancy being one of the most common manifestations. Typically, the joints of the pelvis, particularly the symphysis pubis, are meant to be VERY stable - they support the whole weight of your upper body and control the stability and movement of your lower body .
(that’s why when I see someone with ankle or knee pain, I ALWAYS look at the pelvis too, and typical treat from the pelvis down… but that’s for another blog post!)
But SO many changes in the body contribute to the development of SPD in pregnancy.
Some of the main reasons SPD in pregnancy develop are:
The hormonal changes of pregnancy, particularly relaxin, can cause this joint to become more mobile than usual
The symphysis pubis joint supports a LOT of weight as it is, and has to work harder as your belly grows
Shifts in your posture and center of gravity put additional pressure on the symphysis pubis joint during pregnancy
Hormonal changes that can contribute to SPD in pregnancy:
The hormone relaxin helps to prepare your pelvis for birth by allowing it to be more mobile than it would be otherwise. If it can move, it can open to allow your baby to pass through.
This is a good thing! However, since these joints are meant, under normal circumstances, to be super stable, when they move too much without the support of the surrounding muscles, they can get unhappy.
2. The Symphysis Pubis supports a bigger load during pregnancy (literally)
When you think about it, your pelvis supports your ENTIRE upper body, and the movement that comes from your legs starts with having stability at the pelvis.
This is why it is essential that the pelvis stays strong and stable ALL the time, but particularly in pregnancy.
The physical demand on the pelvis, and particularly the symphysis pubis, increases as your belly grows - it’s not just a tiny baby in there, it’s TONS of extra fluid, the placenta (a whole giant organ your body grows to nourish your baby), and often extra weight that your body puts on for pregnancy.
All of this amounts to a MUCH greater force that your pelvis must HOLD UP, while also supporting the necessary movement of your spine and lower body.
3. Shifts in your posture and center of gravity during pregnancy change the entire movement system
SPD in pregnancy often gets attributed to 1 and 2 above - and is unfortunately used to gaslight a lot of mamas into believing nothing can be done because “this is just a part of pregnancy.”
Let’s not blame everything on relaxin and excess weight!
The truth is, pregnancy changes the way your whole movement system works. For example:
Your center of gravity changes as your belly grows, so your brain has to recalibrate where your different body parts are and adjust accordingly.
Our -very smart- bodies compensate for this with postural changes, such as shifting the hips forward and arching the back slightly
Which can change the way you are utilizing your hip and core muscles
which can then contribute to and exacerbate the pain patterns I see in women with SPD during pregnancy.
This is why if you suspect you have SPD in pregnancy, it is so important to get an assessment of your movement patterns from a pelvic physical therapist (particularly one who specializes in pregnancy) - rather than assuming you just have to live with it until the baby comes.
Getting a plan to strengthen your core, pelvic floor, and hip muscles to meet the demands of your changing body can help to reduce or prevent pain from SPD in pregnancy.
In addition, working on this now can help prepare your body for the physical demands that come once baby is here (HELLO that car seat is HEAVY!) to have a smooth postpartum recovery.
(If you are wanting to make a plan to strengthen your body to have a smooth, pain-free pregnancy and easy postpartum recovery, I can help with that!)
places.
What can I do about SPD in pregnancy? Do I just have to be in pain my whole pregnancy?
If you suspect you have SPD in pregnancy, it is so important to get an assessment of your movement patterns from a physical therapist (particularly one who specializes in pregnancy) - rather than assuming you just have to live with it until the baby comes.
Unfortunately, I hear very commonly from my clients that their OBGYN or midwife told them some version of, “sorry, you just have to deal with this, it’s part of pregnancy.”
Well guess what? There IS much that you can do to help with SPD in pregnancy (and prevent SPD in future pregnancies).
You CAN feel better and you do not have to live in pain!
PRETTY PLEASE don’t listen to any provider that tells you that this is something you just have to deal with. You deserve to feel great your whole pregnancy!
Do chiropractic adjustments help with SPD in pregnancy?
It’s definitely great to get an assessment from a trained professional like a pelvic health physical therapist and/or a chiropractor who can help you calm down your symptoms and inflammation.
Getting chiropractic adjustments can help to get your pelvis into more ideal alignment, calm the nervous system, and be a helpful part of your bigger care plan for SPD in pregnancy.
However, without training your core, hip, and pelvic floor muscles to support the changes in your body during pregnancy - you’ll likely have to keep going back week after week.
Seeing a chiropractor can help with SPD in pregnancy (and I encourage it as part of routine pregnancy care!), but getting better pelvic alignment only goes so far.
To make the pain STAY away (and even prevent SPD in pregnancy from the get-go), we need to train your body to meet the demands of your changing hormones, postures, and movement system.
A pelvic floor physical therapist can teach you how to make sure that pain STAYS away, and also how to help your body prevent SPD from the get-go.
(This is especially important if you had SPD in a previous pregnancy and are pregnant again. It is really common for problems that showed up at the END of your last pregnancy to come on SOONER the next time)
While alignment can be important, learning specific exercises to help SPD in pregancy can help you to stabilize your core, hips, and pelvic floor and beyond so that you can have a pain free pregnancy (and beyond!)
Keep reading to learn my favorite exercises to help with SPD in pregnancy!
3 of my favorite exercises for SPD in pregnancy:
A little disclaimer: Please note that depending on the severity of SPD, some of these exercises may not be appropriate for you. That’s why I ALWAYS recommend seeing a pelvic health specialist and someone trained in safe exercise for pregnancy before trying these.
And remember, it’s always better to prevent SPD - so even if you ARE NOT having problems now, It’s a good idea to incorporate these exercises to help you have a pain-free, enjoyable pregnancy.
With those disclaimers, here are my favorite exercises for SPD in pregnancy.
These exercises will help increase muscular control over the movements of your pelvis, low back, and hips to prevent and heal SPD in pregnancy from the root.
Clamshells:
Lay on your side with your knees bent. Your knees should be at about a 60 degree angle from your hips, and bend your knees 90 degrees so your heels are in a straight line underneath your bottom.
Keeping your heels together, lift your top knee, hold at the top for one second, and SLOWLY lower it back down. Relax completely, then repeat. Shoot for about 20 repetitions. You should feel this in your “side-butt” muscle, not your inner thighs or the front of your hip.
2. Hip Bridges
Lay on your back with your knees bent.
Squeeze your bottom to lift your hips up, keeping your back from over-arching. Lower down slowly, thinking about keeping your feet rooted into the ground to get good gluteal muscle activation.
(You should feel this in your butt; if you feel it in your back and it causes pain, you may need additional help with your form by working with a pregnancy exercise specialist.)
Modification option for super pregnant mommies: if laying down flat is uncomfortable for you, try a hip thrust instead, starting by sitting on the floor, knees bent, and your midback resting on an ottoman or a weight bench)
3. Modified Bird Dog
This exercise will teach your body to stabilize your pelvis as you shift your weight , which is likely one of the factors that led to the development of SPD during pregnancy.
I LOVE A BIRD DOG - all the reasons why deserve their own blog post! But if you are having current SPD pain, tread lightly as this may aggravate your symptoms since it involves shifting the weight from one leg to another. The goal is to improve your tolerance (and your core system’s ability to stabilize you) during weight bearing and weight shifting while ALSO avoiding a flare up.
Here’s how to do it:
Get on all fours and keep your back straight (think, the in-between of a Cat-Cow, not too much arch either way).
Slide one foot back while keeping it on the ground, and then lift your opposite arm.
Hint: Imagine you have a glass of water on your low back and you don’t want it to tilt over -
You want to keep your pelvis from rotating AND you want to minimize the amount you are shifting your weight to the stationary leg so you can get better core activation - you will likely find it’s hard to do this!
If it’s impossible to do this without lots of wobbling, you can modify further by alternating ONLY arms, or ONLY legs.
There you have it- my favorite exercises for SPD in pregnancy!
There you go! I hope this blog gave you helpful information on the signs and symptoms of SPD in pregnancy, why it is so common, and exercises you can try have an amazing, pain-free pregnancy!
Remember, these exercises are a great starting point to get your gluteal muscles and core system firing and reduce pain for SPD in pregnancy.
You may find you need more robust program to heal your SPD in pregnancy and prevent future flare ups. This is a shameless plug to schedule a pregnancy consultation (virtual or in-person) with me - this is EXACTLY what I help mommies like you with! Not sure what you need? Fill out a contact form and I’ll get back to you ASAP!
BTW HI! I’m Dr. Jackie Roelofs, a pelvic floor physical therapist in New Orleans specializing in pregnancy and postpartum, and I offer virtual coaching services everywhere.
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