Symphysis Pubis Dysfunction (SPD) and Pregnancy-Related Pelvic Girdle Pain (PGP): Relief Strategies

Symphysis Pubis Dysfunction (SPD) and Pregnancy-Related Pelvic Girdle Pain (PGP): Relief Strategies

Pregnancy-related pelvic girdle pain (PGP), often referred to as symphysis pubis dysfunction (SPD), is a common and sometimes debilitating condition affecting many pregnant women. It results from the relaxation of pelvic joints due to hormonal changes, leading to pain and instability in the pelvis. This comprehensive guide outlines evidence-based strategies for managing and relieving SPD/PGP during pregnancy.

Understanding SPD/PGP

SPD/PGP arises when the pelvic joints, particularly the pubic symphysis, become overly mobile due to the influence of relaxin hormone. This can cause pain, clicking, and functional limitations during daily activities. While symptoms often subside after delivery, effective management during pregnancy can minimize discomfort, improve quality of life, and support a safer delivery.

1. Non-Pharmacologic and Lifestyle Modifications

Activity Modification and Movement Patterns

  • Avoid high-impact, twisting, or straddling movements: These can worsen pelvic joint instability.
  • Change positions frequently: Sit, stand, and move regularly; avoid sitting or standing for prolonged periods.
  • Proper posture: Keep shoulders back, pelvis slightly tucked, and maintain balanced weight distribution.
  • Careful movement: When getting in or out of bed or a car, keep knees together, swivel gently, and log-roll to avoid excessive strain.
  • Use supportive devices: Consider crutches, wheelchair, or a pelvic support belt if mobility is limited.

Supportive Devices and Ergonomics

  • Pregnancy support belt: Worn over the lower abdomen and pelvis, these belts stabilize the pelvis, reduce strain, and can provide immediate pain relief.
  • Supportive footwear: Wear well-cushioned, flat shoes with good arch support.
  • Ergonomic aids: Bath boards, shower chairs, raised toilet seats, and bed levers can help reduce strain during daily tasks.
  • Pillow support: Place a pillow between your knees when lying down to maintain hip alignment and reduce pubic joint stress.

2. Physical Therapy and Exercise

Early Referral and Specialized Physiotherapy

  • Consult a pelvic health physiotherapist: Early assessment and personalized exercise plans are essential.
  • Manual therapy: Hands-on treatment (joint mobilization, soft tissue therapy) by specialists can restore normal joint function.

Core and Pelvic Floor Strengthening

Pelvic floor exercises (Kegels):

  • Perform both “slow” and “quick” pelvic floor contractions multiple times daily.
  • Practice tightening the muscles as if stopping urine flow; hold for a few seconds, then relax.

Transverse abdominis activation:

  • Lie on your side or back; draw your belly button toward your spine while maintaining steady breathing.
  • Hold for several seconds, release slowly.

Pelvic tilts and stabilization:

  • While lying on your back or on all fours, gently tilt your pelvis upward to flatten the lower spine against the floor.
  • Repeat regularly to improve stability and reduce lower back strain.

Hip, Glute, and Core Strengthening

Wall squats:

  • Stand with your back against a wall and slowly slide down into a squat position, keeping your knees aligned with your toes.
  • Hold for 10 seconds and repeat 10 times.

Pillow squeeze:

  • Lie on your side with a pillow between your knees; squeeze the pillow to engage your inner thighs.
  • Hold for 10 seconds, release, and repeat 10 times.

Bridging:

  • Lie on your back with knees bent; lift your hips gently off the floor by contracting your glutes and core.
  • Hold briefly, lower slowly, and repeat.

Additional exercises:

  • Cat/cow stretch, hamstring stretches, and gentle yoga or Pilates can improve flexibility and support joint function.

3. Adjunctive Therapies

Heat and Cold Modalities

  • Ice packs: Apply a cold pack to the pelvic area for 10–15 minutes, 2–3 times daily, to reduce inflammation and numb pain.
  • Heat therapy: Warm baths or heating pads can relieve muscle tension and improve comfort.

Hydrotherapy and Aquatic Exercise

  • Water-based activities: Swimming (avoid breaststroke) and water aerobics can decrease joint stress and promote movement.
  • Benefits: Improved function, less pain, and reduced sick days reported.

Transcutaneous Electrical Nerve Stimulation (TENS)

  • Safe and effective: TENS units applied to the pubic area for 30 minutes, three times per week, can significantly reduce pain by activating pain gate mechanisms.
  • Usage: Combining TENS with exercise and pelvic bracing increases symptom relief.

Acupuncture and Massage

  • Acupuncture: Multiple studies suggest acupuncture can reduce pelvic pain and improve function during pregnancy.
  • Massage and myofascial release: Can relieve muscle tension and support movement ease.

4. Pharmacologic Options

Pain Relief Medications

  • Acetaminophen (Paracetamol): Considered safe in pregnancy and effective for mild to moderate pain.
  • NSAIDs: Can be used early in pregnancy under medical guidance but should be avoided after 30 weeks due to potential fetal risks.
  • Prescription pain relievers: Only under direct supervision if non-pharmacologic measures are insufficient.

5. Assistive Devices and Mobility Aids

  • Pelvic support belt: Worn all day except during sleep/showering, and positioned just below the anterior superior iliac spines.
  • Crutches or wheelchair: Recommended for severe mobility limitations.
  • Ergonomic modifications: Encourage side-lying sleep, use of pillows, and careful movement during daily tasks.

6. Lifestyle, Psychosocial, and Delivery Support

Practical Tips

  • Weight management: Maintain a healthy weight through pregnancy to reduce joint strain.
  • Sleep hygiene: Sleep on your side with a pillow between your knees for optimal alignment.
  • Rest and relaxation: Prioritize rest periods and practice stress-reduction techniques.

Emotional and Mental Health

  • Counseling or support groups: Can help manage chronic pain-related distress.
  • Relaxation techniques: Breathing exercises, mindfulness, and guided imagery may improve coping.

Birth Planning

  • Discuss your condition with your birth partner and midwife: Request modifications to your birth plan.
  • Comfortable positions: Consider water birth or side-lying delivery to reduce pelvic strain during labor.

7. When to Seek Additional Medical Help

  • Persistent, severe pain: If pain interferes with daily activities or sleep.
  • Neurological symptoms: Numbness, tingling, or weakness in the lower limbs.
  • Inadequate response to conservative measures: Seek specialist referral for advanced pain management or surgical options if necessary.

8. Summary Table: Key Relief Strategies for SPD/PGP

Intervention Description Key Points
Supportive Devices Pelvic support belt, crutches, wheelchair Stabilize pelvis, reduce pain
Exercise & PT Core strengthening, pelvic floor, hip exercises Performed under guidance
Heat/Cold Therapy Ice packs, warm baths Reduce inflammation, relax muscles
Manual Therapy Physiotherapy, joint mobilization Under specialist care
Adjunctive Therapies TENS, acupuncture, massage Complementary pain relief
Medications Acetaminophen, limited NSAIDs Medical supervision required
Activity & Lifestyle Proper posture, ergonomic aids, careful movement Prevent pain exacerbation

Conclusion

Effective relief of SPD/PGP during pregnancy centers on a multi-modal approach, combining lifestyle modifications, targeted physical therapy, adjunctive therapies, and supportive devices. Early recognition and professional physiotherapy referral are crucial, along with the appropriate use of pelvic belts and pain management techniques. While most women find substantial symptom relief through conservative measures, severe cases may need further medical intervention. Always consult your healthcare provider before initiating any new treatment regimen.

Note: The information provided is for educational purposes only and is not a substitute for personalized medical advice. Pregnant women should consult their obstetrician or physiotherapist for tailored treatment plans.

Cleveland Clinic (source [0] from search results)
NHS (source [1])
RCOG patient info (source [2])
Physiopedia (source [3] not used)
Royal Berkshire PDF (source [4])
PMC3364059 (source [5])
TENS study (source [6])

https://my.clevelandclinic.org/health/diseases/22122-symphysis-pubis-dysfunction“, “https://www.nhs.uk/pregnancy/common-symptoms/pelvic-pain/“, “https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/“, “https://www.physio-pedia.com/Pubic_Symphysis_Dysfunction“, “https://www.royalberkshire.nhs.uk/media/gv5pg45z/physio-pregnancy-related-symphysis-pubis-dysfunction.pdf“, “https://pmc.ncbi.nlm.nih.gov/articles/PMC3364059/“, “https://mjcu.journals.ekb.eg/article_444266.html“

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