One of the goals of my blog is to bring awareness to the pregnancy and postpartum issues that I felt completely blindsided by. If even just one person learns something new and useful, then I’ve done my job. Personally, I know I liked to be prepared for the unknown! So going into pregnancy I tried to be as prepared as possible. I hired a doula, attended birthing classes, read several books and fell into way too many internet rabbit holes. I was obsessed with all things gestation related. But the truth is, no matter how armed and ready you think you are, life will always throw you a couple of curve balls. Today’s pregnancy curve ball is called symphysis pubis dysfunction, or SPD for short. It can cause a crap ton of pelvic pain!
My SPD Experience
If you know me, you know I like to keep active! During the first half of my pregnancy, I was working at a fitness studio, exercising several times a week, and generally feeling good. But close to week 16, after being on my feet for too long or moving my body in just the “wrong” way, my hips, lower back and pelvis radiated with pain. By week 20, I was told to take it easy anyway due to my short cervix (will add a link to that story when it’s done!), but I knew something was really wrong when a simple walk in the park left me hobbling in agony.
Around week 24, I had a physical therapy evaluation and was promptly diagnosed with SPD. At my doctors behest, I started a regimen of twice weekly physical therapy, and biweekly chiropractic adjustments. And let me tell you – it was lifesaving. Within weeks, I was able to function normally again without wincing from SPD’s effects. I still couldn’t return to my normal workout routine of course, but that didn’t matter as long as my baby was safe and I was feeling good. Thankfully, once you deliver the baby, it goes away almost immediately.
I am so grateful I was able to manage my symptoms and get the proper help, but dealing with SPD really threw me for a loop. Why hadn’t I heard about it before? Why isn’t there more easily accessible information out there? It can affect up to 25% of pregnant persons, but many fewer than that are diagnosed. I want to help bridge the gap.
So I’ve decided to add my own resource into the mix! In order to give you the best info I could, I reached out to my former physical therapist, Flora Cohen. Flora is an amazing PT and pelvic floor specialist who rescued me from the excruciating pain that had become everyday life. She always came in with best smile and the warmest vibes, even though I was chronically ten minutes late. Sometimes I really miss our time together!
The following information is to help you learn a bit more about SPD, basically the things I wish I had known about as I prepared for pregnancy. This is not a substitute for medical advice. If you have any questions or concerns regarding your pregnancy, please contact your doctor right away.
What are the basics?
Jess: All I know is SPD is caused by your body making too much relaxin. Relaxin is a hormone which helps your ligaments open up in preparation for childbirth. Too much relaxin, too early on, causes instability in the pelvic region and all sorts of symptoms ranging from simple discomfort to excruciating pain.
Flora: “The two bones of the pubic region begin to slowly separate causing pain. The pubic bones sit above the genitalia and is also referred to as the “crotch bone” sitting in the very front of the pelvis. Because these two bones are held together by ligaments, they are susceptible to compressive and shearing forces making simple everyday tasks painful that even walking to the bathroom may be too debilitating. This is of particular importance because one of the main roles of the pelvis is to be a reliable load bearing structure for both the mother and fetus.”
Are there some signs or symptoms to watch out for?
Jess: Personally, simply walking too much or climbing the subway stairs would cause my crotch bone to yell out pain! I literally remember taking the train to PT and tackling each stair one at a time like a toddler.
Flora: “Symptoms may include pain in the pubic area, groin, inner thigh, sacroiliac area (located in the back of the pelvis) low back and suprapubic region (or area above the “crotch” bone). However uncommon, referred symptoms may even spread into the genitalia. One may also notice swelling in the suprapubic area making the area very tender to touch.
Usually, pain is most evident when standing on one leg say when putting on your pant or shoes, walking, getting into and out of a car, rising from a seated position or turning in bed. In some cases, a mother may have more of a waddle gait than usual from trying to avoid pressure into this area.”
When does SPD start?
As Flora confirms: “SPD can start as early as a woman’s first trimester or later on as the fetus continues to grow, it really can vary. Pretty much as soon as the mother’s hormones start to fluctuate in her first few weeks, SPD can [begin].
Automatic Ad Middle Of Content
Jess: I recently talked to another mom who is experiencing SPD symptoms already at 15 weeks. Her doctor dismissed her concerns as it was “too early on” for SPD. Excuse me what?! I also was starting to feel it around this time, so that is just complete BS. Always advocate for yourself mamas!
Why does it happen?
Flora: “There are many potential reasons as to why a mother may develop SPD. One known cause is joint hypermobility. (If you are one of these people who can take their thumb and bend it backwards, further than most, until it touches your wrist you may have hypermobile joints.) When coupled with pregnancy-related hormones, this creates a perfect opportunity for increased movement and pain in the pubic symphysis.
Other reasons can include previous history of trauma such as a straddle injury, falling down a flight of stairs or even a previous sports injury.”
Can it be prevented?
Flora: “The best prevention is seeking a consult from your physical therapist who can perform a full evaluation and identify which areas of the musculature may require stretching and releasing. If there is significant pain during pregnancy, your physical therapist may recommend the use of a soft belt also known as sacroiliac belt further stabilize this area. The use of this belt is safe during pregnancy and is best utilized with painful activities i.e., walking, transferring from sit to stand, house chores and during exercises if it is comfortable enough for the mom to wear.”
Jess: You better believe that if and when baby #2 comes along, I’ll be seeing Flora ASAP to make sure SPD doesn’t take over again.
Can you have a normal delivery with SPD?
Flora: Absolutely! A mother can still have a normal vaginal delivery or C-section with SPD. However, when the option is available, delivering in different positions may decrease strain into pubic symphysis region.
What’s an at-home exercise one can do?
Flora: “Lay comfortably on your back with your knees bent and feet flat on the floor. Inhale slowly through the nose exhaling as you draw your navel towards the baby. Hold this abdominal contraction for 5 seconds. Release and repeat the same sequence for a total of 5 repetitions.
For mom’s with sensitivity laying on their back, this activity can be performed laying on their side. This exercise is contraindicated if your OB-GYN has advised your against core strengthening, if you experience pain or if you have a diastase recti.”
I really hope this has been useful for all you moms or moms to be! If you’d like to reach out to Flora with questions or concerns, you can reach her at floracohenpt@gmail.com. Flora also works with Union Square Play in offering suggestions to moms and answering questions.