Pubic Symphysis Dysfunction (SPD): What is It? What Can Pregnant Mamas Do?
How many symptoms during pregnancy and postpartum are written off because they are considered “normal,” even if they cannot be fully explained? Your feet are getting bigger? Pregnancy. Your hair is thinning? Postpartum. What about one of the most common symptoms—pelvic pain? Pregnancy or postpartum can be the culprit, and there is not much you can do about it; maybe if it gets very severe, you could use a wheelchair. This normalization of pain, whether mild or severe, is doing a huge disservice to pregnant people everywhere, setting the expectation that you are resigned to being in pain throughout your pregnancy and possibly for many months postpartum. Let’s demystify pelvic pain—specifically pubic symphysis dysfunction—and explore how you can address the issue with the goal of reducing pain and promoting functional healing.
Pubic symphysis dysfunction is the cause of pelvic pain for many people, especially during pregnancy. The pubic symphysis is a joint at the front of the pelvis where the two pubic bones meet, joined together with fibrocartilage, which is tough but still flexible. During pregnancy, the body produces a hormone called relaxin, which softens joints throughout the body to increase mobility and help with vaginal birth. During a vaginal delivery, the pubic symphysis joint allows the pubic bones and pelvis to open more as the baby travels through the birth canal. We need this mobility to safely allow for birth; however, since relaxin is produced as early as 8–12 weeks into pregnancy, these joints begin softening long before delivery. This can result in instability, and at the pubic symphysis, it can cause a gap or separation between the bones or a shearing movement at the joint, causing pain. This pain can be sharp and shooting—especially with walking, going up stairs, or single-leg movements such as lunging. It can also present as a dull, bruised feeling to the touch or as aching throughout the day.
Pubic symphysis joint instability can be compounded by decreased core strength during pregnancy, as well as tension in the pelvic floor muscles and supporting structures. Relaxin is also produced during the menstrual cycle to help relax the uterus and promote shedding of the uterine lining, so people may experience pelvic pain outside of pregnancy as well. So, what can be done about pubic symphysis dysfunction?
Here are Ways to Prevent Pubic Symphysis Pain or Relieve it Once it Has Started:
Strengthening your Deep Core:
The transverse abdominis muscle helps stabilize the pubic symphysis joint, but during pregnancy it can become underactive as the baby grows. Working on movements that gently draw the baby toward the spine can help maintain strength and support throughout every trimester.
Strength Building Around the Pelvic Complex:
There can be fear around pregnancy and lifting, and some people are told to avoid it entirely. However, lifting during pregnancy is safe (barring other medical conditions or concerns related to blood pressure or cardiovascular health) and highly beneficial. Following a program that loads and strengthens the gluteus maximus, gluteus medius, adductor group, and hamstrings can reduce the risk of pubic symphysis separation and decrease pain.
Pelvic Floor Training:
Pelvic floor therapy during pregnancy is an invaluable tool to help people understand how their pelvic floor impacts functional activities and may be a key piece of the pain puzzle. Addressing tension and weakness, and promoting mobility are all incredibly important for pain management during pregnancy, ensuring you can remain active in whatever way works for you. Additionally, pelvic floor training can help prepare you for birth, assist with pushing, reduce tearing, and promote confidence—so it’s a win all around. If you are already experiencing pubic symphysis pain, you can try the following strategies to help manage and reduce symptoms:
Before standing up, exhale to engage your deep core and brace.
Limit movements where your legs are wide apart, as this can aggravate pelvic pain.
Common activities where this is noticed include rolling over in bed or getting out of a car.
Try squeezing a pillow or block between your knees as you roll over (as long as it does not worsen pubic bone pain) to help support the joint.
When getting out of a car, turn your whole body toward the door so you can stand with both feet together rather than stepping out with one leg first.
Modify daily activities to protect the pubic symphysis joint. Instead of standing on one leg to put on pants or socks, sit down to get dressed. If you go up and down stairs frequently, try going up sideways to reduce shearing forces.
Wear a belt or band. If your belly feels heavy and you are experiencing a lot of pelvic pressure, an elastic band that provides lift may help relieve symptoms during daily activities. A more rigid support band that stabilizes the pelvic bones can be very relieving and may help prevent worsening of a separation. If belts or bands are uncomfortable, compressive clothing such as supportive undergarments, leggings, or tight shorts may also be helpful.
Pelvic pain is not something you are forced to live with, and you are not alone in experiencing it. Research has shown that 1 in 4 women may experience pubic symphysis dysfunction. There is growing evidence that exercise, strengthening, movement, and external support are effective ways to manage symptoms—and possibly avoid them altogether.
If you are a new or expecting mom in Denver, CO, we are here to help you. We utilize all of the above skills and many other techniques including massage and pelvic bone realignment in order to help decrease pubic symphysis pain. Our primary focus is working with pregnant and postpartum clients, so we are the leading specialists in pubic bone pain in the Denver Metro Area. If you are interested in chatting more about your symptoms, please feel free to text or call our office number or book a free 15 minute phone consultation here:
Sources:
Depledge, J., McNair, P. J., Keal-Smith, C., Williams, M. (2005). Management of symphysis
pubis dysfunction during pregnancy using exercise and pelvic support belts, Physical
Therapy 85(12) Pages 1290–1300, https://doi.org/10.1093/ptj/85.12.1290
Shim, J. (2025). Exercise-based intervention of symphysis pubis diastasis: A systematic review.
Korean Journal of Neuromuscular Rehabilitation 15(4).
