Symphysis Pubis Dysfunction (SPD) Pelvic Girdle Pain (PGP) Diastasis Symphasis Pubis (DSP)
The pelvis is a structure which is circular in shape and comprises of three large bones: the sacrum and the two large ilium bones. The two ilium bones are joined together at the front via cartilage and ligaments. These structures make up the symphasis pubis joint. At the posterior the hip bones (ilium) attach to the sacrum via he sacroiliac joints.
The symphasis pubis allows for small amounts of movement which is normal however during pregnancy the hormones relaxin and progestorne cause the ligaments to soften and stretch in order to provide flexibility needed for giving birth. However these hormones may cause pelvic joint instability. Thus pelvic joint instability is often pregnancy-related, occurring either during pregnancy or after childbirth.
Pelvic pain in pregnancy can be related to pelvic girdle (the bones that make up the pelvis) muscle or ligament laxity. Relaxin allows the pelvic bones to shift enough to make way for the baby. Usually, the pelvic bones barely move. Pelvic joint instability may cause them to shift out of alignment. Instability can also be caused by injury during childbirth. Research suggests that as many as 25% of pregnant women experience pelvic pain. Most women recover well from pelvic pain during pregnancy. In about 7% of women, however, pelvic pain may persist after childbirth. In some women, pelvic pain may return during their next pregnancy, regardless of how much time passes in-between.
For most, a regimen of physical therapy and supportive taping will do the trick in controlling pelvic pain during and after pregnancy. In general, the earlier pelvic joint instability is diagnosed, the better the outcome.
Symphysis Pubis Dysfunction
The main function of the symphasis pubis is to hold the pelvis steady during any activity which involves the legs. Thus symphasis pubis dysfunction simply means the joint located at the front of the pelvis is not working correctly. Many symptoms of SPD arise from the joint not being firmly tied by its ligaments thus their role is ineffective resulting in strain being placed on all the pelvic joints.
Normal Gap
The normal gap for a non pregnant woman at the symphysis pubis (the distance between the two sides of the joint) is 4-5mm. However during pregnancy there is an increase in this gap of at least 2-3mm. During pregnancy the ligaments that hold the joint together become slacker due to the influence of pregnancy hormones. A total width of 9mm between the two bones is normal for pregnant women.
Diastasis Symphysis Pubis
Diastasis Symphasis Pubis (DSP) is defined by an abnormally large gap that is represented between the two pubic bones at the symphasis pubis. An abnormal gap is considered to be 10mm or more, sometimes with the two bones being out of alignment. This type of condition is diagnosed through ultrasound, x-rays or an MRI scan. This abnormal gap remains evident after the time that the joint should have regained the normal non-pregnant width.
Symptoms of Pelvic Joint Instability
- Pain at the symphasis pubis joint
- Pain in the groin and lower abdomen
- Pain in the lower back
- Pain and difficulty parting the legs
- Sciatica
- Unusual gait
- Knee pain
- Bladder dysfunction
- Difficulty walking after sleeping or sitting
- Difficulty and pain on walking, climbing stairs, sitting down/standing back up, bending, lifting and getting out of cars/driving
Causes
- Misalignment of the pelvic bones: The bones do not line up correctly causing additional pressure on the symphasis pubis cartilage
- Pelvic misalignment after birth is associated with babies who are born occipital posterior – baby is head down but facing towards the symphasis pubic
- Prolonged and painful labor
- Positions used during labor
- Interventions used during labor- Epidurals make it difficult to tell if unnecessary strain or further damage is occurring
- Hyper-mobility
- Previous trauma or accidents involving damage to the pelvic area
- Multiparity (more than one pregnancy)
- Having large babies
It is important to mention many cases are mild and resolve quickly after the baby’s birth.
Diagnosis
- MRI scans
- X-rays
- Ultrasound
Effects
- Difficulty in day to day activities such as walking
- Difficulty in doing household tasks
- Psychological effects- isolation, resentful, guilty
Treatment
- Stretching- hamstrings
- Strengthening muscles around the pelvis
- Massage
- Acupuncture
- Equal distribution of weight through both legs
- Avoid heavy lifting
- Ice over painful joints to reduce inflammation
- Use a pillow or cushion between your knees when sleeping
- Swimming (not breaststroke) and walking in water
- Rest
- Osteopathy
- Physiotherapy
- Support belt and orthotics
- Surgery
Diagnosing Pelvic Joint Instability
If you suspect pelvic joint instability is causing your pelvic pain, you can expect any of the following at your doctor’s office:
- A verbal history
- Palpation of the pelvic joints
- Manual muscle testing
- Passive range of motion
