What is SPD?

Symphysis Pubis Dysfunction, now referred to as Pelvic Girdle Pain, affects up to one in four women during pregnancy.  It causes pain in or around the pelvis and affects normal things we do like walking, turning over in bed and climbing stairs.

Traditionally it was thought that PGP was caused by the increase in hormones such as relaxin, and it was thought there was nothing that could be done about that. More up-to-date studies show that in fact it is the movement (or lack of it) in the pelvic joints at the back, the sacro-iliac joints, which causes the problem, and this is very good news as it means that it can now be treated.

The Pelvic Girdle, also called the hip girdle, is composed of two innominate (hip) bones. The coxal bones are also called the ossa coxae or innominate bones. During childhood, each coxal bone consists of three separate parts: the ilium (denoted in purple above), the ischium (denoted in red above), and the pubis (denoted in blue above). In an adult, these three bones are firmly fused into a single bone. In the picture to the right, the coxal bone on the left side has been divided into its component pieces while the right side has been preserved.

In the back, these two bones meet on either side of the sacrum. In the front, they are connected by a joint called the pubic symphysis (denoted in green above). Another function of the pelvic girdle is to be a link between the trunk and the legs, which is why PGP can result in pain when walking.

The pelvic girdle serves several important functions in the body. It supports the weight of the body from the vertebral column. It also protects and supports the lower organs, including the urinary bladder, the reproductive organs, and the developing foetus in a pregnant woman.

The pelvic girdle differs between man and woman. In a man, the pelvis is larger and the iliac crests are closer together. In a woman, the pelvis is more delicate and the iliac crests are farther apart. These differences reflect the woman's role in pregnancy and delivery of children. When a child is born, it must pass through its mother's pelvis. 

**The picture above is of a female pelvis. All divisions are approximations only.** 

In PGP, the pelvic joints, which should work together in a ring-type system, are not working normally. Often one joint becomes stiff and this causes irritation in the other joints (you may not even feel pain in the stiff joint). By treating the stiff joint, a manual therapist can help the joints to function normally again, and allow the irritation at the painful joint to settle.  

It is assessed, managed and treated in the same way, whatever the cause and whenever it started. So if you have pelvic pain during or after a pregnancy, ask for treatment. It is important to remember that PGP is a common and, in most cases, treatable condition. It can be safely treated at any stage of pregnancy, and this can be done by any physiotherapist, chiropractor or osteopath who has had training and experience in treating pelvic joint problems. 

Using water for your labour and birth is particularly helpful for women with PGP

It may be necessary to consider your PGP when planning your birth; as you may not be able to move around as easily as you would have liked during labour. Using birthing pools can be very helpful as it allows you to move freely without gravity, so you can change position easily and comfortably, as well as giving all the usual pain-relieving benefits of labouring in water . 

Women who have had severe PGP have successfully laboured and given birth in water, both in hospital and at home, and felt that their positive birth experience has helped their overall recovery. It is helpful to avoid positions where your legs move apart using pain in your pelvis, so try to avoid lying on your back or putting legs in stirrups. As a woman who has had PGP herself, the Chairman of the Pelvic Partnership, Sarah Fishburn, is an advocator of using water for labour and birth, and her birth story is incredibly empowering.

After you have had your baby, try to make sure your PGP is completely better and that you are back to your pre-pregnancy level of activity.  If this is not happening, do keep asking for treatment or a second opinion from another therapist.  This is particularly important if you are planning another pregnancy.  Unfortunately, if you have had PGP once, you are very likely to experience it again in another pregnancy. However, forewarned is forearmed, and you are likely to deal with it more effectively next time round as you will know exactly what it is and where to find the treatment you need.

Download a membership form to join the Pelvic Partnership and receive some valuable information to support you through this time. Their website is a font of information and has been recently revised.

Special thanks to; Applegate, Edith J. The Anatomy and Physiology Learning System: Textbook. W.B. Saunders Company. Philadelphia. 1995 and Van De Graaff, Kent M. Human Anatomy 5th Edition. WEB McGraw-Hill. Boston, MA. 1998  http://www.mnsu.edu/emuseum/biology/humananatomy/skeletal/pelvic/pelvic.html and the Pelvic Partnership for their help and information.