SPD in pregnancy


SPD stands for symphysis pubis dysfunction and is the cause of sometimes agonising pain during pregnancy. How do you know how to spot the signs of SPD in pregnancy and what treatment is on offer?

What is SPD?

One of the first signs that you may have SPD is pain that is located over the pubic bone, around the lower back and pelvis and sometimes at the perineum.

SPD is when the pubic bone undergoes excessive or uneven movement; some women report hearing a grinding or popping sound when they are walking. Any movement that involves slight separation of the legs can cause mild to extreme discomfort and motions such getting out a car or walking up and down stairs can be extremely difficult.

What are the causes of SPD?

There is no known singular cause of SPD but it is possible that if excessive weight is gained during pregnancy, this can predispose you to SPD. The position of your baby may also have an influence.

It is possible that there may be a link to pelvic malalignment prior to falling pregnant.

Malalignment can stem from as high up as your mid-back (thoracic spine) and some people have a functional scoliosis that is acquired over time; this can be caused by motions you make at work, for example, or when carrying your kids.

The pelvis then compensates for the problem higher up in your back and can become ‘stuck’ or restricted on one side. The muscles that attach to the pelvis, which includes the abdominal wall muscles, your quads and hamstrings, start to get tight to support the pelvis.

When a woman gets pregnant, the hormone Relaxin allows the joints to separate to make space for the baby.  If the pelvis is already compromised prior to pregnancy, it is thought that this can increase the likelihood of having SPD.

Signs you have SPD

  • You may initially find that you are finding it difficult to weight bear on your legs.
  • Sharp pain over the pubic area
  • The pain may increase when using stairs or getting out a car
  • Throbbing pain in the lower back and both hips
  • Occasional shooting pain into the legs
  • A clicking or grinding sound in the pelvis when walking
  • In extreme cases, some women experience urinary incontinence.

How is SPD treated?

Treatment for this condition is conservative. The aim is to help support the pubic symphysis and reduce the level of pain. If the pain is extremely painful, some women need crutches in order to take the weight off their legs completely. Post-pregnancy, the symptoms of SPD usually diminish quite quickly though it is often important to try to see a manual therapist to ensure that the spine and pelvis return to the correct position. This will prevent any predisposition to sciatica or early degenerative changes.

Tips on helping yourself and when to seek help

  • Where possible, use crutches if the pain is very bad.
  • See a manual therapist like a physiotherapist or osteopath who can help advise on support belts to wear as your stomach grows. The belt will help with stability.
  • Sleep on your side, with a pillow between your knees and a pillow behind your back. Although it’s not the most sociable way to sleep, it’ll prevent you from turning onto your back in the night.
  • Seek help with some pelvic floor exercises.
  • Use a pillow when sitting down in the car or on a sofa. Not only behind your back, but also under your bottom. This will raise the height of your pelvis and make it easier and less painful to get up.
  • It’s always a good idea to get the professional opinion of an expert – some women find relief from gentle massage and osteopathic mobilisation relieving and helpful.
  • Placing an ice pack on the area for five minutes can help reduce any inflammation build up in the area.

Before doing any of the above, it is wise to seek a medical professional’s opinion and inform your GP of any symptoms you are experiencing.

Anisha Joshi (B.Ost.Med ND DO) is an Osteopath and Director of the Woodside Osteopathic Clinic in Hertfordshire & Central London.