Overview:
Symphysis pubis dysfunction (SPD) is a common musculoskeletal condition characterised by pain and instability in the pelvic region, specifically around the symphysis pubis joint. SPD typically occurs during pregnancy due to hormonal changes and increased strain on the pelvic joints and ligaments. However, it can also affect individuals outside of pregnancy, particularly those with pelvic trauma or structural abnormalities.
Anatomy:
The symphysis pubis is a cartilaginous joint located at the front of the pelvis, connecting the pubic bones. During pregnancy, hormonal changes, particularly elevated levels of relaxation, soften the ligaments and cartilage surrounding the symphysis pubis to accommodate foetal growth and facilitate childbirth. However, excessive laxity or misalignment of the pubic joint can lead to instability and pain.
Causes:
Symphysis pubis dysfunction can be attributed to various factors, including:
- Pregnancy-related changes: Hormonal fluctuations, increased weight, and altered posture during pregnancy can place additional stress on the pelvic joints and predispose individuals to SPD.
- Previous pelvic trauma: History of pelvic injuries, such as fractures or dislocations, may weaken the pelvic ligaments and contribute to instability or misalignment of the symphysis pubis.
- Overuse or repetitive stress: Activities that involve repetitive movements or excessive strain on the pelvic area, such as heavy lifting or high-impact exercises, can exacerbate pelvic joint dysfunction and lead to pain and discomfort.
Symptoms:
Common signs and symptoms of symphysis pubis dysfunction include:
- Pelvic pain: Dull, aching, or sharp pain in the pubic area, groyne, hips, lower back, or thighs, aggravated by weight-bearing activities or changes in position.
- Difficulty walking or climbing stairs: Impaired mobility and discomfort with weight-bearing movements, particularly during activities that involve separating or spreading the legs.
- Pelvic instability: Feeling of “giving way” or instability in the pelvic region, especially when standing from a seated position or transitioning between movements.
- Painful movements: Discomfort or sharp pain during activities such as standing on one leg, rolling over in bed, or lifting heavy objects.
Diagnosis and Tests:
Diagnosing symphysis pubis dysfunction typically involves:
- Medical history and physical examination: Healthcare providers assess symptoms, medical history, and conduct a physical examination to evaluate pelvic alignment, range of motion, and tenderness around the symphysis pubis.
- Pelvic imaging: X-rays, ultrasound, or MRI scans may be ordered to visualise the pelvic joints, assess for any structural abnormalities or signs of pelvic instability, and rule out other underlying conditions.
Management and Treatment:
Management and treatment options for symphysis pubis dysfunction aim to alleviate pain, improve pelvic stability, and enhance functional mobility. Treatment strategies may include:
- Pelvic support: Wearing supportive garments or pelvic support belts to stabilise the pelvic joints, relieve pressure on the symphysis pubis, and reduce pain during weight-bearing activities.
- Physical therapy: Engaging in specialised exercises and manual therapy techniques under the guidance of a physical therapist to strengthen the pelvic floor muscles, improve core stability, and promote optimal pelvic alignment.
- Pain management: Using heat or cold therapy, over-the-counter pain relievers, or prescribed medications to alleviate pelvic pain and inflammation, as recommended by a healthcare provider.
- Modified activities: Avoiding high-impact or strenuous activities that exacerbate pelvic pain, and adopting proper body mechanics and ergonomic strategies to minimise stress on the pelvic joints.
Prevention:
Preventive measures to reduce the risk of symphysis pubis dysfunction include:
- Maintaining a healthy weight: Achieving and maintaining a healthy body weight can reduce excess strain on the pelvic joints and ligaments, promoting pelvic stability and minimising discomfort.
- Practising safe exercise techniques: Incorporating low-impact exercises, such as swimming, stationary cycling, or prenatal yoga, can help improve muscle strength and flexibility without placing undue stress on the pelvic area.
- Using supportive equipment: Utilising ergonomic seating, supportive footwear, and assistive devices to minimise pelvic strain during daily activities and promote optimal pelvic alignment.
Outlook / Prognosis:
The outlook for individuals with symphysis pubis dysfunction depends on various factors, including the severity of symptoms, underlying causes, and effectiveness of treatment interventions. With appropriate management strategies, most individuals experience symptom relief and improved pelvic function over time. However, some cases of SPD may persist or worsen, necessitating ongoing management and support to enhance quality of life.
Living With:
Living with symphysis pubis dysfunction involves implementing practical strategies to manage symptoms, optimise pelvic stability, and support overall well-being. By adhering to treatment recommendations, practising self-care techniques, and seeking appropriate medical guidance, individuals with SPD can effectively manage their condition and achieve improved pelvic health.
