Not so long ago, treating women through their pregnancy and into parenthood was an academic interest of ours, a specialty area of practice that we enjoyed. Then I injured my pelvis late in my first pregnancy (moral of the story is not to jump puddles when one is 8 months pregnant) and it became much more real. The pain was intense, at times debilitating, and to be honest a bit frightening about how I would give birth when I could barely get myself out of bed. I always knew I would have osteopathic treatment to help, I just wanted to try regular maternity services first to see how they worked for me. My Lead Maternity Carer (LMC) gave me a support belt which succeeded in making me hot and uncomfortable, probably more than a little grumpy, but most importantly it didn’t change my pain. What fixed it was a few sessions of osteopathy combined with someone else telling me to slow down, some home exercises and stretches and a lot of frozen peas. This experience changed our academic interest in pregnancy related problems to a real passion. Textbook knowledge of how debilitating SPD can be is very different to being on the end of it, or living with someone with it for that matter!
SPD stands for Symphysis Pubis Dysfunction – quite a mouthful and hence it is usually referred to by its abbreviation. Essentially, it describes some kind of dysfunction or injury to the joint at the front of your pelvis. What it doesn’t do is describe what type of dysfunction or injury has occurred, and therefore a diagnosis of SPD doesn’t in itself tell you what sort of treatment will be helpful. A SPD issue for example that stems from very tight inner thigh muscles that occur as your body adapts to pregnancy, will need a very different approach than a true joint separation and again will be different to a ligament strain of the symphysis itself from a twisting and lifting injury.
Wearing a support belt can be a limited and sometimes completely unhelpful treatment approach for SPD. Where it has its most value, is if the Symphysis Pubis (SP) joint is undergoing true separation due to advancing pregnancy changes, but this only applies to a small percentage of SPD sufferers. The SP joint can twist, strain, develop swelling and inflammation at the muscle attachment sites, be pushed out of alignment by issues at the back of the pelvis, as well as undergo true separation. So a one size fits all solution of wearing a support belt for all forms of SPD simply doesn’t work- the SP can become sore for many reasons and therefore there are many ways of treating this condition. Make sure you don’t settle for a support belt if it isn’t helping, or if it isn’t helping enough. Seek out a practitioner who works regularly with pregnant women, and understands how important it is to help recovery of the SPD not only to reduce daily levels of pain, but to allow for comfortable sleep and birth readiness.
One of the reasons osteopathy is so successful with SPD, is that we check for all the different reasons and areas that can cause SPD, and then treat only the ones that are problematic. To understand this better, it would be worth knowing a little about the anatomy we are talking about. Here is the SP, the front join of your pelvis. Your pain may be centered here, or it may be in your groin, pelvic floor, hips, lower back or in your thighs. There is a little cartilaginous disc in between the bones, ligaments that run above and below the joint, and muscles that attach into the top and bottom surfaces of the joint. It’s important to remember too that the SP joint is only part of the pelvis, and with the two Sacroiliac joints at the back they together make up the pelvic ring. Any shifts or injuries to those joints around the back of the pelvis can cause pain in the SP region that strictly speaking comes from the sacroiliac joints. So you can see that simply adding a tight support belt around your pelvis doesn’t fix all of these issues. For you to get better, you need to have treatment focused on your particular problem and the reason that your SP is in pain.
There are some exercises that are more important than others, and at this point in your pregnancy combined with having SPD, you want to be really picky about which ones you choose to do. There is not normally much energy to spare at this point in the game! A good rule of thumb to stick to is “what feels good is good, and what feels bad is bad.” Please don’t keep doing an exercise that hurts, even if you have read that it is good for you, and equally, trust your body that if you are comfortable lying a certain way or doing a certain exercise then it is ok for you to do. On top of that, DO keep your legs together wherever possible (getting out of bed, sitting to get dressed, swimming freestyle rather than breaststroke), DO engage your abdominal muscles (check with your osteo for help with this if you need), and DO sleep with a pillow between your legs. DON’T squat, run, jump or stride it out when you are walking. And extra pelvic floor exercises is a MAYBE – there are good reasons to improve your pelvic floor control but sometimes this can irritate SPD so please be guided by pain on this one.
Firstly, going in to your upcoming birth without pre-existing pain and disability (how long can you stand, what positions can you labor in etc) is a great start. We want all cards on your side! Secondly, we know that general advice for SPD is to keep your legs together, so it is helpful to get far enough along in your recovery that you can comfortably use all birthing and laboring positions. The other thing to think about is that the SP forms part of the pelvic ring, as we talked about earlier, through which your baby will descend during his or her birth. Any misalignment or swelling from inflammation in the area could potentially reduce the overall size of the pelvic outlet, and its ability to move and stretch as your baby descends.
SPD is very treatable, and successful treatment can make a remarkable difference to your levels of comfort and ability to continue with normal activities. If you have had unsuccessful treatment elsewhere or in previous pregnancies, it does not mean you cannot be helped. Once we work out exactly what is causing the pain for you, then we know how to treat you effectively and what to advise you regarding home exercise and care. We know it can be tricky choosing your treatment providers when you are pregnant; somehow it seems like a much bigger decision when you are growing another wee human!
We take a limited number of new patients each week, and our experienced team would love to help you with SPD and all the other physical complaints that may come with pregnancy.
Try this article of ours featured in OhBaby Magazine for an in-depth look at how and when osteopathy can help you and your growing baby.