Pelvic Pain- Symphysis Pubis Dysfunction (SPD)
The miracle of growing a human in your body also comes with the miracle of just the right amount of changes, that include pain in several areas!
As early as the first trimester of pregnancy, a woman may begin to feel pain in her sacrum (as I did).
As the fetus grows and the uterus expands entering the second trimester, more pains expand into the body, including the infamous pelvic and hip pain.
Walking, standing, sitting, rolling over in bed, can all be painful due to the shifting and loosening of the hip and pelvic joints.
This loosening is preparing those hips to accompany a small human to enter the world.
In this post we will go over:
- Anatomy and Physiology of the Pregnant Pelvis and 4 Deep Core Muscles
- Parts of the Pelvis
- Sacroilliac Joints
- Pubic Symphisis Joint
- Pelvic Floor (or Pelvic Bowl) Muscle
- How Pilates can Help
- Pelvic Floor Conditioning
- Zipping and Unzipping
- Pelvic Tilts
- Pelvic Floor Conditioning
Here is a short anatomy and physiology lesson on the pregnant pelvis:
Hormones Relaxin and Progesterone
These remarkable hormones are responsible for:
- the loosening of the joints and ligaments, particularly in the hips and pelvis-the sacroiliac joints and pubic symphysis joint (explained below).
While this is absolutely necessary to accompany the growing fetus and expanding pregnant uterus, and ultimately the birth,
the instability causes pain in the hips and pelvis.
- These hormones also cause lax joints and ligaments in other areas of the body, resulting in issues such as a pregnant woman’s susceptibility to sprained ankles.
Anatomy of the Core
Bone and Ligament Structures of the Core:
- The Pelvis
- Sacroilliac Joints
- Pubis Symphysis
- Lumbar vertebrae and supporting ligaments (Thoracolumbar Fascia)
- Uterus and Pelvic Ligaments
4 Primary Muscles of the Core -deepest core muscles
- Transverse Abdominals
- Pelvic Floor Muscles
Secondary Muscles of the Core
- Latissimus Dorsi
We are going to go over the anatomy of the pelvis. But keep in mind that to relieve pain, the deep core muscles have to be involved. Our body parts work together.
This fused vertebrae, posterior (in the back of) of the pelvis, provides maximum stability for the spine when positioned neutrally.
In pregnancy, the top of pelvis tends to tilt anteriorly (forward), causing sacrum to tilt up and the low back to sway into an exaggerated arch (lordosis), see first pic.
Hugging the Baby, shown above in the second pic, can help mom-to-be stabilize her pelvis.
Pelvic tilts (shown below) help mom find her neutral during pregnancy, bringing the sacrum back to its most stable position.
Pic of the Pelvis
These joints attach the sacrum to the hip bones, normally allowing limited movement in the sacrum (nutation and counternutation). During pregnancy, these joints loosen (due to the hormones relaxin and progesterone) causing hyper mobility, contributing to the pelvic pain problem.
Pubic Symphysis Joint
This is a normally a somewhat flexible band of cartilage that links the two halves of the pelvis together, allowing independent movement of the hip bones while walking.
Loosening of this joint is the primary reason for pelvic pain.
In women, the pubic symphysis is created wider and more flexible than in men to allow the pelvis to stretch during child-birth.
The pelvic floor is a group of small, long muscles that create a sling-like support in the pelvis.
These muscles connect to the joints of the sacrum, coccyx, and hip bones.
A strong, flexible, well-conditioned pelvic floor helps to:
- stabilize the upper torso and hip area,
- prevents incontinence (peeing when you laugh),
- supports the weight of the uterus, bladder, and bowels,
- and makes the bladder and bowels functional.
The pelvic floor works with the transverse abdominals to provide optimum stability of the core, helping to reduce the chance of diastasis recti
Pelvic Floor Muscles
Notice how they attach to the sacrum
How Pilates can Help:
Deep Core with the Pelvic Floor Conditioning and Awareness
Proper conditioning and awareness involves:
- Learning how to contract and release the pelvic floor muscles without involving the butt muscles, inner thighs, or abdominals.
- Learning to isolate is just as important as learning to let the deep core muscles work together.
- Kegels are the most popular form of pelvic floor exercises.
In addition to Kegels, try this exercise:
Zipping and Unzipping
1. Become aware of the pelvic floor by contracting and releasing.
Prepare your diaphragm by taking a few deep breaths, fully exhaling.
2. Imagine your pelvic floor is a zipper.
Inhale – Start at the bottom of the ‘zip’ and
Exhale – slowly contract the pelvic walls together as if zipping up a pair of jeans.
3. Once you have zipped to the top
Inhale – at the top of the zip
Exhale – slowly begin to ‘unzip’ the pelvic walls
Do this 5-10 times at least once a day.
The great thing about practicing pelvic floor exercises is you can do them anywhere and no one needs to know (so if you do end up practicing while standing in-line at the store, be aware of your facial expressions!)
This practice of contracting and releasing control is incredibly beneficial during all stages of pregnancy, before and after.
During the 3rd trimester, put emphasis on releasing the pelvic floor to prepare for the birth.
Much of the problem with pain stems from the body’s effort to rebalance its center of gravity.
Pelvic tilts along with proper engagement of the pelvic floor will:
- help keep the low back from tightening up, and
- keep the pelvis properly aligned as the uterus grows.
How to do a Pelvic Tilt
1. Stand in your neutral position (1st Pic)
2. Inhale – Engage the pelvic floor and transverse abs (Hugging the Baby)
3. Exhale – tilt the top of your pelvis back and the sacrum and tailbone under.
This is your pelvic tilt. (Second Pic)
4. Return to Neutral and repeat pelvic tilt 5-10 times. Can be done every day, multiple times a day.
Body Patience During and After Pregnancy
Knowing that your body will make drastic changes, and being patient and accepting of those changes is the BEST thing you can do to for you and your baby!
Zoe Withers at Thinkbaby.org talks more about how VITAL patience is, ESPECIALLY after pregnancy, in her blog post Why Body Patience After Pregnancy is so Important!
Thank you for investing your time to learn at YourPregnantCore.com
I would love to hear from you! Questions? Comments?