Dr. Annie and Dr. Rachel talk to Alyssa about Symphysis Pubis Dysfunction (SPD), how to prevent it, how to treat it, and things every pregnant and postpartum woman should be doing!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Hello.  Welcome to another episode of Ask the Doulas.  I am Alyssa, and I’m talking with Dr. Rachel and Dr. Annie again of Rise Wellness Chiropractic.  How are you?

Great!

So I got asked by a client about symphysis pubis dysfunction, and I’m not even exactly sure what that is, but you knew.  Right when I told you, you knew.  So can you tell me?

So SPD — sometimes people think of sensory processing disorder, which is with older kids, but in relation to pregnancy, it’s symphysis pubis dysfunction.

And what the heck does that mean?

It’s a mouthful!  So basically, where your two pelvic bones meet in the front is called your symphysis pubis, so that’s where the two bones meet together.  There’s cartilage in between there, and that area widens for birth.  So usually late second to third trimester, we’ll see some women will start having pain.  That can be related to the relaxin that’s in their system that’s helping the ligaments loosen and helping that area separate, but what we usually find is it’s more due to pelvic imbalances.  Usually one side of the pelvis is higher than the other or something like that or it’s rubbing in a weird way.  That’s usually what causes that symphysis pubis dysfunction.

So it’s strictly for pregnancy?

Yes.

And are there any ways to not get it?  Avoid it?  Treat it?

Get adjusted!

Yeah, just because if it’s caused from a misalignment —

Exactly.  Yeah, if it’s caused from pelvis imbalances, then that is directly a chiropractic issue.  It’s biomechanical.  That’s something that we can address through adjustments.  And then we also have stretches that you can do, and there’s also a Serola belt which is like an SI  belt.  It goes around your sacroiliac joints, and it’s just a low belt.  It doesn’t really do anything in terms of — it’s not like a belly band or something that you would wear to support the baby, but it does help to support the SI joints and keep everything together.  Really, it’s hypermobility in that joint that’s causing that pain.

It’s too mobile?

It’s too mobile.  Yeah, so we usually see it with not first-time pregnant moms but usually second or third, especially if they’ve had some kind of fall or something like that while pregnant.  They can injure their pelvis, and that’s usually what brings those things up.  I actually had a patient a couple weeks who came to us for SPD, and under care, she was doing great.  All her pain went away.  But she had fallen during her first pregnancy, and then during her second pregnancy, she started having all this pain and stuff come on. 

So falling during pregnancy; it’s not just like a random fall at any time in your life that could affect this?

It could be.  Pregnancy is really good at exacerbating existing issues or past issues.  Like if you’ve had any pelvic imbalances in your past and then you’re pregnant, just that relaxin is going to kind of flare things up.  Typically, what we see is pain with putting weight on one leg.  Climbing stairs is when your pelvis is moving the most, so that’s usually when a lot of the pain is flared up.

Walking; something that you don’t have to do very often.

Yeah!

Sounds horrible!

But sitting is not good for it either.  It’s one of those things that nothing is good for it.

Laying hurts; turning while you’re laying.  Like that’s not already hard when you’re in the third trimester!

Does it actually cause any more pain or discomfort during labor and delivery?

It can.  It depends on really, like, what the pelvis — because if you think of the pelvic bowl, if there’s imbalances in the pelvis, it’s not just affecting the bones.  It’s also affecting your pelvic floor muscles.  It’s affecting all of your stabilizer muscles.  So it can potentially affect how things go during labor.  I don’t know if it creates more pain, necessarily, or if it would be, but any pelvic imbalance is going to effect, probably, the efficiency of your labor.

Plus, it doesn’t necessarily clear up after.

That was my next question.

Yeah, it’s not like you deliver the baby and then it’s gone.

Because you still have that imbalance?

Exactly.

Exactly, yeah.

So then what do you do for that?  Just keep getting adjusted?

Well, it should clear.  If you’re getting adjusted, it should help clear it up while pregnant.  So I guess what we’re saying is, you should get checked if it’s happening.

I mean, it’s definitely like you have to retrain that pelvic imbalance somehow, and you do that through chiropractic adjustments or through exercises, through physical therapy, sutff like that.

Yeah.  PT floor rehab, yeah.

Probably a combination of both, right?

Right.  If you do it all, then you probably have best outcomes. 

Yeah, I don’t think we understand how important the pelvic floor is, and all we’ve learned is Kegels.  That’s not necessarily even a good thing to think.  When I saw a physical therapist for pelvic floor issues specifically, I was, like, that makes so much sense!  Even just the way we breathe; I didn’t know that my diaphragm was part of — what would that be?  The top?  The diaphragm is the top of your pelvic floor?

Yeah.  It’s the top of your —

Like the space?  I guess I can’t say top of the floor.  Your pelvic floor is the floor.

Your intrabdominal space.  So it’s like the lid, and then your pelvic floor is the bottom.  But it’s a big airtight balloon, pretty much, so when you breathe, it affects everything.  But pelvic floor is an issue that we don’t talk about, really, with women in birth, but it’s a huge thing.  Every woman who pushes out a baby has pelvic floor issues.  Every woman who has a C-section has pelvic floor issues because those are attached to your abdominals, too.  So, really, every woman should be getting some kind of rehab on pelvic floor after birth.  That’s my soapbox!

I’m in these group exercise classes, and every woman is, like, oh, jumping jacks.  I’m going to pee my pants!  I had one friend who was, like, I was working out and I didn’t know if it was sweat or I had peed my pants!  Yeah.  I get it!

Well, pelvic floor and core strength, too, are both things that get overlooked with women after pregnancy, and then we see women with back pain later, and it’s because their core is so weak.  So, really, we’re just promoting physical therapy pelvic floor rehab.  It’s what needs to be done.

And chiropractic care.  Retraining all that neurology is important.

I think even just learning about it!  I’ve done yoga classes forever, and they will say, like, during this pose, tighten your pelvic floor.  I’m, like, what the hell are they talking about?  What?  How do I do that?  But now after learning that even breathing is different and the feeling of — I hate saying Kegel because it’s not even what it is, but I guess that is the feeling of what you would do to stop your pee, but doing that during certain exercises is a whole different feeling, but I think now that I’m conscious of it, I’m, like, oh, that makes sense.  Oh, I can do that here.  Okay.  It’s gotten a lot better, but I still can’t do jumping jacks.

See?  The jumping jacks!  I don’t do them either.  They’re like, do jumping jacks to warm up, and I’m like… No.

I do the ones where I just put my hands up.  I just kick my leg out.  I’m fine with it!

It’s what everyone’s doing!  They call those jumping jills.

Is there anything else pregnant or postpartum women need to know about symphysis pubis dysfunction?

It’s not something that you need to suffer through.  There’s a lot of chiropractic studies where it helps in a lot of case studies, but also, biomechanically, it makes sense.  You don’t have to feel like you can’t walk up the stairs or sit or that you have to be in a lot of pain when you’re trying to sleep.  Find out you’re pregnant and get under care.  That’s really what we tell people. 

Tell people where to find you!

We are in East Town in the Kingsley Building right next to Gold Coast Doulas, or you can find us at our website or on Facebook and Instagram.  You can message us on those platforms.

Well, as always, thanks!  We’ll have you on again soon!