The symphysis pubis is the name given to where two bones meet at the front of the pelvis. The pelvic bone is roughly in the shape of a heart, and is actually formed by three bones, which are held together by very strong ligaments. The bones meet to form three ‘fixed’ joints – at the front (the symphysis pubis) and at each side of the bottom of the spine (the sacro-iliac joints).

Normally, these joints are not designed to allow movement. However, when a woman becomes pregnant, a hormone called relaxin is produced which loosens all the pelvic ligaments in order to allow the pelvis slight movement at the time of birth.

It is a physical mis-alignment of the two ilia (ilium) at the anterior surface where they meet at the syphisis pubis.

The front of the pubic bone interlocks. During pregnancy/birth, a fall and possibly other reasons the two pieces separate.  When they come back together they can get out of line, with the pieces still interlocking but one side higher than the other.  Or the whole bone can be tilted higher or lower within the pelvis.  Even if Bowen corrections are made, the pelvis may not stay aligned if the pubis is out.  An additional side effect is that it disrupts the energy flowing through the central meridian.

For some reason, the ligaments occasionally loosen too much and too early before birth. This means they can’t keep the pelvic joints stable so the pelvis moves, especially on weight bearing. All this is made worse by the increased weight of the growing baby and sometimes the symphysis pubis joint actually separates slightly. The result is mild to severe pain, usually in the pubic area, and is called SPD.

What are the symptoms?

The most common is pain and difficulty when walking. Some women describe the

feeling of their pelvis coming apart. The pain is made worse when turning in bed or doing something that involves standing on one leg, such as climbing up stairs, getting dressed and getting in and out of a car.

The pain is generally felt in the pubis and/or the sacro-iliac joints, but can also be experienced in the groin, the inner side of the thighs, the hips and in one or both buttocks.

When is it most likely to start?

At any time from the first trimester onwards. Some women can be fine during their pregnancy, but get the condition a few days after their baby has been born.SPD sometimes occurs following a period of immobility, an unusually busy overactive period or a particular activity such as swimming breaststroke or lifting something incorrectly.

So what can be done?

If the pain is severe, ask your GP for a referral to a physiotherapist, ideally one who has specialist training in obstetrics and is called a Physiotherapist in Woman’s Health. She or he will be able to assess you and may fit you with a pelvic support belt, which helps to stabilise the pelvis. Your GP will also be able to prescribe painkillers that are safe to take in pregnancy.

The most important thing is to avoid doing anything that aggravates the condition, such as standing on one leg.

• Sit on a chair to get dressed.
• Be very careful to get into a car by putting your bottom on the seat first, and then lifting your legs into the car.
• When you get out, lift your legs onto the pavement and then lift your bottom off the seat.
• If you go swimming, don’t swim breaststroke.
• Always turn over in bed with your knees firmly together.
• Make sure you get a rest (in bed) every day.
• If you already have a child, you will need help, as you will find it difficult to lift him or her.

National Childbirth Trust say up to 1 in 35 women have SPD.

Or for those willing to try the alternative approaches:

The Bowen Technique can be very effective in treating this disorder or you could try osteopathic technique, or McTimoney Chiropractic.