How to train with Symphysis Pubis Dysfunction (SPD)?

pregnant lady squatting with ball against wall

October 9, 2023

Having treated many women in practice with SPD, I know how painful and debilitating it can become. It can really affect what you are able to do both day to day, and in the gym. If you are reading this, you are probably suffering with SPD yourself and wondering how best to manage it. I believe knowledge is power, so I have tried to give you all the information hereyou need to understand the condition and learn how to train with symphysis pubis dysfunction.

What is symphysis pubis dysfunction?

Symphysis pubis dysfunction (SPD) is a common condition during pregnancy, affecting 1 in 5 pregnant women1 . It is part of a wider term called Pelvic Girdle Pain (PGP), but the two are often used interchangeably. PGP and SPD symptoms can vary from mild to severe, and can greatly affect your mobility and quality of life.

What are the symptoms of symphysis pubis dysfunction?

The NHS website details the symptoms associated with SPD. They include the following:

  • Pain in front of the pelvis area, often sharp
  • Can also occur with pain around the back of the pelvis and into the hips
  • Pain worse when walking, climbing stairs, turning over in bed
  • Some women may describe a “clunking” or “grinding sensation” in the front of the pelvis

Why does symphysis pubis dysfunction occur?

The pelvis is made up of three joints: two sacro-iliac joints and the pubic symphysis. These joints normally move slightly to allow everyday movements such as walking, standing up, climbing stairs. During pregnancy, however, the hormones produced relax the ligaments in the body, allowing more movement and causing pain. In addition, the biomechanical changes in the body as the pregnancy progresses puts more strain on the pelvis, often making the pain worse.

Who suffers from symphysis pubis dysfunction?

Anyone can suffer from SPD. However, from experience in clinic, there are some groups of women who are more likely to suffer from it than others. These include hypermobile women, who naturally have a lot more movement in their joints. Women in their second or third pregnancy may also suffer more, as the ligaments and muscles are not as strong as during the first pregnancy.

Does SPD affect the baby?

No, SPD can be extremely painful for the mother but it does not have any negative impact on the baby.

How can I help manage the symptoms of SPD?

There are small changes you can make in your day-to-day life which can help you manage the symptoms. These include:

  • Keep your legs together when getting in and out of the car/turning over in bed
  • sit down to do things like getting changed, putting shoes on
  • try to keep your weight equally through both legs when standing
  • move little and often- it can help to move every 30 minutes but don’t overdo it- rest is important!
  • avoid lifting anything heavy
  • avoid standing on one leg
  • a sacro-iliac belt may be beneficial. We talk more about its uses over on our sister site, the clinic store
  • building up strength in the muscles around your pelvis can help to manage the symptoms

pregnant belly with hands on bump

Can I still exercise with Symphysis pubis dysfunction?

Yes definitely, but you may need to modify what exercise you do. A good rule to follow here is that if it hurts, don’t do it!

Whilst swimming is normally a fantastic exercise during pregnancy, it is not advised to do breaststroke legs when suffering from SPD as it puts a lot of stress on the front of your pelvis. Front crawl and back stroke are generally better for SPD, although in extreme cases, even kicking may aggravate the symptoms. Exercise that involves side to side movement, such as racquet sports, or impact exercise, such as running, are not advised. You may find that even walking aggravates the pain, so reducing walking to little and often can be beneficial.

Strength and resistance training is important because it builds up muscles that can help to stabilise the pelvis. But there are certain exercises that are good, and others that should be avoided. As always, if you’re unsure about whether and how to exercise, please consult your midwife or GP.

What strength training should I do with SPD?

Strength training is invaluable as it helps to build up the muscles that can stabilise your pelvis. Below are some important tips to remember when training with SPD:

  1. Neutral spine: during pregnancy, women tend to adopt a more lordotic posture- this means your pelvis tends to tip forward creating a greater curve in the back. Whilst this is perfectly normal, it prevents your core muscles from functioning as effectively, plus puts more strain on the joints of the pelvis. Trying to keep a neutral spine by tucking your bottom under can allow your core and glut muscles to do their job and stabilise the pelvis.
  2. Avoid deep squatting and single leg exercises: Deep squats and single leg exercises, such as a single leg squat, will put more stress on the pelvis and are likely to aggravate pain. Instead, stick to more shallow squats with a narrower base, and train bilaterally with both feet on the floor.
  3. Avoid movements away from the midline: As a general rule, exercises like lateral squats or abduction exercises will stress the pubic symphysis and cause pain. Many women, however, have weak gluts and abduction exercises are often used to address this. In this case, supported hip abduction exercises can be really useful. You can find out more in our exercise plan for SPD.
  4. Opt for exercises with a stable base or more support: Having two feet on the ground during the exercise reduces the strain on the pelvis. Creating a narrower base by bringing your feet closer together for squats or RDLs can help. Similarly, you may find using extra support, such as TRX squats, can make exercises easier.
  5. Train pain free: A great rule for SPD is that if it hurts, don’t do it! If you are able to find exercises you can do without pain, these will probably be fine to continue.

Still a bit confused about what you can do? We have some great programs for women with SPD here.

Will SPD go away once I’ve given birth?

Many women will find the pain resolves once they have given birth. However, 1 in 10 women1 will continue to experience symptoms post partum. Women who have experiences SPD in one pregnancy are also more likely to experience it in the second. With this in mind, it is essential to make sure that you build up your strength post partum to reduce the likelihood of this happening. We have some fantastic programmes on post natal training here.

Can pelvic girdle belts help?

Pelvic girdle belts can be useful in helping to manage the symptoms of PGP and SPD. You can find out more in our post on this subject.

1 royal college of obstetricians and gynaecologists. www.rcog.org,uk

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