Symphysis Pubis Dysfunction

Both cause pain at the pubic symphysis, and osteitis pubis is one of the conditions a clinician will want to rule out ². The difference is mostly in the story:

• SPD arrives during pregnancy, usually mid-pregnancy, often with pain at the back of the pelvis too, and it's set off by everyday movements like rolling over ^1,2.
• Osteitis pubis is typically a sport-related overload problem that builds over a season. If your pain started with training rather than pregnancy, that page, and our sports physiotherapy approach, is the better starting point.

A few other conditions can look similar in pregnancy and are worth excluding: sciatica, a separation of the pubic symphysis itself, transient osteoporosis of pregnancy, a urinary tract infection, a blood clot in the thigh, and early labour ². Diagnosis is mostly hands-on. Pressing over the symphysis and a modified single-leg standing test (the modified Trendelenburg test) are the most accurate checks for this kind of pain, and scans are rarely needed ^2,4.

The reassuring part: tests usually aren't needed ⁴. A clinician asks about your pain and your pregnancy, and listens for one thing in particular. Is the pain mechanical? That means it comes on with activity and eases with rest. Pain that turns up without any movement is unlikely to be pelvic girdle pain ². They then examine you, rule out your lower back as the source ⁴, and check whether specific movements bring on the pain where you feel it ².

Scans don't show how severe it is. They're kept for rare cases, such as severe pain that isn't responding to treatment, or not being able to take weight through your legs ². It's best to avoid X-rays in pregnancy unless one is needed ⁴. If your doctor recommends one, that's usually to check for another cause of the pain, or because severe pain isn't getting better ⁴. Most medical imaging is unlikely to harm a developing baby, and it's only done when the risk of going without it is greater ⁹. Remind whoever orders it that you're pregnant ⁴.

During pregnancy, the aim is to reduce pain and keep you moving, working and sleeping, rather than make the condition disappear ¹. In practice that means:

• A proper assessment first: confirming it's pelvic girdle pain, which joints are involved, and that nothing on the list above needs a different pathway ².
• Changing how you do the things that hurt: smaller steps, shorter walks, stairs one at a time, sitting down to get dressed, keeping your knees together when you roll over or get out of the car, sleeping on your side with a pillow between your legs, and breaking jobs like vacuuming into smaller pieces ^4,5.
• Strengthening: exercises for the muscles around your hips, back, deep abdominals and pelvic floor, progressed within what your pelvis will tolerate ^1,5. Our women's health physiotherapy page covers how we work with you through pregnancy and after the birth, including when we'd refer you on for a specialised pelvic floor assessment.
• Support where it helps: a pelvic support belt, fitted correctly and worn for short periods, not all day, and occasionally crutches ^1,4,5.
• After the birth: resting lying down instead of sitting, and keeping moving within your pain limits ⁵.

What the evidence can and can't promise. A large review of 34 trials in pregnant women found moderate-quality evidence that an 8 to 12 week exercise program reduced the number of women reporting pain where low back and pelvic pain occurred together ³. For pelvic pain on its own, the picture is weaker: two studies of group exercise plus pain-management advice found no difference compared with usual antenatal care, and that evidence was rated low quality ³. The authors concluded there isn't enough good-quality evidence to make confident decisions about these treatments ³.

So why see anyone? Because treatment from an experienced practitioner can still improve your symptoms during pregnancy, even when it can't make them disappear ¹. And because this pain often goes unaddressed: one Australian study found only 25% of women who reported pelvic girdle pain were offered any treatment ².

Treatment for SPD follows The Well Motion Recovery Path™, with one difference: the birth sets part of the timeline. You move up a phase when your pelvis copes with more, not when a week number arrives.

• Reset: from your first assessment. Changes to how you roll over, dress and climb stairs ^4,5, a support belt for short periods ^1,5, ice or heat ⁴, and manual therapy when pain is stopping you moving. Expect the pain to ease, not vanish ¹. We move you on once your usual triggers are manageable.
• Rebuild: still during pregnancy for most women. Strengthening for your hips, back, deep abdominals and pelvic floor ^1,5, progressed only as far as your pelvis tolerates. Expect good weeks and bad weeks as your baby grows. We move you on after the birth, once everyday tasks no longer flare the pain.
• Return: after the birth. Here that means lifting and carrying your baby, walking further, and exercise if you want it. We check stairs, standing on one leg and carrying before building each one back up. You leave with a home program and a plan to get help early in any future pregnancy ⁴.

How long it usually takes. Symptoms rarely settle fully before the birth ¹. One Australian review reports that 93% of women had symptoms resolve within three months afterwards ². Pain continues past that point for some women ⁴, and it is worth being reassessed if it does.

Prevention has been tested here, and the answer is mixed:

• Exercise won't reliably stop it starting, but it's linked with milder pain. Pooled trials found exercise started during pregnancy didn't lower the chance of having pelvic girdle pain ^{6 7}, though only four small trials measured it on its own ⁶. Women who exercised did report less severe back and pelvic pain during pregnancy ⁷. Australian pregnancy guidance says regular exercise and strong abdominal and pelvic floor muscles can lower your chances ⁴. The pooled trials don't confirm that for pelvic girdle pain, but they all began exercise partway through pregnancy ⁶, and one large Norwegian study linked regular exercise before a first pregnancy with a lower chance of it ⁸. None of this is a reason to stop exercise your midwife, doctor or physio has recommended: it has other benefits in pregnancy ⁶.
• Plan early if there's a next time. In one study, 68% of women with more than one pregnancy had it come back ². Tell your health team early in your next pregnancy, because managing it early can help stop the pain worsening as the months go on ⁴.
• Mind how long you stay put, and what you carry. Avoid long spells of sitting or standing, and heavy lifting such as shopping bags ¹. When you sit, don't cross your legs ⁴.
• Choose your shoes and take your rests. Supportive, low-heeled shoes are recommended ^{2 4}, and so is resting between activities ⁵.