Quick answer: If walking, rolling over in bed, climbing stairs, or putting on shoes has become genuinely painful — you may have symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP).
If walking, rolling over in bed, climbing stairs, or putting on shoes has become genuinely painful — you may have symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP). It’s more common than widely acknowledged, affecting up to 20% of pregnant women, and it is very treatable.
What SPD Is
The pubic symphysis is the joint at the front of the pelvis where the two pubic bones meet, connected by a fibrocartilaginous disc. During pregnancy, the hormone relaxin softens ligaments and cartilage throughout the body to allow the pelvis to expand for birth. In most women this is well-tolerated. In SPD, the joint becomes hypermobile, inflamed, and painful. Pain is centered over the pubic bone, often described as sharp, burning, or shooting, and can radiate into the inner thighs, groin, hips, lower back, and buttocks. Classic triggers: walking (especially distances), stairs, turning over in bed, standing on one leg, and spreading the legs apart.
Recognizing the Symptoms
Key features distinguishing SPD from general pregnancy back pain: pain directly over the pubic bone at the front of the pelvis, possible clicking or grinding sensation at the joint with movement, exaggerated and painful waddling gait, difficulty with any weight-bearing on one leg (stairs, stepping over bath edge, dressing), and pain that improves with rest and worsens with activity. Many women have both SPD and sacroiliac joint pain simultaneously — PGP is the broader umbrella term.
Self-Help Strategies
Move symmetrically: Keep knees together getting out of bed or a car. Put a plastic bag on the car seat to slide more easily. Sit to dress: Never stand on one leg — sit on the bed edge to put on trousers and shoes. Smaller walking steps: Shortening your stride reduces pelvic impact. Warm compress on the pubic bone for acute pain relief. Sleep with a thick pillow between your knees to reduce joint stress overnight. Pelvic support belt worn around the hips (not waist) provides external joint stability and is often transformative during activity. Swimming is often the only exercise that can continue pain-free.
Physiotherapy: The Most Important Intervention
A referral to a women’s health physiotherapist is the most effective treatment for SPD. What to expect: assessment of pelvic alignment and joint mobility, manual therapy, a tailored exercise program strengthening the muscles supporting the pelvis (glutes, pelvic floor, deep abdominals, hip external rotators), movement advice, and possibly acupuncture (some evidence for SPD). Request a referral at the first sign of significant pelvic pain — early treatment has better outcomes. Don’t wait.
Planning Birth With SPD
Discuss SPD with your birth team well before your due date. Key considerations: avoid prolonged lithotomy position (on back with legs in stirrups — this maximally stresses the pubic symphysis). Side-lying, hands-and-knees, and upright positions are significantly more comfortable. Avoid forced hip abduction — note in your birth plan that your legs should not be pushed apart beyond your comfortable range. Epidural consideration: if you can’t feel pain, there’s a risk of inadvertent excessive hip abduction during pushing — positioning management by your care team is essential.
Frequently Asked Questions
Will SPD cause permanent damage?
For the vast majority of women, SPD resolves completely within weeks to months of delivery as relaxin levels normalize. A minority with severe SPD or who didn’t receive physiotherapy have persistent symptoms. Early physiotherapy, during and after pregnancy, significantly improves long-term outcomes. Permanent significant dysfunction is uncommon.
Can I keep working with SPD?
Depends on the work. Desk-based roles with positional flexibility are usually manageable. Jobs requiring prolonged standing, long walking, climbing stairs, or heavy lifting become very difficult. Your employer must make reasonable pregnancy-related accommodations. A sickness note from your midwife or provider supports workplace adjustments.
Is SPD worse in subsequent pregnancies?
For many women, yes — SPD often recurs in subsequent pregnancies, starting earlier and sometimes more severely. Early physiotherapy referral at first symptoms and maintaining pelvic floor and hip strength between pregnancies reduces severity. If you had SPD previously, mention it at your first antenatal appointment so monitoring and referral can be proactive.
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Related Reading
- 31 weeks pregnant: pelvic girdle pain and SPD relief
- Pelvic floor exercises after birth: complete guide
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