Symphysis pubis diastasis or disorder (SPD), occurs as a result of injury or irritation at the pubic symphysis- the joining point of the pubic bones at the front of the pelvis.
If you are familiar with this term likely, you know how uncomfortable pelvic pain can be during pregnancy. Especially, when it feels as though it’s accumulated in or around one specific joint (or pair of joints).
During pregnancy, our joints are already subject to vulnerability due to an excess of the hormones working to relax the joints of the pelvis for birth. This condition can often carry over into the postpartum period and can last throughout breastfeeding as those hormones stay elevated.
With my own SPD, it started early in pregnancy and continued until I was about a year postpartum causing a sharp stabbing pain right in at the pubic symphysis. However, it can affect and cause irritation and pain throughout the entire pelvic girdle and surrounding areas including the SI joints, hips, groin, low back, legs, and perenium. It can also present as mild discomfort or a feeling of the pelvis being shifted or tilted.
While SPD can occur naturally with ongoing growth of the baby, it is related to actions and activities where the feet and legs and thus, the two sides of the pelvis, are moving in opposite directions. High intensity classes like bootcamps or activities where you’re switching directions quickly can make an active mama-to-be more prone to these injuries.
How then do we prevent this condition, or manage the pain and prevent increasing severity?
Read on to learn the top tips I've learned for managing the discomfort or maybe even preventing SPD all together.
1. Avoid high intensity activities or activities where you are changing directions often.
I most often think of running (hoe I got injured), aerobics, step aerobics, bootcamp and HIIT classes. These classes can prompt you to use movements that put a lot of strain on the joints of the pelvis.
Additionally, the impact can impose downward pressure on the pubic joint which is lax to begin with (Julie Weibe). If you are having a hard time giving up your preferred type of exercise try to reduce the impact by avoiding jumps and slowing the movement during position changes.
2. Use proper alignment in all positions- sitting, standing, and moving.
Proper alignment can help in the management of many pregnancy aches and pains.
When we stand, sit, or move with the pelvis tucked we tend to grip the glutes and thrust through the pelvis, both of which create compression on the back of the pelvis with a simultaneous pull at the pubic symphysis (Julie Weibe). The two actions, together or separate, can create irritation and pain in the front. Keep the ribs over the hips throughout your daily activities, escpecially while carrying load.
3. Learn how to engage the pelvic floor correctly.
Because the muscles of the pelvic floor originate and attach all over the pelvis, we want to distribute the work between the front and back halves of the pelvic floor, as to not cause pulling in one direction or another.
We can do this by picturing the action at the perineum, drawing up right in the center of the anus and vagina, and at the same time focusing on engaging the muscles of the transverse abdominis, the deepest layer of abdominal muscles.
You can learn how to engage the pelvic floor and transverse abdominis during breath HERE.
4. Keep the legs closer together
In your strength training routines choose shorter stances when working the legs (bridges vs. lunges) and in yoga classes, shorten the stance in poses such as Warrior II or Triangle Pose or opt out of the poses completely and practice chair, forward fold, or rolling bridge (only engaging the glutes for a moment before returning to start). Multiple pregnancy sites also recommend keeping the knees together when moving in and out of the car or bed.
(An example of modified Triangle Pose (Trikonasana). These feet can be applied to all standing wide stance poses.)
5. Rest, Mama
Of course, as always, there's a time and place for movement. If exercise is not serving you or is causing you great pain it's best to take some time and honor what your body is saying.
There will be time enough for movement after the baby is born or at a future date but in the meantime, further aggravating or injuring yourself is senseless.
I want to help you feel better in pregnancy and beyond. For more musings on prenatal and postpartum fitness and yoga, motherhood, nutrition and mindset, sign up for my newsletter HERE!