Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or temporarily taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

• Don’t over-stretch

  • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

• Limit single leg movements for a few weeks (2-3 weeks) and slowly add them back in your routine to see if you can manage the load. If not, that’s OK…you can take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

  • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis.

  • Here’s the catch…some mamas actually benefit from single leg movements with a little modification. If you notice that deep lunges cause pain, you can modify it! First, try to change the position of your feet by bringing them closer together. You may notice that by bringing your feet closer together decreases your pain but still lets you use those muscles. This is great! You can strengthen this area and then try to increase the distance between your feet as you get more comfortable. The next thing you can change is the depth or how far down you go into the lunge. If a full lunge causes pain, try to lunge at half depth or a quarter of the depth. If you are able to do these without pain, that’s great - you should continue to do them! Our goal is never to exclude the movements you love but to work with them to see what can work with your body at this time.

• Use caution with traditional “core” exercises 

• Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

• Watch deep squats or sumo squats

  • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain. If you notice pain with deep squats OR after deep squats, it’s okay to take them out.

• Adductor stretch or adductor machines 

  • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

• Fast/explosive movements 

  • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize.

Exercises that may improve pubic symphysis pain

• Focus on posture and pelvic alignment

  • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

• BREATHE

  • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

• Balance strength and mobility

  • All movements should be slow and intentional to start to focus on maintaining task-specific pressure (that’s the amount of support/brace/natural tension you need to create to stabilize the body). This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion.

• Work the glutes and adductors in synergy through movement

  • Banded monster walks

  • Glute bridges with band around knees and yoga ball or block in-between knees

  • High Bear or low bear: with bands around knees and yoga ball or block in-between knees —> if you are able to do this and looking to advance the movement without doing a bear crawl, you can simply lift and hold one arm or one leg at a time

  • Hip Hinge or banded good mornings

  • 90/90 or Shin box flow: this is a movement where slow and intentional movements are best

• Work all of the core together

  • Box squats: i mentioned earlier that deep squats may not be beneficial but shortening the range of motion to the point before there is pain can be extremely helpful in pelvic pain and keeping pelvic mobility with core stability

  • Side bridge

  • Bird dog with pelvic floor focus and focus on breathing and elongating spine

  • Dead bug with focus on crossover

Part 3: Labor and Delivery considerations for pubic pain

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.