Symphysis pubis dysfunction (SPD): causes, treatments, exercises
Symphysis pubis dysfunction (SPD) can cause pelvic pain in pregnancy. Learn symptoms, relief strategies, and exercises to improve your comfort.
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Pregnancy comes with plenty of unexpected changes — leg cramps, tingling hands, sore breasts, and sciatica pain, just to name a few. But one symptom that can feel especially surprising is pain at the front of your pelvis that makes it difficult to walk or even put on your pants.
This type of discomfort may be due to symphysis pubis dysfunction (SPD) — a condition that can affect up to nearly one-third of pregnant women.
“It can range from mild discomfort to pain that makes it difficult to take a step or move in bed,” says Holly Tipp, PT, DPT, a physical therapist at Hinge Health.
SPD is a type of pelvic girdle pain during pregnancy. While it typically improves after delivery, you don't have to wait until then to find relief. Targeted exercises, pelvic floor physical therapy, and wearing pregnancy supports can help you feel more comfortable during pregnancy.
Learn more about symphysis pubis dysfunction, including how to ease symptoms, especially with gentle exercises recommended by Hinge Health physical therapists.
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What is symphysis pubis dysfunction during pregnancy?
SPD refers to pain in the pubic symphysis, a joint located at the front of your pelvis where the left and right pelvic bones meet.
During pregnancy, your body produces hormones (specifically relaxin) that loosen ligaments to prepare for childbirth. While this is a necessary and normal part of pregnancy, it can also make your pelvis less stable.
“As ligaments loosen, the pelvis can move a bit more than usual,” explains Dr. Tipp. “At the same time, the muscles that support the joint may not work together as well, which can lead to pulling and pain at the front of the pelvis.”
SPD can begin as early as the first trimester, but it’s more commonly noticed in the second or third trimester.
Causes of symphysis pubis dysfunction
SPD is primarily driven by hormonal changes during pregnancy — specifically the hormone relaxin, which loosens ligaments to prepare for birth. This is a normal and necessary part of pregnancy, though it can reduce stability in your pelvis and lead to discomfort.
While hormonal changes affect everyone during pregnancy, some factors may make you more likely to experience SPD or influence how your body responds to these changes. These include:
Hormonal changes. During pregnancy, your body produces the hormone relaxin to help loosen ligaments to prepare for birth. This can reduce stability in the pelvis and place more strain on surrounding soft tissues (muscles, tendons, and ligaments), Dr. Tipp says.
Growing uterus. Your uterus grows and stretches, much like a balloon, to accommodate your growing baby. It usually expands from the size of a lemon to the size of a watermelon. "Since it happens so quickly, it can affect how the muscles supporting your pelvis work together," says Dr. Tipp.
Posture changes. As your belly grows, your posture naturally shifts. This can place more strain on your lower back, hips, and pelvic muscles. "These muscles all attach to different parts of your pelvis, and can all contribute to SPD pain," explains Dr. Tipp.
Previous injury or pre-existing muscle imbalances. If you've had previous pelvic injuries or have muscle imbalances around the pelvis, you may be more prone to SPD. "We sometimes see this in people who already have muscle imbalances around the pelvis," says Dr. Tipp. "It's like a boat that's tied up at the dock — if one side of the rope is tauter than the other, the boat will pull to one side."
Activity levels. Activities that place repeated stress on the pelvis — like running or heavy lifting — may contribute to SPD symptoms, especially if you're doing more than your body can handle at that particular moment.
Symptoms of symphysis pubis dysfunction
SPD symptoms can vary from person to person. Some people feel mild discomfort, while others experience more significant pain that interferes with their daily routine. Common symptoms include:
Pain at the front of the pelvis
Pain when walking or standing on one leg
Discomfort when getting in and out of a car
Pain when climbing stairs, squatting, or rolling in bed
A clicking or popping sensation in the pelvis
Pain that spreads to the lower back or thighs
How movement can help symphysis pubis dysfunction
If you’re dealing with pelvic pain during pregnancy, it’s understandable to feel nervous or reluctant about moving. But movement is medicine — gentle, targeted exercises are one of the most effective ways to help ease SPD symptoms.
“Movement helps improve stability around the pelvis and supports the muscles that keep the joint aligned,” says Dr. Tipp. It can also reduce muscle tension and improve coordination between your core, hips, and pelvic floor — all of which play a role in how your pelvis moves and feels.
Start with gentle, tolerable movement. As your symptoms improve, you can gradually build back toward your usual activity level. The goal isn’t to avoid movement — it’s to find your movement sweet spot: the level of activity that supports your body without increasing pain or putting the baby at risk of harm.
The exercises below, recommended by Hinge Health pelvic floor physical therapists, can help support your pelvis and ease SPD discomfort.
Check with your healthcare provider before starting a new exercise routine or continuing your usual workouts during pregnancy, especially if you have any medical conditions or are at higher risk for pregnancy complications.
Exercises for symphysis pubis dysfunction
Want expert care? Check if you're covered for our free program →- Seated diaphragmatic breathing
- Seated abdominal bracing
- Standing groin stretch
- Seated hip adduction
Practicing these exercises regularly can help improve pelvic stability, reduce tension, and support the muscles around your pelvis — and the seated versions of these exercises recommended above are safe for all phases of pregnancy. A pelvic floor physical therapist can help guide you toward the right exercises based on your symptoms, but consider starting with these gentle movements.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Treatments for symphysis pubis dysfunction
Symphysis pubis dysfunction often improves within a few weeks after delivery, but there’s also several things you can do before then to help manage and alleviate discomfort. Staying active, applying heat or cold therapy, and using supports can all help. Consider these simple treatments:
Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help reduce tension in your pelvic region and strengthen muscles that may have weakened during pregnancy. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a pelvic floor PT via telehealth/video visit. “A PT can help identify what might be contributing to your symptoms, such as certain weak or tight muscles, and prescribe exercises that can help target those issues,” Dr. Tipp explains.
Keep moving. Walking is one of the best forms of aerobic exercise for pregnant people, but if that’s too painful due to SPD, you may find that other exercises during pregnancy, such as swimming or even stationary biking, feel better, Dr. Tipp says. Water aerobics has also been shown to be particularly helpful for pregnant people with pelvic pain. “It’s very important that you stay strong during your pregnancy,” says Dr. Tipp. “This can help prepare you for delivery and support your recovery from SPD postpartum.”
Pace your activities or make modifications. Modify activities that trigger pain. If standing or walking for long periods aggravates symptoms, break up activity into shorter sessions. “Also, if you have a lot of pain when putting on your pants, or rolling over in bed, a PT can suggest movement modifications so that you can do those daily activities more comfortably,” Dr. Tipp says.
Take over-the-counter (OTC) medication as needed. Acetaminophen (Tylenol) is safe to use for pain relief during pregnancy in most cases, but always check with your provider before you use it. Avoid NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin) or naproxen (Aleve), due to risks with these medications during pregnancy.
Apply heat or cold therapy. Applying a heating pad, hot water bottle, or taking a warm shower can help increase blood flow and relax tense muscles, providing relief from SPD during pregnancy. Ice packs may also help reduce inflammation and soothe sore areas. Always avoid placing ice or heat directly on your belly, and check with your OBGYN before using heat therapy to make sure it’s safe for you.
Wear a pregnancy support belt. Unlike belly bands (which support your belly), pelvic support bands fit more snugly and are positioned lower (around your hips) to support your joints, which can help ease SPD pain.
Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.
Try complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for SPD relief, such as massage and acupuncture — which may be safe to use during pregnancy, says Dr. Tipp.
Physical therapy for symphysis pubis dysfunction
When you’re dealing with pelvic pain during pregnancy, it’s natural to want to avoid movement. But in many cases, gentle, targeted activity can actually help you feel better.
“Exercises that support the pelvis and improve muscle balance can play a key role in managing SPD,” says Dr. Tipp. These may include low-impact activities like walking or swimming, along with strengthening and stability exercises. Movement and physical therapy can help:
Improve pelvic stability
Reduce muscle imbalances
Ease pressure on the pubic joint
Improve coordination between core and pelvic muscles
Reduce pain during everyday activities like walking or rolling in bed
When to see a doctor
Pain from SPD often improves on its own with simple management. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:
Sudden inability to bear weight or walk
New or worsening numbness, tingling, or weakness in the legs, groin, or "saddle" area
Sudden bladder or bowel changes, such as incontinence or difficulty passing urine/stools
Severe / sharp pain
Pain following an injury, such as a fall or accident
Worsening pain
How to prevent symphysis pubis dysfunction
While you can’t always prevent SPD during pregnancy it isn’t inevitable either. Simple strategies, such as modifying how you lift certain items (or children) and strengthening the muscles that support your pelvis, can help improve stability in this area and reduce the likelihood of discomfort. Here’s what you can do to help prevent SPD:
See a PT early. “It’s a good idea for all people to see a pelvic floor therapist early in pregnancy (or better yet, before becoming pregnant), to look for any imbalances in their pelvic area that they can address right away,” says Dr. Tipp. “Many people know that SPD is common during pregnancy and sometimes accept that they may have pain throughout their pregnancy. It doesn't have to be this way! Being proactive and addressing pain when it first starts can be really helpful in managing pain later in pregnancy.”
Balance your activity levels throughout the day. You don't have to choose between activities that matter to you — like playing with your kids and getting housework done. Instead, pace yourself and adjust how you approach different tasks. "For example, you might break activities into shorter sessions, alternate between more and less demanding tasks, or modify movements that aggravate symptoms — like taking fewer trips up and down stairs, or using a stool to reduce bending when emptying the dishwasher," says Dr. Tipp."
Adjust your lifting form. This doesn’t mean there’s a wrong and right way to lift objects — instead, there are certain techniques you can adopt to alleviate pressure off your pelvis and supporting muscles. This is important, whether you’re pregnant or not, but it’s especially important during pregnancy. “Using the correct muscles to maintain pelvic stability when you lift or move something,” explains Dr. Tipp. “Also, make sure you exhale with exertion of the lift to reduce additional pressure on the pelvis and pelvic floor muscles.”
Strengthen your core, glutes, and pelvic floor. Supporting these muscles can help your body feel stronger and more stable as your pregnancy progresses. “The more you can engage your core, the more stable your pelvis will feel,” says Dr. Tipp.
PT tip: Sleep smarter to protect your comfort
SPD can make nighttime uncomfortable, but how you position yourself in bed can make a difference. "Try sleeping on your side with your hips stacked and a pillow between your legs," says Dr. Tipp. "This alignment helps take pressure off the rectal area."
When you need to roll over during the night, engage your core and glutes to perform a mini bridge — lifting your hips slightly off the mattress before turning. "This technique reduces friction and direct pressure on the area as you move," Dr. Tipp explains. These small adjustments can help you rest more comfortably while your body heals.
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
Pubic Symphysis Dysfunction. (n.d.). Physiopedia. https://www.physio-pedia.com/Pubic_Symphysis_Dysfunction
Elden, H., Ladfors, L., Olsen, M. F., Ostgaard, H.-C., & Hagberg, H. (2005). Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ, 330(7494), 761. doi:10.1136/bmj.38397.507014.e0
van Benten, E., Pool, J., Mens, J., & Pool-Goudzwaard, A. (2014). Recommendations for Physical Therapists on the Treatment of Lumbopelvic Pain During Pregnancy: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, 44(7), 464-A15. doi:10.2519/jospt.2014.5098
Fogarty, S., McInerney, C., Chalmers, J., Veale, K., & Hay, P. (2023). The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 16(4), 5–19. doi:10.3822/ijtmb.v16i4.877
Howell, E. R. (2012). Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. The Journal of the Canadian Chiropractic Association, 56(2), 102–111. https://pubmed.ncbi.nlm.nih.gov/22675223/