Symphysis Pubis Dysfunction (SPD)

Symphysis pubis dysfunction is a condition that causes pain and instability at the front of the pelvis.

It is particularly common during pregnancy but can also occur in athletes and individuals with pelvic trauma or biomechanical issues.

Pubic symphysis pain can significantly affect mobility and quality of life, especially when walking, climbing stairs, or turning over in bed.

In this article, we’ll explore what symphysis pubis dysfunction is, where the pain comes from, why it happens, what symptoms to look out for, how it’s diagnosed and treated, and what you can do to help prevent it.

What Is Symphysis Pubis Dysfunction?

Symphysis pubis dysfunction is a condition involving excessive movement or instability at the front of the pelvis. It is also known as SPD, pubic symphysis dysfunction, or pubis symphysis dysfunction.

With symphysis pubis dysfunction, the joint becomes excessively mobile, misaligned or inflamed, often due to hormonal, mechanical, or biomechanical changes. The result is sharp or aching pain in the pubic region, instability, and difficulty with normal movement.

During pregnancy, hormonal changes increase the laxity of the ligaments around this pubic symphysis to allow for your pelvis to expand as the fetus grows, but in some cases, this can lead to pain and dysfunction. Symphysis pubis pain affects around 25% of women during pregnancy and is just one possible cause of pelvic and inner thigh pain.

What Causes Symphysis Pubis Dysfunction?

Pubic symphysis dysfunction is most commonly associated with pregnancy, especially in the second and third trimester, but can affect anyone. Common causes include:

• Hormonal changes in pregnancy increase the laxity of the pelvic ligaments around the joint to allow for delivery. Your body may start producing the hormone relaxin as early as 10 weeks into pregnancy.
• Weight gain, changes in posture and pelvic instability due to the growing uterus alter the load on the pelvis and shift the center of gravity
• Trauma to the pelvis, such as from a fall, high-impact sports injury, or car accident
• Post-surgical changes, especially after pelvic or abdominal procedures
• Muscle imbalances, particularly weak or tight abdominal, gluteal, and adductor muscles
• Hypermobile joints, particularly in individuals with generalised joint laxity e.g. Ehlers-Danlos Syndrome
• Biomechanical issues, such as poor posture, leg length discrepancy, altered gait or uneven loading through the pelvis (e.g. carrying a toddler on one hip) can place strain on the pubic symphysis.

Some women may be more predisposed to symphysis pubis dysfunction in pregnancy due to pre-existing pelvic asymmetry, previous pelvic trauma, or a history of lower back pain.

Symphysis Pubis Dysfunction Symptoms

Symptoms of pubic symphysis dysfunction can vary from mild to severe and may affect one or both sides of the pelvis. Common symptoms of SPD include:

• Pain at the front of the pelvis, especially directly over the pubic bone, that may radiate into the groin, hips, inner thighs, lower abdomen or lower back
• Worsening pain with activities where your legs move apart e.g. walking, climbing stairs, getting in/out of bed or a car, standing on one leg, or rolling over in bed
• A feeling of instability in the pelvis
• Clicking, grinding, or popping sensations in the pelvic area, especially with movement
• Pain during sexual intercourse

The discomfort can range from mild discomfort to sharp, stabbing pain that affects daily life. It often worsens as the pregnancy progresses and the pelvis prepares for birth. Symphysis pubis pain may persist postpartum if not properly addressed.

Diagnosing Pubic Symphysis Dysfunction

Diagnosis of symphysis pubis dysfunction involves a detailed clinical assessment, often supported by imaging if needed.

A healthcare provider, usually a physiotherapist or obstetrician, will:

• Review your symptoms and history, including pregnancy stage, physical activity, previous injuries, or pelvic surgeries
• Palpate the pubic symphysis and surrounding muscles for tenderness
• Perform specific tests, such as the active straight leg raise or single-leg stance, to assess pelvic stability and reproduce symptoms
• Evaluate posture, gait, and pelvic alignment

Although not always required, imaging may help in severe or unclear cases:

Differential Diagnosis

Several other conditions can mimic symphysis pubis dysfunction, including:

• Pelvic Girdle Pain (PGP): a broader term where multiple pelvic joints are affected including the sacroiliac joint
• Groin strain or adductor tendinopathy
• Osteitis pubis: inflammation of the pubic symphysis due to overuse or trauma
• Inguinal hernia
• Hip joint issues, such as labral tears or impingement
• Urinary tract or gynaecological conditions

A thorough assessment is crucial to differentiate pubis symphysis dysfunction from these and guide appropriate treatment.

Treatment for Symphysis Pubis Dysfunction

Symphysis pubis dysfunction treatment focuses on relieving pain, stabilising the pelvis, and improving function and usually involves a combination of:

1. Physical Therapy

A tailored physical therapy programme is key to successful recovery from pubic symphysis dysfunction and may include:

• Pelvic stability exercises, such as core activation, pelvic floor strengthening, pelvic tilts, and glute strengthening
• Stretching tight areas like hip flexors or inner thighs
• Manual therapy to address joint restrictions and muscle imbalances
• Postural re-education and advice on safe movement strategies
• Functional retraining, including how to move, lift, and roll out of bed with minimal pain

2. Pelvic Support Belts

3. Pain Relief

Ice or heat therapy can reduce symphysis pubis pain and inflammation and ease muscle tension

Paracetamol is typically the first-line medication during pregnancy. Anti-inflammatories (NSAIDs) may be used with caution postpartum or under medical advice

4. Modifying Activities

Avoid aggravating movements such as wide-leg positions, deep squats, or prolonged standing.

Use a pillow between your knees when sleeping and keep movements symmetrical when possible. Try to keep both legs together during activities such as getting in and out of the car or rolling over in bed.

5. Surgery (Rare)

In severe or unresponsive cases, particularly post-trauma or postpartum, surgical stabilisation of the pubic symphysis may be considered. This is very rare and typically reserved for persistent cases that fail to respond to conservative care.

Recovery Process

The recovery timeline for symphysis pubis dysfunction can vary depending on the underlying cause and the individual’s overall health. With early intervention, most people see significant improvement within a few weeks to a few months.

• During Pregnancy: Symptoms of SPD often improve or resolve after childbirth, although they may persist for several months postpartum. The ligaments will start to tighten up once your body stops producing relaxin and you will regain the stability in your pelvis
• Non-Pregnancy Cases: Most improve within 6–12 weeks with consistent physiotherapy and activity modification
• Chronic Cases: May require longer rehabilitation and multi-disciplinary input

Commitment to rehab exercises, proper pelvic support, and lifestyle adjustments are crucial to a successful recovery.

What Activities Should You Avoid with SPD?

Certain everyday activities can aggravate symphysis pubis dysfunction by placing uneven stress on the pelvis, so try to limit or avoid the following:

• Standing: avoid standing with you weight on one leg e.g. when dressing or carrying a child on one hip, and avoid standing for too long
• Lifting: avoid twisting or bending when lifting objects, and avoid lifting anything heavy e.g. laundry baskets, shopping bags, toddlers
• Sitting: avoid crossing your legs when sitting, sitting on the floor, sitting in a twisted position, or sitting for prolonged periods
• Activities: avoid vacuuming or pushing heavy objects like a shopping cart, and avoid carrying anything with one hand instead of evenly distributing the weight

Making small adjustments to how you move and carry things can help protect your pelvis and reduce pubic symphysis pain.

How to Avoid SPD

While some risk factors for symphysis pubis dysfunction, such as pregnancy hormones, are unavoidable, there are still steps you can take to reduce your risk:

• Stay active during pregnancy with gentle, low-impact exercise like walking, swimming, or prenatal yoga, as long as they don’t aggravate your symptoms
• Strengthen your core and glutes to improve pelvic stability
• Avoid heavy lifting or activities that cause pelvic strain
• Maintain good posture, especially when sitting or standing for long periods
• Avoid standing on one leg e.g. putting pants on while standing
• Wear comfortable, supportive footwear to promote even weight distribution - avoid high heels and flip-flops
• Consider wearing a pelvic support belt during late pregnancy or if at high risk

Being proactive with pelvic health before and during pregnancy can make a big difference in preventing or reducing pubic symphysis dysfunction pregnancy symptoms, particularly if you suffered from SPD in a previous pregnancy

FAQ’s on SPD

Pubic Symphysis Dysfunction Summary

Symphysis pubis dysfunction is a common but manageable condition that causes pain and instability at the front of the pelvis. It most frequently affects women during pregnancy but can also occur due to injury or biomechanical stress.

Early diagnosis and a structured management plan, including physiotherapy, pain relief, and lifestyle adjustments, can lead to full recovery and better quality of life.

If you are struggling with pubic symphysis pain, especially during pregnancy, don’t ignore it, the right care can make a huge difference in your comfort and mobility.

You may also be interested in the following articles:

• Inner Thigh Pain
• Front Hip Pain
• Osteitis Pubis
• Snapping Hip Syndrome
• Glute Strengthening Exercises
• Knee Pain Diagnosis Chart

Related Articles

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Medical & Scientific References

1. Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts. Physical Therapy & Rehabilitation Journal
2. Postpartum Pubic Symphysis Diastasis. National Library Of Medicine
3. Pubic Diastasis. Radiopaedia
4. Management Of Symphysial Dysfunction In Pregnancy And Post-Partum Period: A Review. Sri Lanka Journal Of Obstetrics & Gynaecology

Last Updated: June 19th, 2025
Next Review Due: June 19th, 2027