Pubic Symphysis joint holds the pelvic bones together and is strengthened by ligaments and muscles. Symphysis pubis dysfunction (SPD) occurs when the joint becomes relatively mobile which leads to allow instability in the pelvic girdle. It is common in pregnancy due to increased pelvic load, laxity of ligaments under the influence of hormonal changes, and weakening of muscles. It is also related to physically strenuous work, lack of exercise, and poor posture in pregnancy. Other causative factors include trauma and repetitive force on the pelvis.

Pain is usually felt on the pubic symphysis and may radiate to the abdomen, groin, lower back, and hips with difficulty in walking, climbing stairs, turning in bed, rising from a chair, and getting out of the car. Symphysis Pubis Dysfunction affects mobility and impacts the quality of life. Following stretches and exercises help with the Symphysis Pubis Dysfunction pain.

1. Pelvic and Core Stabilization Exercises-
   • Kegels– Squeeze the pelvic muscles as if trying to stop urine flow. The feeling is one of ‘squeeze and lift’. Hold it for 10 seconds, release it, rest for a few seconds, and repeat it 10 times.
   • Bridging– Start with supine lying with knees flexed together and pointing to the ceiling, arms by your side with palms facing down. Inhale and push through your heels, lift your lower back and hips, so that the whole body from knees to shoulder is aligned in a slanting line. Your body must be resting on your upper back and shoulders. Hold for 10-15 seconds, repeat 10 times.
   • Bird dog exercises-Go on to your hands and knees, keeping your shoulders over your hands and your knees spaced hip-width apart. Simultaneously straighten and raise your left leg and right arm, keeping your pelvis and shoulders in a neutral position. Hold for 5-10 seconds and go back to the starting position. Repeat on the other side. Try to do 2-3 sets of 10 reps.
   • Squats -Stand with the feet hip-width apart. Bend at the knees to bring the buttocks toward the floor, as if going to sit on the chair. Keep the back straight and leaning slightly forward. The knees should be in line with the toes. Focus on tightening the buttocks and pelvic floor while returning to a standing position. Repeat 10 times.
   • Posterior pelvic tilts -Lie down on your back with hips and knees flexed to 45 degrees and feet flat on the bed—draw in your tummy and press the lower part of your back into the bed to flatten your back. Hold this position for 5 -10 seconds, release and repeat 10 times.
   • Cat and Camel exercises-Go on to your hands and knees, keeping your shoulders over your hands and your knees spaced hip-width apart. Arch and hollow your back alternately, repeat 10-15times.
2. Hip Adductor Strengthening-.
   • Lie down on your back with hips and knees flexed to 45 degrees and feet flat on the ground. Place a medium-size rubber ball or a pillow between your knees, and press it for 5-10sec, release and repeat 10 times.
3. Hip Clams-Lie on your side with your knees bent and hips one over the other. Keeping your feet together, slowly raise your top knee toward the ceiling. Do not roll back. Hold for 5 seconds and slowly bring back knees together. Repeat 10 times on each side.
4. Stretch your Hams and Quads.

Some other tips for Symphysis Pubis Dysfunction–

• Avoid activities putting undue strain on pelvis.
• While standing, put equal weight on both legs.
• Lie on less painful side while sleeping.
• Avoid lifting heavy loads.
• Avoid sitting with legs crossed.
• Do not sit for long periods, change your position frequently.
• Avoid twisting, bending and stooping.
• Use pelvis belt to support the joint.

Creating awareness about Symphysis Pubis Dysfunction in pregnancy is important because of its high prevalance with increasing maternal age and second time pregnancies.

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• Hip and pelvic conditions
• Women Health