You Know This Pain. You Just Did Not Know It Had a Name.
You roll over in bed and something grinds at the front of your pelvis. You swing one leg out of the car and a sharp pain shoots through your pubic bone. Walking up the stairs feels like your pelvis is splitting in two. You used to be able to move without thinking about it. Now every step is a calculation.
If this sounds familiar, you are likely dealing with symphysis pubis dysfunction — commonly called SPD. And if you have been told it is “just a normal part of pregnancy” or to “wait it out until the baby comes,” I want you to know: that is not the whole story.
SPD is common. It is also treatable. And you do not have to spend the rest of your pregnancy afraid to move.
What Is SPD and Why Does It Happen During Pregnancy?
Your pubic symphysis is the joint at the very front of your pelvis, where the two halves of your pelvic bone meet. It is held together by ligaments and cartilage, and under normal circumstances, it barely moves — about 1 to 2 millimeters.
During pregnancy, your hormones shift and you now have a huge amount of estrogen flowing through your body. Estrogen increases tissue elasticity for everything — ligaments, skin, blood vessels (hello varicose veins), etc. This is a natural and necessary process. But when the pubic symphysis becomes too mobile — or when the surrounding muscles cannot stabilize it well enough — the joint can shift and cause pain. Our nervous system also gets fired up when things feel different, which can increase your experience of pain.
The hormonal change isn’t inherently the problem. If it were, every pregnant woman would have SPD, and they do not. What actually drives the pain is usually a combination of factors:
- Pelvic floor muscle tension — tight pelvic floor muscles can pull asymmetrically on the pelvis, creating more stress at the pubic symphysis
- Hip and adductor imbalances — your inner thigh muscles attach directly to the pubic bone. If they are tight on one side or pulling unevenly, the joint takes the hit
- Core and pelvic asymmetries — as your baby grows and your center of gravity shifts, compensations develop. One side works harder than the other, and the pubic symphysis sits right in the middle of that tug-of-war
- Insufficient support from above — as the abdomen expands, the weight of the baby puts increasing downward pressure on the pelvis. Without adequate core and abdominal support, the pubic symphysis absorbs more load than it can handle
This is why “just wait it out” rarely works. The underlying imbalances do not resolve on their own — they usually get worse as the pregnancy progresses.
What SPD Actually Feels Like
Not everyone describes SPD the same way, but the pattern is usually recognizable:
- Sharp, stabbing, or grinding pain at the front of the pelvis
- Pain that gets worse with single-leg activities — stairs, getting in and out of a car, rolling over in bed, standing on one foot
- A feeling that your pelvis is “unstable” or could “give out”
- Clicking or popping at the pubic bone
- Pain that radiates into the inner thighs or groin
- Difficulty walking, especially after sitting for a long time
Some women have mild discomfort that is manageable. Others have pain so severe they can barely walk. Both deserve treatment, and both respond well to it.
How Pelvic Floor PT Actually Treats SPD
When I see a pregnant patient with pubic symphysis pain, I am not just looking at the joint that hurts. I am assessing everything that connects to and affects that joint — because SPD is rarely just about the pubic symphysis itself.
A good pelvic floor PT looks at the whole picture: your pelvic floor muscles internally, your hip muscles, your adductors, your core, how you move, where the asymmetries are. The assessment tells us exactly what is driving your pain — not a guess, not a generic exercise list.
I had a patient come to me who was active before her pregnancy and wanted to keep lifting weights. She was starting to have severe pelvic pain at the front of her pelvis — classic SPD. Here is what we did:
What Treatment Looked Like
- Internal pelvic floor treatment — muscles that were tight and referring pain to her pubic symphysis. Releasing that tension reduced the pull on the joint
- Adductor and hip muscle work — treating tension and asymmetries that were pulling on her pelvis unevenly using dry needling and other manual therapy releases
- Progressive single-leg exercises — starting with both legs together, progressing to split stance, then single-leg activities. Single-leg work was where her pain was worst, so we built up to it systematically
- KT tape for abdominal support — as her pregnancy progressed and her abdomen put more pressure on her pelvis, the tape provided support from above and reduced the load on the pubic symphysis
She was able to continue exercising during her entire pregnancy and manage her pelvic pain. That is the goal — not just reducing pain, but keeping you active and strong through pregnancy to help you have a better delivery and easier recovery.
Why Staying Active During Pregnancy Matters More Than You Think
One of the biggest things I want to challenge is this fear-based approach to pregnancy and exercise. I hear it constantly: “Exercise is good when you are pregnant, but let us not exercise too hard.”
The research does not support blanket restrictions. There is no evidence that pregnant women must avoid heavy lifting, rotation, or even crunches. What matters is modifying based on your individual symptoms — not following blanket rules that take away your ability to stay strong.
I know this firsthand. During my fourth pregnancy, I exercised consistently the entire time, including core work that traditional advice says to avoid. I wore a pelvic support belt, listened to my body, and returned to the gym at six weeks postpartum — essentially symptom-free. That was my best recovery by far, and it was not a coincidence. Staying strong through pregnancy meant I was not starting at zero postpartum.
When SPD is treated and managed properly, most women can keep exercising. When it is ignored, women stop moving — and then face an even harder recovery postpartum.
Building Your Care Team
Pelvic floor PT is the primary treatment for SPD — it directly addresses the muscular imbalances, pelvic floor tension, and coordination issues that drive the pain. That is what resolves the problem.
Some women also benefit from complementary care alongside their PT. Prenatal chiropractic, prenatal massage, or acupuncture can provide additional relief, especially for skeletal alignment. But these work best as supplements to your pelvic floor treatment plan, not replacements for it.
If you are looking for trusted providers in the area, I am building a women’s health network in Utah Valley — a directory of providers I know and trust who serve women throughout pregnancy and postpartum.
SPD After Pregnancy: It Does Not Always Just “Go Away”
Many women are told that SPD will resolve after delivery once your hormones readjust. And for some, it does improve significantly. But for others, the pubic symphysis pain lingers — weeks, months, sometimes longer.
Why? Because the hormonal changes are only part of the equation. If the muscle imbalances, pelvic floor tension, and movement compensations are not addressed, the joint stays irritated even after the baby arrives.
If you are postpartum and still dealing with pubic symphysis pain, it is not too late to get help. Postpartum pelvic floor PT can address lingering SPD alongside all the other recovery work your body needs.
When to Get Help
Do not wait until you cannot walk. The earlier SPD is addressed, the easier it is to manage and the better the outcomes. Here are signs that it is time to see a pelvic floor PT:
- Pubic bone pain with walking, stairs, or getting in and out of bed
- Pain that is limiting your exercise or daily activities
- A feeling that your pelvis is “unstable” or shifting
- Pain that is getting progressively worse as your pregnancy advances
- You have been told to “just rest” and it is not helping
In Utah, you do not need a referral from your doctor to see a physical therapist. You can schedule directly or start with a free 15-minute consultation if you are not sure whether pelvic floor PT is right for you.
The Cost of Waiting
When SPD goes untreated during pregnancy, it does not just mean pain. It means you stop moving. You stop exercising. You lose strength that you will desperately need for delivery and postpartum recovery.
And the research is clear: women who exercise during pregnancy have shorter labor times, fewer complications, and faster recoveries. A coordinated pelvic floor — one that can squeeze when it needs to squeeze and relax when it needs to relax — makes delivery more efficient and recovery smoother.
You are not being tough by pushing through it. You are just making postpartum harder than it needs to be.
What Your First Visit Looks Like
If you have never been to a pelvic floor PT — especially while pregnant — here is what to expect at Radiant Pelvic Health:
- Dr. Danaya comes to your home with everything needed for a full evaluation and treatment
- Your first visit is a dedicated 60 minutes — never rushed, never handed off to an aide
- The assessment includes your whole body: posture, movement, hips, core, and pelvic floor
- Internal pelvic floor assessment is optional and always at your pace and comfort level
- You leave with a clear understanding of what is causing your pain and a plan to address it
Your kids can be there. Your house does not need to be clean. And you do not have to drive anywhere with a belly that makes the seatbelt uncomfortable.
Learn more about what to expect at your first visit.
