Pregnancy & Postpartum
Symphysis Pubis Dysfunction (SPD) Treatment
Sharp pain in your pubic bone with every step. A clicking or grinding sensation. Trouble getting out of the car or rolling over in bed. SPD is one of the most common — and most undertreated — causes of pelvic pain during pregnancy.
Understanding SPD
What SPD Actually Is
Your pubic symphysis is the joint at the front of your pelvis where the two halves meet. During pregnancy, the hormone relaxin softens the ligaments that hold this joint together — preparing your pelvis for birth. For some women, that softening becomes too much. The joint moves more than it should, the surrounding muscles tense up to try to stabilize, and you get pain.
That’s symphysis pubis dysfunction. It’s also called pelvic girdle pain (PGP), pubic symphysis dysfunction, or SPD. The names all describe the same problem: a pelvic joint that’s moving incorrectly, causing pain in the pubic bone, groin, inner thighs, lower back, or all of the above.
SPD affects up to 1 in 5 pregnant women, with another 7% experiencing symptoms postpartum. Most providers treat it as something to “just get through” — wear a belt, take it easy, wait for delivery. That’s not what we do at Radiant.
Signs & Symptoms
What SPD Feels Like
Sharp Pubic Bone Pain
Sharp pain in the pubic bone when walking, stepping up stairs, or getting out of a car. Often the first symptom women notice.
Clicking or Grinding
A clicking, grinding, or shifting sensation in the front of the pelvis — like the joint isn’t holding together correctly.
Pain Rolling Over in Bed
One of the most diagnostic symptoms. Sharp pain rolling from one side to the other in bed often points directly to SPD.
Inner Thigh & Groin Pain
Pain spreading to the inner thighs, groin, or lower back. The adductor muscles attach right at the pubic bone and frequently get involved.
Pain Separating Your Legs
Difficulty putting on pants, getting out of a low chair, or opening your legs in the shower. Movements that separate the legs aggravate the joint.
Worse on One Side
SPD is often asymmetric. If you can do a single-leg stance for 30 seconds without pain, your SPD is mild. If you can’t put weight on one leg without sharp pubic pain, it’s significant.
Not sure where to start? Schedule a Free Consultation →
Why Standard Advice Fails
Why “Wait It Out” Doesn’t Work for Most Women
Standard advice for SPD during pregnancy is some combination of: rest, ice, a pelvic support belt, and “see how you feel after delivery.” That advice misses three critical things.
First, SPD doesn’t always resolve at delivery. About 7% of women have persistent SPD postpartum, sometimes for months or years. The pelvis has been compensating around a misbehaving joint for the entire pregnancy. Birth doesn’t undo those patterns automatically.
Second, the muscles around the joint matter as much as the joint itself. Your adductors (inner thighs), gluteus medius (side hip), pelvic floor, and deep abdominal muscles all work together to stabilize the pelvis. When one is weak or one is gripping, the joint takes the load. Treating the joint without addressing the muscles is like adjusting a bike chain without checking the gears.
Third, the right exercises in pregnancy actually help. Modified single-leg work, hip mobility, and pelvic floor coordination training can keep you active and stable through your third trimester. Without them, the pelvis weakens and the joint gets less stable, not more.
How PT Helps
How We Treat SPD at Radiant
Dr. Danaya is a board-certified pelvic floor specialist (PRPC, Cert-DN) with extensive training in pregnancy-related pelvic pain. SPD treatment is one of her clinical specialties. She personally treats every patient.
A Typical Treatment Plan Includes:
- Comprehensive Assessment First: Before any treatment, evaluation of how your whole body is moving — gait, single-leg stance, hip mobility, core engagement, breathing. SPD is rarely just about the joint.
- Internal Pelvic Floor Work: To release tension that’s compensating around the joint. Pregnant patients are often surprised that internal work is appropriate during pregnancy — it is, and it’s frequently the missing piece.
- Adductor & Hip Work: Tight or weak adductors are one of the biggest drivers of SPD pain. Hands-on release plus targeted strengthening makes a measurable difference.
- Dry Needling for Trigger Points: Dr. Danaya is Cert-DN certified and trained in dry needling during pregnancy. Insurance rarely covers dry needling — at Radiant, it’s included in your full session at no extra cost. Learn more about dry needling →
- KT Taping: For in-the-moment support, especially if you need to be on your feet a lot.
- Progressive Single-Leg Exercise: Simple stuff at first — wall sits, side-lying clamshells, standing balance. Then more challenging work as your stability improves.
- Education on Daily Movement: Sleeping positions, getting out of bed, climbing stairs, lifting your other kids — every daily activity has a way to do it that protects the joint and a way that aggravates it. Most patients see significant improvement just from changing how they move during the day.
What to Expect
Most patients with SPD see meaningful improvement in 2-4 sessions. More complex cases or postpartum SPD with long-standing patterns may take longer. With early treatment, most patients stay active through pregnancy and recover faster postpartum.
Differential Diagnosis
Is This SPD or Something Else?
Several pregnancy-related pain conditions share symptoms with SPD. Use this comparison to narrow down what you’re experiencing — but a proper diagnosis requires a hands-on assessment.
| Condition | Pain Location | Pain Pattern | Made Worse By |
|---|---|---|---|
| SPD | Pubic bone, can spread to inner thighs and groin | Sharp, sudden, often with single-leg movements | Stairs, getting out of car, rolling in bed, walking |
| Round ligament pain | Lower abdomen / sides | Brief, sharp, stretching sensation | Sudden movements, sneezing, position changes |
| Sciatica | Buttock down the back of one leg | Burning or shooting, often with numbness/tingling | Sitting, prolonged standing, certain bending positions |
| SI joint dysfunction | Lower back, one or both sides | Deep ache, sometimes sharp | Standing on one leg, climbing stairs, getting in/out of car |
If you have multiple of these patterns at once, that’s not unusual — pelvic girdle pain is often a combination, which is why a comprehensive assessment matters.
Quick Self-Assessment
How Severe Is Your SPD?
Score one point for each “yes”:
- I have pubic bone pain when walking
- I have pubic bone pain rolling over in bed
- I have pain getting in or out of a car
- I have pain putting on pants while standing
- I have pain climbing stairs
- I can hear or feel clicking/grinding in the front of my pelvis
- The pain is worse on one side than the other
- The pain is interrupting sleep
- I’ve stopped exercising because of the pain
- The pain is getting worse week over week
| Score | Severity | Recommendation |
|---|---|---|
| 0-2 | Mild | Modify daily activities, watch for worsening, consider PT if not improving in 2 weeks |
| 3-5 | Moderate | Pelvic floor PT recommended — most patients see meaningful improvement in 2-4 sessions |
| 6-8 | Significant | Pelvic floor PT recommended urgently — don’t wait for delivery |
| 9-10 | Severe | Schedule PT this week — consider a pelvic support belt for daily activities while you wait |
When to Get Help
When to Seek Treatment
If you have any of these, get evaluated:
- Pubic bone pain that’s interrupting walking, exercise, or sleep
- Symptoms that have been getting worse, not better, week over week
- Symptoms that started after a fall or a long car ride
- Postpartum SPD symptoms still present 6+ weeks after birth
- Pain so sharp you’ve considered using crutches
You don’t need a referral. Utah is a Direct Access state, which means you can see a pelvic floor PT without going through your OB first.
Your Questions Answered
Common Questions About SPD
Is SPD dangerous for the baby?
SPD is a maternal pain condition — it doesn’t directly affect the baby. The risk it poses is to you: if pain forces you to stop walking and exercising, that affects your cardiovascular health, mood, and overall pregnancy well-being. Treating SPD is about keeping you active and comfortable, which benefits both you and your pregnancy.
Will SPD go away after I deliver?
For most women, yes — the pubic symphysis stabilizes within 4-6 weeks postpartum as relaxin levels drop. But about 7% of women have persistent SPD beyond that window. If your symptoms aren’t improving by 6 weeks postpartum, you need pelvic floor PT to retrain stability.
Can I exercise with SPD?
Yes — but with modifications. Sweeping rules like “stop all exercise” or “no single-leg work” are usually wrong. The right exercises actively help stabilize the joint. The wrong ones can make symptoms worse. A pelvic floor PT can give you a specific, individualized plan.
Should I wear a pelvic support belt?
A belt can give short-term relief, especially if you’re on your feet a lot. But it doesn’t fix the underlying instability — and using it constantly can let the surrounding muscles weaken. Best use: short bursts combined with a treatment plan that strengthens the muscles a belt is replacing.
Is dry needling safe during pregnancy?
Yes, when performed by a clinician trained in it (Cert-DN credential). Certain points are avoided during pregnancy, and the technique focuses on hip and back trigger points contributing to SPD pain. Dr. Danaya is Cert-DN certified and uses dry needling regularly with pregnant patients.
Do I need a referral from my OB?
No. Utah is a Direct Access state. You can see a pelvic floor PT without a referral.
Related Reading
Learn More
Related Conditions
You May Also Be Interested In
Ready to Stay Active Through Pregnancy?
Schedule Your Free Consultation
Let's identify what's actually causing your pubic bone pain and build a plan that keeps you moving.
Or call/text: (385) 204-4135
In-home pelvic floor physical therapy throughout Utah Valley