Symphysis pubis dysfunction (SPD), commonly known as pubic symphysis dysfunction or lightning crotch, is a condition that causes excessive movement of the

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...

, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

. Most commonly associated with

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

and

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...

, it is diagnosed in approximately 1 in 300 pregnancies, although some estimates of incidence are as high as 1 in 50. SPD is associated with

pelvic girdle pain Pelvic girdle pain (abbreviated PGP) can be described as a pregnancy discomfort for some women and a severe disability for others. PGP can cause pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP ha ...

and the names are often used interchangeably.

Symptoms

The main symptom is usually pain or discomfort in the pelvic region, usually centered on the joint at the front of the pelvis (the pubic symphysis). Some sufferers report being able to hear and feel the pubic symphysis and/or

sacroiliac The sacroiliac joint or SI joint (SIJ) is the joint between the sacrum and the ilium bones of the pelvis, which are connected by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side. The ...

, clicking or popping in and out as they walk or change position. Sufferers frequently also experience pain in the lower back, hips, groin, lower abdomen, and legs. The severity of the pain can range from mild discomfort to extreme pain that interferes with routine activities, family, social and professional life, and sleep. There have been links between SPD and depression due to the associated physical discomfort. Sufferers may walk with a characteristic side-to-side

gait Gait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency. Di ...

and have difficulty climbing stairs, problems with leg abduction and

adduction Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

, pain when carrying out weight bearing activities, difficulties carrying out everyday activities, and difficulties standing.

Diagnosis

A diagnosis is usually made from the symptoms, history, and physical exam alone. After pregnancy,

MRI scan Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s and

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

scanning are sometimes used. Patients typically initially report symptoms to a

midwife A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...

chiropractor Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscie ...

obstetrician Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

, general practitioner,

physiotherapist Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patien ...

or an osteopath. On seeing a health professional, patients should expect to receive a thorough physical examination to rule out other

lumbar In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...

spine problems, such as a

prolapsed disc Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical ...

pelvic and or pubis joint misalignment The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

, or other conditions such as

iliopsoas muscle spasms The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usua ...

urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

s and

Braxton Hicks contractions Braxton Hicks contractions, also known as practice contractions or false labor, are sporadic uterine contractions that may start around six weeks into a pregnancy. However, they are usually felt in the second or third trimester of pregnancy. ...

. Unnecessary radiation from medical imaging is avoided during pregnancy, so in most cases a physical examination and history are considered sufficient to refer to physical therapy.

Treatment

A promising treatment for chronic or post natal dysfunction is prolotherapy. Other treatments include the use of elbow crutches, pelvic support devices and prescribed pain relief. The majority of problems will resolve spontaneously after delivery. There are two case studies that show reduction of pain and dysfunction with conservative chiropractic care. Physical therapists—especially those specializing in pelvic floor physical therapy—can assist with pain relief techniques, provide manual therapy to alleviate related muscle spasms, and manage exercise protocols. While most pregnancy-related cases are reported to resolve postpartum, definitive diagnosis and treatment are still appropriate in order to optimize comfort and function and ensure a good course of recovery. Long-term complications can develop without proper care. Postpartum follow-up in cases of pregnancy-related SPD may include radiologic imaging, evaluation by a specialist such as an orthopedist or physiatrist, ongoing pelvic floor physical therapy, and assessment for any underlying or related musculoskeletal issues. In extreme cases that do not resolve with conservative management, surgery is considered after pregnancy to stabilise the pelvis, but success rates are very poor.

Everyday living

Typical advice usually given to people with SPD includes avoiding strenuous exercise, prolonged standing, repetitive reaching movements, lunges, stretching exercises and squatting. Patients are also frequently advised to: *Brace the transverse abdominis (lower abdominal muscles) before performing any activity which might cause pain *Rest the pelvis *Sit down for tasks where possible (e.g. dressing, workplace discussions, teaching, repetitive manual tasks) *Avoid lifting and carrying *Avoid stepping over things *Avoid

straddle In finance, a straddle strategy involves two transactions in options on the same underlying, with opposite positions. One holds long risk, the other short. As a result, it involves the purchase or sale of particular option derivatives that allow ...

movements especially when weight bearing *Bend the knees and keep the legs 'glued together' when turning in bed and getting in and out of bed, while engaging transverse abdominis *Place a pillow between the legs when in bed or resting *Avoid twisting movements of the body If the pain is very severe, using a walker or crutches will help take the weight off the pelvis and assist with mobility. Alternatively, for more extreme cases a wheelchair may be considered advisable.

Pharmacological interventions

It is not usually considered advisable to take

anti-inflammatory Anti-inflammatory is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs, also called anti-inflammatories, make up about half of analgesics. These drugs remedy pain by reducing inflammation as o ...

medication in pregnancy, which makes SPD a particularly difficult condition to manage.

Acetaminophen Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...

may be a safer option. Of note,

opiates An opiate, in classical pharmacology, is a substance derived from opium. In more modern usage, the term ''opioid'' is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain (including antagonist ...

are considered high risk with a more addictive nature, and carry a risk of depressed respiration in the newborn baby if taken near the time of birth, if taken at all. Therefore, it is considered advisable to discuss any pain relief medications with a physician, and cease taking any opiates 2–4 weeks before the estimated due date, as advised by a medical professional.

Symptoms

Diagnosis

Treatment

Everyday living

Pharmacological interventions

See also

References

Further reading