Lightning Crotch in Pregnancy: How You Can Start Recovering from SPD

What is symphysis pubis dysfunction (Lightning Crotch)?

Symphysis pubis dysfunction (SPD), also known as pubic symphysis dysfunction, anterior pelvic girdle pain, or lightning crotch, is a common musculoskeletal condition that is experienced by pregnant women and can vary from minor discomfort to severely debilitating pain. It is typically characterized by discomfort in the front pelvic area that can radiate to the inner thighs and perineum (think where your pubic bone is).

The prevalence of SPD during pregnancy ranges from 14-85% with a higher prevalence tending to be towards the expected date of birth.1

What causes SPD / Lightning Crotch? 

The exact cause of SPD is unknown, however there are two main theories for the cause of SPD: 

• Hormone changes: Typically, the ligaments that work to support the two halves of your pelvis together are very strong and tight. However, pregnancy induced hormone changes can make these supportive structures more stretchy, helping to create more space in the pelvis that is necessary for vaginal delivery. 
• Muscular imbalance: combined with the increased stress on the pelvis from biomechanical changes such as weight gain and altered weight distribution that occurs during pregnancy contributes to the development of symptoms.2

Common risk factors include multiparity, trauma to pelvis or back, family history of pelvic pain in mothers or sisters, pelvic pain in previous pregnancies, early menarche (early age of first period), lack of regular exercise, joint hypermobility, macrosomia, postterm delivery, neonatal developmental hip dysplasia and breastfeeding.3

Common symptoms of Lightning Crotch include: 

• Pain and tenderness at the pubic symphysis - commonly described as burning, stabbing, or grinding
• Pain commonly radiating to the inner thighs and perineum4
• Pain with the following activities:
• Stair climbing
• Standing on one leg
• Lunging 
• Walking 
• Getting up from a seated position
• Wide legged movements - getting in and out of the car
• Turning over in bed

What can I do to help with Lightning Crotch?

Start to modify your activities: Get in and out of the car with the legs together to avoid aggravating symptoms. If the exercise that you are doing during pregnancy involves single leg activities (ex: tree pose in yoga, single leg squats), modify those exercises to keep both feet on the ground for now. Try walking on the street or sidewalk for exercise as opposed to uneven ground or sand. 

Wear a pelvic belt! Pelvic support bands can be very helpful by providing external support to both sides of the pelvis, reducing the forces transmitted through the pubic symphysis. Here are some of our favorites:

Serola Sacroiliac Belt

NeoTech Care Maternity Support Belt

Learn how to relax your pelvic floor: During pregnancy, your pelvic floor muscles are working overtime to not only support you, but your growing baby. This can cause muscles to spasm, become tight and painful. Sometimes pelvic floor muscle dysfunction can mimic or exacerbate symptoms of symphysis pubis dysfunction. Working with a pelvic floor physical therapist can be very helpful to learn how to not only relieve pelvic pain, but also prepare your pelvic floor for childbirth. Taking a warm (not hot) Epsom salt bath is also calming to the other muscles, like you adductors, that can become overactive and tight when you have SPD. We like these from Kneipp.

Exercises also help to stabilize the instability often found with SPD. Try these exercises to help stabilize your pelvic girdle and reduce SPD pain.

Our physical therapists at Femina Physical Therapy are experts in the treatment of symphysis pubis dysfunction! If you have any additional questions or need more support, contact us to schedule an appointment today.

References: 

1. Wellock VK, Crichton MA. Understanding pregnant women’s experiences of symphysis pubis dysfunction: the effect of pain. Evidence-Based Midwifery (Royal College of Midwives). 2007;5(2):40. Accessed June 21, 2024. 
2. Ramachandra P. Telerehabilitation for pelvic girdle dysfunction in pregnancy during COVID-19 pandemic crisis: A case report. Physiotherapy Theory & Practice. 2022;38(12):2250-2256. doi:10.1080/09593985.2021.1898706
3. Aslan E, Fynes M. Symphysial pelvic dysfunction. Current Opinion in Obstetrics and Gynecology. 2007;19(2):133-139. doi:10.1097/GCO.0b013e328034f138
4. Clark CJ, Carr ECJ, Way S. Pregnancy-related lumbopelvic pain: Prevalence, persistence, risk factors and management implications. British Journal of Midwifery. 2013;21(5):323-330. doi:10.12968/bjom.2013.21.5.323