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Help for Pubic Symphysis Pain

Help for Pubic Symphysis Pain

International Journal of Childbirth Education. June 2009.

Heather Jeffcoat, DPT

Pubic symphysis pain, or anterior pelvic girdle pain, is one of a myriad of musculoskeletal pains that women may experience during pregnancy. This pain can be debilitating, requiring some women to use crutches or a rolling walker to alleviate the pain while allowing some mobility. Some studies report that up to 50% of pregnant women have some type of pelvic girdle pain prior to 20 weeks gestation. Additionally, this pain negatively affects perceived health and sexual life during pregnancy (Mogren, 2006).

pubic symphysis painPubic symphysis pain is defined as mild to severe pain over the pubic symphysis, and can extend down into the groin and medial thighs (unilateral or bilateral). It generally presents clinically as pain with standing (especially on one leg), prolonged sitting, or with transitional movements such as going from a sitting to a standing position, rolling over in bed, or going up or down stairs. In some women, there may be a clicking in the joint present.

Oftentimes, this pain is present along with other types of pain, most commonly with lower back or sacral pain. One study pointed to additional physical and psychosocial factors that may increase risk of pubic symphysis pain during pregnancy, such as increased weight and less job satisfaction (Albert et al, 2006). Risk factors that are associated with prolonged pelvic pain at six months' time include increased BMI and pelvic joint hypermobility (Mogren 2006).

A study published earlier this year looked at pelvic girdle pain (including anterior or pubic symphysis pain) and disability reported in pregnant women in the first trimester and again at gestation week 30 (Robinson et al, 2010). Clinical examinations were also performed. The results showed that self-reported pain locations in the pelvis, a positive posterior provocations test and the sum of pain provocation tests present in early pregnancy are statistically significant with disability reports at 30 weeks gestation, but the number of pain sites is not.

Another study looked at hormonal contraceptive use and the occurrence of all types of pregnancy-related pelvic girdle pain (Kumle et al, 2004). It found that the use of hormonal contraceptives was only significant with regards to pelvic girdle pain for the first pregnancy. The most significant determinant of pelvic girdle pain in subsequent pregnancies is the presence of pain in a previous pregnancy. Studies have looked at several factors to identify risk in developing various types of pelvic girdle pain, but there is no single factor that appears to play the biggest role. Once the pain occurs, there are some exercises your client can perform that may alleviate her symptoms.

Modifications in your client's daily activities are an essential first step to alleviate pain and pressure in the pubic symphysis. Instruct her to keep her legs together when she is rolling over in bed or getting out of the car, like she is wearing a tight mini-skirt. Also, it is generally more comfortable for her to get into bed "on all fours" and then lying on her side, rather than sitting in bed and lifting her legs up.

Additionally, there are some exercises your client can perform, which have been shown to reduce pubic symphysis pain (Depledge et al, 2005).


  • Abdominal Stabilization: Instruct your client to gently pull her navel towards her baby.
  • Kegels: Instruct your client to contract her pelvic floor gently, like she is closing the openings.
  • Gluteus Squeezes: Instruct your client to gently squeeze the buttocks. This can be done while standing.
  • Lat Pulls: Instruct your client to grasp a door handle and gently pull it toward her.
  • Adductor Squeezes: Instruct your client to place a small, soft ball between her knees and squeeze gently.

The good news is that pubic symphysis pain usually resolves on its own after birth. However, if the pain worsens or these initial exercises do not work, there are additional exercises and treatments your client can learn or receive from an experienced Women's Health physical therapist. To locate one in your area, go to www.womenshealthapta.org or call (800) 999-APTA extension 3229.

Related Search Terms:


Bump, et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug;165(2):322-7

Carriere, B., Feldt, C.M. 2002. The Pelvic Floor. New York: Thieme.

Di Benedetto, P., Coidessa, A., Floris, S. Rationale of pelvic floor muscles training in women with urinary incontinence. Minerva Ginecol. 2008 Dec;60(6):529-41.

Hay-Smith, E.J., Dumoulin, C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005654.

Stephenson, R., O’Connor, L. 2000. Obstetric and Gynecologic Care in Physical Therapy. New Jersey: Slack, Inc.

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My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

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Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

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Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

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I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

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I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

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