Pubic symphysis dysfunction is a term referring to pain and discomfort of the pubic symphysis. The pubic symphysis is a joint that is a part of the pelvic girdle, located in between the two halves of your pelvis.

It is just below your belly button and has a piece of cartilage that connects the right and left side. This joint helps with stability and support of the upper body, absorbs shock while walking or running, and helps support pregnancy and childbirth by becoming flexible.

While it may be confusing, pubic symphysis dysfunction is known by many names. Oftentimes, it is used interchangeably with pelvic girdle pain (PGP).

However, pelvic girdle pain encapsulates pain in or near the entire pelvic region, whereas pubic symphysis dysfunction is pain felt particularly in the front of the pelvis where the pubic symphysis joint is located. 

The pelvic girdle is made up of the pubic symphysis, sacrum, and hip bones, so using the term “pubic symphysis dysfunction” rather than “pelvic girdle pain” is a bit more specific method of describing the location of the pain or problem.

It is also often called symphysis pubis dysfunction (SPD), lightning crotch, or osteitis pubis. Osteitis pubis is a very similar condition involving the pubic symphysis joint, but specifically refers to inflammation of the area usually caused by repeated stress. You can think of it as a type of pubic symphysis dysfunction.

In the case of pubic symphysis dysfunction, the pubic symphysis joint becomes either excessively mobile or misaligned, which leads to a range of symptoms for the individual. Symptoms of this issue include:

• Steady pain or sudden, shooting pain—specifically in the lower frontal region of the pelvis that may also be felt near the groin, inner thighs, lower abdomen, and perineum.
• Pain during weight-bearing activities such as lifting.
• Difficulty walking, climbing, and doing other movements such as bending or standing on one leg.
• Clicking or grinding sounds from the pelvis.
• Difficulty with urination or bowel movements.

In extreme cases, the symphysis pubis can rupture, known as diastasis of the symphysis pubis, but this is more rare.

In most cases, symphysis pubis dysfunction is very treatable—especially with pelvic floor physical therapy! But first, let’s look at some common causes of this condition.

Start Healing with Hive

As mentioned earlier, pubic symphysis dysfunction originates from misalignment or excessive mobility of the pubic symphysis joint. Misalignment or mobility of this joint can be caused by a number of things, such as repetitive use, surgery, injury, pregnancy, or childbirth.

Many people associate this condition with pregnancy, and although it does typically occur in pregnant people, it can affect others as well.

In the case of pregnancy, this type of dysfunction may occur because of the drastic changes that occur during pregnancy and childbirth. When a person is pregnant, their center of gravity shifts as weight increases in a concentrated area of the body.

This can put additional pressure on the pelvic floor and pubic symphysis joint as they work hard to maintain balance and stability for the body.

Additionally, the body releases more of the relaxin hormone, which allows the body’s muscles, joints, and ligaments to loosen in preparation for delivery. This hormone will make the pubic symphysis joint more mobile and flexible, which in turn can create dysfunction.

In terms of childbirth, the pelvic girdle widens in order for the baby to exit the body. Occasionally, this can create over-stretching or strain of the pubic symphysis joint.

For those who experience pubic symphysis dysfunction due to these reasons, the symptoms usually improve some time after childbirth. However, in some cases, the symptoms may persist, and require professional attention.

Outside of pregnancy or childbirth, this type of dysfunction can be created by other situations:

• Repetitive strain and overuse, such as with athletes
• Trauma or injury, such as a fall or accident that misaligns the pelvis or pubic symphysis
• Muscular imbalances in the pelvic floor, hips, or abdominal muscles
• Pelvic floor dysfunction
• Poor posture, especially when walking or lifting
• Metabolic disease, joint diseases, infection
• Underlying conditions such as sacroiliac joint dysfunction

One important cause to note is pelvic floor dysfunction. As mentioned before, the pubic symphysis joint is a part of the pelvic girdle. The pelvic girdle and pelvic floor are very interconnected, and affect each other in many different ways.

If problems arise with the pelvic floor, problems will likely arise with the pelvic girdle, and vice versa.

The muscles, ligaments, and other structures of these two body parts are closely connected—therefore, your physical therapist will address any problems with the pelvic floor as part of your treatment for pubic symphysis dysfunction.

For example, when there are muscle imbalances with the pelvic floor, this can create imbalance of the pelvis and therefore create misalignment in the pelvic girdle and hips. On the other hand, if misalignment occurs in these areas, it can cause pelvic floor dysfunction, too.

This is also why some symptoms of pubic symphysis dysfunction involve functions controlled by the pelvic floor, such as difficulties with bowel movements or urination.

This is especially important to know for pregnant individuals, who are more likely to experience pelvic floor dysfunction.

Your pelvic floor physical therapist may utilize a variety of treatments to help restore alignment and function to your pubic symphysis joint and pelvis.

They will always start with an assessment, which involves discussing your symptoms and completing examinations of your pelvic floor, gait, posture, or other relevant factors.

This will allow them to identify the severity of your dysfunction, and what treatments will be needed in order to address it. These treatments can include:

Exercise Prescription: To provide proper alignment, support, and stability of the pubic symphysis joint, your physical therapist will provide an exercise plan to strengthen your pelvic floor, pelvis, hips, abdominals, back, and other nearby areas as necessary. This will help lessen the strain on your pubic symphysis joint by addressing muscle imbalances and enhancing stability.

Pelvic Floor Training: In order to combat pubic symphysis dysfunction and prevent other related symptoms of pelvic floor dysfunction, your pelvic floor therapist will identify weakness, tightness, lack of coordination, or other problems with your pelvic floor. These problems will be addressed with a variety of treatments, such as manual therapy, biofeedback, neuromuscular reeducation, exercises, and more.

Posture Training: Your physical therapist will be able to identify any harmful posture habits you may possess while walking, lifting, sitting, or making specific movements—and improve on those to support better posture and prevent misalignment.

Pain Management: Pubic symphysis dysfunction often causes pain, which will take time to resolve as you and your physical therapist target the root of the problem. Therefore, your physical therapist can offer mobilization, cupping, dry needling, or other treatments to help minimize pain. 

Supportive Aids: In some cases, especially in the case of pregnancy, it may be helpful to utilize supportive aids for your body to help encourage stability and reduce pain. Your pelvic floor physical therapist can help suggest these items, such as pelvic support belts, belly belts, and more.

Behavioral Modifications: Your physical therapist can help modify any activities or movements that you currently engage in regularly—such as when exercising or working—to avoid exacerbating your symptoms and help prevent future complications.

These are just some of the many ways that a pelvic floor physical therapist can address symptoms of pubic symphysis dysfunction. Additionally, treatment methods can vary depending on whether or not you are pregnant.

Each and every patient at Hive Therapy and Wellness receives a holistic, comprehensive, and curated plan of care—therefore, you can expect any of the following treatments to be included in your unique care plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities