Symphysis, also known as pelvic girdle pain, is a common issue among women during pregnancy, although it's not often talked about. In fact, very few women are aware that they can take action to address the loosening of the ligaments that hold their pelvic bones in place. We often only find out about symphysis when we are confronted with the pain of a growing belly during pregnancy. It's that uncomfortable pulling sensation that happens in the pubic area which can sometimes be so painful that normal walking, putting on shoes, or climbing stairs becomes a challenge.
Where and what is Symphysis exactly?
Our pelvis has multiple important functions. It not only protects internal organs and allows us to walk upright, but it also plays a crucial role during pregnancy and childbirth. The pelvis consists of a ring of bones and the pelvic floor muscles. Within this pelvic ring, there are three joints: the two sacroiliac joints and the symphysis, also known as the pubic symphysis.
The symphysis serves as the connection between the left and right pubic bones through connective cartilage. Normally, the pelvic ring doesn't offer much flexibility. However, during pregnancy, the female body produces a hormone called relaxin, which softens the tissues and makes the ligaments more elastic. This effect is particularly noticeable in the symphysis area and the sacroiliac joints between the ilium and sacrum. It's a normal process, but if the widening of the pubic symphysis becomes too pronounced, it can lead to pain. This condition is referred to as symphysis loosening.
Hormonal changes are often attributed as the cause of symphysis loosening. Additionally, excessive strain on the expectant mother's body can also contribute to this condition, which doesn't necessarily have to be physical in nature. A loosening of the symphysis can also be promoted by undetected structural injuries from previous pregnancies or insufficient regression, which leads to greater overall instability in the pelvic girdle.
Symptoms that may be related to a loosening of the symphysis
Pain in the pubic bone area, sometimes accompanied by pain that radiates from the back and into the outer or inner thighs.
Walking can become challenging, and the characteristic waddling gait of pregnant women is often attributed to symphysis loosening. The feet may naturally turn outward during walking or running to make it more bearable.
Standing on one leg can be painful and difficult.
Lying on the side without a pillow between the knees can be uncomfortable, and some women experience pain when changing positions while lying down.
Getting up from a bed, chair, or car may also be challenging.
The severity of pain varies for each woman experiencing symphysis loosening during pregnancy. Some women may only have selective pain, while others may face major problems and limited mobility for an extended period of time. It's important to remember that every woman and every pregnancy is different. If you experience any symptoms, it's crucial to consult with a doctor or midwife. They can provide early pain relief and recommend individual measures to alleviate discomfort.
How to relieve symptoms
Regardless of the causes for the symptoms, the relaxation of the symphysis is always a signal from the body. This is a reminder to adjust your daily workload as much as possible and to fit more rest into your daily schedule. Please keep in mind that the following information and tips are not medical advice and we cannot make any promises regarding healing.
1. Avoid certain movements while experiencing symphysis pain in everyday life and during sports/yoga:
When the pain is severe, some women try to avoid it by moving as little as possible. This is, however, not always advisable, especially since the pain occurs even when lying down or sitting. Preferably, it is crucial to specifically avoid or modify those movements that cause pain.
- lateral movements of the legs and scissoring movements
- one-sided movements of the legs (e.g. lunges)
- excessive stair climbing (steep steps and large steps). Take stairs slowly and deliberately.
- Cross-legged and stretching the adductors, e.g. butterfly in yoga
- Refrain from lifting too much weight (especially small children)
- take shorter walks instead of longer walks
2. Supportive Abdominal Belt/Maternity Belt
A pregnancy belt fits tightly below the abdomen and ensures that the ilium is compressed and the entire abdomen is supported. This provides more support and relief the pelvis, alleviating related pain. Until the belt arrives, you can mimic the support of a belt by using a sling or a cotton scarf. At home or when sitting, the belt is often felt to be uncomfortable. In this case, a good alternative can be lighter, less firm maternity support corsets.
Kinesiology tape isn't only for competitive athletes. Kinesiology taping can also alleviate many discomforts during pregnancy. The elastic cotton tape works by relieving and supporting the affected muscle groups. The tape also stimulates blood circulation and metabolic activity in the body. The skin is gently lifted and massaged by the tape with every movement, stimulating lymph and blood flow. Muscles, supplied with more blood, can now relax. If you also work with tension during the application technique, the tape also has a stabilizing effect on the body. Kinesiology tape is therefore also applied under and on the stomach in pregnant women. It supports the lateral and rectus abdominis muscles to support the baby's weight.
SYMPHYTUM C6 Capsules. The recommended dosage should definitely be discussed with your doctor, pharmacist, alternative practitioner, or midwife. (Common recommendation: take three capsules three to six times a day)
5. Physiotherapy, osteopathy and acupuncture can also provide relief.
6. Everyday tips for symphysis complaints/relaxation
Always take breaks and decide which of your to-dos are actually important!
Put your pants on while sitting, then evenly distribute your weight on both legs while standing up.
Sleep with a nursing or side sleeper pillow between your legs to help keep your legs/hips parallel. The abdomen can additionally be supported when needed.
Different sitting and lying positions:
We also recommend incorporating a variety of sitting and lying positions. From the sofa to the chair to a yoga ball and sometimes to the floor, changing positions brings relief and ensures that the muscles and the musculoskeletal system are not challenged too one-sidedly.
If you have to sit for a long time, a slightly inflated Pilates ball makes it easier to straighten out your lower back.
A plastic bag on the car seat makes it possible to turn with both legs at the same time to get out.
The four-footed position in particular is felt to be very relieving, as the baby's weight is taken from the pelvis.
Of course, a healthy and balanced diet always contributes to general well-being. Calcium-rich foods help strengthen bones and joints. Vitamin D intake is also worth mentioning repeatedly in this context.
7. Exercise and sport in moderation
This aspect seems to be the biggest challenge in the face of pain: less is more and it is important to watch how your body reacts.
A gentle, balanced yoga practice is highly recommended and helps to alleviate long term symptoms. This should also include some daily strengthening exercises (e.g. with a large ball) to stabilize the pelvic girdle. Activating the deep abdominal muscles and the pelvic floor helps to stabilize the pelvis and thus indirectly the symphysis.
Pelvic and symphysis stabilization exercises
In all exercises, keep your breathing even and try to maintain clear alignment! If you are new to yoga, be sure to have a teacher or midwife show you the exercises first.
Easy chair or squat position (Utkatasana) and variations
Take a ball between your knees in a seated position on a chair. Squeeze the ball 10-20 times while exhaling. Keep your spine lengthened and your knees directly above your ankles. Adjust the intensity individually!
Then take the ball between your thighs and repeat the exercise in the same way. Be sure ground your feet well and evenly.
In the case of symphysis weakness or instability, these exercises should be part of your daily routine.
To increase the intensity, get into the chair or light squat position and squeeze a ball/block between your legs. Alternatively, an elastic band can be used. Repeat this 5 to 15 times.
You can keep your arms down at the hips or stretched out upwards or to the side.
Heel seat/kneeling exercise
Come into a heel seat. Find the alignment in the pelvis and the length in your spine.
As you exhale, raise your pelvis, get on your knees and at the same time open your arms to the side. Notice the insides of your legs. As you breathe in, bring your arms together while lowering your pelvis again. You can take a short break or continue doing this without stopping.
Camel ride or Cat & Cow in heel seat
The camel ride works just like Cat & Cow, only sitting on your heels on a bolster instead of on all fours. On the inhale you'll open into a slight heart opening, on the exhale you'll round your back.
Gentle activation of the abdominal muscles in the diagonal
Come into the forearm stand. The knees should be placed under the pelvis and the elbows under the shoulders, feet long or planted. Your hands can be folded into one another, and direct your gaze towards the mat. Note that the spine is maintained in its natural vibration. Connect with your baby through a few mindful breaths.
On the next exhale, establish basic tension and press your right elbow and left knee into the floor – imagine pushing both towards your navel. Hold the tension for a few seconds. Gently release the tension and switch diagonals. Repeat these sets three to ten times a day.
Cow Face Pose (Gomukhasana Legs)
Get on all fours. Make sure that your hands are directly underneath your shoulders, your toes are pointed back, or your feet are long and flat. Cross one leg tightly over the other, with your foot outstretched. Notice the insides of your legs.
Start flowing through Cat & Cow here. As you inhale, gently raise your breastbone, and as you exhale, bring your baby closer and round your back while grounding your hands and legs well. Flow through this movement 5 to 15 times.
Alternatively, you can also take a ball under one hand and press it with the exhale, then release it a little with the inhale. Important: Always exercise both sides!
Strengthening the core muscles in a side position
A (nursing) pillow between the legs is recommended for optimal pelvic alignment and to avoid unpleasant tension on the symphysis.
Lie on your side, extend your lower arm, and rest your head on it. With your legs bent, hold a (nursing) pillow between your knees and thighs. Place your top hand in front of you, balled into a fist, at chest height. You can also support your hand on a small ball. Make sure your upper and lower arms are at right angles to each other. As you exhale, build up basic tension and at the same time press the floor with your raised fist. The idea of literally hugging the baby with the abdominal muscles helps to bring in all of the core muscles.
The pose should be held for three to ten seconds. As you inhale, release some of the basic tension and build it up again with the next exhalation. Repeat this three to ten times. Then take a short break before switching to the other side.
Shoulder Supported Bridge (Setu Bandhasana)
When the discomfort subsides and your pelvis feels stable enough, go into shoulder bridge and squeeze a block/ball between your knees/thighs in the manner outlined above. Again, your knees should be aligned above your ankles.
In the next step, raise your pelvis rhythmically while exhaling, while at the same time increasing the pressure on the ball between your legs. If this is painful, stick with the previous exercises for a few more days/weeks.
Symphysis loosening and childbirth
"It is important to emphasize that a loosening of the symphysis does NOT have to be a reason for a caesarean section. Exceptions confirm the rule here, too, and of course this should be clarified in individual cases in consultation with the doctor," explains Jessica Strickmann (@erdmutterberlin), midwife at St. Joseph Hospital in Berlin.
In her experience, many women report that the symptoms and pain caused by the loosening of the symphysis are less noticeable during childbirth or even disappear completely. On the one hand, because body and mind focus differently, on the other hand, because the baby steps deeper into the pelvis, more tension and stability is restored in the pelvic girdle for a short time.
"But regardless of whether the symphysis is loosened or not, childbirth is movement and women should always be guided by their intuition," explains Jessica. If the pressure becomes too intense, an experienced midwife will advise positions that relieve the strain, such as the deep knee elbow plank or the getting on all fours. Warmth and movement in the water, as well as lying on your side with a pillow between your legs, can also bring relief.
"How long the symptoms last after the birth is very individual," continues Strickmann. Rest after birth and subsequent targeted regression are always important, especially with regard to possible later pregnancies.
We wish all the best to you and to your baby!