S..P.D Symphysis Pubis Dysfunction

So I have been experiencing twinges in my front pelvis, predominantly when I'm walking and using the stairs. I also notice swelling on one side of my pubic area. Exercising wasn't causing me any bother to my pelvis but I am not sure if this is because my joints and body are more warm. Luckily I recently started a static desk job because the role I was previously doing involved being active all day. So  I decided to mention it to my midwife on a routine visit and she referred me to the hospital physio. I was lucky and managed to get an appointment within a week.

So after the initial consultation with the physiotherapist, it was concluded that I had unfortunately got SPD. Yes, it is as painful as the name sounds Symphysis Pubis Dysfunction.This apparently more common in second pregnancies and can effect 1 in 5 pregnancies.

SPD is also known as pregnancy-related pelvic girdle pain PPGP, which is a variety of  uncomfortable symptoms caused by misalignment or stiffness in the pelvic area. This leads to instability in the pelvic joint allowing it to move in ways it was never intended to move. The condition is not harmful to the baby but painful for the mother SPD is not only painful, but it also puts a damper on workouts during and after pregnancy.

Symptoms can include
* Pain over the pubic bone at the front in the centre
* Pain across one or both sides of your lower back
* Pain in the perineum

So I had the pain across the front and obvious swelling on one side, the physiotherapist said my pelvis had actually dropped about 2 inches on one side. This was quite frightening to hear but actually easy to fix. The physiotherapist positioned me where my leg was over her shoulder and I had to push against her while she pushed my pelvis. So after about 30 seconds the pelvis had been corrected and back in line. It was now down to me to maintain this and was given a beautiful NHS support band to wear. The band was very tight so only could realistically wear it when I was walking and standing. It did help taking the weight off my pelvis and continued using this while walking.


The Association for Chartered Physiotherapists in Women’s Health (ACPWH) also offers this advice:

• Be as active as possible within your pain limits, and avoid activities that make the pain worse.
• Rest when you can.
• Get help with household chores from your partner, family and friends.
• Wear flat, supportive shoes.
• Sit down to get dressed – for example, don’t stand on one leg when putting on jeans.
• Keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel.
• Sleep in a comfortable position – for example, on your side with a pillow between your legs.
• Try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks.
• Take the stairs one at a time, or go upstairs backwards or on your bottom.
• If you’re using crutches, have a small backpack to carry things in.
• If you want to have sex, consider different positions, such as kneeling on all fours.

 

 

 

So after resting for a few days and getting used to the rather large NHS pelvic support band I headed back to the gym. I talked everything through with the personal trainer and had told him that I did have the all clear to exercise. The conditions were, don't do anything that hurts or uncomfortable, no plyometric or single sided exercises. Split squats, lunges, step ups, pistol squats and lateral jumps would leave me in agony.

 

 So the focuses for us to avoid when rewriting a revised program were exercises that involved

 

standing on one leg

bending and twisting to lift, or carrying a baby on one hip

crossing your legs

sitting on the floor, or sitting twisted

sitting or standing for long periods

lifting heavy weights

pushing heavy objects

carrying anything in only one hand

The first adaptation was to isolate the pelvis, previously I was using stability ball while lifting weight and cable machines. This was so that my core was engaged and I could work on pelvic tilt in between sets (recommended by the physio). Alternatively now I am using a fixed weights bench.

I am avoiding

• Lunges
• Lateral twists
• Cross trainer
• Single leg deadlifts
• Kettlebell swings
• Single arm weights
• Supermans

I still want to achieve an all over body work and still want birth preparation to be a focus. To work my legs I am using the seated leg press as my weight load is off my legs and my pelvis is supported. I have been using the seated cable machines to focus on shoulders, core, upper back and arms. Using dumbbells (both hands) while seated on a weight bench enabled me to isolate the delts and lats. I also did an elevated plank on the weight bench to ensure I was maintaining a tight transverse muscle that will help support the baby weight. I did not wear the NHS support band while training, it as too restricting so I wore my own support to keep the baby weight off my pelvis.

At this point in my pregnancy I decided to stop the functional training class I had been attending up to now. Since falling pregnant I had been coming at least once a week and working on my own adaptations within each circuit. I have now decided to focus on birth and post birth preparation in the gym.

So the initial troublesome pain began to fade away and I was no longer taking painkillers and I gradually introduced my original programme back into my training.