Understanding Pubic Bone Pain During Pregnancy & How Pelvic Physiotherapy Can Help

May 2

Amy Price, BScPT
Registered Physiotherapist -Pelvic Health

Pregnancy is a time of many physical changes happening at a relatively rapid rate - which can unfortunately result in pain and dysfunction for the pregnant person! One of the significantly impactful conditions expectant mothers may face is pubic bone pain. Pubic bone pain is medically known as Symphysis Pubis Dysfunction (SPD), and is a subset of Pelvic Girdle Pain (PGP). This condition can cause discomfort or pain in the front central region of the pelvis, where the pubic bones join together. This can make movements and activities like walking, turning in bed, or standing on one leg challenging. In this blog I will discuss what contributes to SPD during pregnancy, and how pelvic floor physiotherapy can help manage pain and improve function.

What Is Symphysis Pubis Dysfunction?

The symphysis pubis is a joint located at the front of the pelvis, where the two halves of the pelvis meet. The symphysis pubis has quite a bit of cartilage between the two bones, meaning that it’s very stable and typically doesn't allow for much movement. During pregnancy, the body releases a hormone called relaxin, which helps to prepare for childbirth by promoting more laxity in the ligaments and connective tissue than usual. This hormonal change is an essential part of pregnancy, but in some individuals, it can contribute to increased movement in the joints — particularly the symphysis pubis — resulting in pain and discomfort.

Causes and Mechanism of Pain

Several physiological and biomechanical changes during pregnancy contribute to the development of SPD:

Hormonal changes: As mentioned, the surge of the hormone relaxin causes the ligaments supporting the pelvis to become more elastic. While this allows the pelvis to widen during delivery, it can also lead to increased movement of the symphysis pubis joint and result in discomfort.
Weight and postural changes: As the baby grows, the body’s center of gravity shifts, altering posture and potentially placing extra strain on the pelvic joints. The added weight and altered movement patterns can increase the stress on the symphysis pubis.
Pelvic misalignment: Uneven pressure from activities like climbing stairs, standing on one leg, or turning in bed can cause the pelvic bones to move asymmetrically, increasing pain.
Reduced strength of core and pelvic muscles: If the muscles supporting the pelvis — especially the pelvic floor, abdominals, and glutes — are weak or imbalanced, the pelvic joints have less support, making dysfunction and pain more likely.

Common Symptoms of SPD

Sharp or burning pain at the front of the pelvis (pubic bone area)
Pain radiating to the inner thighs, hips, or lower back
Difficulty walking, especially with long strides or stairs
Increased pain when changing positions (e.g., rolling over in bed or getting out of a car)

The severity of symptoms of SPD can range widely. Some may feel mild discomfort, while others may experience significant pain that interferes with daily functioning and movement. These symptoms often worsen in the second or third trimester but can appear as early as the first trimester in some cases.

Treatment Options for Pubic Bone Pain

Managing SPD often requires a combination of strategies to reduce pain, improve function, and support the body through pregnancy.

1. Lifestyle and Activity Modifications: Modifying movements that would typically require standing on one leg (like putting on pants) can help to minimize aggravation. Sleeping on your side with a pillow between the knees and feet for neutral pelvic alignment can reduce pain overnight and in the morning. Avoiding lifting heavy objects or sudden twisting movements can minimize pain in the day to day. Take your time!

2. Supportive Devices: A pelvic support belt can help stabilize the pelvis and reduce pain during movement, allowing for more activity during pregnancy without pain.

3. Pelvic Floor Physiotherapy: One of the most effective treatments for pubic bone pain during pregnancy is pelvic floor physiotherapy. A pelvic floor physiotherapist is specially trained to assess and treat the muscles, joints, and ligaments in the pelvic area.

How Pelvic Floor Physiotherapy Helps:

Exercise: A pelvic floor physiotherapist can identify tight or weak muscles contributing to pelvic instability and develop a personalized exercise plan to improve strength and function.
Joint Mobilization and Manual Therapy: Gentle hands-on techniques can help reduce tension and pain around the symphysis pubis.
Postural Training: Improving posture and body mechanics can reduce strain on the pelvis during daily activities.

• Education and Support: Learning how to move safely and protect your pelvis during pregnancy empowers you to manage pain more effectively.

When to Seek Help

While pubic bone pain during pregnancy can be challenging, luckily it’s treatable. Through a combination of physiotherapy, supportive strategies, and lifestyle adjustments, many pregnant people can find relief and regain confidence in their movement. If you’re experiencing pain in your pelvic area during pregnancy, don’t dismiss it as just a normal part of pregnancy. Early intervention can prevent the condition from worsening and improve your quality of life. A pelvic floor physiotherapist at Proactive Pelvic Health Centre can identify what factors are contributing to your pain, and help develop a treatment plan to improve your symptoms.

References:

Bø, K., & Hilde, G. (2013). Pelvic girdle pain and physical therapy. Current Opinion in Obstetrics and Gynecology, 25(6), 382–386.

Hilde, G., Tennfjord, M. K., Mørkved, S., & Bø, K. (2013). Women's experiences of pelvic girdle pain and the role of physiotherapy during pregnancy: A qualitative study. BMC Pregnancy and Childbirth, 13, 171.

Stuge, B., Hilde, G., Vøllestad, N., & Vøllestad, N. K. (2004). Physical therapy for pregnancy-related low back and pelvic pain: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 83(10), 929–938.

Wu, W. H., Meijer, O. G., Uegaki, K., Mens, J. M. A., van Dieën, J. H., Wuisman, P. I. J. M., & Ostgaard, H. C. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575–589.

Angelique Montano-Bresolin