Symphysis Pubis Dysfunction Treatment
Recent research confirms what we hear from patients following childbirth who suffer from Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction. That these women suffer from pain that is largely ignored or dismissed by doctors.
Doctors asked 23 women, who after their first childbirth had continuing pain in their pelvic region for at least 3 months following the birth. The doctors then identified four themes in the patient interviews.
They found that:
- The women put up with the pain, but had to balance activities and were grateful for support from family and friends;
- The women did not “feel back to normal”, but described feelings of physical limitations, frustration and a negative impact on their mood;
- The women were distressed that they were not told these symptoms may occur and the symptoms were an unexpected consequence;
- The women wanted a treatment, but the future impact of their symptoms was met with great uncertainty, so much that the women expressed worry about having another baby.1
Here is what new research is saying and it is just as bad:
In this study, 176 women reporting Pregnancy related low back pain (PLBP) and pelvic girdle pain (PGP) postpartum where:
- 34 (19.3 %) reported ‘no’ pain,
- 115 (65.3 %) ‘recurrent’ pain,
- 27 (15.3 %) ‘continuous’ pain.
- The vast majority (92.4 %) of women reported that they had neither been on sick leave nor sought any healthcare services (64.1 %) during the 6 months – 12 months postpartum. (Agreeing with the above research that the women were tolerating the pain and discomfort.
- Women with ‘continuous’ pain during the 6 months – 12 months postpartum reported a higher extent of sick leave and healthcare seeking behaviour compared to women with ‘recurrent’ pain.
- Most women with persistent Pregnancy related low back pain and pelvic girdle pain had been on sick leave on a full-time basis. The most commonly sought healthcare was physiotherapy, followed by consultation with a medical doctor, acupuncture and chiropractic.2
The pubic symphysis is frequently an overlooked joint located in the front of the pelvis. It is a joint that is strongly bonded and is rarely injured in isolation. The pubic symphysis is actually a fibrocartilagenous disc supported on the top by the superior pubic ligaments. It helps unite the left and right pubic bones.
In the female, the pubis is located above the vulva. In cooperation with the sacroiliac joints the symphysis pubis forms a stable pelvic girdle. The anatomy of the pelvic girdle is quite complex. The pelvis is a ring, and any anatomical change or force of pressure to one area will expand throughout the ring.
- Childbirth causes changes in the pelvic girdle, which can lead to excessive movement and instability.
- Severe shearing stress injuries, such as a fall may disrupt the pubic symphysis as well as fracture the pelvis.
The pubic symphysis joint can move about 2 millimeters, and with one degree of rotation. This small amount of movement is normal, but in some women the joint may become unstable, allowing for too much movement in the pelvis. Again, because of the anatomy of the pelvic ring, instability at the symphysis pubis often also affects the sacroiliac joints, and vice versa.
Symphysis pubis dysfunction has been described as a collection of signs and symptoms of discomfort and pain in the pelvic area, including pelvic pain radiating to the upper thighs and perineum.
What causes Symphysis Pubis Dysfunction in women? Other than childbirth?
Although there are various causes of symphysis pubis dysfunction, women are more frequently affected, and some of those women affected are going through or have gone through pregnancy and childbirth. During pregnancy, hormones such as relaxin allow for more flexibility of this ligamentous disc. Relaxin breaks down the collagen in the pelvic joint, causing softening and laxity, allowing for an increased stretch of up to 9 mm between the two bones in a normal pregnant woman. Pregnancy leads to a change in the pelvic load, causing lax ligaments. This can lead to pelvic instability and symphysis pubis injury.
Dysfunction of the pubic symphysis is due to excessive movement at the joint, either anterior movement or lateral movement. This movement causes pain. There may also be misalignment of the pelvis. The pubic symphysis widens slightly whenever the legs are stretched far apart, and therefore sports activities requiring this type of movement, such as in horseback riding, have a higher risk of causing injury to the pubic symphysis. This causes misalignment and instability of the symphysis pubis joint. The resulting pain can be quite severe, especially on further strain put upon the affected joint.
Damage can occur to the ligaments of this pubic joint as a result of repetitive stress, or by falling, tripping or slipping. Activities that require repetitive movements such as swimming the breast stroke, previous injury to the pelvis, and injuries sustained in contact sports, all increase the risk of developing injury to the pubic symphysis.
Particular movements or activities can cause a slight but continual separation or shearing in the symphysis, which can erode the joint surfaces, causing a kind of roughening in the cartilage and bones that form the joint. This condition is known as osteitis pubis, which means an inflammation of the pubic bone. Any type of back or sacroiliac problem that causes excessive movement of the pelvis can result in excessive movement in the front of the pelvis – the location of the pubic symphysis and its ligaments.
Symphysis Pubis Dysfunction Treatment
Women with pubic symphysis injury may be prescribed elbow crutches, pelvic-support devices, and pharmaceutical interventions for pain relief.
Physical therapy may be ordered to help increase core strength and pelvic stability. Women may also be encouraged to discuss birth planning with an obstetrician or midwife. In severe cases surgery is recommended after the childbirth to stabilize the pelvis.
The problem with this approach is that it does nothing to repair the lax and/or injured ligaments of a pubic symphysis injury and, thus, does not alleviate the chronic pain that women with this condition experience. Chronic pain that does not respond to exercise, massage or manipulation is usually a ligament problem.
The approach of prescribing pain medications and anti-inflammatory medications is problematic with women who are pregnant. Also, although anti-inflammatory drugs have been shown to produce short-term pain benefit, they result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration.
Prolotherapy gives long lasting benefits for a Symphysis Pubis Dysfunction
The fibrocartilagenous disc, that is the pubic symphysis joint, is composed of bundles of thick collagen fibers. These fibrous bundles resemble tendon cells. Since unresolved pain from symphysis pubis injury involves instability of this disc as well as ligament laxity in the pelvic girdle, a better approach is to strengthen the joints with Prolotherapy.
Prolotherapy solutions injected into the affected ligaments, tendons, and/or joints causes a local inflammation in the injected area. This inflammation is a good thing since the body heals by inflammation. The mild, localized inflammation boosts blood supply and regenerative cells to the weakened area. This results in the deposition of new collagen, the material that the symphysis pubis is made of. The new collagen tightens the weakened, unstable joint and makes it stronger.
Prolotherapy treatment is typically given to the symphysis pubis joint and may also be given to the back joint of the pelvic bone, the sacroiliac joint, because laxity or weakness in one usually implies laxity or weakness in the other.
The symptoms from symphysis pubis dysfunction and injury resolve with Prolotherapy, because the source of the injury, the weakened disc and the lax ligaments, are comprehensively treated. Prolotherapy is an effective and successful treatment for pubic symphysis injury in women.
1. Wuytack F, Curtis E, Begley C. The Experiences of First-Time Mothers With Persistent Pelvic Girdle Pain After Childbirth: A Descriptive Qualitative Study. Phys Ther. 2015 Apr 30. [Epub ahead of print]
2. Bergström C, Persson M, Mogren I. Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiropr Man Therap. 2016 Feb 15;24:7. doi: 10.1186/s12998-016-0088-9. eCollection 2016.