Pubic Symphysis Pain

The pelvis is a ring of bone that contains three joints. One is in the front (the pubic symphysis) and the other two are in the back on either side of the sacrum (the SI joints).

The terms symphysis pubis dysfunction (SPD), pubic symphysis dysfunction (PSD) and diastasis symphysis pubis are used interchangeably to describe pubic symphysis pain.
Pubic symphysis pain is specific to the area of the joint. Pressing directly on the pubic symphysis should reproduce your primary pain. Many also feel soreness in the lower abs, perineum, and groin along with joint pain.
People with pubic symphysis pain usually experience pain when walking, getting in and out of bed, and standing on one leg. During exercise, they may experience pain with running, lunges, and step ups.
Some people with pubic symphysis pain also experience sacroiliac joint pain. To read more about sacroiliac joint pain, check out this article!

Pubic symphysis pain occurs almost exclusively in pregnant and postpartum people. We know that it is extremely common and resolves within about 6 months postpartum for most people.
It is still possible for non-pregnant people to have pain in the pubic area, but other diagnoses are usually more specific. If you aren’t pregnant but have pubic pain, Agile’s pelvic PT clinic is still a great place for you to get care!
- Athletic pubalgia: Repetitive stress injury to the muscle and connective tissue near the pubic bone)
- Osteitis pubis: Inflammatory joint pain at the pubic symphysis that most often occurs after bladder and prostate surgeries. It has also been shown to result from repetitive stresses for athletes
- Groin pain related to inner thigh (adductor) tendon or muscle pain

Research indicates that a combination of factors leads to pubic symphysis pain. Hormonal changes in pregnancy increase the movement in the pubic symphysis, but the increased amount of joint movement does not itself seem to be the cause pain.
The best evidence suggests that pubic symphysis pain is a sensitivity to force through the joint. Someone with much better stability from muscles and connective tissues on one side of the pelvis than the other may be more likely to experience pain than someone who has equal levels of stabilization.
In rare cases, the pubic symphysis can separate during vaginal childbirth because of the combination of high physical stress and hormones. While most people recover fully after this injury, they do experience a longer recovery period. We have experience with these clients and are ready to help!

Many providers still talk about “pelvic misalignment” as the cause of pubic symphysis pain. However, there is no reliable evidence that this is the case. Years of research shows that it is not possible to detect pelvic joint position through touching a patient.
The treatments that are frequently used to “correct alignment” can feel good and helpful! However, this isn’t because the joint alignment was changed. Contracting muscles and creating movement around a painful area is often helpful for reducing pain for short periods.
Many people who are concerned about joint alignment are also worried to move normally and participate in their desired exercise. We don’t want anyone to limit their movement because of this fear. Your pelvis is strong and stable, even if you have pain!

If your symptoms are severe, we recommend temporarily resting from painful activities. However, staying active within a mild to moderate degree of pain is safe and advisable. Your PT can help you navigate your daily activity and exercise program to make sure you can stay moving!
Once your symptoms calm, we can start building back up! We use an exercise-based approach that focuses on building strength in the pelvic floor, abdominals, back, hips, and thighs. By building strength and tolerance for painful movements, we can get you back up to speed!
Many find relief from a pelvic support belt. If this works for you, feel free to use it to keep yourself moving! This is best used as a temporary measure, as we don’t want you to have to rely on it forever.
If movements in bed or getting out of the car are painful, try keeping your legs together (“move like a mermaid”). Your PT can help you troubleshoot bothersome activities if you’re still having issues.