In short. Symphysis pain (pubic symphysis dysfunction, SPD) is excessive separation or instability of the pubic joint under the action of relaxin. According to various data, 10-30% of pregnant women face SPD symptoms in the second half of the term. The main signs: sharp or pulling pain above the pubis, when walking, parting the legs, turning in bed, or going up stairs. What makes it worse: parting the legs out to the sides (plié, sumo squats, frog pose), wide lunges, supine cycling, asymmetric loads on one leg, deep squats. What helps: symmetrical load with a narrow stance, bridge with a ball squeezed between the knees, transverse abdominis activation, Kegels with an emphasis on relaxation, cat-cow, diaphragmatic breathing. The goal is to stabilise the pelvis through deep muscle work, not to stretch. A support belt or kinesiology taping helps symptomatically. After birth, symphysis pain usually resolves in 4-12 weeks; after a C-section it resolves faster, because there is no stretching of the joint in the pushing stage.
Symphysis pain in pregnancy affects 10-30% of women, and the work with the joint is built through pelvic stabilisation using narrow symmetrical movements – parting the legs to the sides (plié, sumo, frog) worsens the separation rather than stretching it “correctly”.
A pulling or sharp pain above the pubis when walking, painful rolling in bed, the feeling that the pelvis is “splitting apart” – this is not “normal” for pregnancy. Often behind it lies symphysis pain, or pubic symphysis dysfunction. A condition that responds to correction if you know which exercises help, which are dangerous, and which everyday habits unload the pelvis.
What symphysis pain is
The pubic joint (symphysis) is a junction of the two pelvic bones via a dense cartilage disc at the front. During pregnancy, under the action of relaxin, this joint softens – needed for the baby to pass through in labour. In some women the process goes further than required, and excessive mobility or separation appears – this is symphysis pain, or SPD (symphysis pubis dysfunction).
Frequency: according to various data, from 10% to 30% of pregnant women experience SPD symptoms to some degree, especially in the second half of pregnancy. For most it is a mild form that can be managed without significant restrictions. For some – pronounced pain requiring lifestyle adaptations.
How to recognise symphysis pain
The main signs:
- Pain above the pubic bone – sharp or pulling, appearing or worsening when walking, parting the legs, turning, going up stairs.
- Pain when moving one leg – for example, getting out of a car, stepping over an obstacle, putting on trousers while standing.
- Clicks or a sense of “friction” in the symphysis area.
- Pain radiating to the groin, inner thighs, tailbone, lower back.
- Painful rolling in bed – one of the most characteristic features.
- A sense of “splitting” or instability in the pelvic area.
If you have one or more of these symptoms, it is a reason to see a gynaecologist. Symphysis pain is confirmed clinically and sometimes by ultrasound of the symphysis.
What is strictly contraindicated
In SPD the following exercises are excluded – either spreading the legs or loading one side of the pelvis:
- Spreading the legs out to the sides: plié, sumo squats, lotus pose, butterfly pose with knee spread, supine frog.
- Wide lunges.
- Asymmetric load on one leg: standard lunges, curtsy lunges, Bulgarian split squats, exercises with one vertical leg lift.
- Cycling movements lying on the back.
- Deep squats below parallel.
- Running and jumping.
- Long walking without rest – especially in the third trimester.
- Lifting heavy weights.
In daily life:
- Do not get into the car legs first – sit sideways, then turn in keeping the knees together.
- Do not step over high obstacles.
- Do not go up stairs taking two steps at a time.
- Do not stand long on one leg (for example, when putting on clothes).
- Do not sleep on the back without a pillow between the knees.
What helps
Exercises that support pelvic stability:
- Bridge with a ball between the knees. Lying on the back, knees bent, a small ball or cushion between the knees. Squeeze the ball and lift the pelvis on the exhale, lower on the inhale. 2 × 8-10 reps. Symmetrical glute activation without spreading the legs.
- Transverse abdominis activation. Lying, on the exhale gently pull the belly towards the spine. 10 reps × 2-3 times a day.
- Kegels with emphasis on relaxation. Special care – with pelvic floor hypertonus, symphysis pain may worsen.
- Cat-cow. Standing on all fours, smooth arching and rounding of the back. No jerks, no pain.
- Diaphragmatic breathing. 5-10 minutes daily.
What to wear:
- A pregnancy support belt or a special SPD belt. Put on lying down, take off at night.
- Kinesiology tape on the symphysis area – applied by a specialist. More on what tape actually does – in a separate breakdown.
- Comfortable flat shoes – no heels, no narrow unstable platforms.
Everyday tips:
- Rolling in bed: do not spread the legs. Keep the knees together and turn over as a single “log”.
- A pillow between the knees at night – keeps the pelvis in a stable position.
- Sit with knees straight ahead – no wide leg position.
- Climb stairs with a side step – both feet on one step, then the next.
- A cool or warm compress on the symphysis area for severe pain.
Session structure for SPD
Warm-up. Diaphragmatic breathing 3 minutes + cat-cow 8 reps.
Main block (10-15 minutes):
- Bridge with ball: 2 × 8.
- Transverse abdominis activation: 10 reps × 2 sets.
- Kegels: slow contractions 5 sec × 8 reps with full relaxation.
- Seated band row: 2 × 10.
- Side plank on the knee with bent legs: 10 seconds × 2 (only if it does not cause pain).
Closing. 5 minutes of calm breathing + relaxation on the side with a pillow between the knees.
3 times a week. The main thing is consistency, not volume.
What can make the situation worse
- Ignoring pain and continuing with familiar training.
- Self-prescribed “pelvic-opening stretches” – often increase instability.
- Long walks in the third trimester without breaks.
- Heavy shopping bags, moving furniture.
- Sleeping on the back without a pillow between the knees.
After birth
In most cases symphysis pain resolves within 4-12 weeks after birth as relaxin levels fall and the ligament system recovers. What helps in the early postpartum period:
- Continued work on pelvic stabilisation (bridge, transverse abdominis).
- A postpartum belly binder for the first 2-4 weeks.
- Avoiding long walks and heavy lifting in the first month.
- Active pelvic floor work from week 6-8.
If pain persists 12 weeks after birth – see a pelvic physiotherapist or an osteopath with experience in postpartum rehabilitation.
Related materials
- Lower back pain during pregnancy – often goes hand in hand with SPD.
- Third trimester and training – when SPD shows up most often.
- Pelvic floor after birth – why pelvic floor work matters in SPD.
- Preparing the body for birth.
If you have symphysis pain and need a programme that helps rather than worsens it, book the intro session. More details – «What is the intro session».
