PGP (Pelvic Girdle Pain) and SPD (Symphysis Pubis Dysfunction) occur when there is some sort of strain on the muscles and ligaments that support the pelvis, typically resulting from a lifetime of misalignment causing weakness, particularly in upper body and core strength as well as pelvic tilt. PGP is a generic term for all pelvis pain. SPD specifically occurs when the cartilage - the pubic symphysis - that connects the two halves of the front of the pelvis weakens (and sometimes separates in severe cases). In the American low movement and sitting culture, various forms of PGP are very common.
Over time, the misalignment caused from mono-movements (where one movement, like sitting, outweighs the other movements like walking, standing, squatting, climbing...etc.) makes the pelvis tilt and weight ends up being carried directly on the pubic symphysis. This tilt causes strain on the pubic symphysis, the PSOAS, the iliacis (some refer to this as iliacuspsoas but it is actually two separate muscles), and all the connecting muscles and ligaments surrounding the pelvis. Because the pelvis is so central, literally, to the body's support system - referred pain can be felt in other areas easily from this misalignment.
Some causes of SPD and PGP
- Culture/Lifestyle of mono-movements that changed the natural position of the body over many years, shortening muscle length in the hamstrings, back, and pelvic area. (This is rarely an incident-related issue, rather an extensive whole body concern developed from the time we wore our first shoes, ingrained by long-term desk sitting, and exacerbated by too much bent-leg-tucked-pelvis sitting. Unfortunately, pregnancy is the straw that breaks the
cam... mother's back. For some this is one pregnancy, for others 5-6 pregnancies, for some the birth itself).
- Sitting job or activities, whether at a desk, machine, weaving blankets...etc. - where you sit way more than other movements
- Sofas, chairs, dining tables and all furniture that increases sitting throughout the day
- Lazy furniture like hammocks, recliners, and any furniture that is used more than movement and positions the body to sit on the sacrum causing imbalances
- Too much sitting even in furniture-free homes
- Standing job or activities - where you stand way more than other movements, particularly if you're not aligned while standing
- Heeled shoes - of any kind including "flats" that have a heel increase (including men's shoes)
- Shoes - of any kind that decrease barefoot walking over a variety of terrain
- Flat surfaces that decrease barefoot walking over a variety of terrain
- Habits - Like leaning on one leg more than the other, jotting out your pelvis when standing, and generally not supporting your weight over the center of your heels with your pelvis in proper alignment
- Lack of vitamins and minerals for bone, muscle, and ligament health like properly prepared dark leafy greens, vegetables, and sprouted grains and legumes
- Lack of hydration (which doesn't just mean drink more water)
PGP and SPD Symptoms
- Round ligament pain
- Diastasis Recti
- Back pain, especially in the lower back
- Pregnancy Waddle
- Symphysis Pubis, SPD Pain
- Foot pain
- Breech, transverse, or posterior baby positions (especially that have trouble staying in one position after adjustments)
- Prodromal Labor
- Pain on the inner thigh
- Feeling like the baby is "really down there" with lots of pressure, even in mid-pregnancy
- Achy pelvis/vagina
- Varicose Veins, especially near the vagina/vulva
- Pain when opening the legs, especially in the mornings when getting out of bed or after long periods of rest
PGP and SPD Tips for Comfort
All cultures, even the most primitive, have a lifestyle that creates unbalanced habits (and even discomforts) from their repetitive movements. Its important to remember that pain during pregnancy is not a "pregnancy symptom" there is almost always an underlying cause, such as body misalignment. There are usually fixes but temporary relief is not typically a long term solution. Finding long term solutions while utilizing symptomatic relief is ideal.
A movement based lifestyle, while being intentional with alignment during movement, is the only way to fully fix the underlying cause of PGP and SPD pain in pregnancy, and beyond. Mono-movement lifestyles will create habits because the body is amazing. The body wants to do the least amount of work possible because that means it needs less energy for survival. The muscles, over time, adapt by shortening and lengthening to accommodate the movements (or lack thereof) in the easiest way. If we do a lot of one thing, we get really good at that (like sitting) because our muscles and ligaments adapt to that position. Making movement a part of our daily lives, not exercise, is the only way to make the muscle adapt adequately.
PGP and SPD discomfort can be temporarily remedied with chiropractic care, massage, and stretching.
Osteopathic manipulation or chiropractic care helps to realign the bones and muscles caused from the habits that have made the muscle adapt. This is only a temporary fix - and in some cases this may cause more pain if there are a lot of alignment issues and even hydration issues. There is not really one specific type of provider that is the best; find someone that specializes in a multifaceted approach so you can work on various modalities from hard and soft tissue, and especially relearning movement to fix the root causes.
Massage and stretching, particularly light touch myofascial release, can help to loosen the myofascia and relax tension in the muscles caused during the alignment transitions you're making from better movement practices. These practices also enable hydration to get to the cells needed for full body function.
Bodywork can not be done without changes in lifestyle or its not going to make a difference.
Stretches for PGP and SPD Relief
- Hamstring Stretch
- Calf Stretch (do this anytime you're standing)
- Yoga and stretching with a yoga strap
- Rebozo round ligament massage
- Squatting (though not an option for everyone with SPD as it may exacerbate the condition) - Keep your shins vertical and a curve in your spine. This is a stretch, not the exercise. Tucking your pelvis will stop it from working. Doing deep squats may make it worse. Listen to your body.
Eat Well Balanced
Because of the energy these new movements and alignments will create, you need to be sure to stay hydrated. If you're not hydrated, the myofascia gets hard and brittle and it will continue to bring these muscles and ligaments back to their previous positions. Likewise, if you're not receiving well balanced nutrients of all the whole foods colors of the rainbow, then you're missing valuable nourishment your bones and muscles need to properly function
Eat bone stock based meals three times a week. Be choosey how your food is grown and picked so you get the most nourishment bang for your buck. Add in a whole foods supplement - without any synthetics - to fill in the gaps as needed.
A salve of comfrey, chamomile, calendula, st. john's wort, and cayenne can help to relieve tension, relieve pain, and heal the muscles during these movement adjustment and stretching periods.
Comfrey - Comfrey, a.k.a. knit bone, is a wonderful cell regenerating herb for the skin, bones, muscles, and ligaments.
Chamomile - Chamomile is often used to sooth griping and upset tummies in little ones, but its antispasmodic effects are great, and gentle, for muscles, too.
Calendula - Calendula is an excellent addition to any skincare regimen as well as for an anti-inflammatory.
St. John's Wort - St. John's Wort is well known for its anti-depression abilities, but is also another great antispasmodic and skin healer (goodbye stretch marks).
Cayenne - Cayenne's capscasin allows it to block the body's pain signals reducing the effects you may feel from PGP or SPD discomfort.
This blend is easy to whip up by you or your local herbalist, or you can check out this salve in the Esali Shop.
Wrap Your Belly
SPD pain and discomfort can temporarily be remedied quickly by using a long wrap to take the weight off the front of the pelvis. This is especially helpful if you're not used to being up on your feet and need to be for the day and as you increase your lifestyle movement. There are various wraps for purchase to support the pregnant belly, and a long baby wrap works great as well. As the baby grows in a misaligned pelvis, the weight bears forward on the pubic symphysis causes more misalignment and low back pain. Using a wrap to shift the weight a bit will relieve discomfort as well as reduce chances of diastasis recti and other related conditions. You can wrap by tying under the belling and knotting in the back, front under the belly, or wrap up around the shoulders for more support. Keep in mind proper alignment throughout this or you may end up with more issues than you started with.
Postpartum belly wrapping is also helpful to healing and support through early parenting. This helps prevent diastasis recti (along with physical therapy) and decreases discomfort.
Postpartum & Breastfeeding After PGP Pain
Because this experience is created from misalignments, baby will be developing in a misaligned space that is the foundation for their body's alignment, tightness and flexibility, and ability to latch and breastfeedg well. Consider planning ahead for osteopathic care, craniosacral therapy, or chiropractic care for your baby soon after birth. You may anticipate a baby with symptoms of tongue ties (which may or may not be actual tethered oral tissues, but the need for loosening up tight tissue), and the need for an adjustment for yourself after birth as well. Some moms experience headaches, limited mobility, back pain, and other similar symptoms postpartum where chiropractic care or other bodywork therapy can be of benefit.
Desire support with belly wrapping or other PGP and SPD discomfort? Get in touch for one-on-one perinatal mentoring.