Understanding Symphysis Pubis Dysfunction (SPD): Safe Pre- and Postnatal Exercise Strategies

If you’re experiencing a sharp, stabbing pain at the front of your pelvis, especially when walking, rolling over in bed, or putting on trousers, you might be dealing with Symphysis Pubis Dysfunction (SPD), also referred to as Pelvic Girdle Pain (PGP) or Pubic Symphysis Diastasis (PPSD).

I have trained a few postnatal clients with this issue, so I thought I would share a few things about it.

It can feel isolating, but it is a manageable condition with the right movement strategies.

What is Symphysis Pubis Dysfunction?

The pubic symphysis is the joint where the left and right sides of your pelvic bones meet at the front. Normally, this joint moves very little.

During pregnancy, pregnancy hormones (like relaxin and progesterone) soften the surrounding ligaments to allow the pelvis to expand for birth. However, if the joint becomes overly lax or the surrounding muscles (core, glutes, pelvic floor) aren’t firing evenly, the joint can shift unevenly or widen beyond normal physiological limits. This causes friction, inflammation, and sharp localised pain.

Common Symptoms:

• Sharp pain over the front pubic bone.

• Radiating ache into the inner thighs, lower back, or groin.

• A clicking, grinding, or popping sensation in the pelvis.

• Increased pain during asymmetrical movements (e.g., standing on one leg, stepping into a car, walking up stairs).

Movement Rules: The “Keep Your Knees Together” Principle

Before introducing exercises, the primary goal for SPD management is minimising shear forces across the pubic joint.

• Keep your knees together: Squeeze your knees together when rolling over in bed or getting in and out of the car.

• Avoid asymmetrical stance: Skip lunges, single-leg step-ups, or standing on one leg.

• Sleep with a pillow: Place a firm pillow between your knees and ankles while sleeping on your side to keep your hips parallel.

Evidence-Based Pre- & Postnatal Exercises

Research highlights that deep core stabilisation, pelvic floor integration, and symmetrical glute strength are key to reducing PGP and SPD pain.

1. Transverse Abdominis (TvA) Breathing & Co-Contraction

Activating the deep abdominal “corset” muscle helps stabilise the anterior pelvis without stressing the joint.

• How to do it: Sit upright or lie on your back/side with knees bent. Inhale into your ribcage. As you exhale, gently lift your pelvic floor and pull your belly button toward your spine (think of zipping up tight jeans). Hold for 3–5 seconds while continuing to breathe.

• Target: 8–10 repetitions, 2–3 times daily.

2. Isometric Adductor Squeeze with TvA Activation

Isometrics recruit the inner thigh muscles (which attach near the pubic joint) to normalise pressure across the symphysis.

• How to do it: Sit or lie on your back with knees bent. Place a soft Pilates ball or yoga block between your knees. Inhale, and as you exhale, gently squeeze the ball at ~30% effort while engaging your deep core. Hold for 5 seconds, then release.

• Target: 10 repetitions. (Stop immediately if this reproduces sharp pain).

3. Symmetrical Glute Bridges (with Squeeze)

Glute strength is critical for pelvic girdle stability, but standard bridges can trigger pain if your hips shift unevenly.

• How to do it: Lie on your back with feet hip-width apart and a yoga block or soft ball between your knees. Exhale, engage your core, gently squeeze the block, and press through your heels to lift your hips into a low bridge. Inhale as you lower down under control.

• Target: 2 sets of 10–12 repetitions.

4. Seated or Side-Lying Clamshells (Gentle Range)

Work the gluteus medius to support lateral hip stability without forcing extreme hip abduction.

• How to do it: Lie on your side with knees bent at 90 degrees and hips stacked. Keep feet together and lift your top knee slightly—only through a comfortable, pain-free range.

• Target: 10–12 reps per side.

Clinical Evidence & Research Studies

For those wanting to dig deeper into the clinical data, these studies support structured exercise and physical therapy for SPD/PGP:

• PubMed: Postpartum Pubic Symphysis Diastasis (StatPearls)

  Explores the pathophysiology of peripartum pubic symphysis separation, hormonal influences (relaxin/progesterone), and conservative management protocols.

• PubMed: Stabilizing Exercises for Postpartum Pelvic Girdle Pain (Stuge et al., Spine)

  A landmark study demonstrating that individualized, supervised stabilization exercises focusing on deep local muscles significantly reduce pain and improve function in women with postpartum PGP.

• PubMed: Pelvic Floor Muscle Training Combined with Stabilizing Exercises (PubMed)

  A randomized controlled trial showing that combining pelvic floor muscle training with core stabilization yields significantly greater reductions in pain and disability than core exercise alone.

• PubMed: Management of Symphysis Pubis Dysfunction During Pregnancy (PubMed)

  Demonstrates the efficacy of targeted exercise, movement advice, and support belts in managing SPD during pregnancy.

Disclaimer: SPD/PGP presents differently for everyone. If you experience severe pain, difficulty walking, or suspect a complete diastasis separation, consult a women’s health or pelvic floor physical therapist for a personalised assessment.