Pubis Symphasis Derangement: The bones of the pelvic area are joined in the front of the body by very strong ligaments that pull these joints together to form the pubic bone. This bone is further cushioned by cartilage. During pregnancy and childbirth these ligaments loosen and the bones separate slightly to allow for the passage of the baby through the pelvic outlet. For most women this does not cause a problem. For some, the degree of separation is enough to cause some problems mainly in the pubic area itself and also in the back and legs. As the pubic bones open, the sacro-illiac joint closes, oftentimes causing pain in that area. The adductor group of muscles is also compromised and will affect the ability to walk and exercise.
Sometimes a separation can occur during the pushing stage of delivery when undue stress is put on the pubic bone. This is oftentimes a result of pushing while in an inclined or back lying position which restricts the sacrum from “lifting”. This in turn may cause the baby’s head to press more on the pubic bone in an effort to open the pelvis.
What are the symptoms of a separation?
The main symptom of a separation is localized pain in the pubic area. This pain can radiate down the inside of the thighs and also into the lumbar area. This pain may be due to the illium “compressing” the SI Joint. If the separation is wide enough, there may sometimes difficulty in walking. Lying on either hip can also cause some discomfort.
What treatment should you seek?
• Gentle manipulation of the area by an osteopath or chiropractor.
• See a physical therapist for exercises and manipulation.
• Strengthen the area with specific exercises.
What to avoid
Any kind of lateral (sideways) movement with the legs will exacerbate this condition. Stretches such as tailor sit may now be contraindicated. ANY action that takes both legs away from each other especially against resistance should be eliminated. This includes side splits on the reformer and other such exercises.
This condition pervades the daily activities and women must be aware of which movement causes pain. Sometimes an SI joint belt or pelvic binder will help this condition.
How to help
• Hip abduction – taking one leg away from the other in a side lying position can actually be ok for this condition. The adductor on the stabilising side should be initiated just before the top leg is lifted This brings awareness to the area and the individual is able to access their own limits
• Hip adduction – stabilising of this area with a small (soft) ball is encouraged. If there is an increase in resistance during hip adduction the condition may worsens. So any time you are doing double leg work (bridge etc) place a ball between the inner thighs NOT the knees.
• Engaging the lower TA with the upper adductor muscles works well for this condition. e.g abdominal roll down with the small ball between the inner thighs.
The condition is painful and manipulation by a physio is a good option but after the manipulation, reeducating the surrounding muscles to support the pubic bone is essential.
Myofascial release of this area is also encouraged so the misaligned muscles do not continue to “pull” on the bone. Sitting on a small ball will release the fascial line through the pelvic floor and into the lower abs helping to release the muscles around this area.