Symphysis Pubis Dysfunction, Pelvis pain and Chiropractic

Diastasis symphysis pubis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture.

Excessive lateral or anterior movement can be seen secondary to pubic diastasis and this can further lead to pubic symphysis dysfunction.External forces such as falling from a horse or a car accident can result in this type of injury to the symphysis pubis.

Under hormonal stimulation during pregnancy, there is widening of the symphysis pubis and the sacroiliac joints. Diastasis wider than 15 mm is considered subdislocation and is generally associated with pain, swelling, and occasionally deformity.

It is most commonly associated with pregnancy and childbirth, though trauma may occasionally be a culprit. In general, one in four women are affected, to a varying degree. The reported prevalence of nontraumatic diastasis varies from 1 in 300 pregnancies to 1 in 30,000 pregnancies.

The inter pubic cartilaginous disc and the anterior pubic ligament are the most important structures maintaining stability of the joint. The physiologic width of the normal cleavage differs with age, ranging from 10mm at the age of 3, to 6mm at 20 years of age, to 3mm at 50 years of age. Women have a greater thickness of the fibrocartilaginous disk, which allows more mobility of the pelvic bones, providing for a greater pelvic diameter to facilitate childbirth. During pregnancy, under the influence of hormones, particularly relaxin, the gap in the symphysis pubis can increase by at least 2-3 mm. In pubic symphysis diastasis, the separation of the right and left pubic rami may increase to a width of greater than 10 mm. This may result from rapid or prolonged vaginal birth or assisted forceps delivery, or it can occur prenatally. If there is complete separation or a traumatic tear, the joint will be completely unstable and the tear can sometimes be heard by women.

The abnormally widened gap can cause significant pain followed by inflammation and swelling. In the supine position, a patient’s legs will involuntarily move apart. When this condition is encountered, investigation into possible involvement of the sacroiliac joints is required. The SI joints may be bilaterally or unilaterally involved.

Clinical presentation

• swelling
• patient’s legs will involuntarily move apart
• UTI (urinary tract infection)
• Burning, shooting, grinding or stabbing
• Mild or prolonged
• Usually relieved by rest
• Radiating to the back, abdomen, groin, perineum and legs
• Disappears commonly after giving birth (not in every case)
• Discomfort sense onto the front of the joint
• Clicking of the lower back, hip joints and saccroillial joints when changing position
• Difficulty in movements like ab- and adduction
• Locomotor difficulty: walking, ascending or descending stairs, rising from a chair, weight bearing activities, standing on one leg, turning in bed, …
• Depression, possibly due to the discomfort

Aetiology

• pregnancy and childbirth
• trauma
• bladder exstrophy
• hypothyroidism
• Diastasis
• Rupture
• Osteomy
• Fracture
• Misalignment of the pelvis
• Frequently associated with pregnancy and childbirth
• Increased age of getting a child
• Sports injury: caused by falling with the legs in hyper-abbduction (example: horse-riding)

Chiropractic and Diastasis symphsis pubis

Our treatment is very effective for pain relating to the spinal and pelvic joints and the treatment is particularly suitable for pregnant women since it is a safe and natural treatment. Chiropractic treatment does not promote the use of painkillers and non-steroidal anti-inflammatory medication (NSAID\’s) in pregnancy.

The chiropractor will take a thorough medical history and do a full chiropractic and orthopaedic examination to diagnose the condition.

Chiropractic treatment may involve:

• Evaluation / treatment of the sacroiliac joints and pubic symphysis
• Work on the soft tissues (muscles / ligaments)
• Ligament release techniques
• Diaphragmatic release
• Blocking techniques (using wedge-shaped blocks placed under the pelvis to relieve the pressure on the joints)
• Activator techniques (non-manipulative techniques for the dysfunctional joints)
• Webster’s technique (to treat malpositioned babies, often associated with SPD)
• Application of ice
• Ultrasound and laser therapy
• Exercise advice
• Supply a sacroiliac (pelvic joint) stability belt

The majority of women who receive chiropractic treatment for SPD (Symphysis Pubis Dysfunction ), both before or after the baby is born, will experience a positive response, particularly if the cause lies in pelvic misalignment. Chiropractic treatment aims to address the root cause of the problem instead of addressing only the symptoms. From the Chiropractic point of view, it is better for a woman with mild SPD to get treatment early on to prevent the problem from becoming more severe later or impeding the birth of your baby.