Symphysis pubis dysfunction, or SPD, causes sharp, sometimes debilitating pain at the front of your pelvis during pregnancy. The good news: a combination of targeted exercises, simple daily adjustments, and support devices can significantly reduce the pain without medication. Most cases resolve within the first few days to weeks after delivery, but you don’t have to just endure it until then.
Why SPD Happens
The joint at the front of your pelvis, called the pubic symphysis, is held together by tough ligaments. During pregnancy, your body releases a hormone called relaxin starting around weeks 10 to 12. Relaxin remodels the collagen in those ligaments, making them softer and stretchier so your pelvis can widen for delivery. In some women, this loosening goes too far. The joint becomes unstable, and the two halves of your pelvis shift slightly with movement, grinding against each other and triggering pain.
Relaxin peaks during the first trimester and stays elevated until late pregnancy, which is why SPD can start early and persist for months. It becomes undetectable in your blood within the first few days postpartum, which is why most SPD pain disappears relatively quickly after birth. The pain itself typically centers over the pubic bone but can radiate into the groin, inner thighs, hips, and lower back.
Movements That Make It Worse
Almost anything that puts uneven force on your pelvis can flare SPD. The Cleveland Clinic identifies these common triggers: standing on one leg, climbing stairs, getting in and out of a car, spreading your legs apart, twisting your torso, bending forward, and rolling over in bed. Even walking can be painful because each step briefly loads one side of the pelvis.
The instinct when pain hits is to move differently to compensate. Be careful with this. Overcorrecting your posture or gait can strain your hips, knees, or lower back. Instead of improvising, focus on the specific movement strategies below.
Exercises That Build Pelvic Stability
Strengthening the muscles around an unstable joint is one of the most effective ways to manage SPD. The goal is to create a muscular “corset” that holds your pelvis steady when your ligaments can’t. A randomized trial of 386 pregnant women found that stabilizing exercises significantly reduced pelvic girdle pain after six weeks of consistent practice.
These exercises have the strongest support for SPD relief:
- Pelvic tilts: Lying on your back with knees bent, gently flatten your lower back against the floor by tightening your abdominals. This improves pelvic alignment and builds core control.
- Kegel exercises: Squeeze the muscles you’d use to stop urinating, hold for a few seconds, then release. Kegels strengthen the pelvic floor, which directly supports the pubic symphysis from below.
- Pelvic bridges: From the same lying position, lift your hips toward the ceiling by squeezing your glutes. This works the glutes and lower back muscles that stabilize the pelvis.
- Gentle leg lifts: Lying on your side, slowly raise your top leg a few inches and lower it. This strengthens the outer hip muscles that keep your pelvis level when you walk.
- Stability ball sitting: Simply sitting on an exercise ball and maintaining balance engages your core and improves posture without high impact.
One important caveat: deep squats and wide-leg stretches can worsen SPD by forcing the joint apart. Stick to small, controlled movements and stop any exercise that increases your pain.
Daily Adjustments That Help
Small changes to how you move through the day can make a surprising difference. The key principle is to keep your legs together and avoid asymmetric movements whenever possible.
When getting out of bed, roll onto your side with your knees together, then push yourself up with your arms rather than twisting your torso. Use the same knees-together approach when getting in and out of a car: sit down first, then swing both legs in as a unit. On stairs, take them one step at a time rather than alternating feet, and lead with your less painful side going up.
Sleep position matters significantly. Side sleeping with a pillow between your knees helps align your spine, pelvis, and hips, taking pressure off the symphysis joint. A full-length body pillow works well for this because it prevents your top leg from dropping forward during the night. If you sleep on your back, placing a pillow under your knees can help relax your lower back and maintain a more neutral pelvic position.
Pelvic Support Belts
A pelvic support belt wraps around your hips just below the belly, compressing the pelvis and partially doing the job your loosened ligaments can’t. A pilot randomized trial found that women wearing pelvic belts for an average of about five hours per day had significantly improved pain and function after three weeks, with no adverse effects reported.
The trial also found that flexible belts were better tolerated and potentially more effective at reducing pain than rigid ones. If you try a belt, wear it during your most active hours, particularly when walking, standing for long periods, or doing household tasks. It’s a supplement to exercise, not a replacement.
Professional Treatment Options
If home strategies aren’t enough, several hands-on therapies can help. Physical therapists and chiropractors who specialize in pregnancy-related pelvic pain use techniques like soft tissue trigger point therapy (targeted pressure on tight, knotted muscles), gentle joint mobilizations to restore normal movement in the sacroiliac joints and pubic symphysis, and pelvic blocking, where wedge-shaped supports are placed under the pelvis to encourage realignment.
Acupuncture has particularly strong evidence for SPD. In a randomized controlled trial published in the BMJ, acupuncture combined with standard care outperformed stabilizing exercises combined with standard care for several patterns of pelvic girdle pain, including one-sided sacroiliac pain and combined sacroiliac and symphysis pain.
Water-based exercise is another option worth exploring. Water aerobics reduce the load on your joints while allowing you to strengthen the muscles around your pelvis. Research has found that water exercise reduces both pain and sick days in pregnant women with pelvic and low back pain. The buoyancy alone can provide temporary relief.
Pain Relief With Ice, Heat, and Medication
Ice applied to the pubic bone for 15 to 20 minutes can reduce inflammation after a pain flare. Heat works better for tight, aching muscles in the hips and lower back. Many women alternate between the two depending on whether the pain feels sharp and inflamed or dull and achy. TENS units, which deliver mild electrical pulses through adhesive pads on the skin, are also used to manage SPD discomfort.
When you need medication, acetaminophen (Tylenol) is the recommended first-line option during pregnancy. Common anti-inflammatory drugs like ibuprofen and naproxen should be used cautiously, if at all, earlier in pregnancy and are not safe in the third trimester because they can affect fetal blood vessel development. Since SPD often peaks in the third trimester, this effectively makes acetaminophen the only safe over-the-counter choice for most women dealing with the worst of it.
What Recovery Looks Like
For most women, SPD pain drops dramatically once relaxin clears the body after delivery. This typically happens within the first few days postpartum, though residual soreness and joint instability can linger for weeks or months, especially if the joint gap widened significantly. Continuing your stabilization exercises after delivery speeds recovery by rebuilding the core and pelvic floor strength that pregnancy diminished. Women who had severe SPD during pregnancy sometimes benefit from a few sessions of postpartum physical therapy to restore normal movement patterns and address any compensatory habits that developed during the painful months.