I recently completed a Masters of Chiropractic Pediatrics through McTimoney Chiropractic College and Ulster University in the UK with a dissertation on the efficacy of chiropractic for pubic symphysis dysfunction (PSD) in pregnancy. It was very exciting to research what I have observed in practice for many years as a perinatal chiropractor and what I experienced myself in my second pregnancy. Here is an abstract of my findings:
Pubic symphysis dysfunction is a significant condition characterized by the strain of the pubic symphysis, the joint in the front of the pelvis, causing dysfunction and pain. This condition often arises during the second and third trimesters of pregnancy due to the hormonal influences and mechanical stresses on the pelvic girdle. Chiropractic care has emerged as a non-invasive treatment option for managing PSD, aiming to alleviate pain, restore function, and enhance the quality of life for affected individuals.
Understanding Pubic Symphysis Dysfunction
The pubic symphysis is a cartilaginous joint uniting the left and right pubic bones. During pregnancy, hormonal changes, particularly the release of relaxin, cause ligaments to loosen, facilitating childbirth by allowing pelvic expansion. However, in some cases, this ligamentous relaxation leads to an excessive strain of the pubic symphysis, resulting in PSD. Symptoms include pain in the pelvic region, lower back, hips, and difficulty performing movements such as walking, climbing stairs, or turning in bed. The severity of symptoms varies, with some individuals experiencing mild discomfort, while others face debilitating pain that impairs daily activities.
Chiropractic Management of PSD
Chiropractic care focuses on diagnosing and treating musculoskeletal disorders, emphasizing manual adjustments to restore alignment and function. In the context of PSD, chiropractic interventions aim to stabilize the pelvic region, reduce pain, and improve mobility. Key components of chiropractic management for PSD include:
1. Pelvic Adjustments
Chiropractors employ specific techniques to correct misalignments in the pelvic joints. Gentle manipulations of the sacroiliac joints and pubic symphysis can enhance joint congruency and reduce mechanical stress. For instance, side-lying mobilizations and instrument-assisted adjustments have been utilized to address pelvic dysfunctions associated with PSD.
2. Stabilization Exercises
Chiropractors often prescribe specific exercises to strengthen the core and pelvic floor muscles. Strengthening these muscles provides better support to the pelvic structures, enhances stability, and reduces the likelihood of recurrent symptoms. Exercises such as pelvic tilts, Kegel exercises, and gentle stretching are commonly recommended.
3. Support Devices
The use of pelvic support belts or sacroiliac belts can offer external stabilization to the pelvic girdle, reducing strain on the pubic symphysis during daily activities. These devices help in maintaining proper alignment and minimizing discomfort so that the patient can stay active through her pregnancy.
Evidence from Peer-Reviewed Studies
Several peer-reviewed studies have explored the efficacy of chiropractic care in managing PSD:
Case Reports by Howell (2012)
Two case reports reviewed the chiropractic treatment and rehabilitation management of Pubic Symphysis Dysfunction. Both patients were 30 weeks pregnant, presenting with pelvic pain. The chiropractic interventions included pregnancy support belts, side-lying mobilizations, pelvic blocks, and instrument-assisted pubic symphysis adjustments. Home care advice encompassed the application of ice, maintaining activity levels, coordinated movements, stretching, use of a pillow between the knees while sleeping, regular breaks from sitting, and pelvic floor exercises. Both patients reported relief with treatment and home care. Postpartum rehabilitation exercises were prescribed to restore muscular endurance, control, and pelvic stability. On long-term follow-up, one patient reported no pubic symphysis pain but some low back pain secondary to a subsequent knee injury, while the other reported being mostly pain-free with rare re-exacerbation of pubic symphysis pain. my.clevelandclinic.org+10pmc.ncbi.nlm.nih.gov+10focuschiropractic.net+10
Collaborative Care
Collaboration between chiropractors, obstetricians and midwives is essential to ensure comprehensive care for patients with PSD. Such interdisciplinary collaboration facilitates the development of integrated treatment plans that address both musculoskeletal and obstetric considerations.
Patient Education
Educating patients about PSD, including its causes, symptoms, and management strategies, empowers them to participate actively in their care. Providing guidance on posture, movement modifications, and home exercises can enhance treatment outcomes and prevent symptom recurrence.
Chiropractic care is not only an effective form of treatment for pubic symphysis dysfunction in the prenatal patient but it is also a natural option which minimizes the need for pharmaceuticals. Along with reducing pelvic pain and improving function, chiropractic helps to support optimal fetal positioning with ideal pelvic alignment. Spinal and pelvic balance helps for a more streamlined labour and delivery both biomechanically and neurologically. Patients who receive chiropractic treatment in pregnancy for PSD have a lesser chance of it returning in subsequent pregnancies. I am honoured to be able to help women have more comfortable pregnancies and less pelvic pain with chiropractic!