Symphysis pubis pain

I mentioned in an earlier post that around 22 weeks, I started suffering from pain in the front of my pubic bone, or symphysis pubic dysfunction (SPD). This is the best online resource I've found so far, which includes a good explanation of the physiology of SPD, frequently asked questions, medical and alternative relief options, and considerations for birth.

This article details the use of a support belt and stabilizing exercises to treat SPD. I recently obtained a maternity support belt (a lot like this one) and wear it when working or walking for long periods, and I think it's somewhat helpful. I don't wear it all the time, because I want my muscles to have to work to maintain their own stability as well, but a 12-hour shift is a lot to ask out of anyone's back and pelvis and so the extra support is nice. The subjects were given the following instructions with regard to exercise and lifestyle:

Abdominals: "Sitting with your feet resting on the floor, gently pull in your lower abdominal muscles abdominal muscles as if you are hugging your baby. Hold for 5 seconds. Repeat 5 times, continuing to breathe normally."

Pelvic floor: "Sitting tall, squeeze to close around your openings. Lift and hold for 5 seconds. Repeat 5 times. Breathe normally throughout."

Gluteus maximus: "Sitting or standing, squeeze buttocks together. Hold for 5 seconds. Repeat 5 times."

Latissimus dorsi: "Sit on a chair in front of a table or a closed door. Grasp door handle or table with both hands and pull toward you. Hold for 5 seconds. Repeat 5 times."

Hip adductors: "Sitting down, put your fist or a rolled towel between your knees. Squeeze knees together. Hold for 5 seconds. Repeat 5 times."

Self-help Management

The aim is to reduce stress on the joint.

It is essential that you tighten the muscles of your pelvic floor and lower abdomen before and during the following activities.

When getting into bed:

* Sit on the edge of the bed, keep knees close together, then lie down on your side, lifting both your legs up sideways. Reverse this to get out of bed.

* Do not attempt to pull yourself up from lying on your back.

When rolling over in bed:

* Keep knees together.

* Do not roll with your knees apart.

When getting up from a chair:

* Keep knees close together, put your hands on your knees, and lean nose over toes to stand up.

When sitting down:

* Do the reverse to sit down.

* Ensure that you feel the chair at the back of your legs first.

When getting into a car:

* Sit down first and then swing legs in, keeping knees together.

When walking:

* Take smaller steps.

When using stairs:

* Step up sideways one step at a time.

* Avoid stairs if possible.

Remember to:

* Sleep with a flat pillow between the legs.

* Take rest breaks.

* Move within the limit of pain.

Avoid:

* Sitting on soft sofas and chairs.

* Walking as an exercise.

* Active stretching.

I've started sleeping with a flat pillow between my knees, and I try to use the body mechanics suggestions whenever I can. I've heard conflicting things about whether walking is contraindicated as an exercise, and it's free and healthy, so I haven't given that up yet. I am planning to start to implement the exercises.

However, I was perhaps most interested in this article from the British Medical Journal, which reports a greater decrease in pelvic pain in subjects who underwent acupuncture than those who underwent interventions involving exercise, support belts, or both.

I'm figuring I can't go wrong with all three. This morning I had my first acupuncture appointment with a delightful acupuncturist in Frederick, Maryland, who has made a name for herself offering treatments on a sliding scale from $15-35 per session. This was my first experience with acupuncture and I was very pleased. A couple of the needles stung a little as they went in, but on the whole I was very comfortable during the approximately 20-30 minute treatment. My pelvis has felt sort of achy and sore all day, and it's hard to say if that's left over from yesterday or if it's a sign that things are resettling themselves, but time will tell. I'm placing a lot of hope in this, because otherwise it's going to be a long next four months...