Is Pubic Symphysis Pain Normal During Pregnancy?

Ask the Expert

Is pubic symphysis pain normal during pregnancy or should it be assessed and treated? At what point should a breast-feeding mom expect her pubic symphysis pain to improve?

Cynthia E. Neville, PT, DPT, WCS, BCB-PMD responds:

Because the pubic symphysis normally separates up to 4 to 6 mm, it is normal to have pain to palpation. When I say pain to palpation, I mean only pain to palpation. There should not be pain with movement. There should not be pain getting in and out of bed. There should not be pain during other activities. If there is pubic symphysis pain during activity, then the joint is likely not transferring load. I am distinguishing between normal pain to palpation because the joint separating causes those ligaments to be under strain. To read more, click here.

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I agree with Cindy Neville in that experienced pain is rare, yet pubic joint pain can be provoked with palpation in this population, or with minor forces such as with spring tests with applied loads using thumbs. I modified a depth gauge to measure indentation of the symphyseal fibrocartilage and a contour gauge can be used to measure increase in width in some clients. I would only measure such in a client with significant symptoms, which occurs in a very small minority. When pubic joint pain is severe, a compressive belt worn at the level of the pubic joint and trochanters is optimal whereas supports worn higher up can perpetuate hypermobility of pregnancy as the forces replicate those of birth mechanics and pelvic spread.

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