Symphysis Pubic Pain during pregnancy

2 May

This is a review of a case study research article highlighting the improvement a pregnant patient had while undergoing Chiropractic care regarding her symphysis pubic pain and dysfunction. Below are some of my favourite excerpts from the article as well as my input describing some of the terms. Enjoy the information and be curious as to how to apply the information!

The title of the research is Resolution of Symphysis Pubic Pain & Dysfunction Following Chiropractic Care in a Pregnant Patient: Case Study & Review of the Literature

Abstract
Objective: To describe the chiropractic care of a pregnant woman with pubic symphysis dysfunction.
Clinical Features: A 28-year-old at 20 weeks gestation presented for care with symphysis pubic dysfunction. The patient had no previous experience with chiropractic and had one previous singleton pregnancy without complications. With her prior pregnancy, the patient experienced symphysis pubic dysfunction to a lesser degree.
Intervention and Outcome: The patient was cared for with the Activator Protocol to address subluxations at the coccyx and right inferior pubic bone, with toggle recoil to adjust a C1 subluxation and drop table (Webster Technique) to address a right sacral posteriority. At three months of care, the patient experienced pain with active movement localized at the pubic bone region and bilateral medial thighs following a fall. This was addressed with chiropractic care as described above. The patient attended 35 visits over a period of 8 months.
Conclusion: This case report provides supporting evidence on the benefits of chiropractic care for the pregnant woman with pelvic bowl dysfunction. We encourage further research in this field.

How common is pubic symphysis dysfunction? and what is it?

“Of interest in this case report is pubic symphysis dysfunction, a subgroup of pelvic girdle pain (PGP) that can affect some 3-8% of women during pregnancy. The symptoms of pubic symphysis dysfunction can be very debilitating and do not necessarily abate after childbirth and is said to have a high recurrence with subsequent pregnancies.”

“The pubic symphysis consists of a fibrocartilaginous disc
connected between the articular surfaces of the pubic bones.
Modern anatomical classification systems refer to the pubic
symphysis as a secondary cartilaginous or fibrocartilaginous
joint.”

“During pregnancy, the effects of relaxin increases symphyseal width
and mobility through resorption of the symphyseal margins
and structural changes in the fibrocartilaginous disc. Pain in
the region is commonly referred to as symphyseal pain,
symphysitis or symphyseal dysfunction.”

“According to Fishburn, recent research associates an
asymmetry of the pelvic joints to the incidence and severity of
PGP and shows the pathophysiology as mainly biomechanical.
As such, evidence supports other care approaches such as
manual therapy for the pregnant woman with PGP.”

-Referring to the problem as being mainly biomechanical means that it is a movement and positioning problem. That is why Chiropractic can have such an important role in helping someone with this type of problem.

Is Chiropractic common for women during pregnancy?

Chiropractic care is popular for pregnant women and highly utilized, particularly if there is prior use of chiropractic services or
when receiving care from a midwife. There is a long history
of pregnancy care by chiropractors. In the interest of evidence
informed practice, we describe the chiropractic care of a
patient suffering from pubic symphysis dysfunction.”

-At our Chiropractic clinic in Mississauga we do care for pregnant women. Contact us.

Who was the person in the case study?

“A 28-year-old female presented for chiropractic consultation
and possible care at 20 weeks of gestation with symphysis pubic dysfunction.”

The problem was occuring for “…three weeks duration with her pain complaint as progressively getting worse”

-If pains are not changing and are worsening it is definitely a time to get checked by your Chiropractor. Something could be “stuck” or “out of place”. As Chiropractors, we refer to these areas as subluxations.

The pubic symphysis pain was described as being “…aching, dull, stabbing and sharp. Pain is worse when moving and standing, better with sitting and is present about 60% of the day.”

What areas of the body were adjusted to help the symphysis pubic pain?

Most people are familiar with adjusting of the spine or back by Chiropractors. It is common to adjust other joints in the body as well, including the pubic bone and pelvis. This patient was adjusted using an Activator (which is a handheld adjusting tool used by Chiropractors to deliver a light but quick adjustment) to the “…right inferior pubic bone using Activator Methods Protocols. Post adjustment examination revealed normal biomechanics as being restored in the pelvis. The patient was cared for similarly over a period of 8 months consisting of 35 visits.”

-normal biomechanics refers to the proper movement of the body. Through the adjustment Chiropractors aim to encourage proper movement/function of the body as well as aim to reduce nerve interference. This allows the body to function as it normally should. Repetition is required to help the body get out of the improper positions, as noticed by the frequency of visits for this patient. As you can imagine, during the changes that continue to occur during pregnancy it is important to keep helping the mother to be find a proper biomechanical position and movements. This is common as well for people who have poor postures or habits as well as who have previous injuries.

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