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?
Answer
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. Yes, it can hurt when you poke on it, but it should not still hurt 5 seconds after you remove your fingers. It should not hurt during activity. That ongoing pain tells us that there is a mechanical problem. The pubic symphysis pain should resolve postpartum. It should resolve almost immediately and at the very least within two weeks. A woman who is still having pubic symphysis pain more than two weeks postpartum probably has a pelvic girdle pain condition that we need to treat.
Cynthia Neville, PT, DPT, WCS, BCB-PMD
Dr. Cynthia (Cindy) Neville, PT, DPT, WCS is Assistant Professor of Physical Therapy, Mayo Clinic Alix College of Medicine, in Jacksonville, Florida. She is a Women’s Health Certified Specialist (WCS), board certified by the American Board of Physical Therapy Specialties. She serves on the faculty of the Mayo Clinic Florida Orthopedic Physical Therapy Residency Program, and advises multiple medical specialty programs at Mayo Clinic Florida. Her outpatient clinical practice at Mayo Clinic Florida serves women and men with pelvic floor disorders. Dr. Neville has authored and co-authored several research articles and book chapters on the topics of pelvic health rehabilitation, pelvic pain, and urinary incontinence. She has presented her research and provided rehabilitation and medical education nationally and internationally. She has developed successful Pelvic and Women’s Health Rehabilitation Programs at premier healthcare organizations including the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab) and Mayo Clinic Florida. At Brooks Rehabilitation in Jacksonville, Dr. Neville developed the first institutional pelvic health rehabilitation program across all levels of care, and the first credentialed physical therapy women’s health residency program in the state of Florida. She has trained more than a thousand physical therapists, occupational therapists, physical therapist assistants, and physicians in pelvic floor examination and pelvic health rehabilitation.
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