Relieve Pubic Symphysis Pain in Nashville
Pubic Symphysis Pain in Pregnancy: How Chiropractic Care Can Help
That sharp, shooting pain right at the front of your pelvis when you try to get out of bed. The feeling like your pelvis is splitting in half when you climb stairs. The inability to stand on one leg to put on pants without wincing. If you're experiencing any of these symptoms during or after pregnancy, you're likely dealing with pubic symphysis pain—one of pregnancy's most limiting and underappreciated complications.
While nearly everyone has heard about pregnancy back pain, pubic symphysis pain often catches women completely off guard. It's not just uncomfortable; it can be genuinely debilitating, affecting your ability to walk, sleep, care for yourself, and function in daily life.
The frustrating part? Many women are told this is "normal" and to just wait it out. While pubic symphysis pain is indeed common—affecting a significant percentage of pregnant women—calling it normal doesn't make it any less painful or any easier to live with.
Let's dig into what pubic symphysis pain actually is, why it happens, what the research shows about managing it, and how chiropractic care at East Nashville Chiropractic can provide real relief through targeted, evidence-based approaches.
Understanding the Pubic Symphysis
Before we can talk about why this joint causes so much trouble during pregnancy, you need to understand what it is and where it lives.
The pubic symphysis is a midline fibrocartilaginous joint that connects the left and right pubic bones at the front of your pelvis. Unlike the ball-and-socket hip joints or even the sacroiliac joints at the back of your pelvis, the pubic symphysis is designed to be relatively stable with only minimal movement.
In your non-pregnant state, this joint has a small amount of give—just 1-2 millimeters of motion. The joint surfaces are covered with fibrocartilage and held together by thick ligaments that limit excessive movement. This stability is important because your pubic symphysis helps transfer forces between your legs and your spine, and it needs to be solid enough to do that job effectively.
But pregnancy changes everything. Hormonal changes—particularly the hormone relaxin—increase joint laxity throughout your pelvis, including at the pubic symphysis. Add mechanical loading from your growing uterus, increased body weight, changes in your center of gravity, and altered walking patterns, and you've got a recipe for joint stress.
In pregnancy, the pubic symphysis can widen by 3-8 millimeters or more. While widening is normal and necessary to prepare for childbirth, excessive widening or asymmetric movement at this joint creates the sharp, shooting pain that characterizes pubic symphysis dysfunction.
What Pubic Symphysis Pain Feels Like
Pubic symphysis pain has some distinctive characteristics that help differentiate it from other types of pregnancy-related discomfort.
The pain is typically located right at the front center of your pelvis, directly over the pubic bone. It's often described as sharp or "shooting" and can radiate to the groin, inner thighs, or lower back. Some women describe it as a feeling that their pelvis is splitting apart or that their bones are grinding against each other.
The pain typically worsens with specific activities and movements like:
Walking, especially for longer distances
Climbing stairs
Turning over in bed at night
Standing on one leg (like when getting dressed)
Getting in and out of a car
Separating your legs (as when getting out of bed)
Weight-bearing activities
Asymmetric movements or positions
Many women find that their pain is worse at the end of the day after accumulating mechanical stress throughout daily activities. Some women also experience clicking, popping, or grinding sensations at the pubic symphysis when they move.
Pregnancy-Related Pelvic Girdle Pain: The Broader Picture
Pubic symphysis pain is usually part of a larger condition called pregnancy-related pelvic girdle pain, or PGP. PGP can be defined as the pain between the posterior iliac crest and inferior gluteal fold that may also occur in the symphysis area.
PGP can include pain at the sacroiliac joints (at the back of your pelvis and bottom of your spine), the lumbosacral region (lower back), and the pubic symphysis (front of pelvis). Some women experience pain in just one of these areas, while others have pain at multiple sites.
Research shows that PGP affects up to about half of pregnant women and is driven by weight gain, posture changes, increased intra-abdominal pressure, and ligamentous laxity. What's particularly significant is that women with pubic symphysis pain have markedly higher odds of more severe pain and disability compared to women whose PGP affects only other areas of the pelvis. Your pubic symphysis is involved in nearly every weight-bearing activity and leg movement. When it's painful, it's hard to find positions or activities that don't aggravate it.
Symphysis Pubis Dysfunction and Diastasis
Sometimes you'll hear the terms "symphysis pubis dysfunction" or "symphysis pubis diastasis" used to describe more severe cases of pubic symphysis pain.
Symphysis pubis dysfunction refers to symptomatic separation or instability of the joint. Diastasis specifically describes excessive widening of the joint—typically defined as separation greater than 10 millimeters, though even smaller amounts can be symptomatic.
A postpartum cohort study examined women with and without pelvic girdle pain and pubic symphysis separation, highlighting that increased symphyseal separation and diastasis recti (abdominal muscle separation) can be associated with greater pain and disability after delivery. The good news is that most cases of pubic symphysis pain and even diastasis improve within months postpartum as hormone levels normalize and the joint gradually returns toward its pre-pregnancy state.
When Pubic Symphysis Pain Requires Medical Evaluation
While pubic symphysis pain is usually mechanical and related to the normal (though excessive) changes of pregnancy, red-flag features require immediate medical or obstetric evaluation.
Seek prompt medical attention if you experience:
Sudden, severe pain following trauma or injury
Neurologic symptoms like numbness, tingling, or weakness in your legs
Fever or signs of infection
Vaginal bleeding or fluid leakage
Pain so severe you cannot bear weight at all
Signs of pelvic fracture (after a fall or accident)
These symptoms could indicate serious pathology like fracture, infection, or other complications that require medical management beyond conservative care.
For typical pregnancy-related pubic symphysis pain without red-flag features, conservative management including chiropractic care is appropriate and effective.
Case Reports on Pubic Symphysis–Specific Chiropractic Treatment
A case report of pregnancy-related symphysis pubis dysfunction described chiropractic treatment including soft-tissue trigger point therapy, sacroiliac mobilization, pelvic blocking, and instrument-assisted adjustment directed at the pubic symphysis. The patient's shooting pubic pain and functional limitations improved over the course of care.
Another case report on postpartum pubic symphysis diastasis is particularly compelling. A 30-year-old woman presented with intense pubic pain, difficulty walking, and radiographic confirmation of diastasis. She received multimodal chiropractic care including lumbar and sacroiliac adjustments, TENS therapy, moist heat, stabilizing exercises, and a sacroiliac belt. Over 14 weeks, her pain decreased from 8 out of 10 to 1 out of 10, and her symphyseal separation decreased by 7 millimeters on follow-up imaging.
What these case reports collectively suggest is that multimodal care addressing pubic symphysis pain may help some women reduce pain and improve function.
How Chiropractic Care Addresses Pubic Symphysis Pain
Based on the available peer-reviewed literature and clinical descriptions, chiropractic management for pregnancy-related pelvic girdle pain and pubic symphysis dysfunction typically uses a multimodal approach.
Gentle spinal and pelvic joint mobilization or manipulation: The focus is on optimizing alignment and function at the sacroiliac joints and lumbar spine. When these areas are functioning well, it reduces compensatory stress on the pubic symphysis.
Chiropractors apply very gentle adjustments or mobilizations directed toward the pubic symphysis itself, as well as treat surrounding areas to indirectly influence symphyseal mechanics. East Nashville Chiropractic tailors the approach based on individual presentation and comfort level.
Myofascial and trigger point work: Muscles that attach near or cross the pubic symphysis—including the adductors (inner thigh muscles), rectus abdominis (abdominal muscles), and pelvic floor muscles—can develop trigger points and excessive tension that contribute to symphyseal pain. Soft-tissue techniques address these muscular components.
Stabilization exercises: Exercises targeting core stability and pelvic stabilization help reduce excessive or asymmetric movement at the pubic symphysis. These might include gentle pelvic tilts, transverse abdominal activation, pelvic floor exercises, and controlled leg movements that strengthen without aggravating symptoms.
Ergonomic counseling and movement modification: Learning how to move in ways that minimize shear forces at the pubic symphysis can significantly reduce pain. This includes techniques for getting in and out of bed, avoiding single-leg stance, keeping your knees together when moving, and modifying daily activities.
External support devices: Pelvic or sacroiliac belts worn low across the hips can provide external compression and support that reduces movement at the pubic symphysis. Multiple case reports mention belts as part of successful multimodal management.
What Happens During Treatment at East Nashville Chiropractic
If you come to East Nashville Chiropractic with pubic symphysis pain, your initial visit will involve a thorough history and examination.
Your chiropractor will want to understand the character of your pain, what activities or positions make it better or worse, and how it's impacting your daily function. Confirming that red-flag features have been ruled out is always the first priority.
The examination will assess your pelvic alignment, sacroiliac joint motion, lumbar spine function, and the tension in muscles around your pelvis. Your chiropractor will also observe how you move—how you walk, how you transfer from sitting to standing, how you manage stairs—to identify movement patterns that might be aggravating your symptoms.
Treatment typically includes gentle chiropractic adjustments to optimize function at your sacroiliac joints and lumbar spine, as well as other areas that are misaligned. You'll be positioned on a specially designed pregnancy pillow that accommodates your belly comfortably. The adjustments are controlled and low-force, appropriate for the ligamentous laxity of pregnancy.
Soft-tissue work addresses tight or tender muscles around your pelvis. This might include manual trigger point release, myofascial techniques, or instrument-assisted soft tissue mobilization, all performed at a comfortable intensity.
Your chiropractor will teach you specific exercises and movement strategies tailored to your presentation. These aren't generic pregnancy exercises—they're selected based on your specific movement dysfunctions and designed to stabilize your pelvis without aggravating your symptoms.
If appropriate, your chiropractor will fit you with a pelvic support belt and teach you how to position it correctly for maximum benefit. The belt should sit low across your hips, not up around your belly, to provide compression across the pubic symphysis and sacroiliac joints.
Sessions typically last 15 minutes, and treatment plans are adjusted based on your response. Some women notice improvement within the first few visits, while others require several weeks of consistent care to see meaningful change.
The Importance of Multimodal Care
Chiropractic adjustments address joint mechanics and alignment. Soft-tissue work addresses muscular contributions. Exercises build stability and control. Belts provide external support. Movement modification reduces aggravating forces. Together, these create a comprehensive approach that addresses the problem from multiple angles.
East Nashville Chiropractic embraces this multimodal philosophy. We integrate all the evidence-based strategies that research suggests may be helpful into a coordinated treatment plan.
This approach also recognizes that every woman's presentation is different. The exact combination of techniques and strategies that works best for you might differ from what works for another woman with similar symptoms. Individualized care based on your specific findings and response is essential.
Combining Chiropractic Care with Other Interventions
Chiropractic care works best when integrated with other supportive measures and, when appropriate, other healthcare disciplines.
Physical therapy: Some women benefit from working with both a chiropractor and a physical therapist, particularly a pelvic floor physical therapist. While there's overlap in what these practitioners offer, physical therapists may have additional expertise in certain exercise progressions, aquatic therapy, or specialized pelvic floor assessment and treatment.
Support devices: In addition to pelvic belts, some women find that crutches or a walker temporarily reduce weight-bearing stress on the pubic symphysis during acute flare-ups, allowing the joint to settle down.
Rest and activity modification: While staying active during pregnancy is generally beneficial, severe pubic symphysis pain may require temporary reduction in high-impact or aggravating activities. This doesn't mean bed rest, but it might mean choosing swimming over walking or using a stationary bike instead of climbing stairs repeatedly.
When to Start Chiropractic Care
You don't need to wait until your pain becomes unbearable before seeking help. Early intervention often prevents pain from progressing to more severe, limiting levels.
If you're noticing mild pubic symphysis discomfort in your second trimester, starting chiropractic care at that point may help you maintain better pelvic mechanics as your pregnancy progresses and prevent the condition from worsening.
If you're already in significant pain, starting care as soon as possible gives you the best chance of meaningful improvement. Even in the third trimester when many women assume it's "too late," chiropractic care can still provide relief and improve function for the remainder of your pregnancy.
Postpartum care is equally important. Remember that most cases of pubic symphysis pain improve within months postpartum, but some women experience persistent symptoms. If you're still experiencing significant pubic pain weeks or months after delivery, chiropractic care can support your recovery and help address any residual dysfunction.
The case reports on postpartum diastasis suggest that even severe cases with documented joint separation can improve with multimodal chiropractic care, though the timeline may be longer than with less severe presentations.
Frequency and Duration of Care
Treatment frequency depends on the severity of your symptoms and how your body responds to care.
For moderate pubic symphysis pain, many women benefit from weekly or twice-weekly sessions initially, transitioning to less frequent care as symptoms improve. For severe pain that's significantly limiting your function, more frequent initial care might be recommended to provide more aggressive symptom relief.
The goal is meaningful functional improvement, not indefinite treatment. As your pain decreases and your ability to perform daily activities improves, the frequency of care typically decreases.
Most women notice some improvement within the first 2-4 weeks of consistent care, though individual timelines vary significantly. The case report showing 7-millimeter reduction in symphyseal separation occurred over 14 weeks, suggesting that structural changes and more significant improvements may require sustained care over several months.
It's important to have realistic expectations about timeline. This isn't typically a condition that resolves after one or two treatments. Meaningful improvement usually requires consistent care over weeks, combined with diligent exercise practice and activity modification.
Safety Considerations
Chiropractic care for pregnancy-related pubic symphysis pain has an excellent safety profile when performed by appropriately trained practitioners.
The techniques used are gentle and specifically adapted for pregnant bodies. Chiropractors trained in prenatal care understand how to modify techniques to account for the ligamentous laxity of pregnancy and position you safely and comfortably throughout treatment.
For the pubic symphysis specifically, many chiropractors use gentle approaches or indirect techniques rather than high-force manipulation directly on the joint. The goal is to reduce stress on the symphysis, not to create more irritation.
Absolute contraindications to care are rare but include:
Active pelvic fracture
Infection
Certain medical complications that your obstetrician would identify.
Relative contraindications might include severe diastasis where direct manipulation could potentially worsen instability, though gentle supportive care is still appropriate.
East Nashville Chiropractic takes a conservative, safety-first approach. We modify techniques based on your specific presentation and always prioritize your comfort and safety throughout the treatment process.
Beyond Pregnancy: Postpartum Recovery
While we've focused primarily on pregnancy-related pubic symphysis pain, the postpartum period deserves specific attention.
Most women experience significant improvement in their symphyseal pain in the weeks and months following delivery as hormone levels normalize and the joint gradually stabilizes. However, recovery isn't always linear or complete.
Some women find that their pain actually worsens briefly in the immediate postpartum period, particularly if they experienced trauma to the pelvic area during delivery. The demands of caring for a newborn—frequent lifting, carrying, bending, and awkward positions for feeding—can also stress a still-healing pubic symphysis.
The postpartum case reports showing improvement with multimodal chiropractic care suggest that active treatment during this recovery period may help reduce pain, accelerate healing, and restore function more quickly than passive waiting alone.
Postpartum chiropractic care can also address other musculoskeletal issues that commonly arise after delivery, including sacroiliac joint dysfunction, diastasis recti, and upper back and neck pain from feeding and caring for your baby.
East Nashville Chiropractic provides comprehensive postpartum care that supports your recovery and helps you adapt to the new physical demands of motherhood.
Real Patient Experiences
While research data provides one perspective, hearing about real experiences from women who have dealt with pubic symphysis pain adds valuable context.
Many women describe the pain as one of the most limiting aspects of their pregnancy, sometimes even more debilitating than labor itself. The constant nature of the pain—present with nearly every movement throughout the day—can be emotionally and physically exhausting.
Women who find relief through chiropractic care often describe it as transformative. Being able to walk without extreme pain, get in and out of bed more easily, and care for themselves and their families without constant suffering significantly improves quality of life.
It's important to note that improvement doesn't always mean complete resolution, especially during pregnancy while the underlying hormonal and mechanical factors are still present. For many women, success means reducing pain from an 8 out of 10 to a 3 or 4—still present, but manageable and no longer limiting daily function.
Some women respond dramatically with rapid improvement, while others see more gradual progress over weeks or months. Individual factors including overall health, severity of diastasis, muscle strength and coordination, stress levels, and adherence to exercises all influence outcomes.
Moving Forward with Confidence
Pubic symphysis pain can be one of pregnancy's most challenging complications, but it doesn't have to be something you simply endure without relief.
The research on chiropractic care for this condition does suggest potential benefit for some women with minimal risk. The multimodal approach combining gentle adjustments, soft-tissue work, exercises, support devices, and movement modification addresses the problem from multiple angles.
East Nashville Chiropractic provides specialized prenatal and postpartum care that is evidence-informed, safe, and individualized to your specific presentation that maximizes your chances of meaningful improvement.
Your pregnancy and postpartum recovery deserve to be experienced with as much comfort and function as possible. Pubic symphysis pain is real, it's limiting, and it deserves appropriate attention and treatment—not dismissal as "just part of pregnancy."
Taking the step to explore chiropractic care might be exactly what you need to reclaim mobility, reduce pain, and move through this transformative time with greater comfort and confidence.