Any Help for Pelvic Separation?

Updated on March 17, 2008
A.K. asks from Saint Paul, MN
15 answers

I'm pregnant with my second child, and once again have a pelvic separation which is painful! I will ask my doctor what I can do about it at my next visit, but I don't recall him having any great advice last time... has anyone else dealt with this? Did you find anything that helped besides avoiding too much activity? That's not very practical for me (or anyone!). Thanks!

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So What Happened?

Thank you all so much, especially Jessie! I found a chiro who specializes in pediatric chiro & the Webster technique on I've been adjusted three times, and the pain is almost gone. A body pillow for sleeping has also helped a lot.

Featured Answers



answers from Minneapolis on

I too had this with my second pregnancy- it is very painful. The only solution I was told of was taking prescription pain meds. The pain was gone immediately after giving birth.

Good Luck!

More Answers



answers from Janesville-Beloit on

You've already made your decision but it's a good one! I've been seeing a Chiropractor for the same issue the past 2-3 months. It helped with my last pregnancy as well. Unfortunately, it doesn't completely alleviate the problems (at least with me), but it sure helps me function again! Good luck!



answers from Minneapolis on

Hi! I had a very minor case of this when I was pregnant with my 3rd. I would suggest you talk with your MD and ask for a referral to a PT who specializes in the pelvis and/or pregnancy. They will evaluate you and decide what is the best treatment for you. Treatment could possibly include manual techniques, exerices and/or bracing. It can be very helpful, but make sure you get someone with experience with the pelvis and preferably someone who knows something about treating pregnant women. Good luck and I hope the pain can be resolved some way....



answers from Minneapolis on

Hi A.! I had my pelvis separate with both pregnancies. The first time Physical Therapy helped for awhile and then once I delivered I got better without issue. With my second pregnancy I actually felt a "pop" and was put on bedrest for the remainder of my pregnancy. After delivery I went to physical therapy for about 3 months. My suggestion based on that is to look into exercises that strengthen the core of your body. Anything that strengthens your back, abdominals and hips will help "pull" your pelvis back together and result in less pain. I'd also make sure to stretch your hips, especially the muscle along the front. My hips had trouble realigning and healing because the muscle on the front of my left hip had become almost permanently contracted and had actually tilted the left side of my pelvis forward.

If you have any questions about exercises, send me a note, I can get them to you. Kegels are EXTREMELY important. Otherwise, good luck with your pregnancy!



answers from Milwaukee on

I just had my second baby a few weeks ago and during the last month or two of my pregnancy I was having a lot of pelvic pain. I thought that it would go away after I gave birth. It is still there, but not as bad as when I was pregnant. My midwife told me to go see a chiropractor. She knew a mother that had a pelvic separation and that woman saw a chiropractor to get it taken care of. I don't know if a pelvic separation is causing my pain, but I plan on going to see a chiropractor to see what they can do.



answers from Minneapolis on

I agree with the suggestion for chiropractic. Dr Anne Langford in Highland Park helped me so much! I did have a different chiropractor in a previous pregnancy who did not know how to help me at all, so I would make sure that whoever you go to specializes in pregnant women.
Good luck!



answers from Minneapolis on

Hi, I actually had this happen while excersizing, I went to a chiropractor and she help alot, along with ice packs.



answers from Milwaukee on

I had this with my second pregnancy... It was literally the worst pain EVER at night, trying to roll out of bed to go to the potty! Tears would just stream down my face! My doctor put me on bedrest, confined me to a wheelchair when I would leave the house, and I saw a physical therapist. In all honesty, I really do not think the therapy helped much... it would only help temporarily... I would need to do the exercises constantly throughout the day. I also wore a special belly belt and helped keep my pelvis together - I think that helped. After giving birth, everything went back to normal immediately. So, I would recommend not moving unless you have to, a wheelchair (be prepared for people staring at you) and the belly belt thing.



answers from Minneapolis on

i had it with my first (fortunately haven't this time around *knocks wood*), and just suffered through it.

since that time, i've made lots of new friends who swear by chiropractors for just that thing. i haven't really needed to check into it, but apparently chiros can work wonders on a pregnant woman's body & all the little aches & pains... well, and big aches & pains. :)

good luck!



answers from Minneapolis on

I had something similar with my 3rd pregnancy and my chiropractor introduced me to my "miracle worker" Deborah Savran who does Maya Abdominal Massage. With this technique, I could walk without feeling like my entire pelvis was going to fall onto the floor.

Maya Abdominal Massage is a noninvasive, external, massage technique. It guides internal abdominal organs into their proper position for optimum health and well being. The technique works by relieving congestion and blockages to improve the flow of energy (chi) and fluids of the circulatory, lymphatic, and nervous systems. Maya massage improves organ function by releasing physical and emotional congestion from the abdomen. You can also learn more about it at and find a practitioner in your area.

If you are able to use Deborah, I highly recommend her. She's got magical hands. Deborah works out of two Minneapolis locations, Blooma at (44th & France) and Northeast Minneapolis.

Good luck!



answers from Rapid City on

Have you considered going to a Chiropractor? I went to mine for all three pregnancies right up to the end. I believe that if everything stays aligned it make for an easier delivery. All of mine were 5 hours or less. My personal Chiro is Dr Brettrick Sutton he's actually a Chiropractic/ Physician. I've been seeing him for over 14 years when needed.



answers from Green Bay on

I'm sorry you are going through this. I didn't have it with my first child but I did with my next two. I also suffered from sciatica pretty bad. I went to see a physical therapist and she helped me go from extreme pain (barely being able to walk, get out of bed) to virtually no pain at all. My hips and pelvis got worse as the pregnancy progressed. My two boys that I had this with came early, with the second boy actually premature. I have to wait for a few years before getting pregnant again so I can put my body back together. I have basically been nursing or pregnant for the past 7 1/2 years. I have a 6 1/2 daughter, 4 yr. son, and 18 mon. son who is still nursing.
I really recommend finding a physical therapist who deals primarily with women's issues. My therapist only sees women and takes special classes and seminars on women's issues. I love her!
I hope your pregnancy goes well and involves little pain.

Good Luck,



answers from Sheboygan on

Hi there!
I agree with Jamie- Chiro is the way to go!! I went to one for it during my first pregnancy and did wonders. Then waited until the last month to go with the second, have suffered the whole time with it, during my second pregnancy. My third I had little problems...
They really do great with the separation and realining everything back into place that the baby tends to kick and hit out of whack!!
Good luck!! No need to suffer so much!!



answers from St. Cloud on

This is a really long post on the topic from the national Holistic Moms yahoo group. I figure if you're in pain, you need all the help you can get!!!

Re: (long reply!) groin pain during pregnancy

I definitely second the chiropractic advice!!! And you never know,
a chiropractor just may be willing to do a trade of sorts in return
for services.

Jennifer in TX

--- In [email protected], "Teddy's mom" <[email protected]>
> [Janine replies:] I had this - here is what I found (do not
recall the
> link)
> Pelvic Pain (Symphysis Pubis Dysfunction)
> Anatomy and Structure
> Your pelvis is a kind of a circular bone that goes all around and
> meets in the middle in front. The two sides do not quite touch;
there is a
> small gap between them connected by fibrocartilaginous tissue
reinforced by
> several ligaments. This area is called the Pubic Symphysis. This
> important for helping your pubic bone to move freely, stabilizing
the pelvis
> while allowing a good range of motion. [An illustration of the
pelvis can
> be found at]
> The Pubic Symphysis and the Sacro-Iliac joints (in the back of the
> are especially important during pregnancy, as their flexibility
allows the
> bones to move freely and to expand to help a baby fit through more
> during birth. In fact, the pregnancy hormones relaxin and
progesterone help
> the ligaments of your body to loosen and be even MORE flexible
than before,
> so that there is plenty of 'give' and lots of room for the baby to
> right through.
> Because of these hormones, it is normal for there to be some extra
> and pelvic pressure in pregnancy. This is good---it means your
body is
> getting ready for birth! It's loosening up to give you maximum
space and
> flexibility, and to help make things easy for you and your baby.
> However, in some women, either because of excessive levels of
> extra sensitivity to hormones, or a pelvis that is out of
alignment, this
> area is extra lax or there is extra pressure on the joint. In
> Snelling described this condition: "The affection appears to
consist of a
> relaxation of the pelvic articulations, becoming apparent suddenly
> parturition, or gradually during pregnancy; and permitting of a
degree of
> mobility of the pelvic bones which effectually hinders locomotion,
and gives
> rise to the most peculiar, distressing and alarming sensations."
> Simply put, significant pubic pain is caused by the pelvic girdle
area not
> working they way it should, probably because of hormones,
misalignment of
> the pelvis, or an interaction of the two.
> Although not every provider has a name for this condition, it is
> commonly called Symphysis Pubis Dysfunction (or SPD), especially
in Britain.
> Other names for it include:
> * pubic shear (osteopathic term)
> * symphyseal separation
> * pubic symphysis separation
> * separated symphysis
> * pelvic girdle relaxation of pregnancy
> * pelvic joint syndrome.
> Diastasis Symphysis Pubis (DSP) is the name for the problem in its
> severe form (where the pubic symphysis actually separates severely
> tears). For ease of use, in this FAQ the 'milder' form will be
referred to
> as SPD.
> Symptoms
> The symptoms of SPD vary from person to person, but almost all
women who
> have it experience substantial pubic pain. Tenderness and pain
down low in
> the front is common, but often this pain feels as if it's inside.
The pubic
> area is generally very tender to the touch; many moms find it
painful when
> the doctor or midwife pushes down on the pubic bone while
measuring the
> uterus (fundal height).
> Any activity that involves lifting one leg at a time or parting
the legs
> tends to be particularly painful. Lifting the leg to put on
clothes, getting
> out of a car, bending over, sitting down or getting up, walking up
> standing on one leg, lifting heavy objects, and walking in general
tend to
> be difficult at times. Many women report that moving or turning
over in bed
> is especially excruciating. One woman wrote, "There were days
that I
> didn't think I was going to be able to get out of bed and actually
had to
> roll out of bed and onto the floor to be able to do so!" [See her
> below <;s
> Stories#Women's Stories> .]
> Many movements become difficult when the pubic symphysis area is
> Although the greatest pain is associated with movements of lifting
one leg
> or parting the legs, some women experience a 'freezing', where
they get up
> out of bed and find it hard to get their bodies moving right away--
the hip
> bone seems stuck in place and won't move at first. Or they
describe having
> to wait for it to 'pop into place' before being able to walk. The
range of
> hip movement is usually affected, and abduction of the hips
> painful.
> Many women also report sciatica (pain that shoots down the
buttocks and leg)
> when pubic pain is present. SPD can also also be associated with
> dysfunction, especially when going from lying down (or squatting)
to a
> standing position. Some women also feel a 'clicking' when they
walk or
> shift just 'so', or lots of pressure down low near the pubic
> Many women with SPD also report very strong round ligament pain
(pulling or
> tearing feelings in the abdomen when rolling over, moving suddenly,
> sneezing, coughing, getting up, etc.). Some chiropractors feel
that round
> ligament pain can be an early symptom of SPD problems, and
indicate the need
> for adjustments. Other providers consider round ligament pain
normal, part
> of the body adjusting to the growing uterus. If experienced with
> and/or low back pain, it probably is associated with the SPD.
> Onset of Pain and Duration
> Pubic pain often comes on early in pregnancy, even as early as 12
weeks. One
> mother reports that she had it at 17 weeks.
> Indeed, although pubic pain often does go away after pregnancy,
many women
> find that it sticks around afterward, usually diminished but still
> If treatment to resolve any underlying causes is not done, long-
term pain
> usually sticks around. Anecdotally, this often seems to be
associated with
> long-term low back pain or reduced flexibility in the hips. Even
worse, if
> the mother is mishandled during the birth, the pubic symphysis can
> even more or be permanently damaged. This is called Diastasis
> Pubis (diastasis means gap or separation).
> Summary
> To summarize, SPD is the mild form of this problem. Its symptoms
> include one or more of the following:
> * pubic pain
> * pubic tenderness to the touch; having the fundal height
measured may
> be uncomfortable
> * lower back pain, especially in the sacro-iliac area
> * difficulty/pain rolling over in bed
> * difficulty/pain with stairs, getting in and out of cars,
> down or getting up, putting on clothes, bending, lifting, standing
on one
> foot, lifting heavy objects, etc.
> * sciatica (pain in buttocks and down the leg)
> * "clicking" in the pelvis when walking
> * waddling gait
> * difficulty getting started walking, especially after sleep
> * feeling like hip is out of place or has to pop into place
> walking
> * bladder dysfunction (temporary incontinence at change in
> * knee pain or pain in other areas can sometimes also be a
> of pelvis problems
> * some chiropractors feel that round ligament pain (sharp
tearing or
> pulling sensations in the abdomen) can be related to SPD
> Cause
> No one knows why SPD occurs for sure, or why it happens in some
women and
> not in others. Some ethnic groups report a high incidence,
> Scandinavian women and perhaps Black women. Other risk factors
may include
> having lots of kids, having had large babies, pre-existing
problems with
> this joint, past pelvic or back pain, or past trauma (car accident,
> obstetric trauma, etc.) that may have damaged the pelvic girdle
area. It
> also seems logical that women who have broken or injured their
pelvis in the
> past would probably be prone to this problem.
> Some sources view SPD simply as a result of pregnancy hormones.
As noted,
> the pregnancy hormones relaxin and progesterone tend to loosen the
> of the body in preparation for birth. One theory is that some
women have
> high levels of hormones before pregnancy, and then additional
> hormones cause excessive relaxation of ligaments, especially in
the pelvis.
> Another theory is that some women manufacture excessive levels of
> during pregnancy, causing pelvic laxity. However, although still
> this theory seems to have been disproven by recent research.
Another theory
> is that women whose joints are especially flexible before
pregnancy may be
> more susceptible to the effect of hormones, or that some women's
bodies are
> just more affected by hormones than others. Traditional medical
> tend to view the problem of pelvic/pubic pain (when they
acknowledge it at
> all) as simply a hormone problem.
> A different theory holds that the problem is structural instead,
and usually
> results from a misalignment of the pelvis. In this view, if the
pelvis gets
> out of alignment, the bones don't line up correctly in front, and
this puts
> a lot of extra pressure on that pubic symphysis cartilage. If the
two sides
> are not aligned, it restricts full range of motion, pulling on the
> connecting pubic symphysis, and making it quite painful. The more
out of
> alignment it is, the more painful this area becomes. It also
tends to
> affect the back, especially in the sacroiliac area, since the
pelvis and
> back are interconnected and work as a unit. And since many areas
> affected by back problems, pain can also extend to other areas too.
> Kmom's personal opinion is that this condition is probably
primarily a
> problem of misalignment, although hormone levels and sensitivity
to hormones
> may also play a role. In her opinion, the first line of SPD
> should probably address the possibility of misalignment. Others
may not
> agree. But whatever the cause, SPD is certainly annoying and
painful to
> deal with, and Kmom knows this from personal experience!
> Implications for Malpositions and Cesareans
> One of the most interesting side-effects of a misalignment of the
> bones is that anecdotally, it often seems associated with
malpositions of
> the baby, including:
> * breech (feet or butt-first)
> * occiput posterior (head-down but facing the mother's stomach
> of her back)
> * asynclitic (head tilted to one side so that the parietal
> presents first instead of the crown)
> * compound (hand or arm by face)
> All of these malpositions tend to cause more difficult labors,
with greater
> pain and often great difficulty in dilation or descent of the
baby. There
> is a high rate of operative intervention when malpositions are
> including lots of forceps in vaginal births, and many cesareans as
well. In
> fact, research shows that only a small percentage of babies with
> malpositions actually are born spontaneously and without
> (See the FAQ on Malpositions
> <; on this
website for
> further information and references.)
> As noted on the website of the Australian Osteopathic Association:
> The descent of the baby through the pelvis is determined by
factors such as
> ligament laxity, hormonal control, uterine contraction, gravity
and position
> of the baby. If the mother's pelvis is mechanically unstable or
is lacking
> mobility, it may interfere with the baby's passage through the
birth canal.
> Unfortunately, very few doctors in recent years have paid much
attention to
> malpositions (except to do cesareans for breech). Only in the
> osteopathic, and chiropractic communities have these positions
received much
> attention, and then only recently. Interest is now just beginning
> re-surface in the obstetric community, but is very limited in
> obstetric journals as of now.
> There is little scientific data to show that pelvic misalignment is
> associated with malpositions because traditional medicine does not
> misalignment as a problem or research it, nor do they take the
idea of
> "pelvic misalignment" seriously. Really, they barely take the
idea of
> non-breech malpositions seriously! Therefore, it cannot be stated
from an
> evidence-based point of view that pelvic alignment is associated
with fetal
> malpositions or difficult labors, or that re-aligning the pelvis
> prevent malpositions, prevent cesareans, or lessen the incidence of
> difficult labors.
> Obviously, research into this issue is very important, but quite
unlikely to
> occur anytime soon. The funding and interest is simply not there
in the
> traditional medical community. This lack of data does not prove
or disprove
> the misalignment theory; it simply has not been researched in the
> traditional scientific manner. Chiropractors, on the other hand,
have seen
> in their own practices for years that women with misaligned backs
> pelvises tended to have more malpositioned babies. There are some
> case series studies on this available in chiropractic research
journals, but
> even this is not very well-documented.
> The first really significant work was done by Dr. Larry Webster,
founder of
> the International Chiropractic Pediatric Association. He found
that simply
> by realigning the pelvis and releasing the soft tissues, most
breech babies
> turned head-down within a few treatments. It is important to
emphasize that
> he did NOT manually turn the baby in any way, but simply realigned
> mother's pelvis and 'released' the ligaments supporting the
uterus. The
> baby then was not "constrained" anymore from assuming the best
> position, and so usually quickly turned vertex.
> Dr. Webster taught this "Webster In-Utero Constraint Technique" to
> other chiropractors. Success rates depend on the skill of the
> but usually are documented at about 80% or more in turning the
breech baby.
> This is much higher than the success rates for manually turning
the baby
> with the often-rough procedure known as a "External Cephalic
Version". ECV
> success rates generally run anywhere from 40-65% or so, whereas
the Webster
> Technique successfully turns 80% or so, at least in the data
available so
> far.
> Thus, it seems likely that many cases of breech babies are quite
> associated with pelvic misalignment, and that treatment to re-
align the
> pelvis may help many breech babies turn head-down. However, proof
of this
> is limited to anecdotal evidence, lectures and articles from Dr.
Webster, a
> few small case series, and surveys about chiropractors' experience
with the
> Webster Technique. Not overwhelming evidence by any means, but all
we have
> at this point. Yet it may be women's best bet in preventing
> and relieving pelvic pain.
> The Webster Technique also has a variant that can be used with
babies that
> are head-down but facing the wrong way (posterior). Although
little formal
> data exists on this, anecdotally many women and midwives have
reported this
> to be helpful for non-breech malpositions as well. Thus, it is
quite likely
> that in many cases, pelvic misalignment is often accompanied by
> malposition of varying types, not just breech presentations, and
> may help resolve such malpositions.
> Anecdotal evidence also suggests that many women who have had past
> for non-progressive labor or "Cephalo-Pelvic Disproportion"
> baby too big or pelvis too small) actually may have had
> babies. It's not that the baby was too big or the mom's pelvis
too small,
> it's that the baby's position did not permit it to go through
> causing it to get "stuck." These women (one of whom is Kmom!)
often report
> that if they get regular chiropractic care in subsequent
pregnancies, they
> frequently go on to have a Vaginal Birth After Cesarean because
the baby
> malposition is prevented or is more easily resolved. They also
> report that their pubic symphysis pain decreases significantly with
> treatment.
> So although little concrete scientific data exists from mainstream
> (largely because it has not been studied), and although anecdotal
> has to be treated with caution, women with misaligned pelvises
often seem to
> experience pelvic pain/SPD, and possibly a higher rate of
> babies. It seems logical (though unproven) that treatment to
help re-align
> the pelvis may help lessen pelvic pain, and may also prevent or
correct a
> fetal malposition.
> Although not every women with SPD experiences a malpositioned
baby, it does
> seem to be very common in this group. Since baby malpositions
commonly lead
> to lots of interventions like epidurals and forceps that tend to
> pubic pain and may even damage the pubic symphysis permanently,
checking for
> misalignments and working carefully to avoid/treat baby
malpositions may be
> important to avoiding long-term pain or permanent pubic symphysis
> This is a fascinating area that is just beginning to be researched
but has
> potentially far-reaching implications.
> Tips for Coping with Pubic Symphysis Pain
> Although the best idea may be to resolve chronic SPD pain through
> the pelvis girdle and soft tissues, most women have at least some
> pubic and low back pain stick around for pregnancy and the early
> weeks because of hormones. Therefore, tips for coping with pubic
pain tend
> to be a focus of many SPD websites. Many of the suggestions
> * Use a pillow between your legs when sleeping; body pillows
are a
> great investment!
> * Use a pillow under your 'bump' (pregnancy tummy) when
> * Keep your legs and hips as parallel/symmetrical as possible
> moving or turning in bed
> * Some women also find it helpful to have their partners
> their hips and hold them 'together' when rolling over in bed or
> adjusting position
> * Some women report a waterbed mattress to be helpful
> * Silk/satin sheets and nighties may make it easier to turn
over in
> bed
> * Swimming may help relieve pressure on the joint (many sites
> recommend avoiding breaststroke but Kmom did not find it to be a
problem at
> all for her; see what works for you)
> * Deep water aerobics or deep water running may be helpful as
> (there are flotation devices to help you stay afloat easily during
this; you
> do not need to know how to swim in order to do this)
> * Keep your legs close together and move symmetrically (other
> recommend a very small gap between the legs with symmetrical
> * When standing, stand symmetrically, with your weight evenly
> distributed through both legs
> * Sit down to get dressed, especially when putting on
underwear or
> pants
> * Avoid 'straddle' movements
> * Swing your legs together as a unit when getting in and out
of cars;
> use plastics or something smooth and slippery (like a garbage bag)
on the
> car seat to help you enter car backwards and then turn your legs
as a unit
> * An ice pack may feel soothing and help reduce inflammation
in the
> pubic area; painkillers may also help
> * Move slowly and without sudden movements
> * If sex is uncomfortable for you, use lots of pillows under
> knees, or try other positions
> * If bending over to pick up objects is difficult, there are
> available that can help with this
> * Really severe cases may need crutches, although these should
> probably only be used as a last resort
> * Sciatica may be helped by stretching the hamstring muscles
with a
> stirrup around your foot (long piece of rope, two neck ties tied
> etc.) See the Elizabeth Noble book for directions (resources)
> * Back pain can often be helped by resting backwards over a
> gymnastic or 'birth' ball (see resources)
> * Some women report that pelvic binders/maternity support
belts are
> helpful for pelvic pain; brands in the U.S. include Prenatal
Cradle or
> BabyHugger or the Reenie Belt. However, if the pelvic bones are
> misaligned, some women report more pain with these. Listen to
your body on
> whether to use these
> Many sites also recommend a lot of bed rest, but Kmom has to
disagree with
> this for most women. In Kmom's experience, her pain levels were
much worse
> when she was inactive. Inactivity may lead to atrophy, and
regular exercise
> is helpful in the prevention of many common pregnancy problems.
Although the
> first 5-10 minutes of activity were uncomfortable for Kmom, she
always felt
> much better after that, and usually returned from her walks
feeling much
> less fatigued and in less pain overall than if she had not walked
at all or
> had stopped partway through. It's possible that in very severe
> bedrest may be the best option, but Kmom would encourage most
women to stay
> reasonably active as long as they use caution and listen to their
> Other tips that don't usually appear on SPD websites but which
have helped
> Kmom cope include pelvic rocks, a lumbar pillow against the back
> sitting, and very strong massage/counterpressure against the lower
> Pelvic rocks (getting on all fours and then slowly tilting the
angle of the
> pelvis back and forth) are general recommended exercises for all
> women, plus they help promote good birth positions for baby. They
can also
> help ease tight low back muscles. It is usually recommended to do
2-3 sets
> of 40 of these throughout the day. You can also do them sitting
or standing
> against a wall, but on all fours is often most comfortable and has
the added
> effect of helping the baby's position, which may be important with
> Lumbar pillows are very helpful to many pregnant women. They are
> at many car stores, but if you cannot find one, try a small neck
> (elongated like a tube), rolled up towel, or tube sock filled with
rice or
> flax seeds. Put it behind your back when sitting, wherever it
feels best;
> for some women this is down low in the small of the back, for some
it is
> even lower against the sacrum, and for others it feels best up
high in the
> middle of the back. Socks or pillows filled with rice or flax
have the
> advantage of being able to be warmed in the microwave before
using, which
> can feel really nice!
> Massage of the lower back or strong counterpressure in that area
> really great to some women. Some women like it just to the sides
of their
> spine (helps loosen the muscles there), and some like it really
low and
> farther out (there are trigger points there). Others like it all
up and
> down on either side of the spine. See what feels best to you and
go from
> there. If your partner's hands get tired (this is a tough place to
> massage!), try a rolling pin, tennis ball, or other hard object
there. For
> women who like extra hard pressure on this spot, try getting on
your hands
> and knees and arch your back a bit, then have your partner put his
> against the area that feels best, lean his weight on it, and rub
around in
> small circles. For others who like more gentle pressure, hand or
> pressure may be more than enough.
> Although it's possible to 'deal with the pain' or use these tips
to help you
> cope with pelvic pain, these ideas only address the SYMPTOMS of
the problem,
> not the root cause of it. If the source of your pain is purely
> then addressing the symptoms is about all you can do until the
baby is born
> and your hormones start to change. However, if the problem is in
> misalignment of the bones creating stress on the joints, only
fixing this
> misalignment can really help resolve the problem, and simply
having the baby
> won't change much. It may make sense to at least get an
evaluation of your
> pelvic area and back to see if there's a problem. Then you can
> whether to try any treatment or not.
> Possible Treatments
> There are many treatment approaches available for SPD, although
> websites have information primarily on traditional medical
> However, there are a number of other alternatives. Unfortunately,
> randomized trials examining the efficacy of different modes of
treatment for
> SPD do not seem to exist. Obviously, Kmom's opinion is that
> care is the best approach, since that was her experience and she
knows a
> number of other women who have benefited from it as well.
However, she
> makes no absolute recommendations to others as to what their best
course of
> treatment would be, merely passes on her experience of what worked
best for
> her. Each person must decide what treatment would be best for
> situation.
> Don't give up easily in your search for effective treatment,
> Because the problem of pubic pain is so underacknowledged even in
> 'alternative' health care fields, women often have to search long
and hard
> to find real help. Expect it to take a while to find effective
help, and
> keep looking for a new provider if the one you're seeing does not
take this
> problem seriously or cannot help. Be willing to try different
> modalities, and be persistent---it took Kmom five years before she
> help!
> Traditional Approach
> It is often extremely difficult to get the traditional medical
> (especially the obstetric community!) to take pubic pain/SPD
> They often simply ascribe pubic pain to the 'normal aches and
pains of
> pregnancy' and brush it off as no big deal. They often believe
that no real
> physical therapy or treatment is possible while pregnant and that
it is just
> a matter of waiting it out.
> Even when traditional practitioners take your pain seriously, the
> recommended by most traditional providers is very conservative.
> painkillers, and anti-inflammatories are the typical
recommendations. Some
> may also recommend wearing a maternity support garment or belt,
such as the
> Prenatal Cradle, Reenie Belt, or Baby Hugger. For severe pain,
some may
> recommend using crutches or a wheelchair as well. Again, this
tends to
> treat only the symptoms, since they believe the cause to be
hormonal, ending
> only with birth.
> In Britain, they have made some strides in recognizing SPD as a
> problem, but they often refer women to an 'obstetric
physiotherapist'. Some
> women report being told that the physiotherapy needed should not
be done on
> a pregnant woman and the physiotherapist would not treat them.
> physiotherapists would treat pregnant women; sometimes it was
helpful, but
> many women report that it was not. Many of the treatments
recommended tend
> to be very traditional (bedrest, crutches, painkillers) and not
> effective.
> Postpartum, if the pain does not disappear or if the pubic
symphysis is
> damaged due to obstetric mishandling, traditional medical
treatment in
> Britain sometimes includes surgery to put a plate over the
affected joint or
> to induce scarring over it in order to 'stabilize' it, or
injecting a
> steroid directly into the pubic symphysis. Very invasive
treatments indeed,
> and ones that involve a great deal of recovery time.
> Chiropractic
> Danielle Rothman, DC FICPA
> Pediatric Certification & Webster Technique
> Englewood NJ US 07631
> Distance: 6 miles
> ###-###-####
> Chiropractic care aims to realign the pelvis, the back, and all
> areas through the use of manual adjustments. Many women with
pelvic pain
> anecdotally report the greatest improvement from chiropractic or
> treatment. Yet the majority of women on SPD websites apparently
have not
> tried chiropractic care, and SPD organizations seem to be
reluctant to
> promote chiropractic care as a possible treatment. Many people
still see it
> as "too alternative" to actively promote.
> If the cause of SPD lies in pelvic misalignment, then only
chiropractic or
> osteopathic manipulation will really address the root cause of the
> instead of addressing only the symptoms. There is no solid proof
of this,
> but anecdotally, it does seem to be the most promising approach.
> The following information is designed to help women be more
> considering the possibility of chiropractic care, and to answer
some of
> their concerns about chiropractic care. Be aware that like
> chiropractors vary in quality, and sometimes you have to see more
than one
> to find the right one for your needs, and of course, it's also
possible that
> chiropractic care may not be the right mode of care for you.
> Different Types of Chiropractic Care
> There are different schools of chiropractic technique. Some
adjust with
> quick sudden movements, while others adjust only with gentle,
> imperceptible movement. Kmom has experienced both styles, and
while she
> would have thought she would have preferred the gentler style, she
> really find much relief from it. When she finally found the
> who helped turn her baby, that chiropractor's style was the more
sudden and
> forceful kind. It wasn't painful, but it was definitely startling!
> However, within an hour amazing changes began to happen, and
Kmom's pain
> level was definitely MUCH improved.
> So while you think you might favor one style over the other, try
to keep an
> open mind. It may be that one style helps you more than the other
style, or
> that if you go for treatment only late in pregnancy, the 'gentler'
style of
> treatment won't have enough time to work. If you find the idea of
> stronger style of adjusting scary, be sure to tell the
chiropractor ahead of
> time so they will know to take extra time to help you understand
what will
> happen and help you relax into the adjustment instead of resisting
it. That
> helps things considerably.
> Finding a Chiropractor Familiar with Webster's In-Utero Constraint
> It is important to find a chiropractor that is well-trained in the
> of pregnant women. Although most chiropractors receive some
training in
> this while in school, some receive advanced post-grad training and
are true
> specialists for pregnant women, babies, and children. In
addition, many
> specially trained chiropractors will know the Webster Technique
(which can
> turn malpositioned babies), something many other chiropractors are
> familiar with. However, it is not always easy to find people with
> training.
> If you can, it's best to find someone who specializes in "pediatric
> chiropractics." One possible way to find one is to check the
website at
> <; and see if there is
> specialist listed in your area. If there is not, you can email
> [email protected] or call 1-800-670-5437 and ask if there's one in your
> area. They have an extensive file of many chiropractors who are
not listed
> on the site itself.
> Another excellent resource is the International Chiropractic
> (ICA). Call and ask for the Council on Chiropractic Pediatrics
> (1-800-423-4690). They also have an extensive list of people
trained in
> this technique and many others. It is not always easy to get
through to
> this group, but their training is extensive and extremely
detailed, so this
> is an excellent place to start.
> If there's no one listed in your area through either of these
groups, start
> cold calling all the chiropractors in your area to find one who
knows the
> Webster Technique. If there is no one in your immediate area that
knows the
> Webster Technique, see if there is one within a few hours. In
> opinion, it is definitely worth driving some distance in order to
> someone specially qualified. It's better to drive a little than
to endure
> the continuing pain of SPD, risk a long and difficult labor with a
> malpositioned baby, or possibly a cesarean because of a breech
baby! So
> don't be afraid to go outside your usual range of driving.
> If there is truly no chiropractor in your area trained in Webster's
> Technique, try to find someone who has extensive experience and/or
> training with pregnant women. Some women have found that even
though they
> didn't have the specific "Webster's Technique" done, they were
able to get
> some pain relief from SPD, and sometimes their babies even turned.
> is the most effective treatment, so you should search long and
hard for that
> before choosing someone else. BUT if you cannot find one trained
> Webster's, a chiropractor with experience in treating pregnant
women may be
> better than no treatment at all.
> Whatever chiropractor you see, it seems to be very important to
have them
> not only evaluate the back and the sacroiliac joints, but also to
> and adjust the pubic symphysis directly, something many
chiropractors omit,
> even those trained in Webster's Technique. Be sure they check and
treat the
> pubic symphysis too! And if possible, they might want to try a
> "diaphragmatic release," a "Xiphoid Process Release," and Cranial
> Therapy as well (see below).
> What Is An Adjustment Like for Pregnant Women?
> Many women who have never seen a chiropractor before are
> anxious about what an adjustment is like, and especially how it is
> during pregnancy. A chiropractic adjustment during pregnancy
> involves the mom lying on her stomach on a pregnancy cushion that
has an
> indentation designed to protect and cradle the baby. Baby is
perfectly fine
> as long as mom is on this cushion. Some chiropractors have a table
that is
> specially designed for pregnant women.
> The adjustment usually takes place on a special chiropractor's
table called
> a 'drop table' (with the pregnancy cushion on top).
Alternatively, the
> woman may also lie on her back for some adjustments as well.
Parts of the
> drop table are able to be tilted up slightly, at an angle to the
rest of the
> table. When the chiropractor does an adjustment, the tilted part
of the
> table drops a bit. The adjustment plus that small drop (usually
not very
> jarring) is often enough to realign the part of the body being
worked on.
> Not all chiropractors use a drop table, but it's often a good tool
> pregnant women because of limited ability to do other maneuvers.
> techniques that may or may not be used involve wrapping your arms
> yourself like a pretzel while they adjust your back, leaning your
> to one side, as well as other techniques that depend on the
> training and background.
> Some (but not all) chiropractors also believe in working with the
> tissues (i.e. ligaments, etc.) that surround the joints. They
feel that if
> these soft tissues are not also 'released', then their tension may
> pull the bones out of place again. This is probably an important
part of
> treatment, one that should not be neglected if at all possible.
Don't just
> get a spine or pelvic adjustment; also ask for soft tissue work. A
> 'diaphragmatic release' or a "xiphoid process release" has also
been noted
> to help turn some babies even when the chiropractor did not know
> Technique. [Kmom is not familiar with what either of these
> involve, but they are not reported to be traumatic at all.]
> Another excellent treatment is called "Cranial Sacral Therapy"
(CST). (It
> may have other names outside the US.) Kmom found CST highly
effective too.
> If your chiropractor does not do soft tissue work or CST, you may
want to
> supplement your treatment with someone else who can do these
things (see
> <; for CST practitioners
in your
> area).
> Is Chiropractic Care Really Necessary?
> Is chiropractic treatment absolutely necessary to give birth? Of
> not; women were having babies long before chiropractic treatment
> invented. Your body knows what to do, and although misalignments
might make
> labor harder or more inclined to malposition, it certainly is not
> automatic sentence to a cesarean. Some women with SPD do have
> births (see below). There are too many variables in birth to say
> certainty that SPD will cause problems. But because such a high
> of women with SPD anecdotally seem to have malpositions and/or
> births, it seems sensible to err on the side of treatment if you
> experiencing significant discomfort.
> What if you are experiencing some pain and discomfort, but not
> amounts? Must any degree of SPD automatically be treated? Most
> chiropractors believe that any level of pain and discomfort
indicate a need
> for treatment, and that this is your body's "early warning system"
to tell
> you that something is wrong and needs fixing. Some degree of
pelvic laxity
> is probably normal in pregnancy, but most chiropractors do not
believe that
> pain, even minimal pain, is normal. From their point of view, it
is better
> for women with mild SPD to get treatment in order to prevent the
> from becoming more severe later on and impacting birth. However,
it is not
> absolutely required.
> Some women are understandably reluctant to try chiropractic care,
> that is still on the fringes of mainstream medicine, and which,
> needs more scientifically rigorous study. Other women do not have
the money
> or insurance to pay for chiropractic care, or cannot find a
> provider near their home. As a result, some women elect to just
live with
> mild to moderate SPD and only get treatment if things become
severe. Kmom's
> personal opinion is that it's better to be treated, even with only
> discomfort, just in case. But if you really feel that treatment is
> something you cannot or prefer not to do, this is of course your
> Some women with SPD do manage to get through pregnancy reasonably
well and
> still have a normal birth. Chiropractic care is not a strict
necessity for
> every woman, though probably a reasonable precaution. If you do
not get
> treatment, keep in mind that you are probably at increased risk
for pubic
> symphysis damage from birth so your providers should be aware of
> SPD problems ahead of time. They should watch for malpositions,
> labor, and should be especially careful about maternal positioning
> labor and birth (see below). These moms should also plan to
avoid labor
> interventions in order to save strain on the area, and to
preferably labor
> unmedicated so they can be more aware of any possible strain on
the area.
> Hopefully, with care, you will be able to prevent or minimize any
> Postpartum, women with mild untreated SPD may find that their pain
seems to
> go away within a few weeks. Sometimes it is slightly worse right
> birth but given time, resolves on its own. Here again,
chiropractic care can
> be helpful but is not absolutely required. However, these women
should be
> aware that the misalignment is probably still there at least
minimally even
> once the pain ceases, and they should be conscious of the
> potential for further damage from accidents or falls. If they
show symptoms
> of problems in the future, they might want to again consider
> What Is a Typical Appointment Like?
> A chiropractor will feel down your back to see if there are any
> (misaligned parts). They may also test range of motion on you in
> joints. In addition, chiropractors trained in Webster's Technique
will test
> you for pelvic alignment. The results are sometimes referred to
as someone
> being "Webster Positive" or "Webster Negative."
> To find out if you are Webster positive or negative, you lie down
on your
> stomach while your chiropractor gently pushes your feet towards
your bottom.
> If one leg reaches further than the other, this means you
are "positive" and
> could use the Webster. If your feet are even, then your legs are
equal in
> length, and you are "Webster negative" and don't need Webster's
> Note that they are not talking about really big leg-length
> (which are unlikely) but rather about small and subtle differences
> leg lengths. These indicate a pelvis that is out of alignment.
> Chiropractors will not do automatically do Webster's Technique on
> they test first to be sure it is needed.
> The Webster Technique is difficult for a non-chiropractor to
> adequately. (An technical description of it can be found in Anne
> book, Holistic Midwifery.) The following description relates
> experience receiving Webster's Technique and then Cranial Sacral
Therapy (at
> 36-38 weeks), but please note that since Kmom is not a
chiropractor, these
> are only her impressions, which may not be completely accurate
> Also note that the full version of Kmom's story is in the section
on Women's
> <;s
> Stories> Stories.
> First, the chiropractor watched me walk; she remarked on how 'off'
my gait
> was. Then she took a history and we discussed my concerns
> Afterwards, she put me on my stomach on the pregnancy cushions on
a drop
> table. She felt along my back to see how the joints were moving
and to
> identify problem areas. Then she took my legs and bent them
upwards at the
> knees towards my hips to see if they were the same length. (She
was looking
> for subtle differences.) She found that one leg was indeed longer
than the
> other, indicating that the pelvic area was out of synch.
> After checking several different things, she raised one small
section of the
> drop table, the area under my hips. She identified the area that
> adjusting, asked me to take a deep breath in, then exhale deeply.
> that exhale, she pushed sharply and strongly on that part of my low
> back/pelvis, and the table section under my hips dropped a bit at
the same
> time. I wasn't quite sure what to expect and was really nervous
> seeing this type of chiropractor, so I was pretty startled by that
drop to
> say the least. But it didn't hurt; it was definitely jarring but
mostly it
> just startled me. She apologized and said that I was so far out
of synch
> that she needed to use more of a drop than she usually used.
Afterwards, she
> also put her hands on my abdomen at various points to
help "release" the
> uterine ligaments and other supporting tissues.
> It's hard to remember if she adjusted anything else that day.
Some sources
> say that you should not have any other adjustments done after
> Technique is initially done. I can't recall exactly everything
that we did.
> I do remember clearly that she did finish up with soft tissue work
> gentle and non-invasive) and Cranial Sacral Therapy (which puts
the weight
> of about a nickel on your head and sacral areas). At other
visits, I know
> for sure she worked extensively on my Sacro-Iliac joints, my
middle back,
> and to a lesser extent, my neck. As is common with chiropractors,
she never
> checked the pubic symphysis joint, however.
> When I walked to the check-out desk after the first visit, I have
to say I
> felt very foolish for being willing to try such a weird maneuver.
As I wrote
> out the check, I felt like I had probably wasted my money. I was
> emotional. My husband took me out to lunch afterwards to comfort
me, and
> suddenly about an hour after the appointment, I noticed that my
pain was
> gone and I was feeling terrific! It was weird how it took about
an hour to
> "register" on me. All of a sudden I felt so good I felt like
getting up and
> dancing around the room! I don't know if it was because the baby
> suddenly turned or what. Whatever it was, it was just an awesome
> and I slept better that night than I had in a long time.
> My first visit to that chiropractor was about 45 minutes or so,
> subsequent visits were about 15 minutes or so, give or take.
After the
> first visit, the baby turned to the best birth position for the
first time
> in pregnancy. The progress was really quite remarkable. I should
note that
> I wasn't entirely pain-free afterwards, and since tissues tend to
> back to previous patterns, I eventually started to feel things go
> again. But I felt so much better than I had before, it was like
night and
> day!
> I had visits once or twice a week for 2+ weeks before the baby was
> Each time I would feel so much better! I just wished I had found
> earlier in the pregnancy so I could have gotten some relief then
and more
> fully resolved everything before the birth! I don't think we were
able to
> fully resolve every alignment issue I had in that amount of time,
but it
> sure helped!
> For the birth itself, I did have another malposition, though one
more easily
> resolved than previously. However, I fell twice the day I went
into labor,
> which could explain the malposition. It was a very rainy day, and
I slipped
> and started falling. I saved myself from falling badly, but I
could feel a
> big constriction in the PS area all of a sudden. Then later on, I
> sitting on a stool and unexpectedly tipped backwards, landing on
my tailbone
> and sacrum. I certainly felt that!
> The labor stalled about 5 cm, and became very painful for a while,
> indicating a malposition. I definitely had some pubic pain and
major back
> pain during labor. However, the malposition resolved when I
shifted my hips
> 'just so', and the baby was born shortly afterwards. I noticed
that I made
> no progress when pushing in the "usual" position (hunched forward
in a "C"
> with legs drawn back), but when I was able to arch my back REALLY
> the baby slipped right under the pubic bone and was born shortly
> Instead of 5 hours of pushing (as with my previous child), this
one was born
> in 12 minutes of pushing. It was short, intense, and wonderful.
> I had a normal vaginal birth after two previous cesareans for
> (believe me, the recovery was MUCH easier), and I give my
> treatment a lot of credit for helping me with that. And I did NOT
> any permanent damage to the pubic symphysis area from giving birth
> vaginally! It was a great experience overall.
> Postpartum, my chiropractor only treats the babies and not the
> mommies, so I did not get any follow-up care after the birth. The
baby did
> have some significant colic (not unusual in malpositioned babies)
so we took
> him in for Cranial Sacral Therapy. I was very dubious about
taking a baby
> to a chiropractor (and my husband was even more doubtful!), but
after having
> experienced for myself how very gentle it was, we decided to try
it. It had
> remarkable results, and REALLY helped the colic.
> Postpartum, eventually my pain came back, especially the back
pain. I saw
> an associate of my chiropractor, and we worked on improving my
back. While
> the treatments did help, sometimes they had the side effect of
causing hip
> pain and restriction. What we didn't realize was that the pubic
bone was
> out of alignment and that was affecting everything else. It took
us some
> time to figure out the problem, but eventually we tried doing a
pubic bone
> adjustment. This had not been done for me in pregnancy; it's
often not part
> of a routine check. But it seemed to be one of the main sources
of problems
> for me.
> In a PS adjustment, they use a drop table raised under the
pelvis. The
> client puts her own hand over the pubic bone (so the chiropractor
is not
> directly touching you 'there'), and they do a quick adjustment,
just like on
> the back. The raised area of the drop table drops down, giving
> 'oomph' to the adjustment.
> I won't lie to you. A pubic symphysis adjustment definitely
stings. The
> back adjustments never hurt me at all, but this joint does
> 'sting' when adjusted. It's not bad and goes away quickly (or I'd
never do
> it!), but women should know that this adjustment is a little
harder than the
> others, especially if the pubic bone is way out of alignment. To
me, it was
> better to have a little sting now then months of discomfort, but
it was
> definitely not as easy as the back adjustments. Harder, but worth
> Of all the adjustments we've done, I'd say this pubic bone
adjustment is the
> one that's given me the most help. It also eliminated the hip
> and restriction I'd previously experienced from treatment. We are
> working on the soft tissue angle; my recent adjustments have not
> the ligaments and such, and probably should. But it is AMAZING
how much the
> chiropractic care has helped! I'm not 100% pain-free at all
times, but I am
> MUCH better. The difficulty we still have is in maintaining the
> long-term. We are still working on this.
> One of the important points of my story, though, is the importance
> keeping up the search for the right treatment modality and the
> provider; see below for the story of how long I actually had to
search to
> find these treatments that helped!
> Caveats: It's important to know that just as with any health
field, there
> are good and not-so-good chiropractors. Some are extremely well-
trained and
> know exactly what they are doing; some do not. Most are ethical
> providers, but just as with doctors, there are some quacks out
there who are
> just looking to make a quick buck. Be cautious when selecting a
> chiropractor, and don't be afraid to switch if needed.
> The Importance of Perseverance
> Not every style or treatment plan works for every patient; some
women have
> to see multiple chiropractors before they find one that really
finds the key
> that resolves the problem. If the first chiropractor you see
doesn't seem
> to change your pain levels, consider trying another. Kmom briefly
saw 2
> different chiropractors and 1 osteopath before she finally found
the best
> approach for her (see her story below
> <;s
> Stories> ), and even now still is experimenting with treatment to
find out
> what works best and what doesn't.
> Remember that there are different "schools" of chiropractic
training and
> tradition too. If you go to one chiropractor, you may get one
form of
> treatment, and if you go to another, you may get a totally
> approach. That's why sometimes you have to search to find the
> that's right for you, and if you are not getting optimal results
with one,
> why trying another approach may help.
> Of course, if you are unhappy with your course of treatment, it
can be
> discontinued at any time. Don't feel tied to any one provider.
In fact, if
> you feel you are no longer making progress with one provider, it
may be that
> trying a new chiropractor will bring fresh new perspective on your
> situation. Just as with doctors, YOU are the employer, and you
can "let go"
> your employee at any time.
> Have Realistic Expectations
> It's important to have realistic expectations going in to a
> Some people expect to have one adjustment and be forever free from
pain or a
> recurrence of the problem. In reality, it usually takes multiple
> (one criticism of chiropractic care), and sometimes it is a
challenge to
> find all the sources of problems. Chiropractors are not miracle
> Making a significant change can take time.
> While many women find total relief of pubic pain with treatment,
others find
> it greatly diminished but not gone entirely. A really significant
case of
> misalignment which has been around for years often takes quite a
while to
> resolve, and some women struggle with chronic alignment problems
all their
> lives. Many need periodic treatment to keep things working well,
and if you
> later experience any falls, car accidents, or other trauma to the
area, you
> may need intensive treatment again. A short-term course of
treatment may
> not always completely fulfill your needs. On the other hand,
sometimes a
> short-term course of treatment is all that is needed.
> The key is not to expect a miracle cure or a permanent
total 'fix,' but to
> look for significant improvement in range of motion, pain levels,
> levels, and comfort. Although it is only human to look for a cure,
> improvement is helpful, and hopefully long-term treatment can
> reduce your discomfort. Don't be afraid to continue to look for
> help if needed, but keep your expectations realistic.
> Osteopathic
> Osteopaths also work with realigning the bones, ligaments, and
soft tissues
> of the body but the philosophy and methods are slightly different.
> Osteopaths are trained in traditional medicine as well as the
> musculoskeletal system, but they tend to place more emphasis on
> medicine, in looking at the body as an interconnected system, and
often use
> osteopathic manipulation and other 'non-traditional' therapies.
They use
> the initials "D.O." after their names instead of "M.D.", but
because their
> training does include traditional medicine, many go on to become
> pediatricians, OBs, etc. as well.
> Although trained in osteopathic manipulations, many D.O.'s have
gone very
> mainstream and no longer do manipulations, may do some only on a
> basis, or may not have much training in manipulation at all.
Simply going
> to any D.O. will not guarantee that they can help you resolve this
> you may need to search to find one that truly knows about
manipulation and
> resolving pelvic issues. You may need what is sometimes called
a "classical
> osteopath."
> At the International Cesarean Awareness Network Conference in
April 2001,
> Kmom saw a presentation by Dr. Anita Showalter, a D.O. who is also
> OB/GYN. Among other things, she mentioned the problem of 'pubic
> where a misalignment of the pelvis causes one side to be higher
than the
> other, resulting in tension and discomfort in the pubic symphysis
> area. A search for 'pubic shear' online brings up this technical
> from an osteopathy website:
> * Inferior pubic shear (inferior pubis): a somatic dysfunction
> which one side of the pubic symphysis is inferior to the
contralateral side
> as the result of a shearing in the saggital plane.
> * Superior pubic shear (superior pubis) reciprocal of inferior
> At a follow-up after the conference, Dr. Showalter elaborated a
bit more,
> explaining how pubic shear happens and what can be done to help.
> following is a summary (from memory!) of her information; please
be aware
> that because it is done from memory, it's possible there are
errors. It's
> also possible that Kmom may have misinterpreted or misunderstood
parts of
> the information, so insert caveats. Be sure to consult an
> familiar with this problem for further information or any
treatment advice!
> As Kmom understood it, pubic shear is where the two pubic bones
are not
> exactly parallel (in the same plane) in front; one is higher than
the other.
> This creates lots of extra pressure on the cartilage and ligaments
in the
> area, because they are being stretched and pulled on in a way they
were not
> designed for. Pregnancy hormones exacerbate this problem. Hip
movement can
> be restricted, movements that involve lifting one leg higher than
the other
> are particularly painful, and problems in this area can affect
other areas,
> such as the sacro-iliac area, etc.
> Dr. Showalter also showed Kmom and others a manipulation that she
says helps
> many women with this problem (and it was nothing like the Webster's
> Technique Kmom had gotten previously!). Because it's hard to
> accurately, because people might hurt themselves doing it wrong,
and because
> it is important to consult an expert before trying treatments like
> Kmom will not recount here exactly what this manipulation entailed.
> However, she will give a basic description so women understand
that it
> really was not very interventive at al, but please don't try this
based on
> this summary!
> It involved the woman lying on her back, having one knee drawn up
> knee depends on which side is out of alignment), and a D.O. or
partner using
> gentle pressure on the opposite side of the pubic bone (towards
the hip)
> while simultaneously pushing down the knee towards the foot until
the heel
> slides down and the leg is stretched out on the ground like the
other leg
> (it's trickier than that, but that's the basic idea). Doing
follow-up with
> the soft tissues may also be helpful.
> Several women tried this with Dr. Showalter, and reported that it
felt good.
> Kmom tried it but did not feel much difference, although since she
was not
> pregnant at the time and had already had chiropractic adjustments,
there may
> not have been much to affect! So finding an osteopath that knows
how to
> help 'pubic shear' may be another option for treatment.
> When told that some doctors have told pregnant women that an
elective c/s
> would be necessary to prevent permanent pubic symphysis damage, Dr.
> Showalter expressed great dismay. She was also upset at how many
women are
> told that this pain is normal to pregnancy, and that the only fix
is to take
> some Tylenol and wait for birth. She felt that treatment was very
> important, and reinforced that back or pelvic misalignment can
increase the
> chances for malposition of the baby.
> When asked about permanent pelvic damage from this condition, she
felt that
> in rare and extreme cases, the pubic symphysis can be torn or
separate, but
> usually only by foolish actions on the part of doctors, nurses, or
> helpers. She said that virtually every case she's ever heard of
> occurred when the woman had an epidural, was on her back, and had
her legs
> flexed back too strongly by well-meaning but over-enthusiastic
> The epidural prevented the woman from feeling the pain at the
time, so
> nobody knew to stop. Thus the woman was injured during birth and
no one
> realized it until later.
> One intriguing note written online by British osteopath Steve Pike
> that not enough attention is paid to the soft tissues when
treating this
> problem. He feels that the 'clicking' problem many SPD women note
may be
> related to a tendon problem instead of a bone problem. He writes
> I have successfully treated several patients with symphysis pubis
> dysfunction. It always amazes me that the muscles, ligaments, and
> connective tissues are virtually ignored in the discussion and
treatment of
> this condition, all attention being focussed on the symphysis
pubis joint
> and the sacroiliac joints. Yet the soft tissues are what binds
the whole
> pelvis together and provide support and locomotion. Treatment of
the soft
> tissues using osteopathic massage techniques almost always
improves the
> condition--sometimes dramatically. I would add that
the "clicking" often
> noticed by sufferers during walking, often does not come from the
> symphysis at all but from the tendon of the psoas muscle---an
> that this muscle is tight and needs treatment.
> One British woman, Lia Hattersley, wrote about her experience with
SPD and
> osteopathy at,3605,724347,00.html. The
> pain was so bad prenatally that she ended up in a wheelchair at
> Postpartum, she found Quentin Shaw, a "classical osteopath" who is
a senior
> lecturer at Surrey Institute of Osteopathic Medicine. She
says, "After one
> treatment I was able to walk and my crutches became obsolete."
> Her article recounts her whole experience, the lack of help she
> from traditional treatments, the reluctance of medical authorities
> consider alternative care such as chiropractic or osteopathic
treatment, and
> the stories of a few other women also helped by alternative
treatments. She
> ends her article with a call for more access and openness to these
> within the British medical system.
> In summary, osteopathic treatment may be another option for women
> pubic symphysis pain. Osteopaths may be a little easier to find
> chiropractors who know the Webster Technique, but not all
osteopaths still
> practice 'osteopathic manipulation' techniques. Many no longer use
> manipulations, and of those who still do, not all are equally
trained. It
> may be necessary to find a "classical" osteopath, especially one
> specializes in pelvic problems. Treatment may also take longer.
> Again, be open to the fact that you may need to try several
> practitioners or treatment modalities before finding what works
best for
> YOU. If one osteopath does not seem to help you, don't assume
that none
> can. Be willing to try several different ones. The quality of
> like chiropractors, seems to vary widely. You want one that
regularly uses
> manipulations in their practice, and if possible, one that
specializes in
> pelvic treatment.
> Other Alternatives
> A. Polarity Therapy - Elizabeth Noble, a physical therapist and
> activist, wrote about pubic pain a bit in her book, Essential
Exercises for
> the Childbearing Year. She describes polarity therapy for pubic
> pain this way on page 219:
> Lying on your side, a partner places all five finger tips firmly
at the
> union of your pubic bones, and the other hand rests flat on your
> The hands should remain still on these two points until warmth,
> vibration, pulsing or other evidence of your body's electric field
can be
> felt equally in your partner's both hands. Usually only one to two
> treatments is necessary. I have successfully used polarity
balancing to
> treat painful PS laxity for fifteen years.
> Kmom tried this with her husband and had no success with it;
perhaps it was
> not done correctly. Kmom knows little about 'polarity therapy'
but tends to
> be dubious so far. However, it's certainly unlikely to do harm to
try it.
> Noble has many excellent ideas and exercises in her book, and does
have some
> ideas for sacro-iliac pain as well, so this book probably is worth
> into for other issues.
> B. TENS - Some women report that TENS (Transcutaneous Electronic
> Stimulation) has helped improve their pain.
> C. Pressure Points - One mother with SPD reported that using
> points seemed to improve her pain levels. Here is what she wrote
about it:
> "If you can't [see a chiropractor], I will tell you of an exercise
you can
> do at home to help relieve some of the pain yourself! First, I
know you are
> going to say, 'Yeah, right, you've got to be kidding' but you have
> points right on the top, corners and sides of your pubic symphysis
bone [the
> pelvis]. Basically, lie down flat on your back (or as close to it
as you can
> get!) and wherever you are feeling pain, take your fingers or
thumbs and
> press on those point for about 10-20 second at each point and do
this once
> or twic



answers from Appleton on

I had pelvic separation and the only think that helped me was a chiropractic. I go to Dr Bill Boots, off college ave. Appleton.(1020 Truman street Kimbery) He uses an activator method to adjust not the old fashion kind with hands. there is very little if any pain. I find the separation more pain full than the treatment. Ajustments will help with labor and delivery too.Dr Bills number is ###-###-####. God bless you and your baby.S. D.

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