The Pubic Symphysis: the joint at the front of the pelvis

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If you have sacroiliac joint problems, the pubic symphysis is another important joint to be aware of.

This joint moves even less than the sacroiliac joint, and is found in the front of the pelvis, as pictured above.

As you can see, the each hip bone runs all the way from the SI joint in the back, where it connects to the sacrum, and then arcs around to connect to the other hip bone at the pubic symphysis in the front of the body.

Because the bones of the pelvis are all connected, if you have a problem in one area– for example, if your SI joints aren’t functioning properly and are under an abnormal amount of stress– this can put too much wear and tear on related areas such as the pubic symphysis.

As a result, similar to what happens with the SI joint, these abnormal forces can pull the pubic symphysis out of alignment. I found a useful article from Therapeutic Associates Physical Therapy which states:

“The pubic symphysis is a very stiff synovial joint…  It moves on average, about 2 millimeters but becomes dysfunctional if it moves more or less.”

Like the SI joint, the pubic symphysis is vulnerable to abnormal forces that can weaken the ligaments that are intended to hold it in place.  When the surfaces of each hip bone are not lined up in the way they are intended to be, this can cause pain and inflammation.

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Here’s a close up of the pubic symphysis on my model pelvis

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I had been experiencing SI joint dysfunction for a little over a year before my chiropractor mentioned that my pubic symphysis was slightly out of alignment.  He is the one that explained to me how SI joint and pubic symphysis dysfunction can be related (although I have since heard the same from physical therapists, as well as in the course of my own research).

I didn’t usually experience any pain in that area, but as I found my chiropractor to be fairly conservative, I think he was probably right.  And again– my adjustments with him always did provide short term pain relief, and helped me feel as though I was moving better again.  The problem was that, over the long term, I think the adjustments were also making my ligaments less stable.  But I do not doubt Dr. K.’s ability to diagnose.

The thing about having someone else adjust your pubic symphysis is that it is, well, awkward.  If you don’t know what I mean, look again at the diagram and consider where adjusting that point would require someone to put his or her hands.  But Dr. K. and I got through it and both pretended it wasn’t awkward, and everything was fine.

Pregnancy

There are other factors that can cause pubic symphysis dysfunction.

Therapeutic Associates says, “The cause for pubic symphysis dysfunction can be attributed to hormonal changes, lengthening and weakening of pelvic ligaments, thoracolumbar fascia and muscles.”

A common reason for pubic symphysis dysfunction to develop on its own, not necessarily related to SI joint dysfunction, is pregnancy.  Pregnant women experience a surge in hormones that cause the pelvic ligaments to weaken, in order to create more room for a baby to pass through the pelvis during childbirth.

Treatment

Treatment for pubic symphysis dysfunction, conceptually, is fairly similar to treatment for the SI joint.  Basically, you need to stabilize the area by increasing strength in the muscles that support the pelvis.

Manual therapy (such as a chiropractic adjustment or similar adjustment by a physical therapist) is also useful to help get that joint back in place.

But it’s really muscle strength as well as changing your movement patterns and habits that are going to make sure it stays in place.  (Check out the Therapeutic Associates article for more).

If SI joint dysfunction is the driving force behind pubic symphysis dysfunction, obviously the most important long-term factor will be to treat the SI joints as well.

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A last important note:

When I first learned about this joint, I learned to call it the pubic symphysis.  However, many people use the term “symphysis pubis” as well– it means the exact same thing.  Keep that in mind if you are trying to do research– both terms will lead you to useful resources.

Further Reading:

Physio-Pedia: Pubic Symphysis Dysfunction

What to Expect.com: Symphysis Pubis Dysfunction

Photo Credit:

Illustration at top of page (modified) from OpenStax College via Wikipedia

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