Part of Pregnancy back and pelvic pain
Pelvic girdle pain and SPD (symphysis pubis dysfunction): are they the same?
Warning signs, and when to get help
Is pelvic girdle pain the same as SPD?
Yes. They are two names for one problem, and pelvic girdle pain is the name current guidance uses.
All three of the patient sources we would normally send you to say so in their own words. The NHS gives symphysis pubis dysfunction, SPD, as another name for pregnancy-related pelvic girdle pain. The RCOG's leaflet says PGP used to be known as SPD. POGP says the condition also used to be called symphysis pubis dysfunction. So if a midwife wrote SPD in your notes a few years ago and a physio says pelvic girdle pain now, nothing about your pelvis has changed in between.
This matters because the two names arrive from different directions and women reasonably assume they must mean different things. Most often the older term comes from someone who trained when it was standard, and the newer one from someone who did not. Occasionally both appear in the same set of notes, which is unsettling to read and means nothing.
One difference is real, and it is about scope rather than severity. Pelvic girdle pain covers the joints of the pelvis at the front, the back, or both. SPD names the joint at the front only. Since plenty of women with this pain have it mainly at the back, over the dimples at the base of the spine, the older name was describing the wrong part of the problem for a good share of the people it was given to.
What SPD stands for, and what the joint actually is
SPD stands for symphysis pubis dysfunction. Three words, and the first two are the only ones that describe anything.
The symphysis pubis is the joint at the front of your pelvis, in the middle, where the two halves of the pelvic ring meet. You can find it: follow the front of your pelvis down from your hip bones to the middle, and the firm ridge under the skin at the bottom is it. The NHS describes pain there as being over the pubic bone at the front in the center, roughly level with your hips. Behind you, the pelvic ring is joined to the base of your spine by two more joints, one on each side (the sacroiliac joints), and those are the ones that hurt in the lower back and buttock pattern.
The third word, dysfunction, is the one that caused the trouble. It sounds like a finding, as though something had been measured and failed a test. Nothing is measured to make this diagnosis. The European guideline on pelvic girdle pain recommends diagnosing it with pain provocation tests and palpation rather than with imaging, and specifically does not recommend X-rays, CT, mobility palpation tests or diagnostic injections for it (Vleeming and colleagues, 2008). A clinician presses in particular places and moves your leg in particular ways, and the diagnosis is the pattern of what hurts.
Why the name changed to pelvic girdle pain
Because the old names were a mess, and the mess was doing harm to research rather than to patients.
The clearest account of it is a review of the terminology from 2004, which found a large number of different terms in use for the same pregnancy problem, many of them hinting at a mechanism nobody had demonstrated. The authors proposed two plain terms in their place, pregnancy-related pelvic girdle pain and pregnancy-related low back pain, which name the symptom and the region rather than any mechanism, and they set out evidence that the two are distinct conditions even if the mechanisms behind them overlap. Their position on the older labels is blunt in the paper itself: many of the terms in the literature hint at a mechanism, relaxation, arthropathy, instability, while the mechanisms remain obscure, and the authors reject the use of terms that hint at a mechanism for as long as the pathology is unknown (Wu and colleagues, 2004).
A separate review the same year looked specifically at the SPD literature and reported the same chaos from inside it: many inconsistent terms and no unambiguous definition, so the condition was being described by its symptoms and signs in practice anyway (Leadbetter and colleagues, 2004). A later update was blunter about why the older labels failed. Names built on cause, symptom or location were unsuccessful, it said, because they either narrowed the syndrome too far or blended it into chronic low back pain, and pregnancy-related pelvic girdle pain appears the most accurate of the terms that have been used (Kanakaris and colleagues, 2011).
There is a second reason the change was worth making, and it is the one that affects how you feel reading your own notes. Dysfunction is not the only word in that family that sounds worse than the facts. Any name implying your pelvis has come apart and needs holding together reads as frightening, and the measurements do not support reading it that way.
The 10 millimetre separation threshold that gets quoted was not proven to be consistent, and no direct association was found between how far the front joint has separated and how severe the pain is (Kanakaris and colleagues, 2011). The SPD review found no correlation between the degree of relaxation at that front joint and the level of pain and disability either (Leadbetter and colleagues, 2004).
Read those two findings for what they say. A measurement at that joint does not predict how much pain or disability a woman has, and that takes the frightening reading apart. They do not say that a measured separation means nothing clinically: in the uncommon case where the joint has genuinely come apart, the gap on a scan is part of what decides the treatment, and that is a separate situation with its own section below (Stolarczyk and colleagues, 2021). POGP's booklet answers the frightening reading directly: the pelvis stays strong and stable through pregnancy and birth, and pain there does not always mean the body or the pelvis has been damaged. The main pelvic girdle pain page carries the same statement.
Does it change your treatment?
No. Whichever name is on your notes, the plan is the same, and that is the one thing worth taking from the whole naming argument.
The NHS advises referral to a physiotherapy service specializing in obstetric pelvic joint problems, and names exercises to strengthen the pelvic floor, stomach, back and hip muscles, along with equipment such as crutches or a pelvic support belt. The RCOG's list is similar: advice on movements to avoid, exercises, hands-on treatment to the muscles and joints, warm baths or heat and ice packs, and a support belt or crutches. The European guideline's recommendation for pregnant women is information and reassurance plus individualized exercise (Vleeming and colleagues, 2008). NICE suggests considering referral to physiotherapy for exercise advice, a non-rigid pelvic support belt, or both, for pregnancy-related pelvic girdle pain (NICE NG201). None of those changes depending on which name you were given.
Belts are the one place where women with an SPD label often expect something extra, because a name about one joint at the front invites the idea of strapping that joint. The trial worth knowing about was done under the SPD label: 90 pregnant women, all three groups given muscle-strengthening exercises and advice on daily activities, with two groups also wearing a rigid or a non-rigid pelvic support belt. Everyone improved on every measure, and the belts did not add to the effects of the exercise and advice except on average pain (Depledge and colleagues, 2005). Where a belt has a place, note what kind: NICE suggests considering referral to physiotherapy for exercise advice, a non-rigid pelvic support belt, or both, for pregnancy-related pelvic girdle pain (NICE NG201). So a belt is something to try with a physio who can fit it, alongside the exercise and advice rather than instead of them, and not the thing the diagnosis entitles you to.
What does change the plan is your own pattern: which movements hurt you, how far on you are, and what you have to do each day. The main program is built around that, and how to sleep with pelvic girdle pain covers the night, which is where most women lose the most.
What SPD pain feels like and where
It depends which joint is sore, and the answer is often more than one.
At the front, the pain sits over the pubic bone in the middle, roughly level with your hips, and it can spread down the inside of the thighs. At the back it sits across one or both sides of the lower back, lower than most people expect, around the dimples above your buttocks. The NHS also describes it between the vagina and anus, and spreading into the thighs, and notes that some women get clicking or grinding in the pelvis, which POGP's booklet says you may hear or feel but which is not harmful in itself.
One exception is worth stating, because clicking at the front also appears in the list of signs of a separated joint (Stolarczyk and colleagues, 2021): a click that arrived in the same moment as a sudden pubic pain, or that comes with not being able to stand on one leg, belongs with the warning line at the end of this page rather than with the reassurance here. POGP's list adds the groin, the hips and the tailbone. Groin pain covers the front-of-the-pelvis pattern and the other things that produce it.
What it does is as recognizable as where it is. Walking, stairs, standing on one leg, turning over in bed and moving the legs apart are the movements both the NHS and POGP name, and they have something in common: the two legs are doing different things. It eases when you stop, and it usually costs more by evening than first thing.
Severity runs the whole range. The SPD review described everything from mild discomfort to severe, disabling pain, and found that the amount of relaxation at the front joint did not track it (Leadbetter and colleagues, 2004). So a woman on crutches and a woman with an ache on the stairs can have the same words written in both their notes, and neither of them can read anything into the label about which of the two she is.
Pain on one side only is common and is not a sign of anything unusual. Nor is pain that moves between the front and the back from week to week.
What it means for the birth
This is the part women ask about most and the part that has been studied least. Kanakaris and colleagues call labor the phase least investigated in pregnancy-related pelvic girdle pain, so what follows is a consensus among authors rather than trial evidence: keep the stress on the pelvic girdle to a minimum, do not let the hips be taken further apart than the woman herself can comfortably manage, and keep time in the legs-up position (lithotomy) short, with side lying or all fours used instead (Kanakaris and colleagues, 2011).
Two practical things come out of that, and both belong in a conversation before labor starts rather than during it.
Know your own comfortable range, and get it written down. Find how far your legs can come apart before the joint at the front complains, and ask your midwife to record that in your notes and your birth plan, with a line saying nobody should take you past it. It applies while you are being moved, examined and stitched as much as while you are pushing.
The second is the epidural, and it is the reason the range has to be known in advance. An epidural takes away the pain that would otherwise tell the room it has gone too far. Kanakaris and colleagues frame the labor advice in exactly those terms: avoid taking the hips wider than that particular woman's comfortable arc under spinal or epidural anesthesia. None of this is an argument against having one. Wu and colleagues graded the evidence linking epidural anesthesia to pregnancy-related pelvic girdle and low back pain as weak, 2 of the 11 relevant studies finding any association, and the point here is only that the limit should be on paper before the feeling goes (Wu and colleagues, 2004).
How your baby is born is a decision for you and your maternity team, and this page cannot settle it. Two findings are worth having for that conversation. A cesarean has not been shown to offer women with established pelvic girdle pain any particular advantage, apart from the extreme where positioning for a vaginal birth is not possible, and early induction or a planned cesarean is argued for by a few authors in the most severe cases on limited evidence (Kanakaris and colleagues, 2011). A separation of the front joint, if you have had one diagnosed, is not in itself an automatic reason for a cesarean either, and that call is made case by case by the doctor looking after you (Stolarczyk and colleagues, 2021).
If the joint at the front does separate
This is the uncommon diagnosis, and it is a different thing from the pelvic girdle pain the rest of the page describes. Reported figures for how often it happens range from 1 in 300 births to 1 in 30,000, a spread that says more about how differently it has been defined and looked for than about your odds (Stolarczyk and colleagues, 2021).
It usually arrives in a single moment, during the birth, a fall or a wide step, and it takes weight bearing with it. Standing on one leg becomes impossible or severely painful, getting up from lying or sitting and climbing stairs hurt over the pubic bone, and walking turns into a sway. That pattern, not the level of pain, is what the two pubic warning lines at the end of this page are keyed to, one for a pain that arrived in a single moment and one for a leg that will not take your weight at all, and it is also why the interim advice in both is to keep off it rather than walk it off. Loading one leg is what opens the joint: the test used to show instability is a view taken standing on one leg, with a vertical shift of 1 cm between the two pubic bones read as instability (Stolarczyk and colleagues, 2021). That is done in a clinic under supervision and is not something to try at home.
It is confirmed by measuring. A gap wider than 10 mm at the narrowest point is the figure given, with ultrasound the first test during pregnancy and in labor, MRI where more detail is needed, and X-ray or CT kept for after the birth so the baby is not exposed to radiation (Stolarczyk and colleagues, 2021).
That is the same 10 mm quoted further up this page, and it is doing a different job in each place, which is worth separating because the two readings look as though they cancel out. As the cut-off for calling a joint separated it is the accepted figure (Stolarczyk and colleagues, 2021). As an explanation of how much ordinary pelvic girdle pain hurts, it was never shown to hold, and it does not apply at all to the women whose pain is mainly at the back of the pelvis (Kanakaris and colleagues, 2011). A number can be the right definition of one thing and a poor predictor of another.
Treatment starts without surgery. A pelvic belt worn while lying on your side is the basic method, with physiotherapy for the pelvic and deep trunk muscles, pain relief and cooling over the sore area. In a hospital, where a separation is acute and the woman's circulation is unstable, a pelvic binder or a properly placed sheet goes on straight away. Getting back on your feet is then staged and guided by pain, with crutches or a walking frame at first, rather than lying still for weeks, because long bed rest brings its own problems and blood clots are one of them. With treatment, the joint is usually seen on a scan to have closed almost completely within about 3 months (Stolarczyk and colleagues, 2021).
Two things belong in your notes for next time. Around a third of women who have had a separation are at risk of another one at a later vaginal birth (Stolarczyk and colleagues, 2021). And whatever you read here, the team who examined and scanned you set your weight bearing, your belt and your timescale, and what they tell you comes before this page.
SPD after the birth
Most of it goes. Some of it does not, and the figures are worth having, because a vague answer here is what leaves women waiting.
The RCOG says pelvic girdle pain usually improves after birth, although around 1 in 10 women have ongoing pain. The SPD review reported that delivery resolves the condition in most cases by 6 months postpartum (Leadbetter and colleagues, 2004). The later update puts persistent pregnancy-related pelvic girdle pain at around 5 to 8.5 percent of women across the period from just after the birth up to two years later (Kanakaris and colleagues, 2011). Those three figures come from different sources, different definitions and different follow-up lengths, so read them as the same broad picture rather than as competing numbers: most women recover, and a real minority do not.
If yours has not settled, the label is not the thing to chase. POGP advises speaking to your midwife or GP first if the self-help advice is not improving things or if sleep and daily activities are affected, and the RCOG advises asking about a physio referral if pain carries on after the birth. The postnatal core and pelvic floor program is written for that stage, including the check 6 to 8 weeks after the birth. If leaking, heaviness or urgency came with it, signs of a weak pelvic floor and pelvic floor weakness cover those, and diastasis recti covers the gap down the middle of the stomach muscles, which often turns up in the same appointment.
One last thing, for anyone comparing notes with a friend. If her label says SPD and yours says PGP, you have the same thing. If her pain started in a single moment with a crack or a pop over the pubic bone, or has left her unable to put weight on a leg, that is different, and the warning list below says what to do about it.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: anything that looks life threatening, at any stage of pregnancy. Call emergency services without stopping to work out which line below fits: 999 in the UK, 112 in the UK and anywhere in Europe, 911 in the United States and Canada, 000 in Australia, 111 in New Zealand. Say how many weeks pregnant you are, and say it again to each new person you speak to (NHS).
- Emergency: heavy bleeding from your vagina, for example soaking a pad soon after you put it on, or any bleeding with severe pain in your tummy, pain in your shoulder, or feeling sick, faint or dizzy. Call emergency services straight away.
- Emergency: pelvic or pubic pain that has suddenly left you unable to stand, walk or put weight on one or both legs. Call emergency services if you cannot stand or walk at all, or you cannot get to a hospital safely. Until help reaches you, stay where you are rather than trying to get yourself up: lie on your side with your knees together and a pillow between them, and do not stand on one leg or let your legs come apart.
- Emergency: hip or groin pain on one side that suddenly becomes much worse, or a leg that will not take your weight at all. Go to an emergency department straight away, and say you are pregnant and that the top of the thighbone may be involved, because pregnancy can weaken the bone there and weakened bone can crack. Call emergency services if you cannot stand or walk at all, or cannot get there safely.
- Emergency: a very high or a very low temperature, shivering you cannot control, breathing very fast or finding it hard to breathe, being confused or slurring your speech, skin, lips or a tongue that look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or a rash that does not fade when you press it. Call emergency services, as this can be sepsis.
- Emergency: you suddenly become short of breath, you get chest pain or pain in your upper back that may be worse when you breathe in, you cough up blood, your heart is beating very fast, or you faint. Call emergency services straight away, even if your leg looks normal. These can be signs of a blood clot in the lungs (pulmonary embolism).
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you find it hard to start peeing, cannot pee, cannot feel yourself peeing or cannot control when you pee, or you do not notice when you need to poo or cannot control when you poo, and this is not normal for you. The same applies to a new change in how your genitals feel during sex, or new trouble getting an erection or ejaculating. Call emergency services or go to an emergency department straight away. These can also be signs of cauda equina syndrome.
- Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away.
- Emergency: pain in your lower tummy or pelvis that is severe, is getting worse, or hurts when you move or touch the area, or that comes with feeling faint, dizzy or lightheaded, passing out, pain at the tip of your shoulder, trouble breathing, heavy bleeding from the vagina, or sudden confusion. Call emergency services or go to an emergency department straight away. Tell them if there is any chance you are pregnant.
- Emergency: you have a lump in your groin and the pain in it is severe or came on suddenly, you cannot poo or pass wind at all, you are vomiting blood or your vomit looks like coffee grounds, or you have suddenly become confused. Call emergency services or go to an emergency department straight away, and do not try to push the lump back in yourself. A hernia that has become trapped can block the bowel or cut off the blood supply to whatever is caught in it (NHS).
- Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or comes with pain spreading down an arm or leg, weakness, numbness or pins and needles in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
- Emergency: you have thoughts of ending your life or of harming yourself or your baby and feel you might act on them, you have already harmed yourself, or you do not feel you can keep yourself or your baby safe. Call emergency services or go to an emergency department straight away.
Get help now, day or night
- Who to call for every line below that says to contact your midwife or maternity unit: call them straight away, day or night, on the number in your maternity notes. In the first 12 weeks, before your first midwife appointment, the NHS routes these calls to a GP surgery or an early pregnancy unit, and from 12 to 19 weeks to a midwife or an early pregnancy unit, so you do not need a maternity unit of your own yet to be seen. Outside the UK, call your obstetrician, or the maternity or labor and delivery unit where your birth is booked. If you cannot reach anyone and you are worried, call NHS 111 in the UK, and anywhere, go to your maternity unit or an emergency department rather than waiting at home (NHS).
- Any bleeding or spotting from your vagina, even if it is light and you have no pain. Contact your midwife or maternity unit straight away.
- Your waters break, or you have a gush or trickle of fluid from your vagina, at any stage of pregnancy. Contact your midwife or maternity unit straight away.
- Before 37 weeks, you have regular tightenings or contractions, period-type pains, or backache that is not usual for you. Contact your midwife or maternity unit straight away, as this can be a sign of early (premature) labor.
- New back pain in the second or third trimester (from 13 weeks), even if you think it is PGP or ordinary backache. Contact your midwife or maternity unit straight away, as it can be a sign of early labor. Once they have checked it, follow their advice about when to call again.
- Your baby is moving less than usual, you cannot feel your baby moving anymore, or the usual pattern of movements has changed. Contact your midwife or maternity unit straight away, even in the middle of the night. Do not wait until the next day, and do not use a home heartbeat monitor to check.
- A severe headache that does not go away with simple painkillers, problems with your vision such as blurring or flashing lights, pain just below your ribs, sudden swelling of your face, hands or feet, being sick (vomiting), heartburn that does not go away with heartburn medicines, or feeling very unwell. Contact your maternity unit straight away, as these can be signs of pre-eclampsia, which needs checking and treating quickly. The same applies to a headache after an epidural or spinal anesthetic that gets worse when you sit or stand up and eases when you lie down. Call emergency services if you have a fit (seizure), or a headache that came on suddenly and is very severe. Call emergency services too if you have a headache with a stiff neck and either a high temperature or bright light hurting your eyes, as this can be meningitis.
- Pelvic or pubic pain that came on in a single moment, for example during the birth, a fall or a wide step, with a crack, pop or tearing feeling over your pubic bone. Contact your maternity unit straight away, and ask them to check the joint at the front of your pelvis. While you wait, keep off it rather than walking it off: lie on your side with your knees together and a pillow between them, get help to move if there is someone with you, and do not stand on one leg or let your legs come apart. If you cannot stand or walk at all, or you cannot get to a hospital safely, call emergency services. Separation of that joint (pubic symphysis diastasis) is uncommon, is not the same as the pelvic girdle pain this page is about, is confirmed on a scan rather than by how much it hurts, and is first treated with a pelvic support belt and side lying, so ask about a belt at that appointment (Stolarczyk 2021). Pain that has built up over days or weeks, even when it is severe, is the usual pattern of pelvic girdle pain.
- Tummy pain that does not go away after you have rested for 30 to 60 minutes, or that comes with lower back pain, vaginal discharge that is unusual for you, regular cramping or tightenings, pain when you pee, or needing to pee suddenly or more often than usual (NHS). The same applies to back or pelvic pain that comes on suddenly, is getting worse quickly or is much worse than your usual pain. Contact your maternity unit straight away. Call emergency services if the tummy pain is severe, any pain comes with bleeding from your vagina, or tummy pain comes with pain in your shoulder or feeling sick, faint or dizzy.
- Back pain with a high temperature (38C or above), feeling hotter than usual or shivery, pain or burning when you pee, pee that looks cloudy, pink, red or brown, or pain in one or both sides of your back just under the ribs. Contact your midwife, maternity unit or doctor straight away, as this can be a urine or kidney infection, which is usually treated easily once someone has seen you (NHS). Call emergency services instead if you have any of the signs of sepsis in the emergency warnings above.
- You fall, or your bump is knocked or hit, for example in a car accident, even if you feel fine. Contact your maternity unit straight away so you and your baby can be checked.
- A calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services. Pregnancy and the first 6 weeks after giving birth also make a clot more likely, so if you are pregnant or gave birth in the last 6 weeks, contact your maternity unit, midwife or GP straight away.
- Lower tummy or pelvic pain and you are pregnant or think you might be. Contact your midwife or maternity unit straight away if you are pregnant, or get medical advice the same day if you might be. Pain low in the tummy early in pregnancy needs checking, because a pregnancy can grow outside the womb (ectopic pregnancy).
- You are out of breath when you lie down, or breathlessness comes with dizziness. Contact your maternity unit straight away. If you are severely short of breath when you are resting, or so breathless that you are gasping or cannot get your words out, call emergency services. Feeling a little more out of breath as your baby grows is common, but this pattern needs checking.
Get help today
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a lump in your groin that becomes painful, hard or red, that you cannot push back in, or that comes with a bloated tummy, feeling or being sick, constipation or a high temperature. Get medical help the same day, in person rather than by phone, for example at urgent care or an emergency department, as these can mean a hernia has become trapped (NHS). Do not try to push the lump back in yourself.
- Same day: dizziness, lightheadedness or feeling faint while you are exercising, or the room seems to spin. Stop, and sit down or lie on your side until it passes. Contact your midwife or maternity unit the same day, and do not exercise again until you have been checked, as dizziness is one of the signs to stop exercising in pregnancy. If you faint, it does not settle within a few minutes of keeping still, or you cannot stand or walk steadily, call emergency services.
- Same day: new back pain and you have had cancer, now or in the past. Get medical advice the same day and mention your cancer history. If you are being treated for cancer now, contact your cancer team the same day.
- Thoughts of suicide or of harming yourself or your baby, even if you do not plan to act on them. Get urgent help the same day from your GP, midwife or health visitor, or NHS 111 in the UK. In the UK, you can also talk to Samaritans on 116 123.
Book an appointment
- Within a few days: hip or groin pain, usually on one side, that is worse when you put weight on that leg, that makes you limp or need a stick or crutch, or that has not eased with position changes and pacing. Ask your midwife or doctor for a review, and say the pain is in your hip rather than only your pelvis. While you wait, take the weight off that leg where you can: lean on a crutch, a stick, a shopping cart or a stroller, use the rail and one step at a time on stairs, sit down for jobs you would do standing on one leg, and do not push through pain you have to limp on. Pregnancy and the weeks after the birth can cause a temporary weakening of the bone at the top of the thighbone, which is uncommon, is often read as pelvic girdle pain for weeks, and shows up on an MRI scan, which is the test to ask about when hip pain has no other explanation (Morton 2024). If the pain suddenly becomes much worse, or that leg will not take your weight at all, do not wait for the review: go to an emergency department straight away, as the emergency warnings above say.
- Within a few days: a new lump or swelling in your groin, especially one that gets bigger when you cough, sneeze or stand and smaller when you lie down. Tell your midwife or doctor, because a lump there needs examining rather than explaining, and an ultrasound scan is what separates swollen veins alongside the round ligament from a hernia (Yeo 2021). Do not try to push the lump back in yourself, and use the same day line above instead if the lump becomes painful, hard or red or you cannot push it back in.
- Low mood, anxiety or stress that is affecting your day to day life, or pain that is causing you considerable distress. Tell your midwife or doctor and ask what support is available, because this is part of what gets treated rather than something to put up with (NHS; RCOG; POGP).
Common questions
Is pelvic girdle pain the same as SPD?
Yes, for practical purposes they are the same problem under two names, and pelvic girdle pain is the name current guidance uses. The NHS lists symphysis pubis dysfunction as another name for pregnancy-related pelvic girdle pain, the RCOG says PGP used to be known as SPD, and POGP says the condition also used to be called symphysis pubis dysfunction. If a midwife wrote SPD in your notes in 2015 and a physio says pelvic girdle pain today, nothing about you has changed. The only practical difference is scope: pelvic girdle pain covers the joints at the front, the back, or both, while the older name points at the joint at the front only.
What is the difference between SPD and pelvic girdle pain?
The difference is in the words rather than in the condition. SPD names one joint, the symphysis pubis at the front of your pelvis, and adds a mechanism to it, dysfunction. Pelvic girdle pain names the symptom and the region, which is what the authors who argued for the change wanted: a review of the terminology proposed two plain terms that name the symptom and the region instead, pregnancy-related pelvic girdle pain and pregnancy-related low back pain (Wu and colleagues, 2004). A later review put it more bluntly, saying the older names were unsuccessful because they either narrowed the syndrome or blurred it into chronic low back pain (Kanakaris and colleagues, 2011). Neither name predicts how much it hurts or how long it lasts.
What does SPD stand for in pregnancy?
Symphysis pubis dysfunction. The symphysis pubis is the joint at the front of your pelvis, in the middle, where the two halves of the pelvic ring meet, and the NHS describes pain there as being over the pubic bone at the front in the center, roughly level with your hips. The word dysfunction is doing the vague work in that name, and it is one of the reasons the term fell out of use: it suggests something has been measured and found faulty, when what is actually being described is pain in a region.
What causes SPD in pregnancy?
The honest answer is that it is not settled, and anyone giving you a single cause is going beyond the evidence. The NHS explains that ligaments soften and stretch in pregnancy to prepare for labor, which can strain the joints of the lower back and pelvis, and POGP adds joints that move unevenly and weaker muscles in the tummy, buttocks, inner thighs and pelvic floor. Where the sources get cautious is in tying the pain to a measurement. A review of the SPD literature reported no correlation between how far the joint at the front of the pelvis had relaxed and the level of pain and disability (Leadbetter and colleagues, 2004), and a later review found no direct association between the extent of separation at the front joint and how severe the pain was, and said the widely quoted 10 millimetre threshold was not proven to be consistent (Kanakaris and colleagues, 2011). So a sore pelvis is not a measurement of how much anything has moved.
What helps SPD in pregnancy?
The same things that help pelvic girdle pain, because they are the same condition. The NHS advises referral to a physiotherapy service that specializes in obstetric pelvic joint problems, and lists exercises for the pelvic floor, stomach, back and hip muscles, along with equipment such as crutches or a pelvic support belt. The RCOG lists advice on movements to avoid, exercises, hands-on treatment, warm baths or heat and ice, and a support belt or crutches. On belts, one trial is worth knowing about: 90 pregnant women with pelvic joint pain all received muscle-strengthening exercise and advice on daily activities, and two of the three groups also wore a rigid or a non-rigid belt. Every group improved on every measure, and the belts added nothing beyond the exercise and advice except on average pain (Depledge and colleagues, 2005). NICE suggests considering referral to physiotherapy for exercise advice, a non-rigid pelvic support belt, or both, for pregnancy-related pelvic girdle pain (NICE NG201), so a belt sits alongside the exercise and advice rather than instead of them. The main program page has the exercises and the daily-life advice, and your own midwife or physio comes before any of it.
Is pelvic girdle pain dangerous?
It is painful rather than dangerous, and the sources are consistent on the part people worry about most: the NHS and the RCOG both say pelvic girdle pain does not harm your baby. What it does harm is your mobility and your sleep, and in a minority it carries on after the birth. That is a reason to be treated, not a reason to be frightened. Pain that behaves differently from pelvic girdle pain is the thing to watch, and that is what the warning list on this page is for: pubic pain that arrived in a single moment, one-sided hip pain that stops you weight bearing, back pain with a fever, tightenings, bleeding, fluid, or a change in your baby's movements. None of those is pelvic girdle pain being dangerous. They are different problems that need checking in their own right.
References
- NHS. Pelvic pain in pregnancy. Page last reviewed 12 December 2022. https://www.nhs.uk/pregnancy/common-symptoms/pelvic-pain/
- NHS. Back pain in pregnancy. Page last reviewed 10 January 2024. https://www.nhs.uk/pregnancy/common-symptoms/back-pain/
- NHS. Premature labour and birth. Page last reviewed 10 January 2024. https://www.nhs.uk/pregnancy/labour-and-birth/premature-labour-and-birth/
- NHS. Pregnancy symptoms you need to get help for. Page last reviewed 24 June 2026. https://www.nhs.uk/pregnancy/common-symptoms/pregnancy-symptoms-you-need-to-get-help-for/
- NHS. Pre-eclampsia. Page last reviewed 23 March 2026. https://www.nhs.uk/conditions/pre-eclampsia/
- NHS. Your baby's movements. Page last reviewed 8 July 2024. https://www.nhs.uk/pregnancy/keeping-well/your-babys-movements/
- Royal College of Obstetricians and Gynaecologists (RCOG). Pelvic girdle pain and pregnancy. Patient information leaflet. June 2015. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pregnancy related pelvic girdle pain and low back pain during pregnancy and after having a baby. https://thepogp.co.uk/patient_information/womens_health/pregnancy_pgp_lbp.aspx
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pregnancy related pelvic girdle pain and other common conditions in pregnancy. Booklet. 23 March 2023. https://thepogp.co.uk/Resources/112/pregnancy_related_pelvic_girdle_pain_and_other_common_conditions_in_pregnancy/
- National Institute for Health and Care Excellence. Antenatal care (NG201). Published 19 August 2021. https://www.nice.org.uk/guidance/ng201
- Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, Ostgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. European Spine Journal. 2004;13(7):575-589. https://doi.org/10.1007/s00586-003-0615-y
- Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008;17(6):794-819. https://doi.org/10.1007/s00586-008-0602-4
- Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Medicine. 2011;9:15. https://doi.org/10.1186/1741-7015-9-15
- Leadbetter RE, Mawer D, Lindow SW. Symphysis pubis dysfunction: a review of the literature. Journal of Maternal-Fetal and Neonatal Medicine. 2004;16(6):349-354. https://doi.org/10.1080/14767050400018247
- Depledge J, McNair PJ, Keal-Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy. 2005;85(12):1290-1300. https://doi.org/10.1093/ptj/85.12.1290
- Stolarczyk A, Stepinski P, Sasinowski L, Czarnocki T, Debinski M, Maciag B. Peripartum pubic symphysis diastasis, practical guidelines. Journal of Clinical Medicine. 2021;10(11):2443. https://doi.org/10.3390/jcm10112443
- Morton A, Savard-Heppel J. Transient osteoporosis of the hip in pregnancy. Obstetric Medicine. 2024;17(4):188-193. https://doi.org/10.1177/1753495X241236222
- NHS. Ectopic pregnancy. Page last reviewed 23 August 2022. https://www.nhs.uk/conditions/ectopic-pregnancy/
- NHS. Hernia. Page last reviewed 19 May 2026. https://www.nhs.uk/conditions/hernia/
- NHS. Inguinal hernia repair. Page last reviewed 28 February 2025. https://www.nhs.uk/tests-and-treatments/inguinal-hernia-repair/
- Yeo JHL, Tashi S. A rare but noteworthy diagnosis for lumps in the groin during pregnancy: round ligament varices. American Journal of Case Reports. 2021;22:e934313. https://doi.org/10.12659/AJCR.934313
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-23.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.