Pubic Symphysis Dysfunction Manual Therapy by Osteopaths

Pubic Symphysis Dysfunction

Pubic symphysis dysfunction occurs at the front of the pelvis.

The joint comprises the medial surfaces of the pubic bones and an intervening fibrocartilaginous disc, which may contain a cleft. Functionally, it resists tension, shearing and compression and yet is able to widen during pregnancy. Pain in the region of the pubic symphysis, referred to as symphyseal pain, symphysitis or symphyseal dysfunction, can affect a diverse group of individuals including athletes, patients with traumatic pelvic injuries, and pregnant women (Becker et al. 2010).

During pregnancy, symphyseal pain typically causes difficulty with weight-bearing activities such as walking and climbing stairs, and turning over in bed  climbing stairs, and turning over in bed; symptoms do not necessarily resolve after childbirth and are very disabling for some women. The reported incidence and point prevalence of pregnancy-related pelvic girdle pain, which includes symphyseal pain, varies widely. This is in part related to differences in the definition of signs and symptoms, but a generally accepted figure for point prevalence is 20% (Becker et al. 2010).

Biomechanics

During everyday activities, the pubic symphysis is subjected to a variety of forces. These include traction on the inferior part of the joint and compression of the superior region when standing, compression when sitting, and shearing and compression during single-leg stance (Meissner et al. 1996). The healthy joint is highly resistant to separation although, on rare occasions, it may rupture during childbirth (Becker et al. 2010).

Pubic Symphysis dysfunction is very common and frequently overlooked condition where joint capsular pain occurs as result of the assymetrical imbalance between the innominate bones at anterior aspect (front) of the pelvis. It can occur as a result of a pelvic ring fracture or muscular imbalance between the abdominal muscles and adductor muscles (of the inner thigh) (DeStefano et al. 2012).

Screening can include functional pelvic / sacroiliac testing, Presence of tenderness around the inguinal ligament.

Pubic symphysis dysfunction can restrict the motion that occurs at the hip.

The pubic symphysis plays a role in dissipating energy and cushioning of impact forces during the human normal gait (walking) and those forces multiply during sport causing biomechanical strain on the pubic symphysis. Chronic Pain at the pubic symphysis results from joint instability. This injury typically occurs where high speed cutting activity is common and is often present with an adductor muscle strain. The disorder an also be seen in pregnancy with the widening of the pelvic joints occuring to allow the passage of a newborn infant through the pelvis during delivery (Seidenberg et al. 2016).

Treatment

There are two techniques that can be applied by Osteopaths to Treat Pubic Symphysis Dysfunction these include a muscle energy technique and a high velocity low amplitude manipulative technique known as a ‘shotgun’. As the technique can cause an audible click / pop.

Pubic Symphysis Superior or Inferior Shearing (Muscle Energy Technique). This procedure is employed to improve the motion between the pelvic bones at the pubic symphysis. Dysfunctional restriction of motion between the two pelvic bones such as one pubic bone is inferior position and the other in a superior position. Since the relationship between these two bones occurs at the pubic symphysis (Nelson et al. 2007)

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Reference List

Becker Ines, Woodley SJ and Stringer MD (2010). REVIEW The adult human pubic symphysis: a systematic review. J. Anat. 217, pp 475–487

Lisa A. DeStefano (2012). Greenman’s Principles of Manual Medicine. Lippincott Williams & Wilkins

Kenneth E. Nelson, ‎Thomas Glonek (2007). Somatic Dysfunction in Osteopathic Family Medicine. American College of Osteopathic Family Physicians

Peter H. Seidenberg, ‎Jimmy D. Bowen, ‎David J. King (2016). The Hip and Pelvis in Sports Medicine and Primary Care (2nd). Springer.

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