In pregnancy, hormonal softening increases laxity of the tissues and there is a widening of the pubic joint in the front of the pelvis (symphysis pubis), designed to increase the pelvic diameters for birth.

With SPD, increased laxity causes mild to severe pain which is felt in the front pubic area and is worse when walking, spreading the legs, lifting one leg, or moving in bed.

There may also be associated pain in the lower back, sacroiliac joints, groin, or inner thighs. Postnatally, joint laxity will decrease again and, with the right care, further discomfort can be avoided.

Pilates is an excellent form of post natal exercise to strengthen muscle tone and give more support to the pelvis postnatally.

Professional treatment

Physiotherapy - If SPD is causing you constant discomfort it is is advisable to see a specialist at your local hospital to arrange to get a support belt for daytime use and a tubigrip bandage to use at night. If the pain is severe, it may be necessary to use elbow crutches for support when walking.

Osteopathy, Acupuncture, or Acupressure and Massage - These therapies can all bring great relief. It may be useful to rotate them if your symptoms are severe.

Self-help suggestions

Homeopathy - Take Sepia 30C three times daily for two days, then Arnica 30C and Hypericum 30C three times daily for five days. Repeat periodically.

Reduce all weight bearing activities such as standing, walking, shopping, and lifting that are not essential and rest a lot.

Take great care when standing and walking to avoid turning out your feet, keeping them parallel instead, or even slightly 'pigeon toed'.

Sit when you get dressed and keep your knees together when getting in and out of the car. Avoid stairs, going up them slowly sideways if you must.

Avoid squatting or yoga positions that involve separating or spreading the legs. You can substitute either of the positions suggested below and still do the movements recommended for the upper body. When keep your legs together instead of kneeling with your knees apart.

Plenty of warm baths and gentle swimming can be a relief, but avoid breaststroke which may strain the symphysis pubis, and take care getting in and out of the bath or pool. Wear well cushioned flat shoes. Be creative when you dress, tying a long scarf around your hips for support.

For comfort at night, put a baby sheepskin under your hips or an "egg box" foam underlay under your bed sheet, and use a soft pillow to support your top leg when lying on your side.

Discuss your care in labour with your birth attendants to avoid greater separation of the legs than you can manage comfortably and consider possible labour and birth positions such as lying on your side, kneeling on all fours, or immersion in warm water.

Be especially careful of spreading the legs too wide if you have an epidural which may mask the pain.

After birth, the first two weeks are crucial to a good recovery, so be careful to avoid strain at this time.

Lolly Stirk's exercises for SPD

Kneeling

Kneel with pile of three or more cushions between your calves, keeping your knees together. Use a long scarf to tie your thighs together just above the knees for support. Sit back so that your pelvis rests on the cushions and make sure that you feel completely comfortable or use more cushions.

Your hips should be higher than your knees. Keep your knees together and your lower legs and feet turned inwards around the cushions. Let your weight drop through your hips.

Sitting

With your lower back supported by a wall, sit with legs stretched out, heels in line with your hips and toes turned in so that they are slightly overlapping or 'pigeon toed'. Tie the thighs together for support just above the knees. Use this position instead of wide-legged yoga positions.

In my experience daily repetition of these exercises helps to prevent SPD from getting worse and also sometimes results in considerable improvement.

Be especially aware of your posture at all times and keep your feet parallel when you walk or stand as this helps to hold the pelvis together (see issue no 2).

You can also contact a local SPD network for advice. (The British SPD Support Group website is at www.spd-uk.org or e-mail: info@spd-uk.org