Fixation of the Pubic Symphysis

During extreme hip flexion and extension the two pubic bones rotate in opposition to one another. Misalignments can result in altered biomechanical activity in the joints above and below.

Pubic Bone Alignment (Fixation of the Symphysis Pubis)

  • Often overlooked by many chiropractors and therapists but a tiny imbalance may cause a huge problem.
  • During extreme hip flexion and extension the two pubic bones rotate in opposition to one another.
  • Misalignments can result in altered biomechanical activity in the joints above and belw.
  • Proper alignment is of crucial importance for any structural correction of the pelvic region to either occur or last.
  • Generally an anterior iliac rotation and an inferior pubic bone will go together.
  • Teach patient how to TFM the pyramidalis (a small triangular muscle at the inferior end of the rectus abdominis)
  • Like the upslip correction, these pubic bone techniques are non-directional mobilization; they’re mainly intended to restore movement, not to create alignment. Sometimes mobility is all that’s needed for the joints to come to good position.

Pubic Bone Alignment

  1. As with any work in this area, insure that you explain why you need to do this assessment before beginning.
  2. Palpate just above the pubic rami with the tips of your index fingers and pull inferiorly until they rest on the rami themselves.
  3. If you are unsure of the location, use the palm of your hand, with the heel facing inferiorly, to glide down the abdomen until it meets the pubic bones, then switch to fingertips for the evaluation.

Pubic Symphysis Mobilization Technique 

  1. Supine with knees bent and feet flat on the table, close together, and close to the buttocks.
  2. Abduct legs equally and ask the client to perform bilateral adduction with a 50% effort for 3 – 5 seconds against the therapist’s resistance.
  3. Instruct client to build into the squeeze slowly.
  4. If painful, start with resisted abduction first.
  5. Straight legs method: once warmed up, a maximal isometric contraction (100%) lasting half a second is performed.
  6. Alternate method: ( if no knee pain) place heel and big toe against therapists legs to perform adduction .

Note: The pubic symphysis and SI joint mobilizations should be performed before any other pelvic corrections. Ensuring adequate mobility at the SIJ’s and pubic symphysis makes a good pelvic correction much more likely.

Home Exercise (555 squeeze)

  • Intended to keep the symphysis pubis mobile.In bent knee position with basketball between knees perform isometric adduction:
  • 555 – 50 % effort; 5 seconds; 5 times

FABER Test - Normal 2” from table top

F =  Flexion

AB =  Abduction

ER =  External Rotation

    • Tests length of Adductors (pectineus, adductor brevis & longus)
    • Perform x-fibre to painful adhesions