Priv.-Doz. Dr. Christopher Becker, a renowned specialist in orthopedics and trauma surgery, has earned a first-class reputation as a senior physician in the Department of Spine Surgery at Artemed Klinikum München Süd and as a specialist at the Musculoskeletal University Center Munich (LMU Hospital). His expertise lies particularly in minimally invasive pelvic ring and spinal surgery, and he offers innovative treatment options. In addition to spinal surgery, he focuses intensively on the treatment of pelvic pain, including pubic bone inflammation, symphysis pain, and sacroiliac joint problems.
Dr. Becker combines comprehensive expertise with years of experience to offer state-of-the-art treatments. His particular interest in pain syndromes affecting the pelvic ring is reflected in the specialized clinic he runs at the Musculoskeletal University Center Munich. In addition, he leads a pain surgery clinic at Artemed Klinikum München Süd.
As a member of leading medical professional associations, including the BVOU (Professional Association for Orthopedics and Trauma Surgery) and the DGOU (German Society for Orthopedics and Trauma Surgery), Dr. Becker stays up to date on the latest research and treatment methods. His involvement in various professional committees demonstrates his commitment to continuous improvement.
Dr. Becker is distinguished not only by his medical expertise but also by his empathetic and dedicated care for his patients. He takes the time to understand each patient’s individual needs and develop customized treatment plans. With Dr. Becker, patients receive first-class, patient-centered care that is individually tailored to their needs.
The editorial team at Leading Medicine Guide learned more about postpartum pelvic pain during a personal interview with Dr. Christopher Becker.
Pelvic pain, pubic bone inflammation, and symphysis problems are common complaints that women may experience after pregnancy. In particular, loosening of the joint between the pubic bones—known as symphysis pubis diastasis—can lead to persistent discomfort. An accurate diagnosis and targeted treatment are crucial to providing effective relief for women suffering from these symptoms and enabling them to recover optimally after childbirth.
Symphysis problems refer to discomfort in the area of the symphysis, a structural connection between the pubic bones at the front of the pelvis. During pregnancy, the symphysis can become overstrained due to hormonal changes and increasing pressure on the pelvis, which can lead to pain and discomfort. This is sometimes referred to as symphysis laxity or symphysis dysfunction and can cause discomfort in the pelvic area.
Pelvic pain after pregnancy can be attributed to various causes.
One of the most common causes is symphysis pubis dysfunction, in which the tissue around the pubic bone loosens to make room for childbirth. This natural change can cause pain in the pubic bone area. “Pelvic pain is generally very diverse. It can be musculoskeletal in nature—non-inflammatory acute or chronic conditions of the musculoskeletal system, which is what I primarily deal with. It can also have visceral, urological, gynecological, or neurological causes. There is also what is known as Pelvic Pain Syndrome, in which the focus is exclusively on treating the pain, since a specific cause is no longer easily diagnosed. In the case of pelvic pain after pregnancy, the tricky thing is that the pain—which often radiates—is usually caused by mechanical factors. This means the pain is only noticeable when movement begins. The cause here is usually edema directly in the bone marrow of the pubic bone itself. During pregnancy, physical pressure in the abdomen can be caused by the baby itself, and hormonally, the pubic symphysis and the ligaments of the pelvis loosen to make a little more room. If this loosening does not resolve after pregnancy, persistent instability may remain. Pain can also arise at the sacroiliac joint, the connection between the pelvic bone (ilium) and the sacrum. Approximately 5–10% of women develop such pain during pregnancy—though this figure is not precisely defined in the literature. Unfortunately, these conditions are often underestimated and underdiagnosed, leading some patients to develop chronic pain. “Women with pelvic pain often delay seeing a doctor and only do so when they can no longer cope with their daily lives,” explains Dr. Becker.
Pelvic Pain Syndrome is a condition that causes chronic pain in the pelvic region. This syndrome affects both men and women and can have various causes, including muscle tension, inflammation, nerve irritation, or structural problems in the pelvic region. It can lead to pain in the lower back, groin, hips, coccyx, or genital area. The exact cause can vary widely and sometimes requires a comprehensive diagnosis and treatment by specialists such as urologists, gynecologists, or physical therapists.
Strain on the pelvic floor muscles during pregnancy is also a possible cause, as these muscles are put under significant stress. Minor injuries or inflammation in the pelvic area during childbirth can also lead to discomfort after pregnancy. In addition, changes in the spine during pregnancy, such as misalignments or disc problems, can contribute to pelvic pain. Symphysis pubis pain differs from other types of pelvic pain because it is specifically caused by the loosening of the joint between the pubic bones. Typically, this pain is felt in the pubic bone area or in the lower back and can be particularly uncomfortable when walking, standing, or moving. In contrast, other types of pelvic pain can have various causes, such as muscle strain, injuries, or spinal problems. This pain can affect different areas of the pelvis and vary in intensity and location.
Typical symptoms of pubic bone inflammation or symphysis problems after childbirth:
Pain in the pubic bone area: The pain may feel dull, pressing, or sharp and can radiate to the lower abdomen, groin, back, or thighs.
Discomfort when walking or standing: The pain may intensify, especially when changing positions, climbing stairs, or turning over in bed.
Difficulty standing up: Standing up from a sitting or lying position can be uncomfortable due to pain in the pelvic area.
Pain when pressure is applied to the pubic bone: Touching or applying pressure to the pubic bone can cause additional pain.
Instability in the pelvic area: Some women report a feeling of instability or looseness in the pelvis, especially when walking.
Diagnosing pubic bone inflammation or symphysis problems after childbirth often requires a thorough examination by a doctor or specialist.
“Diagnosing pubic bone inflammation or symphysis problems after childbirth usually requires a detailed physical examination by a doctor or specialist. The first step involves taking a comprehensive medical history, during which the doctor asks questions about the symptoms being experienced. This is accompanied by a thorough physical examination, during which the affected area is assessed to locate the source of pain and evaluate the condition. To gain a more precise understanding of possible symphysis problems, imaging techniques such as X-rays and magnetic resonance imaging (MRI) may be used. In this process, so-called “flamingo images” are taken—that is, the patient stands on one leg during each image, and the image then reveals whether the symphysis is shifting vertically. “It’s important to note that a slight displacement after pregnancy is completely normal,” explains Dr. Becker.
At the same time, the doctor rules out other potential causes of similar symptoms. This involves considering possible spinal problems or muscle tension in the pelvic area and ruling them out through targeted examinations. The combination of medical history, physical examination, and imaging techniques always enables a precise diagnosis and lays the foundation for targeted and effective treatment.
For pregnant women or new mothers with pelvic pain or symphysis problems, there are various non-surgical treatment options.
“There are quite a few conservative treatment options available. Special pelvic belts can reduce strain and alleviate symptoms, especially when walking or standing. However, such a pelvic belt tends to address horizontal instability rather than vertical instability. Physical therapy plays a central role in treatment, as targeted exercises and techniques can help strengthen the muscles in the pelvic area, reduce pain, and improve pelvic stability. Adjusting posture to be more ergonomic and using special aids such as cushions can reduce strain on the pelvis and relieve pain. Acupuncture, when performed at specific points, can help relieve pain and relax muscles in some women and is highly recommended; osteopathy also provides relief. “Currently, we’re seeing the greatest success with shock wave therapy, especially in cases of bone marrow edema. This treatment should consist of a total of 6–7 sessions, combined with physical therapy once a week,” recommends Dr. Becker, adding: “Only about 5% of our patients undergo surgery at our clinic. For certain conditions, we operate sooner to help patients regain mobility more quickly. We also tend to opt for surgery over other therapies more frequently for athletes so they can return to their careers sooner. Especially in sports like soccer or handball, there are many changes of direction, which place a lot of strain on the pubic symphysis. This can lead to chronic irritation or pubic symphysis inflammation, so this condition is indeed more common among athletes.”
Pubic bone inflammation in athletes can be caused by various factors:
Overuse: Repeated stress from certain sports such as soccer, tennis, track and field, or hockey can lead to pubic symphysis inflammation, especially if the stress is one-sided or if training intensity is suddenly increased.
Poor posture or biomechanical issues: Postural abnormalities, such as insufficient core stability or foot misalignments, can increase the risk of pubic symphysis inflammation.
Muscle imbalances: Imbalances or weaknesses in the muscle groups of the pelvic region can lead to excessive strain on the pubic bone and thus contribute to inflammation.
The sacroiliac joint (SI joint) plays an important role in the pelvic region of athletes.
“The sacroiliac joint is often underestimated as a cause of lower back pain. It connects the sacrum to the pelvis and contributes to the pelvis’s stability and mobility. Problems with the sacroiliac joint can lead to pain in the lower back or pelvis, which can cause discomfort, especially in athletes. As a preventive measure, warming up and stretching are definitely always advisable and help warm up the muscles and promote blood circulation, which can reduce the overall risk of injury. Having strong core muscles and being in good physical condition is always protective. Symptoms should never be ignored, and training should be paused if necessary. This means that athletes should definitely pay attention to warning signs such as persistent pain, imbalances, or discomfort in the pelvic area and seek medical help in a timely manner if needed. “Adjusting posture and movement patterns can also help minimize stress on the sacroiliac joint and reduce discomfort,” explains Dr. Becker. Combining these preventive measures helps reduce the risk of pubic bone inflammation and sacroiliac joint pain and improves athletic performance by preventing potential injuries in the pelvic region.
Looking to the Future
“It would be desirable for more attention to be paid to this condition, as it occurs much more frequently than people realize. Very often, it is mistakenly dismissed as an adductor strain (an injury to the inner thigh muscles). As for treatment options, we’ve developed our own surgical method here in Munich that can be used primarily for symphysis instability. We can perform a minimally invasive ligament augmentation instead of using plates and screws as we did in the past, as soon as conservative methods prove ineffective,” Dr. Becker concludes, and we wrap up our conversation.
Dear Dr. Becker, thank you very much for shedding light on this condition, which is certainly unfamiliar to many!
