Orthopedic problems caused by pregnancy should not be ignored as ‘just part of the process’.
It is no secret that pregnancy is massively taxing on the entire body. While growing a tiny human, the body undergoes a fundamental and sometimes permanent transformation, which can cause a whole host of musculoskeletal issues. In this article, we will go over the most common orthopedic problems caused by pregnancy, as well as their treatment.
Important to note: Don’t be a hero
While many people report that pregnancy can be uncomfortable or even painful, there comes a point where you should seek medical help if your symptoms begin to greatly alter or impact your comfort and way of life. Women are often expected to ‘just suck it up’ because pregnancy ‘isn’t supposed to be a walk in the park’, and in doing so, they set themselves up for a lifetime of issues that might otherwise have been avoided with proper medical diagnosis and treatment.
If muscle, joint or skeletal pain or discomfort:
- Keeps you up at night
- Alters the way you walk (beyond the usual ‘pregnancy waddle’)
- Causes alarming fluid retention, pins and needles, numbness or unexplained weakness
It is EXTREMELY IMPORTANT that you contact a doctor who is well-versed in musculoskeletal orthopedic problems caused by pregnancy. Please also note that your Obstetrician might not be the best point of contact for these problems. While their general medical training briefly covers orthopedic issues, they are not experts in the field of orthopedic problems caused by pregnancy, beyond those commonly found in the pelvis.
Orthopedic problems caused by pregnancy
An enlarging gravid (pregnant) uterus alters the body’s center of gravity, placing extra mechanical stress on the axial (head, neck and spine) and pelvic systems. This can compound the stress already placed on the joints and ligaments, caused by hormonal changes and fluid retention.
A hormone called Relaxin loosens and relaxes your muscles, joints and ligaments during pregnancy to help your body stretch. Relaxin also helps your body prepare for delivery by loosening the muscles and ligaments in your pelvis. It can make you more prone to injury, as ligaments and muscles that normally do not move, suddenly find themselves with a greater ability to stretch. This is the cause of many orthopedic problems caused by pregnancy.
Relaxin can cause pelvic pain in some people during pregnancy. This is pregnancy-related pelvic girdle pain (PGP). It may cause you to feel pain when using the stairs, getting out of cars, changing positions in bed or standing on one leg.
People with PGP feel pain:
- In the front of the pubic bone (at hip level).
- Across one or both sides of the lower back.
- In the perineum (area between your vagina and anus).
- In the inner thighs.
Relaxin causes most of the muscles and ligaments around your pelvis, back and abdomen to loosen. This can make you feel weak or unstable. Some people find that wearing a belly band during pregnancy offers additional support and helps with posture.
SI Joint Problems
The Sacroilial Joints connects the Sacrum (the base of the spine) with the Ilium (the pelvis). They are thick bands of connective tissue that usually do not move, or move very little. The flood of Relaxin experienced during pregnancy can cause this usually immobile band of tissue to become mobile, leading to lower back pain in the pelvis that can radiate down the buttocks.
SI joint pain during pregnancy is a very common complaint and can affect affect either a single SI joint or both SI joints at the same time. It’s commonly referred to as pregnancy related low back back pain and is something that can exist and worsen during pregnancy, or be a new complaint that starts during pregnancy. It’s sometimes accompanied by sciatic nerve pain in the buttocks or down the back of the leg.
Although SI joint pain during pregnancy is considered common, that doesn’t mean that you need to suffer through it for the rest of your pregnancy. There are a number of effective strategies you can try to relieve it and make your pregnancy more comfortable. Start using an SI band, which sits low on your hips to help compress the pelvis. If this doesn’t provide relief, talk to an orthopedic doctor.
Pubic Symphysis Pain
The most common symptoms are difficulty when walking and wrenching pain. Some people describe the pain as though the pelvis is tearing apart. Typically, the pain is focused on the pubic area, but in some women it radiates to the upper thighs and perineum.
The pain can worsen when walking and doing weight-bearing activities, particularly those that involve lifting one leg like climbing stairs, getting dressed, getting in and out of a car, or even turning over in bed.
There are some things you can do to ease your discomfort if you’re suffering from this pregnancy symptom, including:
- Avoid triggers as much as you can. Sit down to get dressed, and avoid heavy lifting and pushing (which you should be steering clear of anyway!).
- Apply a heating pad or ice pack to the pubic bone. If you use a heating pad, don’t leave it on for more than 10 minutes at a time, since longer can can raise your baby’s temperature. (You can safely cycle the pad on and off every 10 minutes.)
- Wear a pelvic support belt. They’re readily available online and “corset” the pelvic bones back into place during pregnancy.
- Do your Kegels and pelvic tilts. Regular practice helps strengthen the muscles of the pelvis.
- Ask for pain relief. If the pain is severe, ask your practitioner about pain relievers.
- Consider physical therapy. Your obstetric provider can help you decide if it’s a good option.
One of the most common orthopedic problems caused by pregnancy is kyphosis. The lower back (lumbar spine) will gradually start to curve more, and the shoulders may also move back a bit to make up for this shifting center of gravity and enlarging uterus. Plus, late in pregnancy, the abdominal muscles of some women separate, which can lead to a change in posture.
Pregnancy-induced kyphosis will usually resolve itself post-partum, but if it doesn’t, it’s important to be assessed by an orthopedic surgeon.
Pregnancy is rarely the cause of a herniated disc, but it will certainly exacerbate a preexisting bulge. For women who are experiencing moderate to severe herniated disc pain during their pregnancy, it’s important to remain positive and have the condition checked out and monitored by a spine specialist, like Dr Jonathan Paley at Dayton Orthopedic Surgery.