The Musculoskeletal time line of pain and problems during pregnancy:
Dr. Meredith Warner, Baton Rouge Orthopedic Surgeon, has spent a lot of time researching pain and its effects on men and women. This post is for women that are currently pregnant, dealing with pain and looking for treatment options that will not harm the baby.
First, you should know that exercise during pregnancy is safe and recommended by the American College of Obstetricians and Gynecologists. That being said, an evaluation by your OB Doctor first should be completed and then you should start a program overseen by physical therapists or other healthcare and exercise professionals. At YogaBliss of Baton Rouge a yoga for pregnancy program has even been developed.
Pregnancy causes many aches and pains and a lot of swelling.
There are specific reasons why these problems occur and also particular time frames during which they occur. I will go through a basic time line first of what you can expect and then go into a more detailed explanation of why each change occurs.
- Week 1-12: Relaxin hormone is released, peaking at week 12.
- Weeks 32-40: Major increases in swelling or ‘tissue edema’ happens.
- Week 12-17: There is a decrease in relaxin to more stable levels.
- Week 10-12: The pubic symphasis widens and the sacroiliac joints widen.
- Week 4-6(after birth) : During the initial post-partum weeks, these symptoms resolve.
Relaxin is a hormone released during pregnancy that causes joints, ligaments and tendons to loosen. Estrogen, progesterone and cortisol are also released by the body during pregnancy. These hormones are also thought to increase the laxity of joints and ligaments. The effects of relaxin, estrogen and progesterone are likely additive and make all the joints move in unusual manners when one is pregnant.
Lumbar lordosis increases during pregnancy. This is sometimes called ‘swayback’. The lordosis increases as the baby grows. Basically, lordosis means the lower lumbar spine bends more toward the belly due to the weight of the fetus and uterus. This displaces the center of gravity in front of the spine, tilts the pelvis and strains the low back.
At least 50% and up to 75% of pregnant women have back pain during pregnancy.
Obesity and previous back pain are risk factors for having back pain with pregnancy. We have a variety of pregnancy-safe ways to treat this back pain at Warner Orthopedics and Wellness.
Pain in the pubic region is due to the widening of the pelvis at that point. The pelvis must widen to allow for the birth of the baby. However, this means that the normally close connection of the two halves of the pelvis stretches, and this can hurt. This event, pelvic relaxation and widening, can also cause pain at the connection of the pelvis to the spine. This is the ‘sacroiliac joint’ or ‘SI’ joint. Pain will be felt in the deep buttock region. Pain in the SI Joint makes sitting cross-legged difficult.
Neck pain is common also. Due to the fact that the center of gravity is too far forward in pregnancy, the neck and shoulder compensate. The shoulders lift outward as the neck also gets increased lordosis and flexion (bending forward). This causes a decrease in the range of motion of the shoulders and can limit function. If you watch pregnant women walk you can actually see them lean backward with their shoulders and necks!
Soft tissues fill with fluid during pregnancy as well. The circulation system in a woman’s body changes with the hormones of pregnancy and with the weight and pressure of the fetus. Because of this, fluid will leak out into the cells all over the body. In certain areas, this increase in fluid can actually cause compression of nerves leading to painful conditions like carpal tunnel syndrome for instance. Only conservative care should occur for these pregnancy-related conditions, such as bracing, massage, safe topical pain creams or therapy, due to the temporary nature of the problem. Another common compression neuropathy (compression of a nerve) occurs in the feet. Pregnant women will often have swollen and painful feet.
Weight gain during pregnancy can cause pain anywhere. Feet are especially prone to pain due to both the effect of relaxin on the ligaments and tendons of the feet, tissue swelling combined with the increased weight. Although foot pain during pregnancy can dramatically affect a woman’s life, treatment should be very conservative. This pain is temporary! One compression neuropathy that occurs in the feet is called ‘tarsal tunnel syndrome’ and will cause burning pain on the soles of the feet. Typically, therapy and massage are recommended during pregnancy for such problems.
Most women will have aches and pains during pregnancy. These occur at certain times during pregnancy and in certain body parts, most commonly the low back. Since there is a growing fetus present, X-rays are usually discouraged when treating a pregnant female. However, at Warner Orthopedics and Wellness we use a state-of-the-art ultrasound device that allows us to look at tendons, muscles and bones and is safe for the baby. Exercise and therapy are good treatments for such pain and will be discussed later.
The usual recommendation is to get all of your vitamins and minerals from your diet. If you are unable to eat enough fruits and vegetables to get the vitamin C, the following regimen is recommended. Vitamin C: 6 grams, per day, is needed for heart disease (as per Dr. Pauling). If you take vitamin C with minerals like magnesium and calcium, less may be taken. One of the side effects of too much Vitamin C is diarrhea. Taking Vitamin C in divided doses can help with that. Minerals to think about taking with Vitamin C include zinc and magnesium.
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