Pregnancy is a unique time in our lives where our body is rapidly changing in a short amount of time, albeit sometimes it doesn't feel all that short. While everyone has a unique pregnancy because every body is different, a common complaint during pregnancy (and sometimes postpartum) is joint pain.
Pelvic floor physical therapy is a specialized form of physical therapy where we look at your whole body as it relates to your trunk and pelvis. To read more on what pelvic floor PT is, view our blog here.
The joint pain during pregnancy that will be specifically covered in this blog post is pubic symphysis pain and sacroiliac joint (SIJ) pain.
Causes of joint pain during pregnancy:
If we view pregnancy as a nine month, slow growing injury, it makes more sense to then conceptualize how pain can occur. The body slowly loses structural integrity on purpose to make room for the baby and prepare for birth. However, in doing so, compensation patterns can arise to help support our movements.
There are many nuances that go into what can cause joint pain, from hormone changes to postural changes due to weight gain. Usually when it comes to pain you want to address the root cause, however in pregnancy you cannot just change the hormone fluctuations or the growth--and neither would you want to.
Usually the body responds to these changes and structural integrity losses in one of two ways:
Reduced force closure: The muscles around the joints that help to control your trunk and movement patterns are not providing the stability they should be. You end up feeling joint sheering pain that can feel sharp, burning, or intensely achy (9/10 level pain with movement).
Excessive force closure: Your body is now trying to stabilize you, but in doing so it's firing at all cylinders causing tension and muscle fatigue. Usually you will then feel tightness, muscle fatigue, and continued joint discomfort.
Role of pelvic floor PT in relief:
Sometimes the issue isn't particularly the pelvic floor muscles per se, but pelvic floor therapists are trained in pregnancy and postpartum neuro-musculoskeletal changes. Pelvic floor PT is just a label for those who are orthopedic physical therapists with a more integrated knowledge base of the pelvic floor and abdominal-pelvic canister.
The joint pain often experienced during pregnancy, either pubic symphysis dysfunction (SPD) or SI joint pain, is most easily remedied with an exercise and mobility prescription unique to you.
Pelvic PT's can assess your movement patterns and your subjective history to determine what areas are best to strengthen and pay attention to in order to alleviate your discomfort. They can recommend external devices, such as a belt, if applicable to your scenario, and give you a plan for managing the symptoms throughout your journey.
Sessions with a physical therapist regarding your pain would look like:
Subjective history of your pain and other contributing factors. We might ask what makes the pain worse (i.e. stairs) and what makes it better (i.e. resting).
Movement and postural assessment to determine if you have compensatory patterns that could create the pain.
Test re-test analysis of the pain. For example, if we have contract your core properly with movement does that change the pain? A session planned like this will allow you to find solutions in real time that you can replicate at home.
Education on exercises, pain management strategies, and self-care techniques.
Pain during postpartum:
Sometimes pain during pregnancy extends into postpartum, despite being told by the general public you'll feel better once you deliver the baby. Around 50% of women report having some type of general discomfort throughout their first year postpartum. That's far too many who continue to feel that their quality of life is less than it was.
While there are many causes of feeling off during postpartum, and we discuss a large amount in this functional medicine blog here, we will continue with the joint pain discussion.
Some common causes of joint pain during postpartum:
Continued pain from pregnancy.
Delivery positions that were hard on the body, for example laying on your back and pushing for an extended period of time.
Continued muscle weakness and joint laxity that is now more pronounced with postpartum.
Cesarean section scars.
Breast feeding posture.
Similarly to pain during pregnancy, a large part of the treatment for pain during postpartum includes:
Subjective history of your pregnancy and labor.
Subjective history of your pain and symptoms currently, in order to assess what other factors aside from pregnancy may be contributing.
Assessment of your body from your ribs, diaphragm, abdomen, movement patterns, and possibly your pelvic floor.
Treatment including manual therapy, dry needling, exercise prescriptions, and education on home care.
How do I prevent pain?
While no strategy is perfect, it is usually recommended to see a pelvic PT earlier on in pregnancy to take care of any dysfunctions you may have had prior to pregnancy (i.e. back pain), and to learn how to strengthen your body throughout the course of the nine months.
Some helpful tips for at home include:
Continue to exercise in whatever way you are most comfortable with. Most often pain happens due to muscle weakness, so maintaining strength can be game changing.
Keep your posture steady. We will often allow the belly to really hang forward while we back-bend, and this can create a lot of stress on the joints of the pelvis. Bring your rib cage up and over your pelvis, so you are centered over your feet. Resist the urge to pelvic tilt and tuck your tailbone.
Don't ignore the pain and hope it'll go away. Getting help and advice earlier on can prevent the pain from becoming debilitating.
Do not kegel. While the advice to kegel during pregnancy sounds plausible, it is not often recommended. We need the pelvic floor to lengthen for birth, and it doesn't actually push the baby out. Sometimes pelvic floor tension can be the cause of joint pain, in which case doing kegels would make the pain worse. It is always better to get an assessment from a skilled physical therapist before attempting anything with the pelvic floor muscles.
Modify activities that bother you. If getting in and out of the car one leg at a time is irksome, then the Queen Elizabeth swivel might be the way you have to navigate during car trips.
TLDR:
While joint pain in pregnancy and postpartum is common, it isn't normal and you shouldn't have to suffer through it. The most common, modifiable causes include posture and muscle stability strength. A pelvic floor PT can help assess the factors causing your pain and create a plan to help you address it.
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things Women’s Health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.