Knee problems after pregnancy

Pregnancy and Knee Pain

When Lyn Mettler suddenly began having knee pain during her seventh month of pregnancy, she said the pain was so bad that she couldn’t walk. The 34-year-old mom, who lives in Mt. Pleasant, S.C., says “I’d never had knee problems before. This came out of the blue and was very painful.” Knee pain is a common complaint during pregnancy and the postpartum period, and the pain can range from mild to annoying to debilitating. Fortunately, knee pain doesn’t have to make you immobile and miserable during and after your pregnancy.

Knee Pain During Pregnancy

It’s hardly surprising that pregnancy can cause knee pain, since it’s well-known that excessive weight contributes to knee problems. “Even if a woman is only carrying 25 additional pounds for a few months late in her pregnancy, the extra pressure on the weight-bearing joints can cause fairly severe knee pain,” says Steven Stuchin, MD, director of orthopedic surgery at NYU Hospital for Joint Diseases in New York City.

Hormonal changes during pregnancy also play a role in knee pain. During the third trimester, hormones are released to loosen up the pelvic ligaments and tendons in preparation for childbirth. But the hormones don’t just trigger looseness in the pelvic area — they can also cause other ligaments and tendons to loosen, including those around the knees, says Dr. Stuchin. “This can make things a little unstable.” As a result, the kneecap may not track exactly right, resulting in knee pain.

Knee Pain After Pregnancy

Knee pain typically goes away after pregnancy, but it may not happen right away. “The tendons and ligaments remain loose for a couple of months after giving birth,” says Stuchin. Plus, having your baby doesn’t guarantee that you’ll shed all the weight you gained during pregnancy — which means that knee pain may linger until you’re back in shape.

A bonus of breastfeeding is that the body burns calories to make breast milk during nursing, and breastfeeding releases hormones that help shrink the uterus, making weight loss somewhat easier to achieve, says Hilda Hutcherson, MD, clinical professor of obstetrics and gynecology at Columbia University Medical Center in New York City. Even so, it may take as long as three months for your weight, and knees, to get back to normal.

Managing Knee Pain for Pregnant Women

The good news is that you don’t have to live with knee pain during pregnancy and the postpartum period. There’s a lot you can do to help alleviate knee pain. Try the following strategies:

  • Exercise. Low-impact exercise can help strengthen the quadriceps muscles that support the knees. “This will help compensate for the looseness of ligaments and tendons in the knees,” says Stuchin, who recommends straight-leg raises and moderate walking.
  • Get off your feet. Take the weight off your knees by propping your feet up whenever possible. Not only will this ease knee pain, it may prevent pain from developing in the first place, says Stuchin.
  • Wear well-cushioned shoes. Footwear with adequate padding and arch support can help absorb shock to the knees. You may want to stick with sneakers during your last trimester to give your knees a break.
  • Avoid excessive weight gain. The American College of Obstetricians and Gynecologists recommends that women who had a normal weight before pregnancy, should put on 25 to 35 pounds during pregnancy (women who were overweight should gain only 15 to 25 pounds). If you stick to these guidelines, it will be easier to chase away knee pain by quickly returning to your pre-pregnancy weight.
  • Take small doses of acetaminophen. The safest over-the-counter pain reliever during pregnancy is acetaminophen (Tylenol), says Dr. Hutcherson. Take the minimum dosage needed to relieve your knee pain, and avoid aspirin and ibuprofen (Motrin, Advil). “Aspirin thins the blood, which could potentially lead to problems with a baby’s development,” says Hutcherson. “And some studies show that ibuprofen may increase the risk of birth defects or premature labor.” It’s best to call your doctor before taking over-the-counter medication during pregnancy.
  • Consider wearing a knee brace. An elastic, doughnut-hole knee brace can help relieve knee pain by supporting loose ligaments and tendons around the knee, says Stuchin. Knee braces are relatively inexpensive — around $15 — and sold in most drugstores.

Knee pain is just one of the many changes that may happen to your body during pregnancy. But with these simple strategies, you should be able to make it though your pregnancy and postpartum period with minimal knee pain.

The scary post-pregnancy condition no one told me about

“What did you expect?” He asked. “You had a baby”.

He agreed it was probably nerve damage and it would probably get better but for now, I’d have to live with it. How much for that little pearl of wisdom? $475.

I cried the whole drive home. I knew it wasn’t nerve damage. And it wasn’t getting better – it was getting worse.

Jenna had to put on a brave face to enjoy snuggles with her newborn. Image: Supplied

Coming to terms with my uncommon diagnosis

I fought for a second opinion. I asked for MRI’s and blood tests and finally I got an answer: I have rheumatoid arthritis, an autoimmune disease where the immune system attacks the joint fluid causing intense pain, swelling and stiffness. It can also affect the lungs, heart and blood vessels. It’s already affecting my eyes, hence the dizziness and blurred vision. It is often caused by a virus and whilst not common, it’s not unknown for women to develop it during pregnancy when the immune system is already compromised. It’s likely mine was a result of the pre-eclampsia.

Rheumatoid arthritis is a chronic illness. It will come and go for the rest of my life, but it’s treatable and on the right drugs, I can function pretty well.

I can now get on the floor and play with Arlo. I can take my beloved dog to the park. But I still have pain in my feet and knees and hands. I’m light sensitive and dizzy and I now need to wear glasses.

I’m still learning how to live with my illness and manage my symptoms, and once I stop breastfeeding the drug options become much greater, but for now, I’m a million times better.

With the right medication, Jenna can enjoy being a mum. Image: Supplied

Why did it take so long to find what was wrong?

The problem is that it took five months of trying to convince countless (mostly male) doctors that my agony was real, that I wasn’t a whiny new mother wasting their time.

One doctor even laughed when I grimaced in pain and remarked, “Come on. Surely it’s not worse than childbirth?” Actually, it was. My pain prevented me from enjoying, even remembering, the first precious months with my son, months I won’t get back and that’s a pain I’m only just beginning to understand.

It’s no one’s fault that it happened to me, but my complaints should have been taken more seriously. No pregnant woman expects birth to be pain-free or without some sort of recovery period. We’re not idiots. But childbirth isn’t uncomplicated and birth-related trauma isn’t uncommon.

I don’t have a single friend who had zero complications from pregnancy or childbirth and yet we all talk about our births like the suffering is a cross we have to bear. That must stop. A healthy baby is always the top priority; a healthy, happy mother is just as important.

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After pregnancy, try cross-training to avoid knee pain

Because I’m trying to get back in shape after having a baby, I have begun jogging again. Unfortunately, I have a great deal of knee pain within 24 hours after my runs. Someone mentioned that the pregnancy could be playing a part. Is that true?

The excessive elasticity in your joints and ligaments during pregnancy was due to the hormone relaxin — and this hormone is still present during breastfeeding. (I’m a prime example: I had to take it slow after my baby was born because of a pulled hamstring due to this extra elasticity.) This hormone could be responsible for your current knee pain. Also, if you’re running your pre-pregnancy mileage with your now postpartum weight, the extra weight could be hurting your knees.

Now, more than ever, you should be cross-training. Try walking with intervals of slow runs. I found the bike to be my most comfortable postpartum cardio exercise and the Stairmaster (on slow) worked well too. Check with your doctor, however, to ensure there’s not another reason for your pain.

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I want to start running again as part of a new shape-up plan, but I experienced shin splints when I ran before. Is there any way to prevent this nuisance?

First, check your shoes and running surface. The shoes should fit properly and be in good condition. As for the running surface, try to avoid concrete and similarly hard material; stick to softer dirt and grass instead.

You could also try strengthening and stretching your shins and calf muscles. Do these exercises a couple of weeks before you hit the trail, treadmill or track.

For your shins, stand about 6 inches from the wall, knees straight, back pressed against the wall. Lift your toes up as far as you can and hold for three seconds, then lower. Repeat 10 times.

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For your calves, stand on the edge of a step and let your heels drop slightly. Starting in that position, raise your body up on your toes. Repeat eight to 10 times. To work another part of the calf, try seated calf raises. Sitting on a bench with an 8- to 10-pound weight across your knees, raise your heels as high as you can eight to 10 times while keeping your toes on the floor. Add weight to increase resistance.

If the above measures fail, see a sports physician. He or she can check your running gait, feet and any physical imbalances that might be causing this injury.

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Stephanie Oakes is the fitness correspondent for Discovery Health Channel and a health/fitness consultant. Send questions by e-mail to [email protected] She cannot respond to every query.

Question

I had a baby four months ago and since then I have suffered from very painful knees when I sit down or crouch to pick something up. They also make a cracking sound.

I am still a stone heavier than I was before my baby was born and he of course is another stone in weight that I am carrying around.

I have been told that it could be a hormonal thing, but would be grateful for your advice.

Answer

Your symptoms are likely to be related to a number of factors.

As you point out, two stone is not an inconsiderable additional weight to be carrying around for a lot of the time on a day-to-day basis.

The hormone progesterone rises to more than three times the normal level during pregnancy.

This is responsible for causing muscle relaxation and enabling the pelvis and vagina to cope with the significant change in shape required for delivery of your baby.

Your joints need muscles for their support and even four months after the happy event, it is possible that you still have increased mobility of your joints compared with before you became pregnant.

The cracking you describe may be due to the knee ligaments being more lax than usual.

These symptoms usually diminish with time as your hormones revert to normal, you manage to lose a little weight and your baby becomes more mobile, probably in that order.

If the pain is severe and your knees swell or give way, I would suggest that you arrange for your doctor to examine them and give their opinion.

Yours sincerely

The NetDoctor Medical Team

Last updated 14.10.2014

Why do my knees hurt after pregnancy?

We know that pregnancy and new motherhood can take a serious toll on the body. Cracked nipples, back pain, tummy separations and urinary incontinence are just some of lovely things we do our best to avoid! Something many new mums don’t expect to experience however is knee pain. Despite this, it is one of the most common pain complaints I see as a physio who treats post-natal women. As with many things that are ‘common’, post-natal knee pain is not something you need to just put up with! So I will do my best to explain what it is, why it happens and what you can do to help…

Why do my knees hurt?

The most common type of knee pain in new mums is caused by a condition known as patello-femoral pain sydrome, which basically means ‘pain under the knee cap’. PFPS is felt mostly at the front of the knee – usually under or around the sides of the kneecap. In new mums, knee pain is usually caused by a combination of three main factors:

The changes your body goes through during pregnancy
  • The hormones released during pregnancy cause your ligaments to soften and pelvis to widen to make room for the baby
  • Your abdominals are stretched during pregnancy & gradually weaken
  • Your posture will usually change to include an increased curve in your lower back or a ‘sway back’ which puts your abdominals and gluteals in a poor position to work

The muscle imbalances that often occur as a result of pregnancy
  • Weaker abdominals (transversus, rectus abdominis and obliques)
  • Weaker hip abductors & extensors (gluteals)
  • Tighter lateral thigh muscles like iliotibial band and lateral quadriceps
The types of activities you do as a mum places a lot of excess load through the patello-femoral joint
  • Sitting to feed / nurse involves your knees being in flexion for a long period of time
  • Rocking and bouncing to settle your baby usually involves lots of weight shit and mini-squats
  • Squatting to the floor and kneeling to pick bub up and down off the floor / bouncer places a lot of load through your knee joints and challenges the length of your quadriceps
  • Lifting capsules and pushing prams (especially uphill/stairs) increases the load through the knee joints by a significant amount compared to just moving your own body weight.

So what should I avoid doing if I have knee pain?

Now realistically, there are many things as new mums you simply can’t avoid (like most of the things on the list above!) But it’s important to remember that knee pain after pregnancy is unlikely to get better if you ignore it or if just ‘push through’ it! Some of the main activities that you should keep an eye on are:

  • squats or lunges, especially with weight (dumbbells or baby!)
  • walking up / down hills or stairs, especially with the pram
  • excessive kneeling

If you notice an association between how much you do these things and your knee pain, it is worth modifying / minimising these activities for a while to see if the pain improves.

What can I do to help improve my knee pain?

Minimising aggravating movements is a really good start, but it is not usually sufficient to get rid of your pain altogether. You should try to:

Get help

To address the main issues contributing to your pain you must first identity them! A good physiotherapist who has experience working with post-natal women will be able to help you. The factors that are contributing to your knee pain might be quite different to those contributing to your friend’s knee pain…

Improve any muscle imbalance

I usually give my mums with knee pain a few exercises to help address their own individual imbalances. These might include stretches or muscle release techniques for ‘tight’ muscles, and strengthening exercises for weak muscles. Here is a short video of a few exercises I commonly prescribe for post-partum knee pain:

Change up your technique

As your muscles get stronger you should notice your pain beginning to improve, however certain exercises can still aggravate your knees. If you get pain on squats for example, try putting a ball between your knees and squeezing as you squat to engage some of your pelvic stability muscles. Or have another look at your knee position and try changing up your alignment to see if that helps:

Wear good shoes

Shoes that have adequate cushioning and arch support will help to keep your knees in good alignment. This can be a ‘quick fix’ for some women, so if you spend a lot of time barefoot or in thongs, try wearing your runners a bit more and see if this reduces your pain!

So, whilst knee pain in new mums is really common, it is not normal and shouldn’t be put up with.

If you’re struggling with post-partum knee pain, get in touch! My aim is to help you to make big improvements with a few small changes so that you can get on with life!

Treating Joint Pain Naturally During Pregnancy

  • Omega-3s: Including foods rich in omega-3s in your diet and/or taking an omega-3 supplement may help relieve joint pain and stiffness.
  • Rest: Take time to rest to give your joints a break. Relaxation exercises as well as putting your feet up may also help alleviate knee and ankle pain.
  • Footwear: Wearing high heels puts a strain on your ankles and feet. Instead, try to wear shoes that provide adequate support.
  • Support: If your joint pain is getting in the way of your daily activities, don’t hesitate to ask for help.
  • GLA (gamma-linolenic acid) is another fatty acid that is used to alleviate joint pain. However, it should not be taken during pregnancy as it may induce labor and pose risk to the fetus. Likewise, turmeric, although used to relieve joint pain, should not be used during pregnancy.

    How to Treat Joint Pain during Pregnancy When Naturally Doesn’t Work

    Acetaminophen is a possible alternative to relieve mild joint pain. Whether pregnant or not, it is important to limit your dosage and frequency because excessive use of the medication is associated with liver damage. Soothing ointments or creams that contain methyl salicylate should be avoided.

    If natural remedies do not relieve your pain, consult your doctor about safe medications to take during pregnancy. It is also important to talk with your doctor if you were taking arthritis medication before pregnancy. Some medications are not safe to take during pregnancy, so your doctor may need to give you a new prescription.

    More Helpful Articles:

    • Massage and Pregnancy – Prenatal Massage
    • Exercise and Pregnancy
    • Pregnancy Exercise Guidelines

    Compiled using information from the following sources:

    1. A.D.A.M, Inc. (2013). Gamma-linoleic acid.

    2. Bernstein, S. (n.d.). Benefits of massage.

    3. Ellis, M. E. (2013, July 30). Natural relief from arthritis pain.

    5. Pietrangelo, A. (2014). Arthritis during pregnancy: Symptoms, treatments, and remission.

    6. University of Washington Department Orthopaedics and Sports Medicine. (n.d.). Pregnancy and arthritis.

    Knee Pain After Pregnancy?

    I cannot diagnose you without a more complete history and a physical examination, but I can tell you about a few possibilities. If your pain is just below your knee in the inside, chances are it’s anserine bursitis.

    A bursa is a small sac filled with fluid that acts as a cushion over bone surfaces or tendons. Pain from anserine bursitis is felt more when walking up or down steps, so that part of your history fits. If you can avoid that activity, it would help you heal. A steroid (cortisone-type) injection can also be helpful. Pregnancy would not directly cause anserine bursitis, but the extra weight carried during pregnancy could conceivably contribute to its development.

    Another possibility is transient osteoporosis of the hip or knee joint, which can occur — although rarely — as a result of pregnancy. It can even cause a fracture. Osteoporosis is the loss of bone substance, which makes bone brittle and susceptible to fractures. It is common among postmenopausal women and in those who received several months of high-dose steroid treatment.

    The cause of osteoporosis during pregnancy is not exactly known; still, this type of osteoporosis also responds to treatment with calcium, vitamin D, and bisphosphonates — medications such as alendronate (Fosamax) or risedronate (Actonel).

    Rarely, young women develop an early osteoarthritis of the knee that affects the underside of the patella (the knee cap), causing deterioration of the cartilage. This type of osteoarthritis is known as chondromalacia patellae, literally meaning “softening of the cartilage of the patella.” The pain caused by chondromalacia is felt behind the knee cap. Treatment is similar to that of other types of osteoarthritis — analgesics such as acetaminophen (Tylenol), followed by NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen) or a coxib (celecoxib). Exercises to maintain mobility and muscle strength are an important part of treatment.

    If your problem persists, you should consult a rheumatologist for a complete examination, and get X-rays if necessary, in order to get a correct diagnosis and proceed with treatment.

    Learn more in the Everyday Health Knee Pain Center.

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