Common Pregnancy and Postpartum Discomforts
Ahh, pregnancy. The daily miracle of our bodies nurturing a new life, the anticipation of the overflowing joy and love that the new baby will bring, the flowering of our maternal spirits, the back aches, the edema, the nausea, constipation, hemorrhoids, stretch marks, weight gain, and getting out of bed to use the bathroom three or four times every night. Ah yes, pregnancy.
Though the common physical discomforts of pregnancy are numerous, you don't have to grit your teeth and bear it. Fortunately, there are many simple steps you can take to alleviate or avoid many of the undesirable side effects of pregnancy and postpartum.
Areas of the Body Most Commonly Effected During Pregnancy and PostpartumClick on a body part below to go directly to information about this topic.
Biochemical Changes Can Make You Susceptible to Injury
During the last half of pregnancy and early postpartum periods, you need to be more cautious during exercise and other physical activities. In response to pregnancy hormones, your ligaments and other connective tissues lengthen, which decreases joint stability. Instability, in combination with the shift in your center of gravity, reduces neuromuscular coordination and balance, leaving you more vulnerable to injury.
These biochemical changes do not destine you for injury, however. Some simple adjustments in your activities, environment and preventative exercises can significantly improve your prospects for having an injury-free pregnancy.
Put Your Feet before Your Sense of Style
The idea of "sensible shoes" may seem like an anathema for women who follow fashion trends, but pregnancy and postpartum-related foot pain can make even the most dedicated fashionista appreciate the value of supportive, good-fitting shoes. For the duration of your pregnancy, shoes with high heels and pointy toes are better left in your closet than on your feet.
Why the Shoe Doesn't Fit—At Least for Now
Shoe-fit problems stem from added body weight in conjunction with ligament laxity and fluid retention. This combination of physical changes can stress and flatten the longitudinal and metatarsal arches of the feet, and ultimately affect they way your shoes fit. With stretched ligaments and swelling from water retention and weight gain, your feet may spread and swell enough to require longer and/or wider shoes. Some women will need to buy larger shoes during pregnancy to accommodate these changes. You'll notice foot swelling especially at the end of the day.
How to Take Care of Your Feet during Pregnancy
- Take frequent breaks to keep from standing for long periods of time.
- If your feet tend to swell, elevate your lower legs and feet while sitting.
- During the last half of pregnancy, get your feet re-measured before buying shoes.
- Avoid walking in your bare feet.
- To increase blood flow and reduce swelling, practice simple ankle exercises, such as flex and point, and ankle circles.
- Select shoes with a contoured foot bed and a large, naturally shaped toe, which support the arches and prevent compression of the forefoot and toes.
Evaluating the Condition of Your Shoes
Evaluate the condition of your shoes to see if they're safe to wear during your pregnancy. Check the heels and soles of your shoes for wear. If, when placed on a table or similar flat surface, your shoes slump in any direction, or the heels show marked signs of wear on one side, they're too worn to wear. Even if they are your favorite pair, wearing them can risk injury. And of course, any shoe that causes pain should not be worn for the duration of your pregnancy.
A history of ankle sprain, muscle and tendon strain, or tendonitis of the Achilles tendon put you at higher risk for re-injury during your pregnancy and postpartum period. Ankle sprains most often occur when walking down stairs, stepping off sidewalks, or during abrupt changes of direction. For women with a history of sprains and strains, hiking or jogging on hard or uneven surfaces during the last half of pregnancy is not advisable.
Pregnancy Safety Tips for Preventing Trips, Falls, Sprains and Strains
- When using stairs, avoid carrying loads that obstruct your view, such as large loads of laundry or stacks of packages.
- Step down from stairs and curbs with greater caution than you did before your pregnancy.
- Use handrails to compensate for the shift in your center of gravity.
- Practice simple balance exercises throughout your pregnancy to maintain ankle motor-control and adjust to center of gravity shifts. See the Balance page of this web site for more information and simple balance exercise.
- Enlist your family and household members in a campaign to keep the floor and stairs clear of obstacles or spills that might trip you or cause slip and fall accidents, explaining that pregnant women are more likely to get injured if they "take a spill."
- Using nightlights in hallways and bathrooms can also help prevent trip and fall accidents.
Obviously, any exercise that causes pain or discomfort in any joint—and especially the knee—should be avoided. Women commonly feel knee-pain during pregnancy and the postpartum period. Fortunately, it's relatively easy to manage or prevent knee pain. Usually, simply building up strength in the thigh—particularly in the muscles that straighten the knee—can relieve symptoms.
All prenatal and postpartum exercise programs need to compensate for ligament laxity and dynamic instability. To protect your knees, eliminate exercises that may strain knee ligament and cartilage from your routine. These may include jogging or running down hill, squats, lunges, leg presses, and weighted leg extensions. Yoga style squats where the knees extend beyond the toes are also not recommended.
How to Prevent or Cope with Knee Pain
- If you experience pain, discomfort, or reduced range of motion in your knee the day after exercise, discontinue the exercise.
- If you have knee pain, don't kneel, squat, crawl on your knees, or get down on your hands and knees for housework, gardening or exercise.
- Avoid hyperextension of the knee and positions that may stress knee ligaments.
- Perform knee-protective exercises, such as leg extension exercise described below.
Pre-and-Post Natal Leg extension Exercise:
- Stand adjacent to a chair, one hand resting on the back of the chair for balance.
- Lift one foot up to the inside of your opposite knee.
- Try to hold your knee in place as you straighten the lifted leg out in front of you, positioning it at a 45 to 90 degree angle.
- Hold the extension for a moment.
- Slowly bend your leg, returning your foot to the opposite knee.
- Perform eight repetitions on each leg.
Pelvis: Pubic Bone
Usually, the right and left pubic bones are fused together at the midline: the pubic symphysis. The hormones of pregnancy, however, soften the dense ligaments of this joint, which allows the pelvic outlet to expand during childbirth. Occasionally, this joint becomes unstable at the end of pregnancy, during labor, or in the early postpartum period. The chief symptom of pubic instability is pain directly at the pubic symphysis. Groin pain, or an inner thigh strain, is more commonly felt slightly off center of the joint, and can often be mistaken for pubic bone instability.
pelvic instability of Any Kind Needs Professional Treatment
If your pubic bone is painful after childbirth, make an appointment with your OBGYN physician, and get a referral for a Physical Therapist who specializes in pre-and-post natal exercise prescriptions.
Precautions to Take if You Have Pubic Pain
- See your doctor as soon as possible to rule out pubic instability.
- Avoid straddle stretches, side leg-lifts and other groin stretches.
- Always directly face any object before you lift or carry it.
- Refrain from twisting and bending movements when carrying heavy loads.
Pelvis: Sacroiliac Joint
The sacroiliac joint is where the back of the pelvis connects with the sacral vertebrae of the lower spine. Most body types display a small dimple on each side of the low back at the sacroiliac joint. Generally, this joint moves very little, however; instability from increased ligament laxity at this joint can occur during the last half of pregnancy and, more commonly, the postpartum period.
Sacroiliac instability is painful and may cause functional weakness in one or both legs, and low back muscle spasms. Bending, lifting and carrying, sitting with the legs crossed or to one side, prolonged standing/slouching, or walking up a steep hill may aggravate the condition.
Take Care of Sacroiliac Problems Right Away
Directly after pregnancy, the abdominal wall is lax and does not have enough strength to adequately support the lower back and sacrum. Untreated sacroiliac instability may worsen or become chronic. If you think you might have a sacroiliac problem, make an appointment with your OBGYN and get a referral for a Physical Therapist or Chiropractor who specializes in pre-and-post natal problems.
How to Prevent or Manage Sacroiliac Problems
- If you have pain in this joint, do not sit with you legs crossed, or with both legs to one side.
- Never sit without lower back support, particularly while nursing.
- Refrain from all exercises that use straddle positions, sitting with the legs folded in front of the body, or sitting with the soles of the feet together.
- Avoid all yoga poses that stretch the sacroiliac joint, including all standing and seated twisting poses, all "lotus" variations, and "pigeon pose."
- Stay away from most Pilates exercises, including mat and reformer; they are contraindicated for sacroiliac instability.
- Do not lift heavy loads.
Many of us habitually sit slouched, or rolled back off the pelvis, with our spines curved in a "C" shape. This misplaces our body weight onto lower spine and sacroiliac, rather than on the bottom bone of the pelvis, the ischium or "sit bones". Slouching stresses the tailbone and sacroiliac joint which are particularly vulnerable during and after pregnancy. During labor and delivery, the natural curve of the tailbone flattens and is pushed outward as your baby's head passes through the pelvic outlet. Not surprisingly, the stress of delivery commonly results in postpartum tailbone pain. If you experience persistent discomfort in your tailbone, consult with your OBGYN.
How to Prevent or Manage a Pain in the Tailbone:
- Sit up tall, with your weight on the bottom bones of your pelvis (the ischium or "sit bones") rather than rolled back onto your coccyx or sacrum.
- If seat cushions are too deep for your frame, use pillows behind the lower spine to help avoid slouching.
- Place a small rolled towel behind the waistline to support a neutral pelvis and lower spine.
- When seated, keep your thighs on a slightly downward diagonal position, rather then parallel to the floor; you may need to elevate your seat height, or use a solid wedge pillow under the pelvis to attain this position.*
- Do not use donut-shaped pillows during pregnancy and the postpartum period; they weaken pelvic floor muscles.
- Avoid any roll-back exercises, either sitting or on an exercise ball, or Pilates style rolls, as these types of exercises are not recommended for pregnancy and the postpartum period.
*This position is especially helpful for women with tight hips and/or lower back
Round Ligament Pain
The round ligaments, found on the right and left sides of the uterus, attach to the pubic bone and help support the placement of the uterus in the abdominal cavity. As the uterus expands, these ligaments endure continual stretching and are a common source of pain in the latter part of pregnancy. Pain, either a sharp spasm or dull ache, is felt on one, or sometimes both, sides of the lower belly. To relieve round ligament pain, perform a "hip-hiker" on the painful side to shorten the ligament, reduce tensile forces, and relieve pain.
Hip-Hiker Exercise for Round Ligament Pain
- Stand adjacent to a wall, back of a chair, or countertop with your painful side facing away from your support object.
- Place your near hand on the wall, chair, or countertop for balance.
- Lift the foot on your painful side and bring it to your opposite ankle.
- Lift the hip bone (called a hip-hike) on your painful side straight upward, so that it moves closer to your armpit. Try to stay as upright as possible on your supporting side to prevent twisting or bending.
- Hold for ten seconds, or until pain has subsided.
- Bring your hip and foot back down and stand evenly on both legs for a moment or two.
Support Garments: Habitual Use May Cause More Harm than Good
Avoid over-relying on lower back and belly-support garments during pregnancy. Wearing a support garment on a daily basis inhibits the deep abdominal muscles and deep spinal muscles from doing the work intended for them—i.e., supporting your spine. When not worked, core muscles will in fact weaken and atrophy—exactly what you don't want to happen.
Maintaining Core Strength Remains Superior to Support Garment Use
In order to support your spine and the growing weight of your baby, build and keep your internal girdle strong and supportive, rather than wearing a support garment. If by the end of the day, you find that you no longer have the stamina to support your lower back, then by all means, use a support garment to ease symptoms for short periods of time.
If you do decide to use a back-support device, put it on while you are lying on the floor, with your pelvis and spine in the neutral position. Putting on any type of support garment on while standing with your pelvis and spine misaligned will not help your back.
Exercises for Relieving Back Pain
- The "Cat Stretch" —either on all fours, or standing with your hands on your knees—is a great way to lengthen lower-back muscles.
- Lying down with your lower legs resting on an ottoman or soft chair seat, or with both knees pulled up to the chest is also effective in relieving pain. During pregnancy, watch for signs of dizziness in this position.
The ribcage expands enormously during pregnancy to help make room for the expanding uterus and to maintain adequate lung capacity. Many pregnant women experience rib discomfort from this expansion, as well as the occasional little foot or knee that might habitually press against the ribs.
Tips for Managing Rib-Pain
- To help ease discomfort, try gentle stretches and spine-mobility exercises, such as twists and upper-spine extensions.
- Centered breathing techniques, in either a sitting or a side-lying position will help to ease discomfort.
- After pregnancy, perform rib-closure exercises to re-bevel the ribcage and re-narrow the waistline.
Shoulder pain is almost universal during and after pregnancy. Alignment changes, heavier breasts, and a weakened core all conspire to impair upper body alignment. When bones are out of ideal alignment, nearby muscle functioning is reduced. Because new moms do so much lifting and carrying throughout their days, shoulder and upper-back muscles strain easily.
How Pregnancy Impacts the Shoulder
- The shoulder girdle muscles become imbalanced and inhibit good body mechanics.
- The internal rotators over-tighten and external rotators weaken.
- Muscles that elevate the shoulders tighten while muscles that depress the shoulders weaken.
Managing and Preventing Shoulder Pain
- Use gentle daily stretches for the chest, neck, and shoulders to improve upper-spine alignment.
- Strengthen muscles groups that tend to weaken.
- Avoid sleeping with your head tilted back or thrust forward.
- Use massage or self-acupressure to relieve muscle spasms.
- Remind yourself to stand and sit up straight to avoid slouching.
- Use ergonomic breastfeeding positions. A complete discussion of ergonomic breastfeeding, and lifting and carrying can be found in my book, "Exercise After Pregnancy: How to Look and Feel Your Best".
Neck and Forward Head Syndrome
Upper body misalignment and neck-pain go hand-in-hand. When the upper spine over-flexes, the head compensates and slides forward. The muscles that lift the shoulders tighten and shorten in response.
Neck-Related Symptoms that Require Medical Consultation
If you have severe muscle spasms, persistent headaches, weakness in one arm, or marked asymmetrical mobility of the head, then see a medical professional for an evaluation.
For common neck stiffness, try gentle stretches and head-rolls, see the tips in the Managing and Preventing Shoulder Pain section of this web page.
- Try to sleep in positions where the back of the neck is elongated, rather than with the head thrust forward or rolled backward.
- Pay particular attention to your head alignment while driving and other seated postures.
- Relaxation and meditation techniques are also valuable for relieving chronic neck-tension.
Exercise to Re-align Forward Head:
- Maintaining a neutral spine, stand with your back and head against a wall, your legs slightly bent, and your feet about a foot away from the wall, about hip distance apart.
- Roll your chin toward your chest without moving your head away from the wall.
- Press the back of your head into the wall as strongly as you can for five slow counts.
- Gradually relax your muscular effort and allow your head to glide back in to the neutral position.
- Perform four repetitions.
Repetitive Stress and carpal tunnel syndromes
Pregnancy and the postpartum period place women at an increased risk for carpal tunnel syndrome. Swelling, fluid retention, and increased blood-volume can restrict and compress the medial nerve as it passes through the wrist—the carpal tunnel—and into the hand, causing pain in the hand, wrist and arm. Repetitive stress injuries and carpal tunnel syndrome are increasingly common, and because they have the potential to cause long-term disability, must not be ignored.
Carpal Tunnel Symptom Checklist
- Pain in your hand.
- Pain in your wrist, sometimes extending into the forearm.
- Weakness in the hand.
- Numbness and tingling in the fingers, wrist and hand, especially after several hours of use or at night.
If you have any of the symptoms of carpal tunnel syndrome or other repetitive stress injury, see a doctor or Physical Therapist who specializes in repetitive motion injuries and the diagnosis and treatment of this condition. Sometimes subtle problems may compound and overlap. Pathology or injury may originate in the neck, shoulder, elbow or wrist. An expert in nerve injuries will be able to conduct the proper tests and correctly diagnose the problem. After your diagnosis, you can receive the appropriate therapy.
Be Persistent: Don't Take "No" for an Answer
Increasingly, some HMO doctors will advise a wait and see attitude, or suggest to new moms that they try not to use their wrists and hands throughout the day as they care for their newborns. One student of mine was actually advised not to pick up her baby! Certainly, since wrist pain can come from overuse and it can be wise to cut back on unneeded activity. But no activity is another matter. If necessary, squeak as much as you have to get the grease from your medical provider! Don't take no for an answer.
Tips for Wrist Pain from Overuse
- Set up an ergonomically sound workstation.
- Refrain from all exercises that flex the wrist or bear weight on the hands, such as push-ups, bench presses, and quadruped exercises.
- Don't use tools or exercise equipment that require you to sustain or repeatedly apply a tight grip.
- Avoid tools that require you to repeatedly twist or flex your wrist.
- Take frequent breaks from keyboard work and other tasks that might compromise areas prone to repetitive motion injury, such as the carpal tunnel.
- Try to maintain a neutral wrist-position (neither flexed or extended) throughout your daily activities.
- When working at a repetitive motion task that makes it hard to keep your wrists in a neutral position, such as keyboard work, or when having a flare-up of symptoms at night, use wrist braces to hold your wrist(s) in the neutral position and reduce stress.