The Doctor Is In: Orthopaedic Issues During Pregnancy

SPONSORED CONTENT: The Doctor Is In

MOBILE COUNTY, Ala. (WKRG) — WKRG News 5’s Devon Walsh sits down with Dr. Joanne Baird, MD with Bayside Orthopaedic Sports Medicine & Rehab to discuss orthopaedic issues during pregnancy.

Below are some commonly asked questions:

What are some of the common orthopaedic problems you see in pregnant women and moms?

  • Low back pain
  • Osteitis Pubis – pelvic pain
  • Carpal tunnel syndrome
  • Plantar fasciitis
  • Meralgia paresthetica
  • Transient osteoporosis of the hip
  • Lateral epicondylitis (tennis elbow)
  • DeQuervain’s tenosynovitis (Mother’s wrist)
  • Patellofemoral syndrome

Why are pregnant women prone to these issues?

  • Added weight of baby, growing uterus and belly
  • Shifted venter of gravity
  • Added birth weight
  • Muscles have to work harder
  • Hormone changes, ligaments stretch, primarily in our pelvis
  • Relaxin is produced, a hormone, that relaxes the ligaments throughout our body.  This helps prepare our pelvis to be able to deliver the baby
  • Joints are strained with added weight
  • The position of the baby will cause different pains throughout pregnancy and can affect the back pain or pelvic pain we have
  • Sometimes women struggle with swelling in the lower extremities and all over even and this contributes and aggravates nerves like in carpal tunnel, or our feet and plantar fasciitis.  Women’s feet may increase in size and their arches are changed

Do they go away after pregnancy?

  • A lot of times yes
  • Some will linger on with new parenthood, now that we are lifting the baby over and over you are doing repetitive activities that you didn’t do before so tendon problems arise as well.
  • Most women who have had kids know that the weight doesn’t always disappear so easily, combine this with lack of sleep, frustrations and new stresses of parenthood and caring for a new baby, and the hormone swings the other way your mental health plays a role
  • I think some of these problems, the bone and joint aches, contribute to post partum depression.  Our body changes so drastically throughout pregnancy and then after pregnancy we still go through changes and we are learning to be a mom. 
  • For some reason moms and women love to talk about the best way to swaddle your baby, the tricks they have for having them fall asleep, breast feeding vs not breastfeeding, the best nipple and bottle, etc but no one talks about the body aches they experience.  I mean we complain our back hurts but no one really expounds on these things and it plays into our mental health.
  • You’re not alone

What is the cause of the back pain?  Is it ever concerning for anything else?

  • Our ligaments relax and stretch due to relaxin, to help prepare our body for delivery.  This loosens our joints, including the joitns that connect our spine to the pelvis and lower extremities.  People may feel less stable with walking and can contribut to pain with prolonged sitting, laying down, walking, bending over
  • The added weight as the baby grows shifts our center of gravity, and this strains our lumbar back muscles.
  • Additionally, the abdominal muscles are weakened as the belly stretches, contributing to back pain.  Core strength is a key component in managing back pain
  • It can also be a sign of preterm labor, miscarriage, ectopic pregnancy, etc
  • So it is important to discuss any concerns with your OB/GYN

Is it safe to work out during pregnancy?

  • Always want to check with your OB/GYN, they will know best based on risk factors during your pregnancy
  • Every pregnancy is different, even for a mother who is 2 kids, they can experience very different things between pregnancies
  • But yes, it is generally safe to continue to exercise, and it is actually good for you and the baby to do so
  • The recommendation is for at least 20-30 minutes of exercise at moderate intensity on all or most days of the week
  • Stay hydrated and eat enough nutrients to feed you and baby and ensure you are gaining appropriate weight

Doc is In FACEBOOK Questions:

How common is back pain during pregnancy?

  • About 60% of pregnant women experience LBP particularly posterior pelvic pain and lumbar pain.
  • Usually starts during second trimester and can get worse as your pregnancy progresses
  • May persist but post partum back pain usually gets better in a few months
  • True sciatica during pregnancy is not common, 1%

Who is at risk for LBP during pregnancy?

  • If you have had this pain before, either during a previous pregnancy or before prengnacy
  • Sedentary lifestyle
  • Not flexible
  • Weak back and abdominal muscles, core weak
  • Carrying twins or multi
  • High BMI
  • Previous spinal fusion or scoliosis in adolescence

Does LBP go away after pregnancy?

  • It often does but you can sprain or strain your back as a young mother too
  • This is because of continuous lifting a new baby and growing child up out of car seats, I mean just carrying those things is insane, breast feeding, etc.
  • Its is important to lift with your legs and not by bendin over with your back
  • Our weakened core after pregnancy contributes as well

What can you do to relieve LBP?

  • Exercise – weight training, stretching, swimming, prenatal yoga, walking, prlvic tilts
  • Bedrest is not helpful for any kind of back pain
  • Pay attention to your posture
  • Comfortable shoes
  • Be aware of movements that aggravate the pain
  • Avoid lying flat on your back
  • Lift through your knees, not bending your back
  • Take care of yourself, sleep, stretch, hydrate
  • Prenatal massage
  • Heating pads or warm tub
  • Sacral belt
  • Physical therapy
  • Acupuncture (prenatal)

What is carpal tunnel syndrome?

  • Condition where the median nerve of the wrist is compressed or pinched
  • Pain and tingling and numbness in the hand and fingers, primarily thumb, IF, MF and sometimes RF
  • Can be exacerbated by retention of fluids during pregnancy, particularly third trimester
  • Further burdened by excessive weight gait
  • Often well managed with night splints, ice compresses, and cortisone injections
  • Usually improves after delivery

What is plantar fasciitis?

  • It is inflammation of the thick band of tissue on the bottom of the foot connecting the heel to the toes
  • Often referred to as a heel spur but really has nothing much to do with a spur or not
  • It presents as stabbing pain in the heel , often worse with first steps in the am or after prolonged sitting and may get better throughout the day but bothersome again after prolonged standing and at end of day
  • Can be associated with rapid weight gain during pregnancy
  • Worse also with later stages of pregnancy
  • Treat with home stretching, ice, shoe inserts, night splints, and foot massage
  • Occasional we will give steroid injections if severe and interfering with mobility

What is meralgia paresthetica?

  • Not common, but seen in pregnancy and in people who are overweight
  • Caused by compression of the lateral femoral cutaneous nerve, a nerve in the anterior thigh that supplies sensation to the upper leg
  • When the baby grows, pressure against the nerve can create a patch of numbness on the thigh, even tingling or a burning sensation
  • Sometimes, steroid injections can help if the symptoms are severe
  • This usually resolves on its own after delivery

Osteitis Pubis?

  • This is an inflammatory condition affecting the bones in the front of the pelvis, the pubic symphysis
  • The junction of these bones of the pelvis can become inflamed during pregnancy due to added weight and position of the baby
  • The ligaments are affected by hormones, that stretch them and allow them to relax in preparation for birth
  • Tx it with ice or heat, NSAIDs if ok by your OB/GYN.
  • Simply staying off your feet can help reduce this pain
  • Pain is localized to the groin and front of the pelvis

Transient Osteoporosis of the hip, what is this?

  • This is associated with late term pregnancy
  • There can be temporary bone loss that significant weakens the hip joint
  • We don’t really know the cause
  • Hormones, added weight bearing stresses, and obstruction of small blood vessels around the hip are contributing factors
  • It presents as sudden onset of pain, typically front of the thigh or groin, the side of the hip or buttock
  • Treatment usually entails use of protected weight bearing, crutches or a walker
  • NSAIDs can help treat pain
  • Nutrition and calcium supplementation may help prevent excessive bone loss

What is the recommended calcium for pregnant women?

  • ACOG (American College of Obstetricians and gynecologists) recommends 1,000 mg per day for pregnant and lactating women that are breastfeeding.
  • Women 19 yrs or younger should get 1300 mg a day.
  • This is because our bone mineral density peaks in our mid 20’s
  • 1000 mg is equivalent to three 8oz glasses of milk
  • If you are younger than 18 and pregnant then they recommend 1300 mg a day
  • Peri and post menopausal women are recommended 1200 mg
  • Important to take with Vit D in order to abs the calcium and if you are supplementing it needs to be broken into multiple doses typically 500 mg 2-3 times a day
  • Foods that are rich sources of calcium are milk, yogurt, and cheese. Non dairy food such as certain vegetables, kale, broccoli, Chinese cabbage
  • Grains have a small amount but are often fortified with calcium as are many fruit juices, tofu and cereals
  • Calcium carbonate and calcium citrate.  Carbonate is best taken with food, citrate is eqally absorbed with or without food.  Carbonate has 40% elemental calcium by weight and citrate 21%
  • Absorption is highest in doses 500mg or less
  • Some people have GI side effects with supplemental calcium and carbonate tends to be more associated with these.
  • Absorption changes as we age, it decreases as calcium intake increases
  • Vit D daily recommended doses 1000-4000 IU.  Over the counter doses 600-2000 IU. >40% of US population is estimated to have a Vit D deficiency

DeQuervains tenosynovitis, what is that?

  • Inflammation of the tendon sheath that surrounds two tendons that run between the wrist and thumb.
  • Due to picking up  and holding your kids
  • Causes pain, occasional swelling over the base of the thumb or the thumb side of the wrist.
  • Pain worse with gripping, grabbing or lifting something
  • Treatment often entails modification of activities, which can be hard for moms
  • Wrist brace can help, icing, NSAIDs (motrin is safe if lactating) or topical NSAID creams
  • Steroid injection
  • Surgery as last resort if no improvement, release the tendon sheath and decompress the swelling around the tendons

Lateral epicondylitis what is that? And how would I get it if I don’t get play tennis?

  • This is an overuse injury to the tendons that attach on the outside of the elbow. Not just from tennis
  • Its results in microtearing and degeneration of the tendons
  • These tendons help straighten your wrist so when these tendon attachments are injured or damaged any activity that requires these tendons to be active hurts – like lifting or gripping
  • Causes pain at the outside of the elbow
  • Even something as simple as a coffee cup – yeti sign
  • Can be excruciating and we know that moms need coffee!
  • This tendon is not good at healing
  • It can last months to a year or longer
  • Eccentric stretches, wrist splints, activity modification, NSAIDs, ice can help
  • Using your wrist with it supinated can help for lifting to avoid straining the extensor tendons
  • Steroid injections or PRP (platelet rich plasma) and even surgery are used for persistent cases

Patellofemoral syndrome is another common complaint in young moms, is this specific to mothers? or

Trying to get back in shape, are there any problems that mothers face?

  • Patellofemoral syndrome is a common problem that new mothers face, although its not limited to new mothers,  it often plaques women of all ages
  • It is anterior knee pain as a result of the kneecap, your patella, not tracking perfectly in its groove on the femur
  • Sometimes you may feel or hear crunching or a rice crispy sensation, particularly with stairs or squats
  • Its hard to get back in shape after pregnancy, especially in early motherhood, and a common goal is losing that baby weight
  • It is easy to think that quick high intensity workouts will be the trick but these can set you up for injuries, particularly anterior knee pain

How do you avoid this and other problems?

  • For patellofemoral syndrome – things to avoid are deep squats, repetitive stairs and stair workouts, and activities where the feet are not on the ground (leg raises vice leg press)
  • Good things for anterior knee pain are quad, specifically VMO strengthening,core strength, and hip abductor strength.  All contribute to proper patella tracking
  • Its important to not let your knee pass over your toes and to do proper technique when exercising. 
  • Always stretch, stay hydrated, and take care of your self
  • Start slow and work up to higher intensity and increased weights if using weights
  • Ice after if you are sore
  • Rest
  • Seek guidance – ask your OB if pregnant, especially for back pain and pelvic pain
  • Talk to your primary care physician and see an orthopaedist like myself at Bayside

Watch the Facebook live video below for Q&A:

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