During pregnancy, most women want to understand the types of pain they’re experiencing and, moreover, want to be educated with possible solutions to overcome that pain. Although a growing belly is a beautiful thing, most women still want to maintain the same level of activity they had before. Knee pain is unfortunately a common symptom of pregnancy and, although it is not a topic related to the expecting baby, it is still an important part of understanding how to make a pregnancy more comfortable for the expectant mother. Most literature explains that during pregnancy, the expectant mother’s posture changes to adapt to the growing fetus. Women tend to lean backwards and overarch their lower back. This allows the fetus to burrow towards the back of the mother. The change in posture and misalignment of the lower extremity joints can cause increased stress on the knees. Hormonal changes also play a factor. Because of the increased levels of estrogen, the ligaments will loosen to prepare for the birthing process. This can cause instability in the knees and produce pain. Understanding the physiological aspect of knee pain during pregnancy is important, but finding ways to overcome the pain is more valuable. The importance of managing pain isn’t just related to knee pain during pregnancy. It is a general health concept that must be addressed and practiced. Pain is the body’s way of telling you that something is wrong. It is a warning signal and in no way should pain be considered a normal occurrence. Unfortunately, many people have the concept of “pushing through the pain.” They feel that ignoring the pain will have it disappear over time. This is not a healthy way of thinking. Pre-existing conditions or pains that occur should be addressed appropriately so that they do not worsen. Imagine the person who has a small cut on their finger and continues to get it dirty. This person would likely develop an infection. The same concept can be related to the pregnant mother who has knee pain and continues to perform her daily activities without consideration of changing the way she does her activities or seeking ways to reduce the pain. The end result may be a worsening of the knee pain and an inability to perform activities in future stages of pregnancy. By understanding the importance of managing knee pain during pregnancy, expectant mothers can avoid worsening their situation and make their pregnancy a more comfortable experience.
Understanding Knee Pain during Pregnancy
Knee pain during pregnancy is a common complaint for expectant mothers. The knee is a complex joint that undergoes tremendous stress during pregnancy. It has been estimated that the knee joint bears as much as 3-5 times a woman’s body weight during walking and going up and down stairs. This is due to a combination of factors including weight gain distributed over the lower extremities, changes in posture, and an increased looseness of the joints due to higher levels of circulating hormones. This increased stress on the knee joint can lead to a specific type of knee pain called patellofemoral pain. This is characterized by pain behind the kneecap that can range from mild to severe. Patellofemoral pain can be very debilitating as it may hinder the ability to climb stairs, getting in and out of chairs, and getting up from the floor. This can be extremely distressing for women who have to manage young children during their pregnancy. Another common cause of knee pain is iliotibial band syndrome. This occurs when the iliotibial band rubs on the side of the femur, causing pain on the outer aspect of the knee. This is often the result of altered biomechanics and increased joint looseness in pregnancy. Finally, swelling of the knee can occur when there is an accumulation of fluid in the knee joint. This is due to increased systemic fluid levels and inflammation and leads to a feeling of tightness in the knee and can inhibit movement. A high level of swelling can also result in an injury to the knee joint, so it is important to monitor fluid levels in the knee.
Importance of Managing Knee Pain for Expectant Mothers
Knee pain is a common problem during pregnancy. Some women begin to have pain in the knee during the first trimester. It is not uncommon for a woman in her second or third trimester to begin to experience knee pain. This may be due to a variety of factors related to pregnancy. Increased weight gain during pregnancy can cause knee joint pain. This added weight puts extra stress on the knees. Along with increased weight, pregnancy causes major changes in the body’s posture which can cause added strain on the knees. Hormone changes during pregnancy can also cause the joints to become more loose or lax, this can lead to muscle weakness or imbalance around the knees and ultimately knee joint pain. Finally, pregnant women often experience swelling in their lower extremities. This can lead to irritation or inflammation in the knee joint and cause pain. Pain in the knee can seriously affect the ability to get around and perform activities of daily living. This is particularly important when you consider that being able to maintain activity is important in promoting a healthy pregnancy. Pain in the knee can limit mobility and ability to perform exercise. Pain can also affect a pregnant woman’s ability to get up from sitting or lying down which can in turn affect her independence.
Causes of Knee Pain during Pregnancy
Weight Gain and Its Impact on Knee Joints
In addition, the increase in body weight causes a shift in the center of gravity of the mother’s body, putting increased pressure on the muscles around the knee to work harder to maintain balance. This leads to increased fatigue of the muscles, causing additional stress on the knee joints as the muscles play a crucial role in shock absorption for the knee.
Imagine the knee joint as a cushion in the middle of two bones. When a light object is placed on the cushion, it does not change shape very much. But when a heavy object is placed on the cushion, it deforms significantly. Similarly, the increased weight on a pregnant mother’s knee joint causes increased deformation of the knee joint cartilage between the two bones, thus predisposing it to pain. This increased stress also causes faster depreciation of the cartilage in the knee joint, leading to an increased risk of osteoarthritis, a common cause of knee pain in the elderly.
During pregnancy, the mother’s body weight increases, thus putting more stress on the knee joints. It is also an inevitable fact, especially during the last trimester when the increase in weight is most significant. The increase in body weight essentially means that there will be increased load on the knee joint. As the load on the knee joint increases, the cartilage in the joint becomes more compressed. The increased compression of the knee joint cartilage predisposes the knee joint to pain.
Hormonal Changes and Knee Pain
Although relaxin has some adverse effects, there is research to suggest that it could be used as a treatment for arthritis in the right doses. It is still unclear whether it has long-term effects on the ligaments and other soft tissues. This hormonal increase in joint laxity decreases the stability of the knee joint. This often results in increased wear and tear of the joint surfaces and a feeling of the knee giving way. These can then lead to a variety of different injuries and pain, particularly in people who have had previous knee problems.
Relaxin is a hormone that is involved in the preparation of the body for childbirth. It acts by increasing the elasticity of the cervix and the softening and relaxing of the pelvic ligaments in order to ease the passage of the baby through the pelvis. However, its effects are not confined to the pelvic area and it affects the whole musculoskeletal system, producing a generalized increase in joint laxity. This increased laxity can predispose pregnant women to an increased incidence of knee injuries and pain. The increased pivot shift and drawer forces that lead to ACL injuries are also more common due to increased knee joint laxity. ACL injury is more common in women than men. It is often associated with the feeling of the knee giving way and followed by pain and swelling, and it can also be the cause of episodic instability and limitation of joint movement. ACL deficient knees are three times more likely to develop osteoarthritis.
Hormones are chemicals that are made in the body and act as messengers, regulating various body functions. Hormonal changes, particularly in the hormones estrogen and relaxin, can have a direct effect on knee injuries and pain. Estrogen is a hormone that is responsible for menstruation and menopause; it also affects the elasticity of soft tissue. During pregnancy, the level of estrogen increases by around 100 times the normal amount. This increase in hormone production and circulation around the body can lead to an increased incidence of injury to the anterior cruciate ligament, due to the changes in collagen formation which affects ligament strength.
Postural Changes and Knee Pain
Specific changes in the posture directly affect the knee joint. The posterior pelvic tilt and increased flexion of the hip cause the hamstrings to assume a shortened position, which produces increased tension at the insertion on the tibia. This added tension on the hamstrings, coupled with the increased compressive forces at the knee due to the weight gain, may lead to mechanical derangement within the joint. An example of mechanical derangement due to increased forces at the knee is the fat pad impingement syndrome, which can lead to anterior knee pain. In addition, increased compressive forces can also lead to aggravation of pre-existing arthritic change within the joint. Furthermore, the laxity of ligaments throughout the body due to hormonal changes may cause an increase in joint instability, which will make it susceptible to meniscus injury.
Postural change is an expected sequela that occurs during pregnancy. The body’s center of gravity is displaced with the advancing pregnancy, which causes a compensatory adjustment in the posture. The result is an increase in the concavity of the lumbar spine, a posterior pelvic tilt, and increased flexion of the hip and knee.
Managing Knee Pain during Pregnancy
Once knee pain has been identified and the cause of the pain determined, a specific treatment plan can be initiated. Treatment can be divided into three phases: pain relief, correction of the underlying cause, and prevention of recurrence. In most cases, the first phase of treatment is focused on reducing knee pain and swelling. This is often accomplished through application of the PRICE principles (Protection, Rest, Ice, Compression, Elevation). Non-prescribed medication, such as paracetamol or aspirin, may also be used to reduce pain and inflammation. For obvious reasons, drug treatment is not the preferred option for pregnant women. An alternative to medication would be to consult a physician to receive a referral for physiotherapy. A chartered physiotherapist registered with The Singapore Physiotherapy Association will be able to treat the knee using various modalities and manual therapy techniques. A good physiotherapy program is aimed at pain reduction and would usually provide immediate relief for most conditions.
The onset of pregnancy is frequently attended by an assortment of discomforts, with knee pain being one of the most prevalent. For most women, the journey to full-term delivery can be an arduous one. Others still will find the path to childbirth more glorious and rewarding, but it is not without a few aches and pains of its own. Whether the path is littered with discomfort or ease, every expectant mother shares the same goal: to give birth to a healthy baby. Thus, coping with daily discomforts during pregnancy can be a challenging task. This article will discuss the various types of knee pain and the implications of pain on the expectant mother. We will also consider different treatments and exercises that can be used to minimize the effects of knee pain through this important period. By practicing the advice in this article, pregnant women can minimize their knee pain and enjoy the wondrous trip that is the birth of a child.
Exercises and Stretches for Knee Pain Relief
Specific exercises can help to strengthen the quadriceps (thigh) and hamstring (back of thigh) muscles without straining the knees. For example, a safe and simple exercise for the quadriceps muscles is the straight leg raise. This exercise is performed by lying on your back with one knee bent and the other leg straight. Tighten the muscles of the straight leg and lift the leg up about 30 cm. This will help to strengthen the front of the thigh. Repeat 10 times, doing 3 sets for each leg. Exercises where you are seated and which involve an elastic band can also help to strengthen the thigh muscles.
Exercise is an important way to help relieve knee pain. Your physiotherapist can advise you on exercises to help maintain range of motion in the knee and strengthen the leg muscles. Exercise and physiotherapy, aimed specifically at improving strength, flexibility, and balance, have been shown to prevent a worsening of knee pain in pregnancy. Low-impact exercises like swimming or aqua-aerobics can also help to relieve the pain and discomfort of knee pain, without further straining the knees.
Proper Body Mechanics and Posture Tips
Maintaining proper body mechanics and posture is very important for relieving knee pain during pregnancy. Poor posture may even increase the pain in your knees due to the change in the center of gravity. When standing for prolonged periods, use a stool to rest a foot on. This takes some pressure off the lower back and legs. While standing up from a sitting position, try to use a “lunge” position instead of bending at the hips and waist. It’s better to pick up items by kneeling down on one knee, as opposed to bending at the waist. When sleeping, lay on the side with a pillow between the knees for support. If trying to get up from lying on your back, slide to the edge of the bed and use your arms to push yourself up to avoid stressing the knees. To avoid unhealthy weight gain, use proper eating habits and an appropriate exercise program, taking into consideration the current condition of your knees.
Supportive Devices and Braces for Knee Pain
For many pregnant women with knee pain, supportive devices and braces can be an effective way of minimizing knee pain and provide a safe alternative to pain medication. Some forms of braces can cause more discomfort than relief, such as those made with an ace bandage or pulling the knee cap in an unnatural position. An effective knee brace should align the knee in a neutral position, minimizing the chances of further injury and reduce the pressure on the knee causing pain in the first place. Maternity wear, an elastic brace, or a neoprene sleeve are the best choices for pregnant women. These forms of braces are effective in providing stability and support to the knees and can be worn through the duration of a normal day, including standing, sitting, walking, and climbing stairs. Step-in-style maternity supports can also give some support to the knee by limiting stress on the knee joint and leg muscles.
Alternative Therapies for Knee Pain Relief
Incorporating alternative therapies to alleviate swelling and knee pain during pregnancy is an important method for expectant mothers to consider. Certified acupuncture and Traditional Chinese Medicine (TCM) physician, Dr. Tan Thiam Chye, Chairman Medical Board of Mount Alvernia Hospital, sheds light on how alternative therapies like acupuncture may be a safe and effective method for pregnant women. “Acupuncture is safe in pregnancy and helpful for some women with mechanical-type low back pain.” Using fine needles at specific acupoints, acupuncture stimulates and improves qi flow to regulate the body’s physiological functions. This method can release natural painkillers such as endorphin and serotonin, which explain why many patients feel so relaxed and euphoric after treatment. According to Dr. Brian Carter, an acupuncturist and herbalist who specializes in women’s health, reproduction, and pain relief, “We’ve seen that when acupuncture is done during late pregnancy, the baby is more likely to have its head down… …we know that acupuncture helps to achieve optimal fetal positioning.” This could be beneficial for pregnant women who are concerned with their baby’s position or are looking for a natural and non-invasive way to correct breech presentation. In a case where certain acupoints are forbidden to use due to acupuncture’s possible effect on uterine muscle contraction and potential induction of early labor, TCM herbal medication can serve as an alternative, but it is important to consult a physician and communicate clearly that the patient is pregnant, for the physician may not be an obstetric TCM practitioner and medicine classification is important.
Seeking Professional Help for Knee Pain
It is advisable for patients to seek professional help if they have experienced knee pain for more than 3 days. We do encourage patients to seek help from doctors who are interested in treating musculoskeletal conditions and have experience treating knee pain during pregnancy. They would be in a better position to diagnose and plan the treatment for the knee pain. An example of a common condition leading to knee pain during pregnancy would be an internal displacement of the knee. Experienced physiotherapists would be able to provide advice and treatment specific to this condition. Although this may require changes and adaptation, physiotherapy exercises are generally aimed at maintaining or improving muscular fitness, which in turn supports the knee and offloads the mechanical stress on the joint. This is with the overall goal to reduce pain and improve function on the specific area affected. Obviously recognized results on the safety of all modalities of physiotherapy is unlikely, however at PhysioWorks, having weighed up the risks and benefits, we are still able to offer some essential services during this period. For those patients who cannot defer treatment, or those whose health would deteriorate with treatment delayed are still able to seek treatment from our experienced physiotherapists.
Finding a Knee Pain Specialist in Singapore
Regardless of the type of specialist you choose to see, it is important to research the individual practitioner to ensure they have a good reputation and provide quality care.
Seeing a surgeon who consults at a public hospital can have the advantage of easier collaboration with other medical professionals, such as physicians or rheumatologists. This is because all the medical staff involved in the patient’s care practice in the same hospital and have regular meetings to discuss patient care.
It is worth noting that high-profile orthopaedic surgeons often work exclusively in the private sector and not in public hospitals. Consequently, seeing them may be expensive, with an initial consultation costing a couple of hundred dollars. However, patients with health insurance may be able to claim some money back. In some cases, surgeons have contracts with specific private hospitals, which means they have a full-time position at that hospital and only consult at their own offices. Although less common, most surgeons divide their consulting time between private rooms and public hospitals.
A knee specialist, either an orthopaedic surgeon or a sports medicine specialist, can provide the full range of treatment options. It is a misconception that knee surgeons are solely focused on operating. As long as you choose a surgeon with a good reputation, they are likely to offer various treatments for your condition. Some knee surgeons specialize in specific areas such as arthroscopic surgery or knee replacement, which may influence the treatments they recommend. For instance, a surgeon specializing in knee replacement may suggest a knee replacement for a patient with a minor meniscal tear, when arthroscopic surgery might have been a better option.
Treatment Options for Knee Pain during Pregnancy
Physical therapy may be a helpful way to decrease knee pain during pregnancy. There are numerous techniques that physical therapists can employ, from joint mobilization to the design of a prenatal exercise program to help the patient deal with knee pain during pregnancy. One important technique that a pregnant woman can do on her own, and which will be helpful with or without a physical therapist, is the use of a knee sleeve to help support the joint and decrease pain.
Treatment for knee pain during pregnancy may include the usage of ice, rest, physical therapy, and in some cases, surgery. No drug treatment should be initiated without the woman contacting her healthcare provider. It is important to remember that some medications may be harmful to the baby. Weight loss and diuretics can be prescribed, although when this is given largely depends on the primary cause of the pain. If it is due to an injury and not due to overuse or obesity, it is unlikely that the doctor will want to prescribe diuretics or recommend weight loss.
