joint pain related to post partum

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Pregnancy can take its toll on muscles and joints. It’s not just the physical stress of carrying a child; it’s also the pregnancy hormone relaxin, which relaxes the ligaments attached to the pubic bone – and all other ligaments. That’s not even counting delivery, which can sprain or sometimes break the coccyx (tailbone). In addition, epidural anesthesia – blessing though it may be – blocks helpful pain signals that say, “This position hurts my back. I need to shift.”

Many new mothers will develop neck, back, hip and even carpel tunnel (wrist) pain as a result of the new responsibilities of caring for a baby and all the unfamiliar work that entails. Physical therapists may use many of the same treatments that help non-moms: stretching and strengthening exercises, posture retraining, hands-on techniques, ultrasound, electrical stimulation, heat and ice.

Of course, there are a few twists: exercises must be modified for a postpartum body, and posture retraining also focuses on ergonomic nursing, burping and baby holding.

Another common cause of joint aches and pains that sometimes gets worse in the post partum period is fibromyalgia. Fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS) are both considered rheumatological diseases whose causes are not known. They can be similar in their presenting symptoms of muscle aches, pains and fatigue which are present in both syndromes. The conditions are overlapping and many women with one of the conditions also meet the diagnostic conditions of the other. Criteria have been developed for the diagnosis of fibromyalgia and although the criteria are mainly based on specific muscle or tendon points of pain, the syndrome also includes "aching all over, poor sleep, stiffness on waking, and being tired all day, headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain and diarrhea." With fibromyalgia, the fatigue and tiredness factor is based primarily on sleep deprivation.

Rheumatoid arthritis often improves during pregnancy, then flares up again afdter pregnancy. It is not uncommon for rheumatoid arthritis to first appear after pregnancy. Possible causes for flare-up during the postpartum period include the following:

• A decrease in the anti-inflammatory steroid levels
• Elevated levels of prolactin (ie, proinflammatory hormone)
• Change in the neuroendocrine axis
• Change from a TH2 to a helper T cell 1 cytokine profile

Postpartum thyroid difficulties are common – as many as 10 percent of women may suffer thyroid problems after childbirth. Thyroid disease can surface in someone who has never had thyroid problems before – or in women who have been previously diagnosed with hypo- or hyperthyroidism. Thyroid disease can often be associated with joint pains.

Journal of Family Practice, July, 1996 by Valerie J. Vullo, James K. Richardson, Edward A. Hurvitz

This study suggests that musculoskeletal pain in the lower extremity is common in all women, but pregnancy is a significant risk factor, especially for hip and foot pain. Biomechanical factors appear to play a larger role than hormonal influences in contributing to lower extremity pain in pregnant women. Exercise, amount of stair climbing, and amount of weight gain do not appear to increase or decrease the prevalence of lower extremity pain in pregnant women, but there was a trend toward more pain among older patients in both groups. This pain, however, tends to be self-limited and generally resolves within 4 months.

Departments of Physiotherapy and Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.

BACKGROUND: The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy-related pelvic joint pain, and to describe the characteristics influencing the prognosis. METHODS: One thousand seven hundred and eighty-nine pregnant women who were booked for delivery at Odense University Hospital formed a cohort to investigate the prognosis. Women whose reported daily pain from pelvic joints could be objectively confirmed were divided, according to symptoms, into five subgroups (n=405) - four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome and double-sided sacroiliac syndrome) and one miscellaneous. The women in the five subgroups were re-examined at regular intervals for two years after delivery or until disappearance of symptoms (whichever was less). Thre hundred and forty-one women from the 5 subgroups participated in the postpartum follow-up. RESULTS: The majority (62.5%) of women in the four classification groups experienced disappearance of pain within a month after delivery. Two years after parturition 8.6% were still suffering from pelvic joint pain (determined subjectively and objectively). Persistence of pain was found to vary significantly from one classification group to another. None of those initially classified as suffering from symphysiolysis had pain 6 months after delivery in comparison to the 21 percent of those with pelvic girdle syndrome who continued to have pain at the two-year mark. CONCLUSIONS: This study shows that pregnancy-related pelvic joint pain had an excellent postpartum prognosis (in general) in three out of four classification groups. The women with pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis than the women in the other three classification groups. High number of positive test and a low mobility index were identified as giving the highest relative risk for long term pain.

Joint pain related to post partum