All About Joint Pain During Pregnancy (and Getting Relief)

While you may feel pain all over, certain areas of your body experience more joint pain during pregnancy.

• Sacroiliac/hip joint pain. The sacroiliac (SI) joints are located where the sacrum meets the ilium. (In plain speak: The joints between your tail bone area and your pelvis.) These joints play a critical role in supporting body weight and distributing it across the pelvis.
• Lumbar or lower back pain. Lumbar or lower back pain is triggered by the softening of the pelvic-area ligaments.
• Knee pain. Some people experience pain in the knee joints from weight gain.
• Pubic symphysis/pelvic joint pain. You may feel pain in the pelvic region in the front center of your pubic bone, in the lower back, or the perineum area. This could lead to a more serious condition called symphysis pubis dysfunction.

According to Carolyn Cokes, MD, an OB-GYN at Mercy Medical Center, joint pain during pregnancy is a combination of several factors, including:

• ligament relaxation due to the hormone relaxin
• increased weight on your lower extremities
• the postural shifts that occur to accommodate the pregnancy,

Here are some of the more common causes of joint pain during pregnancy.

Growing uterus

According to the American College of Obstetricians and Gynecologists (ACOG), as your uterus expands, it shifts your center of gravity while also stretching out and weakening the abdominal muscles.

Additionally, G. Thomas Ruiz, MD, an OB-GYN lead at MemorialCare Orange Coast Medical Center, says this shift in your center of gravity creates stress and low back pain in a different spot than you’d notice prior to pregnancy.

Weight gain

Weight gain doesn’t just happen in your belly. As your uterus expands, so do other parts of your body. Gaining weight, especially around your hips, puts more stress on your bones and joints, causing pain in those areas when you sleep, sit, or walk. (You know, basically do anything.)

Pregnancy hormones

The primary causes of pain or softening of the joint ligaments are due to the pregnancy hormones relaxin and progesterone. Relaxin is a hormone that your body releases during pregnancy, which causes an increase in ligamentous laxity (translation: loose ligaments).

When this happens, some joints lose their normal stability, causing them to feel loose when performing daily activities.

For example, you may experience back pain when your body releases relaxin to widen the pelvis. This causes the SI joints to become more elastic, leading to pain in that area.

Ruiz says the softening to the pelvic ligaments allows for a shifting of the pelvic girdle to allow a baby to pass through the birth canal.

Posture problems

Carrying extra weight in the front of your body is going to change your posture. As your baby grows, you’ll notice a redistribution of weight around your belly. This can lead to pain in your hips and lower back.

Additionally, caring for a child that still rides on your hip can cause posture problems leading to joint pain in the hips and lower back.

Other conditions

Cokes says less common — but more concerning — are things like pubic symphysis diastasis. “When this happens, the pubic bone separates either during pregnancy or during delivery, which can cause significant pain, as well as difficulty walking,” she says.

Joint pain is the worst, especially during pregnancy. But the good news is there are several safe ways to find relief.

Correct postural dysfunctions

Heather Jeffcoat, DPT, owner of Femina Physical Therapy, says there are two places to start:

• correcting postural dysfunction to reduce joint strain
• ensuring adequate flexibility and strength around the affected joints

Beyond postural correction, she also recommends looking at what joints are under strain and developing a rehabilitation program specific to your needs.

Use a belly band

Cokes suggests wearing a belly band, starting in the middle to end of the third trimester, to support the abdomen. “This can help to relieve lower back pain as well as round ligament pain, which isn’t necessarily joint-related, but is also a common complaint,” she says.

Round ligament pain happens when the ligaments that support the uterus stretch. This can cause intense pain in the abdomen or hip area.

Exercise regularly

Performing regular exercise during pregnancy can help you stay fit, keep your muscles strong, and relieve joint pain.

“The more you move throughout the pregnancy, the less joint pain you’ll experience,” Cokes says. For all types of joint pain, she recommends prenatal yoga, prenatal Pilates, and swimming, especially since you can do all three forms of exercise throughout pregnancy.

Change your sleep position

If your lower back is causing pain, Cokes recommends sleeping on your side with a pillow between your legs.

Apply heat to the area

Warm baths with Epsom salts can bring some relief, as can a heating pad placed on your hips, knees, or lower back (don’t apply heat directly to your pregnant belly).

Cokes also reminds to be careful not to burn yourself with a heating pad. She likes using rice-filled flannel bags that you heat in the microwave since they form to whichever body part is in pain.

Get a prenatal massage

Getting a gentle prenatal massage may help relieve muscle aches caused by joint pain. Ideally, seek out a massage therapist that is trained in prenatal massage.

Consider over-the-counter pain relievers

Your doctor may recommend short-term use of an over-the-counter (OTC) medicine like acetaminophen to help manage joint pain during pregnancy.

However, Ruiz says you shouldn’t use nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen during the third trimester because it can have an adverse effect on your baby.

Always consult your doctor before taking any OTC drug or medication during pregnancy.

Designing a pregnancy workout based on trimesters and peak relaxin levels is an excellent way to manage joint pain.

First trimester exercise tips

During the first trimester, Jeffcoat says the first relaxin peak occurs around 8–12 weeks, making this is an especially vulnerable period for a pregnant person’s joints and the ligaments that support them. To help, she says strengthening and cardio exercises should be done in a controlled manner that avoids hyperextension of the joints to reduce the risk of injury.

She also recommends prepping your body for postural changes, starting with pelvic floor and deep core strengthening. The first trimester is an ideal time to learn how to do a pelvic brace, which you’ll use before performing any exercise throughout your pregnancy.

1. Lie on your back with your knees bent and feet flat on the ground, about hip-width apart. Place your pelvis and low back into a “neutral” position. To find neutral position, make sure you’re resting on the back of your pelvis to create a very small space in your lower back (your back should not be pressed into the floor).
2. Inhale to prepare, then exhale and perform a Kegel.
3. Slightly draw the lower abs in with the Kegel. Inhale and relax the abs and pelvic floor. Exhale and repeat the contraction.

Second trimester exercise tips

The postural changes that occur during pregnancy can be one contributing factor to joint pain during pregnancy. Jeffcoat says this will be more noticeable during the second trimester.

“Building off of the first trimester core strengthening (pelvic bracing), you can add functional movements like squats for the legs and rows for the arms,” she says.

Third trimester exercise tips

In the third trimester, Jeffcoat says the focus is on increasing functional strength to assist with the demands of motherhood and maintaining strength and fitness specific to postpartum goals. Core strength is always a pillar of this plan.

“As relaxin’s second peak occurs later in this trimester, avoiding activities that cause a shearing force at the pubic symphysis joint will reduce or help avoid pain in this area,” she explains.

Do this by keeping your weight evenly distributed across both feet. No leaning on one leg jutting your hip out, and no crossing your legs.

While joint pain during pregnancy is normal, you may want to talk to your doctor if the pain:

• intensifies
• prevents you from doing regular activities
• leads to other symptoms

But even if the pain is not severe, it’s still a good idea to bring it up at your next appointment. They can help brainstorm ways to decrease the pain and possibly, prevent it from happening in the first place.