Postnatal knee pain, what can cause it, what can you do about it and how long will it last.
It can be linked to one of the following, your new physical demands, hormone driven instability, ITB pain, excess weight, anserine bursitis, poor exercise choices!
One of the key hormones to understand is Relaxin. This is a hormone that is secreted by woman's ovaries, placenta and even uterine lining during whole pregnancy. During first and second semesters it inhibits muscle contractions preventing premature childbirth and at the end of pregnancy promotes rupture of the membranes surrounding the fetus and opening and softening of the cervix and vagina and relaxing of ligaments of the pelvis to aid the process of childbirth. Relaxin loosens the muscles and ligaments in the body, so pregnant women may be more prone to spraining or overstretching muscles during physical activity and their joints may be in danger. Even after delivery, relaxin is still active so it may take up to five months before you feel more stable in your body. This means that high impact workouts should be limited during this time. Workouts should be lower impact and promote good alignment, range of movement and posture. Remember that low impact does not have to mean low intensity.
So let us get into the nitty gritty of what could be causing your postnatal knee pain.
1. Your new physical demands
Here are a few simple things to consider. You have been caring for a new baby for the past few weeks or months, probably light on sleep and spending a huge amount of time in strange new positions whilst breastfeeding, changing nappies and carrying a new baby. You have most likely spent a fair bit of time kneeling on the floor (your patella isn’t designed to be knelt on!) be that at bath time or just changing nappies on the floor. All of these new tasks place a huge amount of strain on the body and in particular on the knees, hips and back. So discomfort is not uncommon however you can do things to better manage your body and its new demands.
2. Poor exercise choices.
If you have quickly returned to higher impact workouts such as HIIT classes or running the it is highly likely that your body is simply not yet quite ready for the impact and strain this type of activity places on your joints and connective tissue. March 2019 saw the release of the first ever UK guideline to specifically offer evidence based recommendations for postnatal women returning to running – “Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population”(Goom, Donnelly & Brockwell 2019). You can check out the full guideline here. The guidance is that running should only be reintroduced between months 3 and 6 postnatal depending on the clients personal factors. Basically the postnatal body needs time to stabilise, restore and strengthen after birth and this process should ideally include physio led assessment and exercises just like those found in the physio modules of our app. So be mindful that if you have chosen to return to high impact exercise to quickly this could be a factor contributing to knee or other joint pain.
3. Weight
Sorry to say but some peoples bodies adapt more willingly to fluctuations in body weight. So if you did put a significant amount of weight on during your pregnancy and are now spending long days and even longer nights on your feet this could be causing extra strain on your knees, hips, back shoulders and body as a whole. What can be done about this - well outside of the obvious it is important to rebuild your postnatal fitness safely and appropriately which is why the Carifit App begins with core and physio led modules and then a graded workout plan.
4. Anserine bursitis.
Impossible to diagnose without a more complete history and a physical examination, but I can tell you about something I have seen in 17 years of working with postnatal clients and alongside specialist physios. If your pain is just below your knee in the inside, chances are it's anserine bursitis.
A bursa is a small sac filled with fluid that acts as a cushion over bone surfaces or tendons. Pain from anserine bursitis is felt more when walking up or down steps, so that part of your history fits. If you can avoid that activity, it would help you heal. A steroid (cortisone-type) injection can also be helpful but really this is one to get EXPERT MEDICAL SUPPORT for. Pregnancy would not directly cause anserine bursitis, but the extra weight carried during pregnancy could conceivably contribute to its development which could be compounded by the factors already outlined above.
5. ITB pain.
If you’ve got a nagging pain on the outer part of your knee, especially if you’re a runner, or are currently in a period of physical change in terms of demands, posture and alignment it could be a symptom of iliotibial band (IT band) syndrome. It’s an injury often caused by activities where you bend your knee repeatedly, like running, cycling, hiking, and walking long distances. As a new mum this one will particularly sting when you spend any length of time kneeling. Your IT band is a thick bunch of fibers that runs from the outside of your hips to the outside of your thigh and knee down to the top of your shinbone. If your IT band gets too tight, it can lead to swelling and pain around your knee. A combination of ice, foam rolling and a focus on strengthening and improving all of the surrounding muscles particularly the glutes is the way to progress and mange this long term.
Should you worry about postnatal knee pain?
Yes and No. If you have read the above and can easily make some sensible changes to accommodate your newly postnatal body then the combination of appropriate exercise and some easy smart tweaks to lifestyle like kneeling on a rolled up towel to cushion the knee then this phase will pass and your body will return to normal.
Workouts should focus on your core, pelvic floor, posture, alignment and your key supporting muscles the glutes. Choose a workout program that is specifically postnatal like CARiFiT so that the impact is minimised without compromising the fun, intensity or results you get from it.
Mainly try and understand what is going on and manage the triggers of your pain. Understand where you are in terms of your physical and hormonal timeline and operate in the knowledge that as with most things in these early months it will pass and be just another phase of your personal journey and recovery.
Try and mange your hydration and sleep as well as you can. Get your trainer or instructor to check the basics of your form or if working out from home try working out in front of a dresser mirror so you can check your stability and alignment as you move. Build some stretching and foam rolling into your weekly routine, they are useful long term skills to have.
Of course should your symptoms persist consult your doctor and clearly outline the problem.
