Pregnancy, Postpartum, & Prolotherapy: Musculoskeletal Health for Women

Samuel G Oltman, ND, RMSK

My wife, Sara, is 39 weeks pregnant. We are expecting our first child, George "Geo" Michael Oltman, any day now. During the last 9 months, she, like so many other pregnant women, has been experiencing various musculoskeletal aches and pains. Her primary issue has been sciatica, which is very common in pregnancy among other kinds of pelvic pain. Other common areas of pain during pregnancy are foot, knee, and hand (1). These changes follow a basic pattern that show the effects of hormonal changes on the ligaments. While most of these aches and pains of pregnancy resolve on their own, continued postpartum ligament laxity is a common problem that can be effectively treated with prolotherapy.

Estrogen

Sex hormones affect every system in the body, including the connective tissues and muscles of the body, changing injury risk in accordance with exposure to estrogen. Ligaments are the connective tissue that hold our bones together. Estrogen makes ligaments more pliable (less stiff), making them more susceptible to sprains, muscle tightness, and injury because they have too much give, making the joint unstable. In a menstruating female, the levels of estrogen (and progesterone) fluctuate monthly, and we can see injury risk in female athletes fluctuate in accordance with estrogen exposure. There is an increased injury risk when the ligaments are most pliable when estrogen is higher in the late follicular phase (the week prior to ovulation), and during the entire course of a pregnancy (2).

Pregnancy

Pregnancy results in a prolonged exposure to estrogen and relaxin (a different hormone that occurs only in pregnancy to also make tissues more pliable), that continue to increase as the pregnancy goes on. Both of these hormones contribute to increased ligament laxity (3). This is the primary cause of pregnancy-related musculoskeletal issues: as the body prepares to deliver a baby through the pelvis, the hormones that prep the pelvis act all over the body and create ligament laxity everywhere. Research has found knee laxity that develops during pregnancy does not return to normal after pregnancy (4). Repeated pregnancies increase risk of continued ligament laxity due to increased total exposure. When pain persists after pregnancy, addressing the ligaments with prolotherapy can be the key for continued musculoskeletal health and injury prevention.

Prolotherapy

Most pain will resolve on its own after the pregnancy. I recommend postpartum physical therapy to everyone whether they have a specific pain or not, in order to jump start a fitness routine. Like with everything, exercise continues to be the best medicine and strength is our greatest compensation mechanism.

For those with persistent pain that physical therapy is not fully addressing, prolotherapy is an effective therapy that addresses the underlying ligament laxity and pliability (5, 6). By injecting the prolotherapy solution (hypertonic dextrose) into the key supportive ligament structures, the joint becomes more stable, the muscles around it can relax, and the pain recedes. Stabilization also has the benefit of helping to prevent osteoarthritis.

I often see women postpartum with sacroiliac (SI) joint and/or ligament pain that have sciatica or just glute and low back tightness. Foot pain is common as the connective tissue changes can make the feet wider and the ankle less stable. Knee instability can be exacerbated by these hormonal changes too. Prolotherapy, or PRP in more severe cases, can be effective in all of these issues because it addresses the cause: unstable joints with tight muscles trying to hold it all together.

Whether a preexisting condition was made worse or a new problem arose, if pregnancy was the trigger, ligament laxity is likely the underlying cause. Prolotherapy addresses this underlying cause directly. See an expert with years of experience, image-guided precision, and a holistic approach at Cascade Regenerative Medicine. Schedule today and Keep Moving.

References:

1. Kesikburun S, Güzelküçük Ü, Fidan U, Demir Y, Ergün A, Tan AK. Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Ther Adv Musculoskelet Dis. 2018;10(12):229-234.

2. Chidi-Ogbolu N, Baar K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol. 2019;9:1834.

3. Evaluation of ligament laxity during pregnancy. Journal of Gynecology Obstetrics and Human Reproduction. 2019;48(5):351-357.

4. Chu SR, Boyer EH, Beynnon B, Segal NA. Pregnancy results in lasting changes in knee joint laxity. PM R. 2019;11(2):117-124.

5. The effects of hypertonic dextrose injection on connective tissue and nerve conduction through the rabbit carpal tunnel. Archives of Physical Medicine and Rehabilitation. 2009;90(2):333-339.

6. Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul). 2021;16(1):81-95.