Pregnancy hormones, including progesterone but particularly relaxin, cause a chemical change to occur in the ligaments of your joints, in your muscle tendons and in other body structures, such as the walls of your veins and intestines. These structures are chemically 'softened'. Relaxin is produced very early in pregnancy and has its peak production at twelve to fourteen weeks. Although it takes some time for relaxin to cause softening of your ligaments and its effects are not usually felt until later in pregnancy, some women complain of discomfort and softening as early as mid-pregnancy.
The pelvis is normally considered a fused bony ring, similar to the skull. However, under the influence of relaxin, a small amount of movement occurs at each of its joints, causing it to become an unstable ring. It is this movement that may cause discomfort at the front or back of your pelvis or pain to radiate into your buttocks as you move. The most obvious signs of pelvic-joint instability are:
- a pregnant waddle
- pain in the hips or buttocks, especially when you have been standing still for a long time; changed positions, such as rolled over or got out of bed; or taken weight on one side of your body when, for example, climbing stairs.
While the prime purpose of relaxin is to soften your pelvic joints so that they are ready for the birth of your baby, its effects may be felt in other joints of your body, especially those that support your body weight. The structures supporting the small joints of your feet, for example, are softened by relaxin. When you add to this the extra weight you are carrying, you can see why your feet may flatten and widen during pregnancy. The result is usually tired, aching feet and difficulty fitting into some of your shoes.
This hormonal softening also affects the walls of your veins and gut. They tend to widen and may contribute to blood pooling in the lower-leg veins when you stand still for long periods of time, and to constipation, heartburn, gastric reflux and indigestion in the gut.
IMPLICATIONS FOR EXERCISE
You need to protect your pelvic joints during every exercise. Their softened state makes them vulnerable to injury. To help protect them during exercise:
- avoid high-impact exercises or activities
- limit asymmetrical weight-bearing activities, such as 'step' classes
- avoid highly choreographed or fast aerobics
- exercise in shock-absorbing footwear
- wear low-heeled shoes — preferably ones that are also wide heeled
- take shorter strides when you walk
- brace your abdominals and tuck your pelvis under before all movements
- strengthen your postural support muscles; that is, your back, hip and abdominal muscles
- bring your knees together when you change positions.
You should seek advice from your medical or exercise consultant or from a women's health physiotherapist if you have any problems. Most women respond well to individual consultation and so avoid long-term back and pelvic problems.
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