Lower Extremity
Lower extremity pain comprises of pain felt anywhere between the hips down to the toes. Postpartum women can experience lower extremity pain due to several factors associated with physiological changes that occur during pregnancy, labor, and the postpartum recovery. This pain can stem from several different factors: musculoskeletal changes, circulation issues, neural compression, and physical activity and recovery. It is crucial to recognize these symptoms, find support and interventions, and educate yourself on proper body mechanics and postpartum exercises to alleviate pain and promote recovery.
Causes of Musculoskeletal Pain
Hormone Fluctuations: During pregnancy, the body produces hormones like relaxin, loosens ligaments and joints, during pregnancy. The hormone does not immediately decrease after delivery of the baby and will remain heightened during postpartum, causing joint instability and discomfort in lower extremities. After delivery, decreases in estrogen and progesterone, and increases in cortisol levels can cause inflammation in weight-bearing joints, leading to pain and discomfort in hips, knees, and ankles. ​
Weight Gain: Women typically gain an average of 25-35 pounds for single birth and 50-62 pounds when carrying multiples. This creates a significant stress on weight bearing joints, such as hips, knees, and ankles. After the baby is born, the body needs to readjust to this change as it begins to shift your body back to pre-pregnancy status. This can result in increased muscle soreness and joint pain in the lower extremities.
Biomechanics: The weight and position of the baby during pregnancy shifts the center of gravity forward, causing significant changes in sitting and standing postures. These lead to changes in gait mechanics or walking patterns, where there is extra stress placed on the hips and knees. Compensatory mechanisms begin to develop where adjacent joints and muscle groups take on more work. This can become habitual and can persist into postpartum. Weakened muscles, poor posture, and improper movement patterns can lead to increased pain in lower extremities joints and muscles.
Lower Extremity Pain from Circulatory Issues
Signs of Infection
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Fever of 100.4 degrees or greater, chills, or flu-like symptoms
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Foul smelling vaginal discharge
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Swelling, redness, and/or discharge from incision or wound sites
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Pain that will not subside, especially when urinating
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Persistent bleeding
Edema: Fluid retention during pregnancy is common as it is necessary to aid in the development of the baby. However, it can persist postpartum for several weeks. There may be swelling in the legs and feet that can cause discomfort when sitting, standing, sleeping, or walking.
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Varicose Veins: During pregnancy, increased progesterone levels cause the walls of the veins to stretch to accommodate the increased blood volume that supports the growth of the baby. This puts extra pressure on lower extremity veins, which can result in varicose veins. As the body returns to prepregnancy state, the veins can remain stretched. leading to pain and heaviness in the legs. For more details on management, check out the handout on varicose veins.
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Deep Venous Thrombosis (DVT): Deep Venous Thrombosis is a serious condition where blood clots form in the deep veins of the legs, causing pain and swelling. If you notice warmth and redness surrounding the ankle and calf regions, call your doctor immediately. This requires immediate medical attention because DVT can be life threatening if the clot dislodges from the vein and becomes an embolism. Your doctor will want to see you in their office or may immediately refer you to the hospital, where you will obtain an Ultra Sound Doppler test to identify if the DVT exists. Avoid exercising or over exertion until cleared by your doctor.
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Postpartum Infections: Postpartum infections can occur from various causes. Common causes are endometritis (infection of uterine lining), wound infection at the site of cesarean or episiotomy, and sepsis. These types of infections can spread to other parts of the body, cause the body to undergo an inflammatory response, or cause pain to refer down into the lower extremities. If you suspect an infection, call your provider right away, as these can become more serious and painful as they progress.
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Nerve Compression in Lower Extremities
Nerve Damage or Compression: The physical changes during pregnancy and the stress of labor can sometimes lead to nerve damage or compression. As the body changes during pregnancy, the uterus may put pressure on lumbar nerves, causing sharp or shooting pain to radiate into lower extremities. During labor, the prolonged positioning or the use of instruments to assist delivering the baby can compress the nerves in the pelvic regions, which can contribute to lower extremity numbness, tingling, and discomfort.
Sciatica: The most common nerve condition among perinatal women is sciatica. Pressure on the sciatic nerve during pregnancy or delivery can cause sharp, radiating pain from the lower back down the posterior leg. The symptoms are most likely to be triggered with sudden change of positions, such as standing up from seated positions, as well as with long periods of standing where weight is shifted onto the painful leg. Treatment for sciatica include stretching, postural corrective exercises, nerve flossing/gliding, and massage. Seeing a physical therapist will help resolve these symptoms quickly and can decrease the risk of future exacerbations.
Physical Activity & Recovery
Decreased Physical Activity: A period of reduced physical activity during the late stages of pregnancy and early postpartum can lead to muscle atrophy or weakness. As you begin resuming normal activities, you may feel discomfort as a sign of resistance from your body. This is common and will eventually pass as your body acclimates. However, if the pain is persistent and paired with any other signs such as swelling or redness in the lower extremity joints, further consultation may be needed from your provider.
Overexertion: New mothers are consistently engaged in physical activities to care for their newborn. This involves frequently bending, lifting, carrying the baby, standing, bouncing, perhaps even going up and down stairs, which can all lead to fatigue and pain in the legs. Prepare for your early postpartum recovery by setting up your necessities on one floor, on surfaces that are waist level or above to avoid bending, and having assistance for a few hours a day to give your body a rest break and allow it to heal. For more information, check out the tips and tricks section of the website.
what can you do?
Lower Extremity Exercises & Stretching
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Exercises: Gentle active range of motion (AROM) exercises to improve circulation, reduce swelling, and improve joint mobility is recommended throughout your postpartum recovery. Start with seated exercises initially and transition to more impactful exercises once cleared by your provider. It is strongly recommended to see a physical therapist before progressing to more strenuous exercising so they can help resolve any imbalances or issues with biomechanics to avoid injury risks.
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Stretching: Lower extremity muscle stretching and nerve gliding/flossing is very important to maintain flexibility and reduce muscle stress. Check out Exercises and Ergonomics section on our website.
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Walking: Consistency of walking and performing activities of daily living will help mobilize your joints and muscles, which may also help with decreasing inflammation as well as kick start weight loss
Rest & Nutrition
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Rest and Elevate: Resting your body and elevating your legs will help improve circulation, reduce swelling, and decrease overall pain and discomfort. Try elevating your legs above the heart with use of pillows or other supportive objects for 10-15 minutes at least 3 times a day.
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Diet: Staying hydrated and consuming anti-inflammatory foods will help reduce swelling and support overall recovery.
Pain & Swelling Management
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Compression Socks/Stockings: Medical grade compression socks or stockings are useful when it comes to persistent lower extremity swelling. These will also help improve circulation and reduce risk of varicose veins. There are different levels of pressure: 15-20mmHg for mild swelling, 20-30mmHg for moderate swelling, and 30-40mmHg for severe. Check out the handout for Lower Extremity Swelling Management to learn more.
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Hot Pack: Moist heat or hot pack is recommended for 10-20 minutes to help reduce lower extremity muscle tension and improve blood flow. Heat is not recommended on areas that are red or swollen as it may increase the inflammation and pain. Be sure to avoid open wounds and incisions as heat may increase risk of infections.
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Cold Pack: For swelling and pain management, an ice pack is recommended for approximately 15-20 minutes at a time with 2 hour gaps. Avoid open wounds and incisions to prevent risk of infections.
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Foot soak: In a small tub or container, mix luke warm (~97 deg) water with epsom salt, essential oil is optional. Soak your feet for 15-20 minutes to improve circulation, reduce tension, and reduce swelling.
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Massage: Gentle massage is recommended to improve circulation, decrease muscle tension, and reduce swelling in lower extremity. Consult with a postpartum massage therapist.
Medical Intervention
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Pain Management: Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage pain. Consult with your doctor before taking any medications. For more severe pain, consult with a healthcare provider to learn about your options
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Analgesic Agents: Apply an ointment or gel with analgesic properties to the painful sites. Be sure to avoid any incisions or open wounds. For more questions, ask your provider.