Knee pain in pregnancy and after birth

Why pregnancy affects the knees

During pregnancy the body releases hormones, including relaxin, that soften ligaments so the pelvis can widen for birth. These hormones act on ligaments throughout the body, so the knees and kneecaps can feel less stable than usual, particularly in women who were already very flexible.

At the same time, body weight rises and the centre of gravity moves forward. Many women stand with their knees pushed back or their feet turned out, which changes how the kneecap tracks. Fluid retention, especially in late pregnancy and in hot weather, can make the knees and ankles feel puffy and tight. Together these explain why knee pain often appears or worsens in the second and third trimesters.

Common patterns of knee pain

• An ache around or behind the kneecap on stairs, when getting up from a chair or after sitting for a long time.
• Pain on the inside of the knee, sometimes from the tendons that attach there.
• A knee that feels wobbly or less reliable, especially when turning.
• Swelling of the legs and ankles that makes the knee feel stiff by the end of the day.
• Flare-ups of an old knee problem, such as previous kneecap instability or early arthritis.

Most of these are mechanical and are not harmful to you or the baby, but they deserve to be checked if they do not follow the usual pattern.

What helps day to day

• Stay active with low-impact exercise such as walking on flat ground, swimming or pregnancy-appropriate classes, if your obstetrician agrees.
• Keep up gentle strength work for the thighs and hips, such as sit-to-stand from a firm chair, bridges and side-lying leg lifts, within comfort.
• Wear supportive, flat or low-heeled shoes with good cushioning.
• Avoid deep squatting, kneeling on hard floors and sudden twisting movements.
• Break up long periods of sitting, and rest with your legs raised when the ankles swell.
• In Qatar's summer, exercise indoors or at cooler times of day and drink plenty of water.

A physiotherapist with experience in pregnancy can tailor exercises safely.

Painkillers and medicines: ask your doctor first

Do not take any painkiller, anti-inflammatory tablet or gel, or supplement for knee pain during pregnancy or while breastfeeding without first asking your obstetrician, GP or pharmacist. Some medicines that are commonly used for joint pain are not suitable at certain stages of pregnancy, and the right choice depends on how far along you are and your own health.

Ice packs wrapped in a cloth, rest, elevation and a soft knee sleeve are simple measures that many women find helpful while they wait for advice. Knee injections are generally postponed during pregnancy unless there is a strong reason, and any such decision is made together with your obstetrician.

Scans and examination during pregnancy

Most knee problems in pregnancy can be diagnosed by talking through the symptoms and a careful examination. Imaging is usually kept to a minimum. Ultrasound uses no radiation and can be used to look at fluid or soft tissues around the knee.

A knee X-ray gives a very small dose to an area far from the womb, and MRI without contrast dye is generally considered acceptable in pregnancy. Even so, scans that would not change treatment straight away are usually postponed until after birth, while a significant fall or injury may need imaging sooner. Any scan is planned with your obstetrician, and you should always tell the radiology team that you are pregnant.

After birth

Ligaments do not tighten overnight. Many women find knee aches ease gradually over the months after delivery as weight, posture and hormones settle, although this may take longer while breastfeeding. Caring for a baby brings its own strain: kneeling to bathe or change the baby, sitting on the floor and carrying a car seat all load the knee.

Return to exercise gradually, starting with walking and core and pelvic floor work, and then progress to strength training. After a caesarean section, follow your obstetrician's advice on when to start. Building up thigh and hip strength is one of the most useful things you can do for your knees.

When to seek help in Doha

Seek urgent care for a swollen, red, hot or painful calf or leg, especially if one leg is affected, because pregnancy and the weeks after birth raise the risk of blood clots. Sudden breathlessness or chest pain needs emergency care; call 999 in Qatar. Sudden swelling of the face, hands or feet, especially with a headache or blurred vision, needs same-day review by your obstetrician.

Book an assessment if your knee locks, gives way repeatedly, swells after a twist or fall, or if pain stops you walking or persists for months after birth. Dr. Pablo Gelber at Aman Hospital can assess knee problems during and after pregnancy, working alongside your obstetrician where needed.