Addressing Scoliosis in Pregnancy and the Importance of Specialized Personal Training when you have health issues

On this week's episode I deal with 2 emails; 1 regarding scoliosis and pregnancy and the other asking for a very specific skillset and personal training.

I go through the scant but vital research on the interplay between pregnancy and spinal curvature, addressing concerns about potential pain and curve progression.

Can your scoliosis get worse when you're pregnant?

Is there really a link between increased backpain in scoliosis and pregnancy?

I also offer advice on beneficial workouts and stretches for the prenatal and postnatal phases.

Then I discuss the crucial role of specialized training in the fitness industry.
One of the biggest potential risks for clients is dealing with personal trainers overstepping their knowledge limits, especially when dealing with clients recovering from strokes or managing multiple health issues.

I highlight the difference between the thoughtful trainers who truly understand their clients' needs and those merely going through a list of exercises.

Some links to the studies and websites that I was referring to with regards to scoliosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604750/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472295/

https://clear-institute.org/blog/scoliosis-pregnancy-complications-research/

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Email peter@healthypostnatalbody.com if you have any questions, comments or want to suggest a guest/topic

Playing us out this week "Born to roam" by Tommy Welton

Transcript

Peter: 0:00

Hey, welcome to the healthy postnatal body podcast with your postnatal expert, Peter Lap. That's, as always, would be me. Today I am talking scoliosis and pregnancy. After getting an email from somebody who asked said that she was planning on having a baby and she was concerned about the sorts of pain that might arise. She has a moderate amount of spinal curvature scoliosis, and she asked what kind of stretches and workouts they should be doing, should focus on during and after birthing and all that sort of stuff. And I thought you know what? I haven't touched scoliosis yet. I haven't touched on that yet. So that's what we're going to do, right? Increased risk of the curve getting worse is that a thing? Back pain will there really be more back pain in scoliosis? When you have scoliosis during pregnancy and, more importantly, what sort of thing should you be doing to help prevent anything, if anything at all, because you know it might just be a waste of the next half hour. You know how these things often go. Anyways, here we go. So welcome again to the podcast, the He Body Podcast.

Peter: 1:38

This is the podcast for the 19th of November 2023. t. And I'm here with Dinky Buddy and Bob the Cat. If you hear any snoring in the background. That's Kitty Dinky. She has started to make a lot of noise and this is, believe it or not, I am in my 12th attempt of doing an intro because she keeps snoring, so I'm giving up. If she keeps snoring, she keeps snoring. That's what you hear in the background. Anyways, I hope you're well. I hope you're well. It's only a month and a bit until Christmas. Isn't that nice? Isn't that nice?

Peter: 2:11

I've had some wonderful guests on in the past few weeks, but it's time that I do want to harm myself again. I've got some other guests lined up and I've got some requests in, but if you have anything, anyone in particular you'd like me to interview or a subject you'd like me to touch on, Peter@healthypostnatalbodycom com. com.. is obviously who to email. You don't need to be a member of HPNB. The question I'm answering today that I, of course, already answered via email as well is just from a listener who's not a member. That is completely cool. I love getting emails. So if you have any questions at all, peterathelphiposnatalbodycom that's where you send a little thing to Obviously like and subscribe to the podcast as you can. It does help. When you give us, when you give it five little stars, and all the sorts of Amazon, spotify, make it a hell of a lot better.

Peter: 3:09

I'm not sure, you know. I'm not sure why, I'm not sure how that pushing it out works, but you know, apparently it works. That's what they tell me, that's what they kind of see in the numbers. Whenever I pay a little bit of attention to the numbers, what am I doing? Scoliosis, curvature of the spine. So I had an email from somebody that I shall read out and that said hey, peter, hi, peter, I listened to a podcast episode where you're talking about ways to get your body back after giving birth. So I'm planning on having a baby and I'm concerned about the sorts of pain that might arise, since I have a moderate amount of spinal curvature scoliosis. What sort of stretches and workouts should I focus on? Should I focus on during and after birthing? Thanks in advance.

Peter: 3:55

I never read the name, so I'll . through a couple of things. First, does pregnancy increase the curve progression? So can it make your curve worse? Can it make your scoliosis worse? That's a question you might have if you're a woman with scoliosis want it to get pregnant, and scoliosis is mainly something that affects women, right? So the first issue we come across of course, a lot is, as with all women's health, it seems to be a weekly sort of thing, so they're very little solid research done into this, right, because I tried to run an evidence-based thing. Yeah, it would help. It would help if there was a bit more research done into this, but I'm fairly sure it'll catch up as I bang my head into the thing, into the microphone. That's how my day is going. I won't take 15 of this, by the way. Genuinely now, I won't 'm on take 15. Believe it or not, this is one of those that I've actually had restarted a lot due to noise and interference and my own lack of mental clarity today.

Peter: 5:17

So let's start here. Can it make the curve worse? In short, no, there's very little to say that it will. There are a couple of articles, a couple of studies that were done into this from a long time ago, because the last review I could find was from 2011,. So that's the best part of 12 years ago, right, and that basically said, okay, the studies weren't particularly good, they're not particularly large and there was very little evidence anyway, so there was any issue with any sort of curve progression getting worse. So one of the conclusions, one of the studies, came up with saying that among patients who had prior or foretick treatment, there's some evidence that suggests women experiencing one or more pregnancy had a higher risk of curve progression compared to never pregnant women.

Peter: 6:15

And then the strength of evidence for this conclusion is low. And when I say low, I mean ridiculously low. I mean the confidence interval for this was like 35, something like that, so between 1.8 and 35.8. So you know, that is, that is yeah, that's just not great. We can't really do much with that. And that makes sense, right, because it's.

Peter: 6:49

You know, scoliosis isn't caused by well, to be fair, most cases of scoliosis are idiopathic, so we don't know what causes them, but it's not caused by pregnancy. So there is very little reason to expect your scoliosis would get worse just because you fall pregnant. And I don't know, the court doesn't support things as well as it used to, or, you know, the the center of gravity of the body and all that sort of stuff shifts a little bit because it's not a permanent condition. And let's be honest, six months isn't. I know you're pregnant for nine months, but six months of that is is when the belly is is clearly bigger than in the first few months. There's very little to suggest within six months. That would be going wrong to the extent to put pressure on the, on the spine, to the extent that your scoliosis would get a lot worse. Right, so it's, there's nothing there to worry about. That's kind of what I'm saying. Right, that's that's where it comes from.

Peter: 8:00

So the next question and this is the main question, the lady who emailed in asked about what kind of pain can I expect Now? And this, of course, very much depends on on how severe your scoliosis is. Right, so this is a how long is a piece of string sort of sort of situation. Basically, what we find with people with scoliosis when you pregnant, there isn't, it's not that much more intense than than any normal pregnancy. Well, I've come across in in people with with scoliosis and this is very much more anecdotal than because, again, there aren't any good studies in this at all and this at all. And but I can only look at this from, like, a biomechanical point of view.

Peter: 8:59

Most people that's complained about extra back pain during pregnancy with scoliosis either already had back pain or are not doing anything to prevent the prevent the back pain, so they're not exercising. Right, I can't think of a single reason again, why, if you don't already have back pain, why your back pain should be significantly worse? Just because, just because you have a bit of a bit of scoliosis, mother scoliosis, especially if you're, if you're walking around with with quite decent amount of scoliosis, quite severe scoliosis, and you're already taking pain killers, then it's not going to get more comfortable during pregnancy, right? But there is not a single study out there that showed that there was an increased risk of back pain. That I could find at least. You know let me put a cat, a caveat in there. So it's much more likely, as I responded to to this lady, is it's much more likely that the people who had scoliosis and back pain during pregnancy would have had that back pain anyways. It's not like the pregnancy caused the scoliosis, the caused the back pain, right. So as I say to everybody and everybody can get back pain during pregnancy pregnancy is not particularly comfortable for a lot of people. You're not at higher risk of back pain when you have scoliosis.

Peter: 10:39

I found nothing and there's some, you know. You have the Clear Institute. There's one or two studies. Where would I come across that, just for everybody, scoliosis Reduction Center, who of course come at enough from a certain angle. So there's a bit of bias is they say that the back pain can increase. That which implies, of course, that there's a certain amount of back pain to begin with, right Now.

Peter: 11:12

That is some people say that again, this is anecdotal. Some people say they don't have an increase in scoliosis related pains and other people say that it identifies it intensifies during pregnancy. And then what the scoliosis reduction guys are saying is in general, a woman with scoliosis is at higher risk for lower back pain. But in most pregnancy scoliosis, not lower back pain, is a factor. Okay, now there are two statements there. First of all, a woman with scoliosis is at higher risk of lower back pain. There's no study that backs that up. Right, women during pregnancy are tend to get more back pain anyways, and there's nothing to suggest that women with scoliosis are at higher risk than women who do not have scoliosis to get increased back pain during pregnancy. There's nothing I could find that comes even close to backing that up. There is one study from one Israeli study funnily enough, that is a very small study that said increased back pain after a screw operation to treat scoliosis, the women who fall pregnant after that. But this is a tiny study. It's not very good, not particularly reliable, and even they found that they're confident. Their coincidence, they just didn't track everything, so their confidence was very low in the results of that study. They basically came out and said we need more money for research, which is how all these things start. They should have been given more money for research, but I don't think that actually went anywhere. It makes sense.

Peter: 13:09

Your pregnancy is traumatic on the body, but pregnancy is not. For most people, 99% of people, it is not a disabling experience or it is. The back pain that you're likely to get is back pain you would have had anyways, and that makes it normal to treat back pain. That makes it comfortable and easy to treat back pain. What I tell all my clients to do, regardless of whether they have scoliosis or not but if you have scoliosis, like I responded to this lady, is anybody in an ideal world?

Peter: 13:52

You keep exercising regularly during pregnancy. Now we're coming across stuff that some of you will have heard me say a million times. You focus on the glutes and you do it by doing squats, resistance, band glute kicks, step ups and all that sort of stuff, because the glutes are often the source of the problems and they keep coming back to this lower back pain. In pregnancy, it's hardly ever caused by the lower back, and postpartum as well, it's hardly ever caused by the lower back. It is inevitably the glutes or the surrounding areas around the lower back that's the problem. So posture but quite often during pregnancy, focusing on the glutes really helps. Now, the benefits of doing squats is that they will also make labor a lot easier. A lot of my prenatal clients tell me that being able to squat during the labor process or whilst they were waiting to actually give birth really helps a lot For the core.

Peter: 14:52

Whilst you're pregnant, I always recommend things like core presses, paloves, paloves, wood choppers, all that sort of stuff. All core exercises obviously a good idea, but those things you can do during your final trimester. So that's what I always recommend and it is just about keeping your core as active as possible. As I've said before, diastasis recta is a given. You're going to get that during pregnancy. You need to make space for the baby, but if you can keep your muscles strong and active and keep working them, then you're going to support, especially in this case, your lower back, a tremendous amount and that will be a huge, huge help because that prevents back pain.

Peter: 15:38

One of the leading causes of back pain isn't pregnancy, it isn't scoliosis, it isn't poor ergonomically designed chairs or the chair being the wrong height or sitting behind the desk in a funny way, it is not being active enough. That is the leading cause of back pain. And by not being active enough I don't just mean moving. I'm also talking about not exercising, not training the surrounding muscles, not strength training the surrounding muscles enough. It's not just enough to get up away from your desk every hour for four or five minute walk to ease the back of a little bit. That helps right, being sedentary really, really doesn't help your lower back pain, but just doing the right exercises to help the surrounding muscles get stronger or stay strong or whatever you want to do, whatever your goal is, is the leading way to prevent back pain. So, whether you have scoliosis or not, it seems to be during pregnancy.

Peter: 16:47

To sum, that 15 minute bit up seems to be completely irrelevant when it comes to pregnancy. There is no link that I could find right and, like I said, there's 15, 20 minutes of your time wasted. No evidence that I could find of pregnancy and scoliosis being a problem. I even saw a website that said, infertility issues when you have scoliosis. That is simply not the way that works. That makes no sense whatsoever. Just because you have a curve in your spine doesn't mean that your uterus won't do what it's supposed to do, right? That makes very little sense at all. You don't have to do special stretches, you don't have to do special workouts during your pregnancy. When you have scoliosis, you can just do your normal thing or do the normal thing. That is completely fine, right. Where else are we Right? So we're what 18 minutes into this thing.

Peter: 18:01

I'll quickly touch on something else, because I had an email from somebody who said hey, I'm looking for a personal trainer and this is on my little PT bit so come to the house, or it's available locally in the area and we could support the exercise program for people with reduced mobility, in this case, prolapse disc and stroke recovery, putting fatigue with medical knowledge or physiotherapy knowledge. They also state that pilates is inaccessible. Only chair yoga works. Right, and that was someone who emailed. And don't get me wrong in my town, in Edinburgh, I am a fairly well-established personal trainer with some credentials and all that sort of stuff, and there's a ton of information on the old website and all that sort of thing. But this kind of thing then becomes the importance of knowing when to stay in your lane as a PT. This person has so many health issues that they should not be emailing me Right, and this is not their fault. This is very much the health service in the UK's fault. When you have these issues you need to deal with the specialized physio.

Peter: 19:38

Stroke recovery isn't something you just go to a normal personal trainer with. It really isn't. One of my clients had a TIA, so a mini stroke, so to speak. You know transysemic attack and that is fine. That is pretty much if you know what you're looking out for. Basically, when someone has a stroke, all you can do is phone the ambulance. There's not that much you can do, but you have to kind of know what you're out for. But when it comes to stroke recovery stuff, that is a specialized field of exercise. That is very much not something you can walk into with David Lloyd or Pure Gym or start emailing around around town going can you help to loads of PT's? Because the issue with that is that not so much that none of the personal trainers can do it, it's that you might well get a response from somebody who is not aware they can't do it Let me put it that way or who's really stuck up for clients, who's really stuck for clients and would rather do some sessions and all that sort of stuff and can pick up the knowledge online.

Peter: 21:13

There's a lot of information about a lot of things online. I know, for instance, the Healthy Post Natal Body Body website. healthypostnatalbody. com that's healthypostnatalbody. com the program. There's about 70 personal trainers signed up to them, about 70 that are personal trainers and that are just in the field. I'm not sure whether they've given birth reason or they're just, but a lot of them I get emails from saying can you explain how this works? Can you explain how that works? And I love those conversations. Don't get wrong. I'm delighted that they're members. You know what? If you want to sign up for three months and just gain a bit of knowledge, then that's awesome. The problem is, we're going to probably find it out of those 70. And that's current, the current members. I think there have been a few hundred over the course of the past few years, because we're almost coming up to five years of that. I set the HPNB website up.

Peter: 22:18

Not everybody is as scrupulous as everybody else, let me put it that way, and you're going to find that some people just copy the information without knowing why, and the why matters. I spoke about this before. You know the exercises from a personal trainer's point of view, the exercises might all be the same. Someone can take you through the same set of exercises as I do on the Healthy Postnatal Body website. But knowing why you do certain things is what makes a difference between a good personal trainer that you can work with one-on-one, and someone that is kind of just going through the paces as dinky snores in the background. I told you this would happen. Yeah, so you know it's. That's kind of it.

Peter: 23:19

We want to make sure that your personal trainer understands the why of why we're doing certain things so that adjustments can be made in a sensible way. So if I work with somebody with diastasis recti, they find that they can do certain exercises. They find a certain exercise not so much. They get very little little benefit from certain exercises that they don't feel right, that they can't do them or whatever. Then I can easily make adjustments that takes about two minutes to do, right, it doesn't take long.

Peter: 23:56

If you don't know why we're working certain muscles in a certain order when you do a postpartum program, they either might well push through or you don't know what to replace the exercises with. Does that make any sense, right? This is, and that's kind of the difference between working with a specialist that does this sort of stuff all the time and someone who has information but doesn't know why certain things have to be done a certain way, right? So I always say it's a difference between a thinking personal trainer and someone who just goes with them. Yeah, this is. This is the list of exercises we're doing today, rather than focusing on the personal element of personal training.

Peter: 24:52

And this is kind of where I, a while ago, I touched on this before. You know, pink the singer and a wonderful personal trainer has a really good personal way that she worked with and they then incorporated postpartum. They incorporated the someone else's postpartum program. They did the MUTU program. They incorporated those exercises into Pink's personal postpartum routine and Pink says it's wonderful and it really really works.

Peter: 25:26

The issue with that a little bit is that unless your personal trainer knows why Wendy, who built the MUTU system, put that in place in the way that she did, you're not really. You don't really get what you're doing, and I'm not saying that Pink's personal trainer didn't know why, but I'm guessing, if you copy someone else's personal training program to work with your clients, that you don't really know what you're doing with regards to that. One element of nothing wrong with that. I'm just saying that that is it's okay to have, it's okay to have the skills gap that you just don't know, but it's much better to go Actually, I just don't know work with somebody else rather than copy information online or copy somebody else's program and to just say, yeah, so we will just do this and we will be okay.

Peter: 26:21

Right, at least sit down with the person who designed the program, or have a phone call, have a Zoom call, but I have them all the time with PT. Just get in touch. Hey Pete, why are you doing this? I love explaining stuff. That's what I do. Don't charge for it. If you're already a member of HPNB, I don't care why you're a member. You can copy the entire program. I genuinely don't mind. I would, however, like if you have a question, you have a question. You ask the question rather than guessing your way through it. Alright, hpnb and healthypostnatalbodycom.

Peter: 26:54

And this podcast is mainly meant for education purposes. This is not a money-making exercise. I wish it was Right. Just ask the questions and know when to stay in your lane. So, as I responded to this person, I have some slots available, but I think you're probably better off doing something for people recovering from strokes and all that sort of stuff first.

Peter: 27:28

So get in touch with the specialist. It just makes sense. I know what my skills cap is. I pretty much draw the line out that type of rehab because that's not what I spent the last 10 years learning about. Even a two-week course. I've had people before that say you can learn all about you need to know about Diasas in two days and come do a two-day course and all that sort of stuff. I'm not convinced. I'm just not. I think you're better off working with a specialist. You can gain some knowledge, but you can't learn everything you need to learn in that shorter space of time. At least I can't, not to the level that I'm confident of working with people that need some guided expertise. So stay here lane personal trainers, ask questions. If you don't have them People looking for personal trainers, looking for programs just try to go with a specialist, try to go with an expert, try to go with somebody who really knows what they're talking about. When it comes to that sort of stuff and with regards to scoliosis, don't worry about it, it's fine, as nine out of 10 times pregnancy is scary, but it's not necessarily scary from that perspective.

Peter: 28:52

Now, P{ at Healthy Postnatal Body and waffling for a solid five, 10, 15 minutes. Now, peter@h at Healthy Postnatal Body and if you have any questions, any comments, thank God, we're back to doing the interviews again next week. I think we might have an interval next week and after that we have interviews again, so that smarter people than myself will come back on the podcast. Like I said, leave a little review if you can, not based on this one, of course, based on the old ones. So we're good. Here's a new bit of music. You take care of yourself. See you next week. Bye now.

Speaker 2: 31:40

the phone away. You and I were born to run.